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Sample records for conditions including difficult

  1. Difficult Airway Management in Field Conditions: Somalia Experience.

    Science.gov (United States)

    Özkan, Ahmet Selim; Nasır, Serdar Nazif

    2015-10-01

    Difficult airway is defined as having the patient's mask ventilation or difficult tracheal intubation of an experienced anaesthesiologist. A number of reasons, such as congenital or acquired anatomical anomalies, can cause difficult intubation and difficult ventilation. Keeping all equipment ready for airway management of patients will reduce mortality and complications. In this case, it is intended that the submission of difficult airway management who encountered in mandibular reconstruction for mandible bone defect repairing with reconstruction plates before at the field conditions in Somalia.

  2. Full-face excavation of large tunnels in difficult conditions

    Directory of Open Access Journals (Sweden)

    Giovanni Barla

    2016-06-01

    Full Text Available Following a few preliminary remarks on the tunneling methods at the beginning of the 20th century, the successful applications of the full-face method also in difficult conditions are underlined. The attention is posed on the use of a systematic reinforcement of the face and of the ground, by means of fiber-glass elements. A selection of tunnels where this method was used successfully is reported with the purpose of illustrating the wide spectrum of ground conditions where it has been applied. Then, following a description of the main concepts behind the method, the attention moves from the so-called “heavy method”, where deformations are restrained, to the “light method”, where deformations are allowed with the intention to decrease the stresses acting on the primary and final linings. The progress in the application of the “light method” is underlined, up to the development of a novel technique, which relies on the use of a yielding support composed of top head steel sets with sliding joints and special deformable elements inserted in the primary lining. The well-known case study of the Saint Martin La Porte access adit, along the Lyon-Turin Base Tunnel, is described. In this tunnel, a yield-control support system combined with full-face excavation has been adopted successfully in order to cope with the large deformations experienced during face advance through the Carboniferous formation. The monitoring results obtained during excavation are illustrated, together with the modeling studies performed when paying attention to the rock mass time-dependent behavior.

  3. Full-face excavation of large tunnels in difficult conditions

    Institute of Scientific and Technical Information of China (English)

    Giovanni Barla

    2016-01-01

    Following a few preliminary remarks on the tunneling methods at the beginning of the 20th century, the successful applications of the full-face method also in difficult conditions are underlined. The attention is posed on the use of a systematic reinforcement of the face and of the ground, by means of fiber-glass elements. A selection of tunnels where this method was used successfully is reported with the pur-pose of illustrating the wide spectrum of ground conditions where it has been applied. Then, following a description of the main concepts behind the method, the attention moves from the so-called “heavy method”, where deformations are restrained, to the “light method”, where deformations are allowed with the intention to decrease the stresses acting on the primary and final linings. The progress in the application of the“light method”is underlined, up to the development of a novel technique, which relies on the use of a yielding support composed of top head steel sets with sliding joints and special deformable elements inserted in the primary lining. The well-known case study of the Saint Martin La Porte access adit, along the Lyon-Turin Base Tunnel, is described. In this tunnel, a yield-control support system combined with full-face excavation has been adopted successfully in order to cope with the large deformations experienced during face advance through the Carboniferous formation. The monitoring results obtained during excavation are illustrated, together with the modeling studies performed when paying attention to the rock mass time-dependent behavior.

  4. TAKRAF bucket wheel excavators for difficult operating conditions

    Energy Technology Data Exchange (ETDEWEB)

    Harta, H.; Jurisch, H.

    1987-04-01

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

  5. Mechanical pressure gages under difficult conditions; Mechanische Druckmessgeraete unter schwierigen Einsatzbedingungen

    Energy Technology Data Exchange (ETDEWEB)

    Nieswandt, T. [Wika Alexander Wiegand GmbH und Co. KG, Klingenberg (Germany)

    2008-05-15

    In spite of electronic solutions, mechanical pressure meters still find their place in reliable in-situ process pressure monitoring without external influences. Planners and users often have difficulties selecting the optimum meter for a given application, especially where difficult operating conditions are concerned. The contribution presents a neutral and practical guide. (orig.)

  6. Relationships between young people and labour market: a difficult condition in the Southern Italy

    OpenAIRE

    De Santis M.

    2008-01-01

    This paper aims at identifying individual and family features that represent advantage or disadvantage factors in the participation of young people to labour market. In particular, the difficult condition of the Southern Italy is analysed. First, we will compare the participation of young people to labour market in Italy to the one of the main European countries. The European Union and its main countries represent a natural benchmark for the conditions of labour market in our country. Subsequ...

  7. Application of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    Xu Mao; Li Xiaoxi; Wang Jun; Guo Xiangyang

    2014-01-01

    Background Airway management is crucial in clinical anesthesia.Many complications associated with airway management result from unexpected difficult airway,but predicting a difficult airway is a major challenge.We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis,a population with a high incidence of difficult airway.Methods We randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013.Preoperatively,patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images.Difficult airway was defined as Cormack-Lehane grades Ⅲ-Ⅳ.Logistic regression was used to identify a combined (clinical and radiological) model for difficult airway.A receiver operating characteristic (ROC) curve was used to describe the effectiveness of prediction.Results We identified three clinical predictive factors using the ROC curve:mouth opening,stemomental distance,and neck mobility.We created a clinical model using three factors:gender,age,and mouth opening,with odds ratios (OR) of 0.370,1.034,and 0.358,respectively.Using the clinical and radiological parameters,we formulated a combined model with five risk factors:gender,mouth opening,atlanto-occipital gap,the angle from the second to sixth cervical vertebraes in the neutral position,and the angle difference of δ (the angle between the laryngeal axis and the epiglottic axis) from the neutral position to extension (OR:0.107,0.355,0.846,1.057,and 0.952,respectively).The sensitivity and specificity of the combined model were 80.0% and 65.7%,respectively,and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model.Conclusion The efficacy of the combined model including both clinical

  8. Difficult asthma.

    OpenAIRE

    Ahmet Uslu; Tülay Özdemir

    1989-01-01

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

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

    OpenAIRE

    Aiginger, Karl; Schratzenstaller, Margit

    2011-01-01

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

  10. Adnexectomy Versus Ovarian Conservation During Total Hysterectomy for Benign Conditions. A Difficult Dilemma

    Directory of Open Access Journals (Sweden)

    Ion Păun

    2014-09-01

    Full Text Available Introduction: Bilateral adnexectomy is a surgical procedure that is frequently associated with total hysterectomy performed for benign uterine conditions. Given the relatively wide range of indications for the aforementioned type of salpingo-ooforectomy which in it self is not devoid of potential risks the patients' and physicians' decision-making should take into account several parameters (most helpful to individualize treatment such as published ratio of removal versus conservation of uterine adnexae, patients' age, pre/postmenopausal status at the time of surgery, relevant family and personal history including current use of hormonal replacement therapy. Material and Method: This retrospective cohort study was conducted among 457 women aged 18 years or older who underwent abdominal total hysterectomies for benign uterine conditions between 2000 and 2011. The study patients were stratified by age for better characterization and according to recent publications. Results: Uni- or bilateral oophorectomy was performed in 50% of the subgroup of hysterectomized women younger than 35 years old whereas in the other half of the same age category of patients the uterine adnexas were conserved. Among the study patients aged between 35 and 45 years in 50.5% of the cases the unilateral type of oophorectomy was undertaken while for the other 49.5% of women the bilateral adnexectomy was the rule. Finally, in all patients older than age 45 years the bilateral salpingo-oophorectomy was the procedure of choice. Moreover, out of the 55 study patients in which at least one ovary was preserved, 30.9% of cases underwent the removal of the remaining adnexa when affected de novo by malignant (n=3 or benign (n=14 pathology. Last but not least, in order to reduce both cancer risks and early menopause hazards, our analysis based on recent literature attempted to identify patient characteristics (relevant factors associated with or without bilateral oophorectomy at the

  11. Probe Drilling Ahead of Two TBMs in Difficult Ground Conditions in Turkey

    Science.gov (United States)

    Bilgin, Nuh; Ates, Ugur

    2016-07-01

    This paper summarizes the results of probe drilling carried out ahead of TBMs in two difficult tunneling projects in Turkey. The tunnels have completely different geological characteristics which necessitated two different methods of data analysis. Melen Water Tunnel was excavated under Istanbul Bosphorus within sedimentary rocks which are cut frequently by andesitic dykes, fracturing the surrounding rocks and creating a potential risk for water ingress into the tunnel. At the beginning of Melen Project, pioneering probe drillings with petrographic analysis and strength tests were performed on samples collected from TBM muck. This analysis allowed identifying some critical normalized probe drilling rate values for predicting potential weak zones created by andesitic dykes. These studies gave a sound basis for further interpretation of TBM and geologic data for the same tunnel. The second set of probe drilling analysis was from Kargi Tunnel. The North Anatolian Fault highly affected the tunnel excavation by fractured rock formations. Although the change in normalized probe drilling data was a good indicator of fractured zones, the diversity of rock formations made it difficult to interpret the data.

  12. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma.

    Science.gov (United States)

    Smith, N L; Denning, D W

    2011-04-01

    Chronic pulmonary aspergillosis (CPA) is a condition caused by the ubiquitous fungus Aspergillus fumigatus in non-immunocompromised individuals. Numerous underlying conditions have been associated with CPA. Details of the underlying conditions of 126 CPA patients attending our tertiary referral clinic from all over the UK were extracted from the clinical notes, and the distribution of these underlying conditions was analysed. For those with several underlying pulmonary conditions, one was nominated as the primary condition. Many patients presented with multiple underlying conditions, and a total of 232 underlying conditions were identified for the 126 patients. Previous classical tuberculosis and non-tuberculous mycobacterial infection were the most common primary underlying conditions (15.3% and 14.9%, respectively). Others included allergic bronchopulmonary aspergillosis (ABPA), chronic obstructive pulmonary condition (COPD) and/or emphysema, pneumothorax and prior treated lung cancer. Some conditions were found more often as one of multiple underlying conditions, while others were found only as secondary underlying conditions. Tuberculosis, non-tuberculous mycobacterial infection and ABPA remain the predominant risk factors for development of CPA, with COPD, prior pneumothorax or treated lung cancer also relatively common among our referrals. Many patients have multiple underlying pulmonary conditions. CPA should be considered when upper lobe cavitary or fibrotic disease and systemic symptoms are present in those with lung disease. PMID:20595150

  13. Coping with difficult weather and snow conditions: Reindeer herders’ views on climate change impacts and coping strategies

    Directory of Open Access Journals (Sweden)

    Minna T. Turunen

    2016-01-01

    Full Text Available Winter is a critical season for reindeer herding, with the amount and quality of snow being among the most important factors determining the condition of reindeer and the annual success of the livelihood. Our first aim was to model the future (2035–2064 snow conditions in northern Finland, especially the quantities related to ground ice and/or ice layers within the snow pack, exceptionally deep snow and late snow melt. Secondly, we studied the strategies by which herders cope with the impacts of difficult weather and snow conditions on herding by interviewing 21 herders. SNOWPACK simulations indicate that snow cover formation will be delayed by an average of 19 days and snow will melt 16 days earlier during the period 2035–2064 when compared to 1980–2009. There will be more frequent occurrence of ground ice that persists through the winter and the ice layers in open environments will be thicker in the future. The snow cover will be 26–40% thinner and snow in open environments will be denser. Variability between winters will grow. In interviews, herders indicated that a longer snowless season and thin snow cover would be advantageous for herding due to increased availability of forage, but more frequent icing conditions would cause problems. The most immediate reaction of reindeer to the decreased availability of forage caused by difficult snow conditions is to disperse. This effect is intensified when the lichen biomass on the pastures is low. To cope with the impacts of adverse climatic conditions, herders increase control over their herds, intensify the use of pasture diversity, take reindeer into enclosures and/or start or intensify supplementary feeding. The research also reveals that predators, competing land uses and the high prices of supplementary feed and fuel were the major threats to the herders’ coping capacity. Coping capacity was facilitated by, among other factors, the herders’ experience-based traditional knowledge

  14. Difficult thyroidectomies

    OpenAIRE

    Pelizzo, M.R.

    2015-01-01

    The “difficult thyroidectomies” (DT) are motivated by several factors that, alone or in association with each other, make surgery more laborious and increase the related risks. Topographical, technical and anatomical criteria have been used by us to classify DT with a view to illustrating specific problems and suggesting appropriate strategies. According to topographical criteria we considered mediastinal goiter and resurgery; according to technical criteria we considered the presence of auto...

  15. Difficult thyroidectomies.

    Science.gov (United States)

    Pellizzo, M R

    2015-01-01

    The "difficult thyroidectomies" (DT) are motivated by several factors that, alone or in association with each other, make surgery more laborious and increase the related risks. Topographical, technical and anatomical criteria have been used by us to classify DT with a view to illustrating specific problems and suggesting appropriate strategies. According to topographical criteria we considered mediastinal goiter and resurgery; according to technical criteria we considered the presence of auto-immune thyroiditis and locally advanced malignancies; on the basis of anatomical criteria, we considered the presence of "non recurrent" laryngeal nerve and of a pre-operatory vocal cord palsy. PMID:26017102

  16. Conquering the difficult airway.

    Science.gov (United States)

    Gandy, William E

    2008-01-01

    Every medic should practice regularly for the inevitable difficult airway case. Practice should include review of the causes of difficult airways, as well as skill practice. Having a preassembled airway kit can make your response to an unexpected difficult situation easier. Of all the devices mentioned, the bougie is the airway practitioner's best friend. Using the BURP technique, if not contraindicated, together with the bougie will enable you to intubate many difficult patients with confidence. Remember, "If your patient cannot breathe, nothing else matters. PMID:18251307

  17. What Makes Physics Difficult?

    Science.gov (United States)

    Ornek, Funda; Robinson, William R.; Haugan, Mark P.

    2008-01-01

    According to many students, introductory physics is difficult. We are investigating what students believe makes physics difficult and what can be done to overcome these difficulties. Our investigation includes an initial free-response survey given to approximately 1400 students in an introductory physics course and a second survey, which was given…

  18. Conflict Management: Difficult Conversations with Difficult People

    OpenAIRE

    Overton, Amy R.; Lowry, Ann C.

    2013-01-01

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

  19. Conflict management: difficult conversations with difficult people.

    Science.gov (United States)

    Overton, Amy R; Lowry, Ann C

    2013-12-01

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

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

    Science.gov (United States)

    Flouris, Triant; Walker, Thomas

    2005-01-01

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

  1. A job description for the effective self-management of a long-term condition: experiences of living with difficult asthma.

    Science.gov (United States)

    Deacon, Maureen; Rickards, Emma

    2013-04-01

    This paper concerns a study exploring the salience of a 'job description' for the effective self-management of a long-term condition to the experiences of a group of women living with difficult asthma. This is a life-threatening disease. It has been claimed that sufferers are a marginalised, misunderstood, mistreated and vulnerable group. The method involved secondary analysis of focus group data. The job description has been developed as a tool to enable nurses to facilitate and support effective self-management. This study was designed to examine the application of this tool to a particular case. Long-term conditions are a growing feature of the developed world and are strongly implicated in health inequalities. They are more prevalent in socially and economically disadvantaged populations and therefore add further burden to already vulnerable people. Effective self-management is critical to adapting and adjusting to the experience of a long-term condition and nurses have a responsibility to promote this process.

  2. A Lumped Thermal Model Including Thermal Coupling and Thermal Boundary Conditions for High Power IGBT Modules

    DEFF Research Database (Denmark)

    Bahman, Amir Sajjad; Ma, Ke; Blaabjerg, Frede

    2017-01-01

    Detailed thermal dynamics of high power IGBT modules are important information for the reliability analysis and thermal design of power electronic systems. However, the existing thermal models have their limits to correctly predict these complicated thermal behavior in the IGBTs: The typically used...... thermal distribution under long-term studies. Meanwhile the boundary conditions for the thermal analysis are modeled and included, which can be adapted to different real field applications of power electronic converters. Finally, the accuracy of the proposed thermal model is verified by FEM simulations...... thermal model based on one-dimensional RC lumps have limits to provide temperature distributions inside the device, moreover some variable factors in the real-field applications like the cooling and heating conditions of the converter cannot be adapted. On the other hand, the more advanced three...

  3. Difficult to control atopic dermatitis

    OpenAIRE

    Darsow, U.; Wollenberg, A.; Simon, D; A. Taïeb; Werfel, T.; A. Oranje; C. Gelmetti; Svensson, A; Deleuran, M.; A. Calza; Giusti, F.; Lübbe, J; Seidenari, S; Ring, J.

    2013-01-01

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

  4. Making marketing difficult

    DEFF Research Database (Denmark)

    Meyer, Gitte

    2005-01-01

    embraced by the market-place, while maintaining the old scientific alienation from political life. The case is made that modern science was born ambiguous towards the market-place, and that such ambivalence - relating to different interpretations of the idea of knowledge as a common good - is still...... to be encountered among scientists. Drawing on series of interviews with scientists from bioscience and biotechnology it is argued that, on the one hand, scientists are into marketing and PR exercises; but, on the other hand, they also voice a demand that journalists should make such marketing difficult...

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

    Science.gov (United States)

    Cock, I E

    2015-01-01

    Plants of the genus Aloe have perhaps the longest recorded history of medicinal usage and are amongst the most widely used plants for traditional medicinal purposes worldwide. Aloe vera, Aloe ferox, Aloe arborescens and Aloe perryi are the best known and most widely used, but many other species are also used for their therapeutic properties. The Aloes have been used since ancient times, particularly for the treatment of microbial infections, gastrointestinal disorders and inflammatory conditions. In addition to their myriad uses in traditional therapeutics, the Aloes have also been used as components of cosmetic formulations, and in the food and beverage industries. Despite their wide acceptance, studies from different laboratories often report wide variations in the therapeutic bioactivities from within the same Aloe species, even when the same extraction procedures are used. Furthermore, leaves from individual Aloe plants within the same species may have widely varying levels of the bioactive phytochemicals. Phytochemical analyses have shown that many Aloe species contain various carbohydrate polymers (notably glucomannans) and a range of other low molecular weight phenolic compounds including alkaloids, anthraquinones, anthrones, benzene and furan derivatives, chromones, coumarins, flavonoids, phytosterols, pyrans and pyrones. There has been a wealth of information published about the phytochemistry and therapeutic potential of the Aloes (especially Aloe vera). Much of this has been contradictory. Intra- and interspecies differences in the redox state of the individual Aloe components and in the ratios of these components may occur between individual plants. These factors may all affect the physiological properties of Aloe extracts. Due to the structure and chemical nature of many of the Aloe phytochemicals, it is likely that many of the reported medicinal properties are due to antioxidant or prooxidant effects. The antioxidant/prooxidant activities of many Aloe

  6. Management of difficult urticaria

    Directory of Open Access Journals (Sweden)

    Yadav Sudha

    2009-01-01

    Full Text Available Chronic urticaria, a major health problem causing patient′s distress, induces often physicians′ dilemma while dealing with its etiology, investigations and management. Clinical approach of such cases should include apart from clinical history and physical examination laboratory investigations like routine blood test, thyroid profile, etc. as well as sometimes special test like autologous serum skin test. Management includes reassurance, avoidance of precipitating factors, treatment of underlying disorders, and non-pharmacological approach along with pharmacotherapy. First line drug therapy comprises non-sedative and sedative antihistamines, second line doxepin, nifedipine, leukotriene-inhibitors, sulfasalazine, etc. and third line cyclosporine, dapsone, colchicin, etc.

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

    Science.gov (United States)

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

    2015-10-01

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

  8. Difficult to control atopic dermatitis.

    Science.gov (United States)

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

    2013-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-10-15

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

  10. LIHTC Difficult to Develop Areas

    Data.gov (United States)

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

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

    Science.gov (United States)

    Afanasyev, A.

    2011-12-01

    Multiphase flows in porous media with a transition between sub- and supercritical thermodynamic conditions occur in many natural and technological processes (e.g. in deep regions of geothermal reservoirs where temperature reaches critical point of water or in gas-condensate fields where subject to critical conditions retrograde condensation occurs and even in underground carbon dioxide sequestration processes at high formation pressure). Simulation of these processes is complicated due to degeneration of conservation laws under critical conditions and requires non-classical mathematical models and methods. A new mathematical model is proposed for efficient simulation of binary mixture flows in a wide range of pressures and temperatures that includes critical conditions. The distinctive feature of the model lies in the methodology for mixture properties determination. Transport equations and Darcy law are solved together with calculation of the entropy maximum that is reached in thermodynamic equilibrium and determines mixture composition. To define and solve the problem only one function - mixture thermodynamic potential - is required. Such approach allows determination not only single-phase states and two-phase states of liquid-gas type as in classical models but also two-phase states of liquid-liquid type and three-phase states. The proposed mixture model was implemented in MUFITS (Multiphase Filtration Transport Simulator) code for hydrodynamic simulations. As opposed to classical approaches pressure, enthalpy and composition variables together with fully implicit method and cascade procedure are used. The code is capable of unstructured grids, heterogeneous porous media, relative permeability and capillary pressure dependence on temperature and pressure, multiphase diffusion, optional number of sink and sources, etc. There is an additional module for mixture properties specification. The starting point for the simulation is a cubic equation of state that is

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-12-15

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

  13. Overcoming difficult conversations in clinical supervision

    Directory of Open Access Journals (Sweden)

    Williams B

    2016-06-01

    Full Text Available Brett Williams,1 Christine King,1 Tanya Edlington,21Department of Community Emergency Health and Paramedic Practice, Monash University, Franskton, VIC, 2The Conversation Clinic Pty Ltd, Melbourne, VIC, Australia Background: Clinical supervisors are responsible for managing many facets of clinical learning and face a range of challenges when the need for "difficult" conversations arises, including the need to manage conflict and relationships. Methods: Spotlight on Conversations Workshop was developed to improve the capacity of clinical supervisors to engage in difficult conversations. They were designed to challenge the mindset of clinical supervisors about difficult conversations with students, the consequences of avoiding difficult conversations, and to offer activities for practicing difficult conversations. Preworkshop, postworkshop, and 4-month follow-up evaluations assessed improvements in knowledge, intent to improve, and confidence along with workshop satisfaction. Results: Nine workshops were delivered in a range of locations across Victoria, Australia, involving a total of 117 clinical supervisors. Preworkshop evaluations illustrated that more than half of the participants had avoided up to two difficult conversations in the last month in their workplace. Postworkshop evaluation at 4 months showed very high levels of satisfaction with the workshop's relevancy, content, and training, as well as participants' intention to apply knowledge and skills. Also shown were significant changes in participants' confidence to have difficult conversations not only with students but also with other peers and colleagues. In follow-up in-depth interviews with 20 of the 117 participants, 75% said they had made definite changes in their practice because of what they learned in the workshop and another 10% said they would make changes to their practice, but had not had the opportunity yet to do so. Conclusion: We conclude that the Spotlight on

  14. Textpresso Site-Specific Recombinases: a text-mining server for the recombinase literature including Cre mice and conditional alleles

    Science.gov (United States)

    Urbanski, William M.; Condie, Brian G.

    2016-01-01

    Textpresso Site Specific Recombinases (http://ssrc.genetics.uga.edu/) is a text-mining web server for searching a database of over 9000 full-text publications. The papers and abstracts in this database represent a wide range of topics related to site-specific recombinase (SSR) research tools. Included in the database are most of the papers that report the characterization or use of mouse strains that express Cre recombinase as well as papers that describe or analyze mouse lines that carry conditional (floxed) alleles or SSR-activated transgenes/knockins. The database also includes reports describing SSR-based cloning methods such as the Gateway or the Creator systems, papers reporting the development or use of SSR-based tools in systems such as Drosophila, bacteria, parasites, stem cells, yeast, plants, zebrafish and Xenopus as well as publications that describe the biochemistry, genetics or molecular structure of the SSRs themselves. Textpresso Site Specific Recombinases is the only comprehensive text-mining resource available for the literature describing the biology and technical applications of site-specific recombinases. PMID:19882667

  15. Drastic Measures for Difficult Times

    Science.gov (United States)

    Galuszka, Peter

    2008-01-01

    This article discusses how colleges and universities are taking drastic measure for difficult times. Hit hard by the global financial crisis, colleges are cutting their budgets in ways that prompt fears about access and retention for minority students. Schools are considering layoffs, unpaid furloughs for faculty and staff, hiring freezes and…

  16. Pneumothorax as an Adverse Drug Event: An Exploratory Aggregate Analysis of the US FDA AERS Database Including a Confounding by Indication Analysis Inspired by Cornfield's Condition

    OpenAIRE

    Hauben, Manfred; Hung, Eric Y.

    2013-01-01

    Introduction: Pneumothorax is either primary or secondary. Secondary pneumothorax is usually due to trauma, including various non-pharmacologic iatrogenic triggers. Although not normally thought of as an adverse drug event (ADE) secondary pneumothorax is associated with numerous drugs, though it is often difficult to determine whether this association is causal in nature, or reflects an epiphenomenon of efficacy or inefficacy, or confounding by indication (CBI). Herein we explore this associa...

  17. Why Behavior Change is Difficult to Sustain

    OpenAIRE

    Bouton, Mark E.

    2014-01-01

    Unhealthy behavior is responsible for much human disease, and a common goal of contemporary preventive medicine is therefore to encourage behavior change. However, while behavior change often seems easy in the short run, it can be difficult to sustain. This article provides a selective review of research from the basic learning and behavior laboratory that provides some insight into why. The research suggests that methods used to create behavior change (including extinction, counterconditioni...

  18. 40 CFR 142.307 - What terms and conditions must be included in a small system variance?

    Science.gov (United States)

    2010-07-01

    ... requirements, for the contaminant for which a small system variance is sought, as specified in 40 CFR part 141... included in a small system variance? 142.307 Section 142.307 Protection of Environment ENVIRONMENTAL... IMPLEMENTATION Variances for Small System Review of Small System Variance Application § 142.307 What terms...

  19. Tough Choices in Difficult Times.

    Science.gov (United States)

    Scheer, Sage Ann

    2002-01-01

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

  20. Statistics concerning the Apollo command module water landing, including the probability of occurrence of various impact conditions, sucessful impact, and body X-axis loads

    Science.gov (United States)

    Whitnah, A. M.; Howes, D. B.

    1971-01-01

    Statistical information for the Apollo command module water landings is presented. This information includes the probability of occurrence of various impact conditions, a successful impact, and body X-axis loads of various magnitudes.

  1. Parathyroid cancer - difficult diagnosis - a case report.

    Science.gov (United States)

    Pyzik, Aleksandra Joanna; Matyjaszek-Matuszek, Beata; Zwolak, Agnieszka; Chrapko, Beata; Pyzik, Dawid; Strawa-Zakościelna, Katarzyna

    2016-01-01

    Parathyroid cancer is a rare disorder of unclear etiology that is difficult to diagnose and treat. It is most often diagnosed incidentally based on multi-organ non-specific symptoms of hypercalcemia as a consequence of parathyroid hormone oversecretion. We present a case of a male with primary hyperparathyroidism who was diagnosed with parathyroid cancer ectopically located in the mediastinum only after the third surgery. However, due to chronic hypercalcemia, problems with localization and a bad clinical condition, the patient was not able to undergo a radical resection and one year after the first pathological fracture died. Taking into consideration the whole clinical picture we want to emphasize the need to apply comprehensive differential diagnosis of hypercalcemia and localization diagnosis of parathyroid tissue with a use of MIBI scintigraphy accompanied by the computed tomography and magnetic resonance imaging, as the most specific diagnostic tools employed in this pathology. PMID:26838944

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

    Science.gov (United States)

    Cavallone, Laura F; Vannucci, Andrea

    2013-02-01

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

  3. Biomarkers in the Management of Difficult Asthma.

    Science.gov (United States)

    Schleich, Florence; Sophie, Demarche; Renaud, Louis

    2016-01-01

    Difficult asthma is a heterogeneous disease of the airways including various types of bronchial inflammation and various degrees of airway remodeling. Therapeutic response of severe asthmatics can be predicted by the use of biomarkers of Type2-high or Type2-low inflammation. Based on sputum cell analysis, four inflammatory phenotypes have been described. As induced sputum is timeconsuming and expensive technique, surrogate biomarkers are useful in clinical practice. Eosinophilic phenotype is likely to reflect ongoing adaptive immunity in response to allergen. Several biomarkers of eosinophilic asthma are easily available in clinical practice (blood eosinophils, serum IgE, exhaled nitric oxyde, serum periostin). Neutrophilic asthma is thought to reflect innate immune system activation in response to pollutants or infectious agents while paucigranulocytic asthma is thought to be not inflammatory and characterized by smooth muscle dysfunction. We currently lack of user-friendly biomarkers of neutrophilic asthma and airway remodeling. In this review, we summarize the biomarkers available for the management of difficult asthma. PMID:26467509

  4. Quality of life, reproduction and sexuality after stem cell transplantation with partially T-cell-depleted grafts and after conditioning with a regimen including total body irradiation.

    NARCIS (Netherlands)

    Claessens, J.J.M.; Beerendonk, C.C.M.; Schattenberg, A.V.M.B.

    2006-01-01

    Thirty-four men and 36 women (median age 43 and 45 years, respectively) underwent stem cell transplantation (SCT) for acute leukaemia in first complete remission or chronic myelogenous leukaemia in first chronic phase between 1981 and 2001 from HLA-identical siblings. The conditioning regimen includ

  5. Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment

    Science.gov (United States)

    Udachan, Tejaswini V; Sasnur, Prasad; Baloorkar, Ramakanth; Sindgikar, Vikram; Narasangi, Basavaraj

    2015-01-01

    Introduction Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy. Aim To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion. Materials and Methods This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test. Results Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion. Conclusion The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection. PMID:26816942

  6. Why behavior change is difficult to sustain.

    Science.gov (United States)

    Bouton, Mark E

    2014-11-01

    Unhealthy behavior is responsible for much human disease, and a common goal of contemporary preventive medicine is therefore to encourage behavior change. However, while behavior change often seems easy in the short run, it can be difficult to sustain. This article provides a selective review of research from the basic learning and behavior laboratory that provides some insight into why. The research suggests that methods used to create behavior change (including extinction, counterconditioning, punishment, reinforcement of alternative behavior, and abstinence reinforcement) tend to inhibit, rather than erase, the original behavior. Importantly, the inhibition, and thus behavior change more generally, is often specific to the "context" in which it is learned. In support of this view, the article discusses a number of lapse and relapse phenomena that occur after behavior has been changed (renewal, spontaneous recovery, reinstatement, rapid reacquisition, and resurgence). The findings suggest that changing a behavior can be an inherently unstable and unsteady process; frequent lapses should be expected. In the long run, behavior-change therapies might benefit from paying attention to the context in which behavior change occurs.

  7. Why behavior change is difficult to sustain.

    Science.gov (United States)

    Bouton, Mark E

    2014-11-01

    Unhealthy behavior is responsible for much human disease, and a common goal of contemporary preventive medicine is therefore to encourage behavior change. However, while behavior change often seems easy in the short run, it can be difficult to sustain. This article provides a selective review of research from the basic learning and behavior laboratory that provides some insight into why. The research suggests that methods used to create behavior change (including extinction, counterconditioning, punishment, reinforcement of alternative behavior, and abstinence reinforcement) tend to inhibit, rather than erase, the original behavior. Importantly, the inhibition, and thus behavior change more generally, is often specific to the "context" in which it is learned. In support of this view, the article discusses a number of lapse and relapse phenomena that occur after behavior has been changed (renewal, spontaneous recovery, reinstatement, rapid reacquisition, and resurgence). The findings suggest that changing a behavior can be an inherently unstable and unsteady process; frequent lapses should be expected. In the long run, behavior-change therapies might benefit from paying attention to the context in which behavior change occurs. PMID:24937649

  8. Integrated modeling of CO2 storage and leakage scenarios including transitions between super- and sub-critical conditions, and phase change between liquid and gaseous CO2

    Energy Technology Data Exchange (ETDEWEB)

    Pruess, K.

    2011-05-15

    Storage of CO{sub 2} in saline aquifers is intended to be at supercritical pressure and temperature conditions, but CO{sub 2} leaking from a geologic storage reservoir and migrating toward the land surface (through faults, fractures, or improperly abandoned wells) would reach subcritical conditions at depths shallower than 500-750 m. At these and shallower depths, subcritical CO{sub 2} can form two-phase mixtures of liquid and gaseous CO{sub 2}, with significant latent heat effects during boiling and condensation. Additional strongly non-isothermal effects can arise from decompression of gas-like subcritical CO{sub 2}, the so-called Joule-Thomson effect. Integrated modeling of CO{sub 2} storage and leakage requires the ability to model non-isothermal flows of brine and CO{sub 2} at conditions that range from supercritical to subcritical, including three-phase flow of aqueous phase, and both liquid and gaseous CO{sub 2}. In this paper, we describe and demonstrate comprehensive simulation capabilities that can cope with all possible phase conditions in brine-CO{sub 2} systems. Our model formulation includes: (1) an accurate description of thermophysical properties of aqueous and CO{sub 2}-rich phases as functions of temperature, pressure, salinity and CO{sub 2} content, including the mutual dissolution of CO{sub 2} and H{sub 2}O; (2) transitions between super- and subcritical conditions, including phase change between liquid and gaseous CO{sub 2}; (3) one-, two-, and three-phase flow of brine-CO{sub 2} mixtures, including heat flow; (4) non-isothermal effects associated with phase change, mutual dissolution of CO{sub 2} and water, and (de-) compression effects; and (5) the effects of dissolved NaCl, and the possibility of precipitating solid halite, with associated porosity and permeability change. Applications to specific leakage scenarios demonstrate that the peculiar thermophysical properties of CO{sub 2} provide a potential for positive as well as negative

  9. Single particle ICP-MS as a tool for determining the stability of silver nanoparticles in aquatic matrixes under various environmental conditions, including treatment by ozonation.

    Science.gov (United States)

    Telgmann, Lena; Nguyen, Michael Thanh Khoa; Shen, Li; Yargeau, Viviane; Hintelmann, Holger; Metcalfe, Chris D

    2016-07-01

    Silver nanoparticles (AgNPs) are used in a large number of consumer products due to their antimicrobial and antifungal properties, and these materials may be discharged into municipal wastewater. Wastewater treatment, including advanced oxidation processes (AOPs), may modify the forms of silver in wastewater before they are discharged into surface waters. In addition, little is known about the changes in AgNPs that occur in natural waters under different environmental conditions. In this project, we utilized single particle ICP-MS (spICP-MS) and dynamic light scattering (DLS) analytical techniques to evaluate changes in the number and size of AgNPs in laboratory experiments with milliQ water under different environmental conditions, as well as during ozonation. Changes in the number and size of AgNPs determined by spICP-MS were evidence of altered stability of the nanoparticles. Increased rates of dissolution occurred under extremes of pH. Lower temperature decreased the rate of dissolution of AgNP relative to the dissolution in treatments at room temperature. The addition of chloride resulted in the loss of AgNPs from suspension due to agglomeration and precipitation. Ozonation led to a rapid decline in the number and size of AgNPs, as indicated by both spICP-MS and DLS analysis. An increase in the concentration of dissolved silver in the ozone treatments was evidence that changes in particle size were a result of oxidative dissolution of AgNPs to silver ion. Graphical abstract Single particle ICP-MS is used to evaluate dissolution of silver nanoparticles under different environmental conditions, including water treatment by ozonation. PMID:27311958

  10. Single particle ICP-MS as a tool for determining the stability of silver nanoparticles in aquatic matrixes under various environmental conditions, including treatment by ozonation.

    Science.gov (United States)

    Telgmann, Lena; Nguyen, Michael Thanh Khoa; Shen, Li; Yargeau, Viviane; Hintelmann, Holger; Metcalfe, Chris D

    2016-07-01

    Silver nanoparticles (AgNPs) are used in a large number of consumer products due to their antimicrobial and antifungal properties, and these materials may be discharged into municipal wastewater. Wastewater treatment, including advanced oxidation processes (AOPs), may modify the forms of silver in wastewater before they are discharged into surface waters. In addition, little is known about the changes in AgNPs that occur in natural waters under different environmental conditions. In this project, we utilized single particle ICP-MS (spICP-MS) and dynamic light scattering (DLS) analytical techniques to evaluate changes in the number and size of AgNPs in laboratory experiments with milliQ water under different environmental conditions, as well as during ozonation. Changes in the number and size of AgNPs determined by spICP-MS were evidence of altered stability of the nanoparticles. Increased rates of dissolution occurred under extremes of pH. Lower temperature decreased the rate of dissolution of AgNP relative to the dissolution in treatments at room temperature. The addition of chloride resulted in the loss of AgNPs from suspension due to agglomeration and precipitation. Ozonation led to a rapid decline in the number and size of AgNPs, as indicated by both spICP-MS and DLS analysis. An increase in the concentration of dissolved silver in the ozone treatments was evidence that changes in particle size were a result of oxidative dissolution of AgNPs to silver ion. Graphical abstract Single particle ICP-MS is used to evaluate dissolution of silver nanoparticles under different environmental conditions, including water treatment by ozonation.

  11. Novel reinforcement learning approach for difficult control problems

    Science.gov (United States)

    Becus, Georges A.; Thompson, Edward A.

    1997-09-01

    We review work conducted over the past several years and aimed at developing reinforcement learning architectures for solving difficult control problems and based on and inspired by associative control process (ACP) networks. We briefly review ACP networks able to reproduce many classical instrumental conditioning test results observed in animal research and to engage in real-time, closed-loop, goal-seeking interactions with their environment. Chronologically, our contributions include the ideally interfaced ACP network which is endowed with hierarchical, attention, and failure recognition interface mechanisms which greatly enhanced the capabilities of the original ACP network. When solving the cart-pole problem, it achieves 100 percent reliability and a reduction in training time similar to that of Baird and Klopf's modified ACP network and additionally an order of magnitude reduction in number of failures experienced for successful training. Next we introduced the command and control center/internal drive (Cid) architecture for artificial neural learning systems. It consists of a hierarchy of command and control centers governing motor selection networks. Internal drives, similar hunger, thirst, or reproduction in biological systems, are formed within the controller to facilitate learning. Efficiency, reliability, and adjustability of this architecture were demonstrated on the benchmark cart-pole control problem. A comparison with other artificial learning systems indicates that it learns over 100 times faster than Barto, et al's adaptive search element/adaptive critic element, experiencing less failures by more than an order of magnitude while capable of being fine-tuned by the user, on- line, for improved performance without additional training. Finally we present work in progress on a 'peaks and valleys' scheme which moves away from the one-dimensional learning mechanism currently found in Cid and shows promises in solving even more difficult learning control

  12. Difficult laryngoscopy made easy with a "BURP".

    Science.gov (United States)

    Knill, R L

    1993-03-01

    Displacement of the larynx by backward, upward and rightward pressure on the thyroid cartilage or "BURP" may improve visualization of the glottis in some cases of difficult direct laryngoscopy. In a patient with the Treacher-Collins syndrome in whom conventional laryngoscopy had proved impossible and tracheal intubation extremely difficult, this manoeuvre exposed the entire glottis and made tracheal intubation under direct vision easy. In a patient with protruding upper incisors and a prominent premaxilla which precluded a view of the glottis by conventional laryngoscopy, "BURP" again revealed the glottic opening and simplified the placement of an endotracheal tube. This experience suggests that "BURP" be considered as a potential aid in the management of difficult direct laryngoscopy. PMID:8467551

  13. Medical Students' Personal Determinants of Overcoming Strategies in Difficult Situations

    Directory of Open Access Journals (Sweden)

    Veretelnikova Yu.Ya.

    2013-03-01

    Full Text Available Goal of the research was to study conditionality of overcoming strategies in difficult situations of social interaction by personal representations of attitude to others among medical students. Material and methods. 134 first-year students of Saratov State Medical University n.a. V. I. Razumovsky took part in the comparative diagnostic study. Results. Comparison of average indices of various strategies evidence in coping behaviour allowed revealing statistically significant dependence of coping behaviour modi in difficult situations of social interaction upon types of personal representations of attitude toward others and gender features of forming effective strategies of coping behaviour among medical students. Conclusion. Correlation between coping behaviour modi in difficult situations of social interaction and typology of personal representations of attitudes toward others among medical students was marked.

  14. Qualitative analysis of unanticipated difficult airway management

    DEFF Research Database (Denmark)

    Rosenstock, C; Hansen, E G; Kristensen, M S;

    2006-01-01

    Unanticipated difficult airway management (DAM) is a major challenge for the anaesthesiologist and is associated with a risk of severe patient damage. We analysed 24 cases of unanticipated DAM for actual case management and anaesthesiologists knowledge, technical and non-technical skills....... Anaesthesiologists' opinions, as well as environmental factors of importance for DAM proficiency, were also assessed....

  15. Qualitative analysis of unanticipated difficult airway management

    DEFF Research Database (Denmark)

    Rosenstock, C; Hansen, E G; Kristensen, M S;

    2006-01-01

    Unanticipated difficult airway management (DAM) is a major challenge for the anaesthesiologist and is associated with a risk of severe patient damage. We analysed 24 cases of unanticipated DAM for actual case management and anaesthesiologists knowledge, technical and non-technical skills...

  16. Questions That Science Teachers Find Difficult (II).

    Science.gov (United States)

    Goodwin, Alan

    2003-01-01

    Presents some questions that science teachers find difficult. Focuses on three further questions relating to "simple" everyday situations that are normally explained in terms of the kinetic theory of matter. Identifies looking at the difference between chemical and physical changes as the most problematic question. (Author/YDS)

  17. [Partnership around difficult teenagers in Brest].

    Science.gov (United States)

    Saint-André, Stéphane; Botbol, Michel

    2013-01-01

    The issues surrounding difficult teenagers results in professionals formalising a partnership. Certain areas of focus are identified such as getting to know each other better in order to understand each other better, working in a "common language", understanding professional identities, or embracing long term partnership. Pressure to assess and rationalise spending, as well as political challenges, must be taken into consideration.

  18. The difficult encounter between inspector and farmer

    DEFF Research Database (Denmark)

    Anneberg, Inger; Sørensen, Jan Tind; Vaarst, Mette

    2012-01-01

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

  19. Engaging Men in Difficult Dialogues about Privilege

    Science.gov (United States)

    Loschiavo, Chris; Miller, David S.; Davies, Jon

    2007-01-01

    Male privilege is one aspect of social inequality that underlies much of the oppression and violence that occurs on college campuses. Mad Skills, a program addressing power and privilege with college men, is described along with general recommendations about how to engage men in difficult dialogues. The PIE Model is used to describe defensive…

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

    Science.gov (United States)

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

    2013-01-01

    discrete groundwater inflow supports streamflow during low-flow conditions along the entire 18-kilometer stream reach. Concentrations of dissolved selenium within all subreaches of Toll Gate Creek exceeded the Colorado aquatic-life standard of 4.6 micrograms per liter in 2007. Concentrations of selenium in the upper portion of the Toll Gate Headwaters subreach (TGH) remained close to the aquatic-life standard at about 5 micrograms per liter. Downstream from a concrete-lined channel section, inflows with selenium concentrations greater than the stream contribute selenium load to surface water. However, stream selenium concentrations were less than 20 micrograms per liter all along Toll Gate Creek. Concentrations of selenium in groundwater were in general substantially greater than the Colorado aquatic-life standard of 4.6 micrograms per liter and at some locations were greater than the U.S. Environmental Protection Agency primary drinking-water standard for selenium of 50 micrograms per liter. The distribution of selenium concentrations in groundwater, springs, and the 11 inflows with the greatest selenium concentrations indicates that shallow groundwater in surficial materials and the Denver Formation bedrock is a source of selenium loading to Toll Gate Creek and that selenium loading is distributed along the entire length of the study reach downstream from the concrete-lined channel. Water-quality and solids-sampling results from this study indicate weathering processes release water-soluble selenium from the underlying Denver Formation claystone bedrock with subsequent cycling of selenium in the aquatic environment of Toll Gate Creek. Exposure of the Denver Formation selenium-bearing bedrock to oxidizing atmospheric conditions, surface water, and groundwater, oxidizes selenide, held as a trace element in pyrite or in complexes with organic matter, to selenite and selenate. Secondary weathering products including iron oxides and selenium-bearing salts have accumulated in

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

    Science.gov (United States)

    Radwanek-Bąk, Barbara; Nieć, Marek

    2014-05-01

    Mineral deposits are non-renewable natural resources. Their protection and reasonable exploitation are crucial requests resulting from sustainable development principles. Those are also fundamental issues in frame of the intergeneration justice and fairness concept. Protection of mineral resources should be based on interrelated activities: maintaining the possibility of economic use of the identified mineral resources, reduced consumption of mineral resources and ensuring satisfactory results of new prospecting and development of innovative technologies for the mineral resources base. The main problem with guarantee to the use of mineral resources is the accessibility to sites with documented deposits and prospective areas of their occurrence. Often, this contradicts with the interests of residents, planners and needs of the biotic environment protection, thus is often a source of conflicts. Legislative regulations are necessary to mitigate such arguable matters. SWOT analysis carried out with respect to introducing such legal regulations serves to identify the sources of conflicts and difficulties associated with their solution. Consensus reaching is a difficult task, so all decision makers are required to show their mutual understanding and willingness to achieve the goals taking into consideration all benefits for the population (including future generations). Foundations for finding the middle ground are: making the communities aware of their demands on minerals and of indispensable conditions for satisfying these demands; providing complete and accessible information; factual, non-emotional negotiations between decision makers and the public.

  2. Difficult treatment decisions in autoimmune hepatitis

    Institute of Scientific and Technical Information of China (English)

    Albert; J; Czaja

    2010-01-01

    Treatment decisions in autoimmune hepatitis are complicated by the diversity of its clinical presentations,uncertainties about its natural history,evolving opinions regarding treatment end points,varied nature of refractory disease,and plethora of alternative immu-nosuppressive agents. The goals of this article are to review the difficult treatment decisions and to provide the bases for making sound therapeutic judgments. The English literature on the treatment problems in au-toimmune hepatitis were identif...

  3. Why Evaluating Semantic Web Applications is Difficult

    OpenAIRE

    Ossenbruggen, van, Jacco; Amin, Alia; Hildebrand, Michiel

    2008-01-01

    This position paper discusses our experience in evaluating our cultural search and annotation engine. We identify three aspects that determine the quality of a semantic web application as a whole, namely: the quality of data set, the quality of underlying search and inference software and the quality of the user interface. We argue that evaluation of semantic web applications is particularly difficult because of the strong interdependency between the three aspects.

  4. Medical Students' Personal Determinants of Overcoming Strategies in Difficult Situations

    OpenAIRE

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

    2013-01-01

    Goal of the research was to study conditionality of overcoming strategies in difficult situations of social interaction by personal representations of attitude to others among medical students. Material and methods. 134 first-year students of Saratov State Medical University n.a. V. I. Razumovsky took part in the comparative diagnostic study. Results. Comparison of average indices of various strategies evidence in coping behaviour allowed revealing statistically significant dependence of copi...

  5. [Difficult teenagers: the challenges of interdisciplinarity].

    Science.gov (United States)

    Saint-Andrté, Stéphane; Botbola, Michel

    2013-01-01

    The adolescents in great distress, because of ruptures in the course of their lives and of their chaotic family environment, need educational and social actions. The consensual point of view is that responding to the needs of the so called "difficult adolescents" implies the involvement of educational, therapeutic and judicial services. Nevertheless, the usual tendency to categorize the users with the idea it will permit to guide them to the appropriate skill field and the transgressive characteristic of these adolescents' behaviours lead all these services to reject them and send them to the two other services. PMID:24450000

  6. Laparoscopic management of difficult recurrent choledocholithiasis.

    Science.gov (United States)

    Dixit, Anupam; Wynne, Kamal S; Harris, Adrian M

    2007-01-01

    The management of common bile duct stones has traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology in the latter half of the last century, endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration has become the mainstream treatment for common bile duct stones in most medical centers around the world. However, in some patients, endoscopic retrograde cholangiopancreatography is difficult and laparoscopy is challenging because of previous surgery. These facts are highlighted in this report. PMID:17651582

  7. conditions

    Directory of Open Access Journals (Sweden)

    M. Venkatesulu

    1996-01-01

    Full Text Available Solutions of initial value problems associated with a pair of ordinary differential systems (L1,L2 defined on two adjacent intervals I1 and I2 and satisfying certain interface-spatial conditions at the common end (interface point are studied.

  8. Difficult male urethral catheterization: a review of different approaches

    Directory of Open Access Journals (Sweden)

    Carlos Villanueva

    2008-08-01

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

  9. Braving difficult choices alone: children's and adolescents' medical decision making.

    Directory of Open Access Journals (Sweden)

    Azzurra Ruggeri

    Full Text Available OBJECTIVE: What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. METHODS: Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1 own informed choice; (2 informed parents' choice to amputate; (3 informed parents' choice to continue a treatment; and (4 uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. RESULTS: Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. CONCLUSIONS: Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process.

  10. Difficult laryngoscopy caused by massive mandibular tori.

    Science.gov (United States)

    Takasugi, Yoshihiro; Shiba, Mayuka; Okamoto, Shinji; Hatta, Koji; Koga, Yoshihisa

    2009-01-01

    Mandibular tori, defined as bony protuberances located along the lingual aspect of the mandible, are a possible cause of difficult intubation. We describe a case of mandibular tori that resulted in difficult intubation. A 62-year-old woman who had speech problems was diagnosed with mandibular tori, and was scheduled for surgical resection. On physical assessment, the patient had a class II Mallampati view and bilateral mandibular tori. Preoperative computed tomography images demonstrated that the bilateral mandibular tori arose from the lingual aspects of the second incisor to the first molar regions of the mandibular corpus, and occupied the floor of the mouth. In the operating room, anesthesia was induced with remifentanil and propofol. After complete paralysis was achieved, laryngoscopy was attempted several times with Macintosh blades. The massive tori prevented insertion of the tip of the blade into the oropharynx, and neither the epiglottis nor the arytenoids could be visualized, i.e., Cormack and Lehane grade IV. Blind nasotracheal intubation was successful and the surgery proceeded uneventfully. The anesthesiologist should examine any space-occupying lesion of the oral floor and should be vigilant for speech problems in order to detect mandibular tori that might impede intubation. PMID:19444571

  11. Effective Climate Communication with Difficult Audiences

    Science.gov (United States)

    Denning, S.

    2015-12-01

    Climate communication is often fraught with ideological baggage ("noise") that makes it very difficult to connect to audiences. In these cases, it is helpful to use "best practices" known from other fields of communication. Engaging audiences with authenticity, using plain language, respecting cultural and political differences, and a sprinkling of humor can go a long way toward establishing a connection. It's important to avoid common but polarizing tropes from popular media, and often quite helpful to frame climate issues in novel or unexpected ways that cut across entrenched political discourse. Emerging social science research Beyond ideology, climate change is Simple, Serious, and Solvable. Effective communication of these three key ideas can succeed when the science argument is carefully framed to avoid attack of the audience's ethical identity. Simple arguments from common sense and everyday experience are more successful than data. Serious consequences to values that resonate with the audience can be avoided by solutions that don't threaten those values.

  12. Difficult weaning in delayed onset diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Ahmed Syed

    2009-01-01

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

  13. Optimising the management of patients with difficult asthma.

    Science.gov (United States)

    Palmer, Evelyn; Higgins, Bernard

    2015-11-01

    Asthma affects 5.4 million people in the UK, around 1 in 12 of the population. Between 5 and 10% of asthma (depending on the definition used) is categorised as difficult asthma, a term which generally refers to patients who continue to experience symptoms and frequent exacerbations despite the prescription of high-dose asthma therapy. Difficult asthma is an indication for specialist review by an appropriate respiratory physician, but close liaison between primary, secondary and tertiary care is critical and it is therefore important that primary care health professionals should be aware of the principles of management. One of the most important questions to ask is whether the individual with difficult asthma is taking their treatment Identifying this, however, is not easy. GPs could assess prescription uptake, looking for low use of preventers and excess use of short-acting bronchodilators. Newer means of assessing adherence have been developed. Inhaler devices that can monitor completion and timing of actuations have been produced. Meters that measure FeNO are available. A recent UK study found that 12 out of 100 patients referred for difficult asthma did not have reversible airflow obstruction or a history suggestive of asthma. Diagnoses included COPD, cystic fibrosis, cardiomyopathy, respiratory muscle dysfunction and severe anxiety with vocal cord dysfunction.

  14. Public health in Kosovo after five difficult years of independence

    Directory of Open Access Journals (Sweden)

    Naim Jerliu

    2015-12-01

    administration. Regarding the health status, five years after independence, compared with other European countries, post-war transitional Kosovo is still characterized by higher mortality rates including traditional public health problems pertinent to infant mortality and maternal deaths. In parallel, however, Kosovo is undergoing a rapid process of epidemiological transition characterized by an aging trend which is inevitably coupled with high cardiovascular and cancer mortality and morbidity along with an excess mortality in external causes of death and injuries among the adult population. Adoption of the new Health Law in December 2012 by the Kosovo Assembly aims the transition from centralized health care system established under emergency conditions of the post-war period towards a contemporary modern health care system with a clear purchaser-provider split based on a high transparency and accountability of the health care providers and their contractors. The health care reform, leading eventually to significant changes within the health sector in Kosovo, consists of two main pillars: (i structural and functional reorganization of the health care system through establishment of Kosovo Health Service (an autonomous and non-for-profit public enterprise at central level of the health care sector, and; (ii establishment for the first time of the public health insurance system with a Health Insurance Fund as its main body. Nevertheless, five years after declaration of independence, Kosovo, the newest state in Europe consisting of the youngest population, is currently facing a particularly difficult socioeconomic and political transition and is additionally struggling and mainstreaming all energies and efforts in order to get full international recognition.

  15. A gene-derived SNP-based high resolution linkage map of carrot including the location of QTL conditioning root and leaf anthocyanin pigmentation

    OpenAIRE

    Cavagnaro, Pablo F; Iorizzo, Massimo; Yildiz, Mehtap; Senalik, Douglas; Parsons, Joshua; Ellison, Shelby; Simon, Philipp W

    2014-01-01

    Background Purple carrots accumulate large quantities of anthocyanins in their roots and leaves. These flavonoid pigments possess antioxidant activity and are implicated in providing health benefits. Informative, saturated linkage maps associated with well characterized populations segregating for anthocyanin pigmentation have not been developed. To investigate the genetic architecture conditioning anthocyanin pigmentation we scored root color visually, quantified root anthocyanin pigments by...

  16. Soaring Cotton Prices to Make Manufacturing Difficult

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    With manufacturing slowly recovering amid improving economic condi-tions, cotton demand has increased prompting more orders among mills. However, with a deficient supply of cotton in the market, prices extend gains

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

    OpenAIRE

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

    2015-01-01

    The overlay of cooler nutrient enriched Beagle–Magellan water with warmer nutrient depleted shelf water and a strong stratification of the water column in the San Jorge Gulf region, Argentina, coincided with relatively high dinoflagellate abundances in April 2012, up to 34,000 cells L− 1. This dinoflagellate proliferation was dominated by Ceratium spp., but environmental conditions also favored to a lesser amount the occurrence of toxigenic dinoflagellates, such as Alexandrium tamarense and P...

  18. Rigid fibrescope Bonfils: use in simulated difficult airway by novices

    Directory of Open Access Journals (Sweden)

    Piepho Tim

    2009-07-01

    Full Text Available Abstract Background The Bonfils intubation fibrescope is a promising alternative device for securing the airway. We examined the success rate of intubation and the ease of use in standardized simulated difficult airway scenarios by physicians. We compared the Bonfils to a classical laryngoscope with Macintosh blade. Methods 30 physicians untrained in the use of rigid fibrescopes but experienced in airway management performed endotracheal intubation in an airway manikin (SimMan, Laerdal, Kent, UK with three different airway conditions. We evaluated the success rate using the Bonfils (Karl Storz, Tuttlingen, Germany or the Macintosh laryngoscope, the time needed for securing the airway, and subjective rating of both techniques. Results In normal airway all intubations were successful using laryngoscope (100% vs. 82% using the Bonfils (p Conclusion The Bonfils can be successfully used by physicians unfamiliar with this technique in an airway manikin. The airway could be secured with at least the same success rate as using a Macintosh laryngoscope in difficult airway scenarios. Use of the Bonfils did not delay intubation in the presence of a difficult airway. These results indicate that intensive special training is advised to use the Bonfils effectively in airway management.

  19. Combined precut in difficult biliary cannulation

    Directory of Open Access Journals (Sweden)

    Jesús Espinel-Díez

    2013-06-01

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

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

    Science.gov (United States)

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

    2015-08-01

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

  1. The Difficult Stoma: Challenges and Strategies.

    Science.gov (United States)

    Strong, Scott A

    2016-06-01

    The problems that a patient experiences after the creation of a temporary or permanent stoma can result from many factors, but a carefully constructed stoma located in an ideal location is typically associated with appropriate function and an acceptable quality of life. The construction of the stoma can be confounded by many concomitant conditions that increase the distance that the bowel must traverse or shorten the bowel's capacity to reach. Stomas can be further troubled by a variety of problems that potentially arise early in the recovery period or months later. Surgeons must be familiar with these obstacles and complications to avoid their occurrence and minimize their impact. PMID:27247541

  2. Clinical situations associated with difficult-to-control hypertension.

    Science.gov (United States)

    Oliveras, Anna; Schmieder, Roland E

    2013-03-01

    There is no doubt that patients with high blood pressure (BP) are at higher cardiovascular and death risk than those subjects whose BP levels are below the admitted normal threshold. However, most of the epidemiological surveys show that BP is uncontrolled in more than fifty percent of hypertensive subjects. There are several reasons that can justify this lack of hypertension control, some of them depending on the patient, such as therapeutic adherence, or some related to the doctor, due to therapeutic inertia or reluctance to increment the number and doses of antihypertensive drugs. Sometimes the efficacy or adverse effects related to the antihypertensive drugs underlie the uncontrolled hypertension. And, finally, there are some clinical conditions that are associated with difficult-to-control hypertension. Among them, comorbidities such as diabetes, obesity, obstructive sleep apnoea syndrome or chronic kidney disease, but also drug-related hypertension or resistant hypertension. In this article we review the epidemiology and the conditions which are related to poorly controlled hypertension and that can explain why hypertension may become difficult-to-treat. PMID:23389084

  3. Abdominal Wall Modification for the Difficult Ostomy

    OpenAIRE

    Beck, David E.

    2008-01-01

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

  4. Childhood Bipolar Disorder: A Difficult Diagnosis

    Science.gov (United States)

    Sutton, Kimberly Kode

    2014-01-01

    Identifying children with emotional or behavior disorders has long been problematic. In a general sense, those children who are most likely to be noticed by teachers and, therefore, referred for possible special education placement are those who exhibit externalizing behaviors, including physical aggression, noncompliance, and rule-breaking. It is…

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-10-15

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

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

    Directory of Open Access Journals (Sweden)

    Lindsay JT

    2013-04-01

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

  7. Laser-assisted machining of difficult-to-machine materials

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-07-01

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

  8. Management of difficult airway in intratracheal tumor surgery

    Directory of Open Access Journals (Sweden)

    Agarwal Surendra K

    2005-06-01

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

  9. Implications of the KONVERGENCE Model for Difficult Cleanup Decisions

    Energy Technology Data Exchange (ETDEWEB)

    Piet, Steven James; Dakins, Maxine Ellen; Gibson, Patrick Lavern; Joe, Jeffrey Clark; Kerr, Thomas A; Nitschke, Robert Leon

    2002-08-04

    Abstract—Some cleanup decisions, such as cleanup of intractable contaminated sites or disposal of spent nuclear fuel, have proven difficult to make. Such decisions face high resistance to agreement from stakeholders possibly because they do not trust the decision makers, view the consequences of being wrong as too high, etc. Our project’s goal is to improve sciencebased cleanup decision-making. This includes diagnosing intractable situations, as a step to identifying a path toward sustainable solutions. Companion papers describe the underlying philosophy of the KONVERGENCE Model for Sustainable Decisions,1 and the overall framework and process steps.2 Where knowledge, values, and resources converge (the K, V, and R in KONVERGENCE), you will find a sustainable decision – a decision that works over time. For intractable cases, serious consideration of the adaptable class of alternatives is warranted – if properly implemented and packaged.

  10. Risk Factors for and Prediction of a Difficult Neuraxial Block

    DEFF Research Database (Denmark)

    Stendell, Line; Lundstrøm, Lars H; Wetterslev, Jørn;

    2015-01-01

    BACKGROUND: A difficult neuraxial block (DNB) may be associated with complications. The aims of this study were to estimate the prevalence of DNB, assess patient-related and organizational factors associated with DNB, and evaluate the diagnostic accuracy of an accumulated risk score for predicting...... DNB. METHODS: A consecutive cohort of 73,579 patients was retrieved. A predefined DNB score and information on patient-related and organizational factors were included in the analyses. Logistic regression analysis was performed. We evaluated the diagnostic accuracy of an accumulated weighted point...... score of the patient-related risk factors of DNB. RESULTS: The prevalence of DNB and abandoned neuraxial block was 3.9 (95% confidence interval [95% CI], 3.7-4.0) and 0.2 (95% CI, 0.16-0.22), respectively. Body mass index of 35 or higher and previous DNB were associated with DNB, with 3.23 (95% CI, 2...

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

    Directory of Open Access Journals (Sweden)

    Viet Q. Tran

    2008-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Pruess, K.

    2011-04-01

    ECO2M is a fluid property module for the TOUGH2 simulator (Version 2.0) that was designed for applications to geologic storage of CO{sub 2} in saline aquifers. It includes a comprehensive description of the thermodynamics and thermophysical properties of H{sub 2}O - NaCl - CO{sub 2} mixtures, that reproduces fluid properties largely within experimental error for temperature, pressure and salinity conditions in the range of 10 C {le} T {le} 110 C, P {le} 600 bar, and salinity from zero up to full halite saturation. The fluid property correlations used in ECO2M are identical to the earlier ECO2N fluid property package, but whereas ECO2N could represent only a single CO{sub 2}-rich phase, ECO2M can describe all possible phase conditions for brine-CO{sub 2} mixtures, including transitions between super- and sub-critical conditions, and phase change between liquid and gaseous CO{sub 2}. This allows for seamless modeling of CO{sub 2} storage and leakage. Flow processes can be modeled isothermally or non-isothermally, and phase conditions represented may include a single (aqueous or CO{sub 2}-rich) phase, as well as two-and three-phase mixtures of aqueous, liquid CO{sub 2} and gaseous CO{sub 2} phases. Fluid phases may appear or disappear in the course of a simulation, and solid salt may precipitate or dissolve. TOUGH2/ECO2M is upwardly compatible with ECO2N and accepts ECO2N-style inputs. This report gives technical specifications of ECO2M and includes instructions for preparing input data. Code applications are illustrated by means of several sample problems, including problems that had been previously solved with TOUGH2/ECO2N.

  13. 困难企业子弟学校高中学生心理卫生状况的相关分析%Analysis about Psychological Health of Students of the Senier Middle Sc hool Attached to the Enterprise on Difficult Conditions

    Institute of Scientific and Technical Information of China (English)

    李晓东; 周于川; 周远华; 杨世文

    2001-01-01

    Using SCL-90 clinal table,188 senier middle school stud ents of a certain enterprise sons and daughters school were tested.The result sh ows that:①The psychological health level of the difficult enterprise school is much lower than that of the norm students in our country.21.3% of the senier students have diff erent kinds of problems about the health.②The change of the psychological healt h level of the enterprise school students shows grade character.Among them,the h ealth level of Grade Ⅱ is even lower than that of Grade Ⅰand Grade Ⅲ.③The re ason of the health problem that has formed to the students of the difficult ente rprise school is that they can't fit in their study and the obsessment of the development of their self-consciouness trouble themselves too.%采用SCL-90临床自评量表,对某企业子弟学校三年制高中188名学 生进行测试。结 果表明:①困难企业子弟学校高中生心理健康水平总体上低于全国中学生常模,有21.3%的 高 中生存在各种明显的心理健康问题。②困难企业子弟学校高中生心理健康水平其变化表现出 年 级特征,其中,二年级水平较低,一、三年级较高。③困难企业子弟学校高中生心理健康问 题产生的主要原因是学习上的不适应,学生自我意识发展问题的困扰

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

    Directory of Open Access Journals (Sweden)

    Chiara Bozzano

    2013-03-01

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

  15. Difficult issues in mentoring: recommendations on making the "undiscussable" discussable.

    Science.gov (United States)

    Bickel, Janet; Rosenthal, Susan L

    2011-10-01

    Many mentoring relationships do not reach fruition because the individuals fail to bridge a critical difference. When a difference prevents a learning partnership from achieving its potential, the loss is multidimensional for the individuals and the institution--wasting opportunities for the fostering of current and future talent. Insights into when such impasses are likely to arise may help both mentors and mentees address what feels "undiscussable." The authors offer numerous examples of how differences related to ethnicity, language, gender, and generation may interfere with the development of mentoring relationships. Next, the authors offer recommendations on preparing for and handling difficult conversations, including creating safety, noticing assumptions and emotions, and raising sensitive issues. Virtually all faculty can become more effective at communicating across differences and addressing difficulties that prevent mentoring relationships from achieving their potential. The pay-offs for these efforts are indisputable: increased effect in the limited time available for mentoring, an expanded legacy of positive influence, and enhanced communication and leadership skills. The honing of these relational skills enhances the colleagueship and teamwork on which virtually all research, clinical, and educational enterprises depend. Academic health centers that systematically support mentoring enhance institutional stability, talent development, and leadership capacity. PMID:21869662

  16. Management of difficult inflammatory bowel disease: where are we now?

    Institute of Scientific and Technical Information of China (English)

    D.S. Rampton

    2000-01-01

    Management of inflammatory bowel disease includes not only drug, endoscopic and surgical therapy but alsopsychosocial support, dietary and specific nutritional measures: a multidisciplinary medical, surgical, nursingand dietetic approach is essential for all patients, particularly those with complex or refractory disease. Inthis paper, current treatment of acute severe ulcerative colitis and steroid-refractory or -dependent Crohn'sdisease is reviewed. Adjunctive intravenous cyclosporin is an alternative to urgent colectomy in steroid-refractory patients with acute severe ulcerative colitis, while the place of intravenous heparin for thisindication awaits clarification. Azathioprine or 6-mercaptopurine are useful options in chronically active,steroid-refractory or -dependent Crohn's disease, but may take up to 4 months to work. Methotrexate is amore recent immunomodulatory alternative. Of new therapies selectively aimed at specific pathophysiologicaltargets, the first to reach clinical application is anti-TNF-alpha antibody (infliximab) for refractory Crohn'sdisease: its benefits are promising, but experience with it is limited to date, its cost is high and there areuncertainties about long-term safety. In view of the increasing variety and complexity of management optionsin inflammatory bowel disease, whether apparently responsive or difficult to treat, patients must participatein decisions about which therapies they are to be given.

  17. Improving oncology nurses' communication skills for difficult conversations.

    Science.gov (United States)

    Baer, Linda; Weinstein, Elizabeth

    2013-06-01

    When oncology nurses have strong communication skills, they play a pivotal role in influencing patient satisfaction, adherence to plans of care, and overall clinical outcomes. However, research studies indicate that nurses tend to keep communication with patients and families at a superficial, nontherapeutic level. Processes for teaching goals-of-care communication skills and for implementing skills into clinical practice are not clearly defined. Nurses at a large comprehensive cancer center recognized the need for help with this skill set and sought out communication experts to assist in providing the needed education. An educational project was developed to improve therapeutic communication skills in oncology nurses during goals-of-care discussions and giving bad news. The program was tailored to nurses and social workers providing care to patients in a busy, urban, academic, outpatient oncology setting. Program topics included exploring the patient's world, eliciting hopes and concerns, and dealing with conflict about goals. Sharing and discussing specific difficult questions and scenarios were encouraged throughout the program. The program was well attended and well received by oncology nurses and social workers. Participants expressed interest in the continuation of communication programs to further enhance skills.

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

    CERN Document Server

    Stern, David

    2013-01-01

    Contemporary library managers face the need to make difficult choices regarding resource allocation in the modern business environment. How Libraries Make Tough Choices in Difficult Times is a practical guide for library managers, offering techniques to analyze existing and potential services, implement best practices for maximizing existing resources, and utilize pressing financial scenarios in order to justify making difficult reallocation decisions. The book begins by asking the fundamental questions of why, what, and how, moving on to look at how to manage expectations and report to both a

  19. Corticosteroid responsiveness and clinical characteristics in childhood difficult asthma

    OpenAIRE

    Bossley, C.J.; Saglani, S; Kavanagh, C.; Payne, D.N.R.; Wilson, N; Tsartsali, L.; Rosenthal, M; Balfour-Lynn, I M; Nicholson, A.G.; Bush, A

    2009-01-01

    This study describes the clinical characteristics and corticosteroid responsiveness of children with difficult asthma (DA). We hypothesised that complete corticosteroid responsiveness (defined as improved symptoms, normal spirometry, normal exhaled nitric oxide fraction (FeNO) and no bronchodilator responsiveness (BDR

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-11-01

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

  1. Species delimitation in taxonomically difficult fungi: the case of Hymenogaster.

    Directory of Open Access Journals (Sweden)

    Benjamin Stielow

    Full Text Available BACKGROUND: False truffles are ecologically important as mycorrhizal partners of trees and evolutionarily highly interesting as the result of a shift from epigeous mushroom-like to underground fruiting bodies. Since its first description by Vittadini in 1831, inappropriate species concepts in the highly diverse false truffle genus Hymenogaster has led to continued confusion, caused by a large variety of prevailing taxonomical opinions. METHODOLOGY: In this study, we reconsidered the species delimitations in Hymenogaster based on a comprehensive collection of Central European taxa comprising more than 140 fruiting bodies from 20 years of field work. The ITS rDNA sequence dataset was subjected to phylogenetic analysis as well as clustering optimization using OPTSIL software. CONCLUSIONS: Among distinct species concepts from the literature used to create reference partitions for clustering optimization, the broadest concept resulted in the highest agreement with the ITS data. Our results indicate a highly variable morphology of H. citrinus and H. griseus, most likely linked to environmental influences on the phenology (maturity, habitat, soil type and growing season. In particular, taxa described in the 19(th century frequently appear as conspecific. Conversely, H. niveus appears as species complex comprising seven cryptic species with almost identical macro- and micromorphology. H. intermedius and H. huthii are described as novel species, each of which with a distinct morphology intermediate between two species complexes. A revised taxonomy for one of the most taxonomically difficult genera of Basidiomycetes is proposed, including an updated identification key. The (semi-automated selection among species concepts used here is of importance for the revision of taxonomically problematic organism groups in general.

  2. Clustering is difficult only when it does not matter

    CERN Document Server

    Daniely, Amit; Saks, Michael

    2012-01-01

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

  3. A novel cannulation technique for difficult urethral catheterization

    Directory of Open Access Journals (Sweden)

    Mehmet Kaynar

    2016-03-01

    Full Text Available Introduction: To propose a novel cannulation technique for difficult urethral catheterization procedures. Technique: The sheath tip of an intravenous catheter is cut off, replaced to the needle tip and pushed through the distal drainage side hole to Foley catheter tip, and finally withdrawn for cannulation. In situations making urethral catheterization difficult, a guide wire is placed under direct vision. The modified Foley catheter is slid successfully over the guide wire from its distal end throughout the urethral passage into the bladder. Results: The modified Foley catheter was used successfully in our clinic in cases requiring difficult urethral catheterization. Conclusions: This easy and rapid modification of a Foley catheter may minimize the potential complications of blind catheter placement in standard catheterization.

  4. Complicated jejunal diverticulitis: A challenging diagnosis and difficult therapy

    Directory of Open Access Journals (Sweden)

    Erik Schloericke

    2012-01-01

    Full Text Available Background/Aim: In contrast to diverticulosis of the colon, jejunal diverticulosis is a rare entity that often becomes clinically relevant only after exacerbations occur. The variety of symptoms and low incidence make this disease a difficult differential diagnosis. Patients and Methods: Data from all patients who were treated in our surgical department for complicated jejunal diverticulitis, that is, gastrointestinal hemorrhage or a diverticula perforation were collected prospectively over a 6-year period (January 2004 to January 2010 and analyzed retrospectively. Results: The median age among the 9 patients was 82 years (range: 54-87. Except for 2 cases (elective operation for a status postjejunal peridiverticulitis and a re-perforation of a diverticula in a patient s/p segment resection with free perforation, the diagnosis could only be confirmed with an exploratory laparotomy. Perforation was observed in 5 patients, one of which was a retroperitoneal perforation. The retroperitoneal perforation was associated with transanal hemorrhage. Hemodynamically relevant transanal hemorrhage requiring transfusion were the reason for an exploratory laparotomy in 2 further cases. In one patient, the hemorrhage was the result of a systemic vasculitis with resultant gastrointestinal involvement. A singular jejunal diverticulum caused an adhesive ileus in one patient. The extent of jejunal diverticulosis varied between a singular diverticulum to complete jejunal involvement. A tangential, transverse excision of the diverticulum was carried out in 3 patients. The indication for segment resection was made in the case of a perforation with associated peritonitis (n=4 as well as the presence of 5 or more diverticula (n=2. Histological analysis revealed chronic pandiverticulitis in all patients. Median operating time amounted to 142 minutes (range: 65-210 and the median in-hospital stay was 12 days (range: 5-45. Lethality was 0%. Major complications included

  5. Assessment of Risk Factors for Conversion from Difficult Laparoscopic to Open Cholecystectomy - A Hospital Based Prospective Study

    Directory of Open Access Journals (Sweden)

    Roman Kidwai

    2016-07-01

    Full Text Available Background: Laparoscopic cholecystectomy is the gold standard in the treatment of gallstones. It has proved to be an effective and safe procedure both in elective and emergency conditions; however, conversion to open surgery is inevitable in some cases. Hence the present study was carried out to identify various factors which can predict the difficult laparoscopic cholecystectomy so that an early conversion to open cholecystectomy can be considered. Material and Methods: A prospective st st study was conducted from 1 February 2011 to 31 January 2012 that included 63 patients of all age groups and both sexes who were found to have symptomatic gallstones and were scheduled for laparoscopic cholecystectomy at Nepalgunj Medical College and Teaching Hospital, Nepal. Age, sex, body mass index, previous abdominal surgery and past history of acute attack of cholecystitis of the patients were recorded. A pre-operative ultrasound was performed just prior to surgery, and three ultrasonographic parameters were analyzed, namely gall bladder wall thickness, number of stones and stone impacted in Hartmann's pouch. Intra-operative causes for difficult laparoscopic cholecystectomy like adhesions in Calot's triangle and gall bladder perforation with bile leak were also evaluated. Results: Total number of patients in this study was 63; out of which difficult laparoscopic cholecystectomy was seen in 25(39.7 patients and 7(11.1 patients required conversion to open cholecystectomy. Ultrasonography was good at predicting difficulty in each component with exception of gall bladder wall thickness which was not statistically significant. Conclusion: BMI, ultrasonographic finding of presence of multiple stone or stones impacted in Hartmann's pouch, adhesion in Calot's triangle and gall bladder perforations are predictors of difficult laparoscopic cholecystectomy.

  6. A MODIFIED TECHNIQUE OF RETROGRADE INTUBATION IN A DIFFICULT INTUBATION CASE

    Directory of Open Access Journals (Sweden)

    Murthy

    2014-08-01

    Full Text Available Anaesthesiologists will be facing difficult intubating conditions, anticipated or unanticipated, quite frequently, whenever they anaesthetize patients with facio- maxillary injuries, temporo mandibular joint ankylosis, obesity, pregnancy, congenital air-way abnormalities, etc. A large number of aids are available now for intubating in such difficult situations and a lot of techniques have been described in literature for giving anaesthesia for such patients. (1 Use of Bullard laryngoscope in difficult air-way situation was described by Dullenkopf et al 2003, (2 Lighted Wand by Agro et al 2004, (3 Shikani flexible seeing stylet by Agro et al 2005(4 Blind nasal intubation, L M A, Fiber optic laryngoscope by Levitan et al1999. (5 Glydoscope by Lim et al 2005(6 . In this case report, we have given one more alternate solution for this problem

  7. A practical clinical approach to management of the difficult airway

    NARCIS (Netherlands)

    Eindhoven, GB; Dercksen, B; Regtien, JG; Borg, PAJ; Wierda, JMKH

    2001-01-01

    Difficult airway management represents a challenge in anaesthesia. In the last decades airway difficulty awareness has improved as a result of better anticipation and decision-making. Airway algorithms and protocols have a more prominent role in training and in clinical anaesthesia practice. In addi

  8. Difficult Temperament, Parental Relationships, and Adolescent Alcohol Use Disorder Symptoms.

    Science.gov (United States)

    Neighbors, Bryan D.; Clark, Duncan B.; Donovan, John E.; Brody, Gene H.

    2000-01-01

    Study tested the hypothesis that the quality of the parent-adolescent relationship mediates the association between difficult temperament and alcohol use disorder (AUD) symptoms. Results suggest that alcohol abuse prevention and treatment programs should consider the role of basic temperamental characteristics in pathological drinking, and the…

  9. Why reference to the past is difficult for agrammatic speakers

    NARCIS (Netherlands)

    Bastiaanse, Roelien

    2013-01-01

    Many studies have shown that verb inflections are difficult to produce for agrammatic aphasic speakers: they are frequently omitted and substituted. The present article gives an overview of our search to understanding why this is the case. The hypothesis is that grammatical morphology referring to t

  10. Complement Constructions in English: Fairly Difficult for EFL Language Learners

    Science.gov (United States)

    Fazeli, Fatemeh; Shokrpour, Nasrin

    2012-01-01

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

  11. What Highly Effective Leaders Do during Difficult Times

    Science.gov (United States)

    Raisor, Michael Louis

    2011-01-01

    The purpose of this study was to determine what the most highly effective leaders do during difficult times to be successful. The backdrop of the study was the 2009 $300 million cuts to the Indiana K-12 education budget, a uniform crisis that affected all 293 public school districts at the same time. The subjects in this study were those…

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

    Science.gov (United States)

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

    2002-01-01

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

  13. Leadership and cooperation at the general medicine department of LMU Munich: Good grades despite difficult conditions.

    Science.gov (United States)

    Schelling, Jörg; Braun, Susanne

    2011-01-01

    The relevance of general medicine at German universities will increase over the next few years. Consequently, the discussion of teaching content and even more the improvement of the structures within the still small and dependent departments of general medicine are of major importance. The example of our department at LMU Munich shows which challenges for leadership and cooperation result from lack of financial and personnel structure. The project "cooperation culture" that the department has conducted in collaboration with the LMU Center for Leadership and People Management is presented as a means to promote leadership and cooperation. This project can serve as an inspiration for the coordinators of smaller departments of general medicine at other German universities that are also striving to improve their structure and their position within the university.

  14. Difficult Behavior in Early Childhood: Positive Discipline for PreK-3 Classrooms and Beyond

    Science.gov (United States)

    Mah, Ronald

    2006-01-01

    Creating a classroom of attentive learners takes more than swift discipline. "Difficult Behavior" can help inspire positive behavioral change and healthy, productive development. Following Acknowledgments, About the Author and Introduction, the book is divided into five sections. Part I, The Role of Discipline, includes: (1) Discipline in…

  15. Effects of Multi-Tier Academic and Behavior Instruction on Difficult-to-Teach Students

    Science.gov (United States)

    Algozzine, Bob; Wang, Chuang; White, Richard; Cooke, Nancy; Marr, Mary Beth; Algozzine, Kate; Helf, Shawnna S.; Duran, Grace Zamora

    2012-01-01

    This article addresses the effects of 3-tiered comprehensive reading and behavior interventions on K-3 student outcomes in 7 urban elementary schools with a high prevalence of students considered difficult to teach. Specific features of each level of the implementation are described including screening and tier placement procedures, scheduling and…

  16. When Your Child Is Difficult: Solve Your Toughest Child-Raising Problems with a Four-Step Plan That Works.

    Science.gov (United States)

    Silberman, Mel

    Written for parents, this book discusses four steps for dealing with children's difficult behavior. The book is divided into two parts. Part 1, "The Building Blocks," discusses baseline perspectives parents need to establish in order to effectively deal with difficult behavior. Topics covered include: (1) parents' dual roles as caregivers and…

  17. Edward’s syndrome: A rare cause of difficult intubation-utility of left molar approach

    Directory of Open Access Journals (Sweden)

    Teena Bansal

    2016-04-01

    Full Text Available Edward’s syndrome (trisomy 18 is an autosomal abnormality with dysmorphic face, visceral deformities and delayed mental and motor development including congenital heart disease. Challenges may arise during mask ventilation, laryngoscopy and/or intubation of the trachea due to dysmorphic face. Difficult airway cart should be kept ready. Left molar approach using a standard Macintosh blade improves the laryngoscopic view in patients with difficult midline laryngoscopy. We hereby present a case report of a 2 year old male child with Edward’s syndrome posted for evacuation and drainage of brain abscess, intubated successfully using left molar approach.

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

    DEFF Research Database (Denmark)

    Lauridsen, Karen M.; Madsen, Henning

    Team Work in International Programs: Why is it so difficult? And what can we do about it? It is common knowledge that students often find it difficult to collaborate on assignments, projects, etc., but we require that they do so for a number of reasons, e.g. to learn how to work in teams or take...... is that the international students are more prepared to work in multicultural teams than their Danish peers. Another one tells us that once students have experience with the diversity of these teams, at least some of them become more open towards working in such teams in the future. It is interesting to discuss...... advantage of the diversity represented by team members. In programmes that accept international students, these difficulties seem to increase. Home students are often reluctant to enter into collaboration with their international peers, whereas the international students tend to be much more open towards...

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

    Directory of Open Access Journals (Sweden)

    Debasis Pradhan

    2015-01-01

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

  20. An unanticipated difficult airway in Lesch-Nyhan syndrome

    Directory of Open Access Journals (Sweden)

    Rashmi Salhotra

    2012-01-01

    Full Text Available An 11-year-old boy with Lesch-Nyhan syndrome presented to the emergency for fixation of a fractured femur. During induction of general anesthesia, unexpected difficult intubation was encountered with a 6.5-mm ID endotracheal tube and successively smaller tubes, also failing to pass 1 cm beyond the vocal cords. Intubation was finally achieved with a 4.5-mm ID tube. The surgery was completed uneventfully. A tracheal diverticulum was found in the computerized tomography (CT scan performed postoperatively to account for this unexpected difficult intubation. This case highlights the anesthetic concerns in Lesch-Nyhan syndrome and also reports the rare occurrence of a tracheal diverticulum associated with it.

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

    Science.gov (United States)

    Song, Hyunjin; Schwarz, Norbert

    2009-02-01

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

  2. Difficult to control asthma in the patient with pseudoachondroplasia

    OpenAIRE

    Wilczynska, Maria; Ching, Teresa

    2011-01-01

    Pseudoachondroplasia (PsA) is a type of short-limbed dwarfism resulting from mutations in the cartilage oligomeric matrix protein gene. Skeletal involvement in the PsA is well-described but there are not any published cases reporting airways involvement. The authors present a case of a female with the PsA and congenital anomalies of the respiratory tract resulting in the tracheobronchomalacia and a difficult to control asthma.

  3. Development of New Tools for the Synthesis of "Difficult Peptides"

    OpenAIRE

    Paradís Bas, Marta

    2015-01-01

    Tesi realitzada a l'Institut de Recerca Biomèdica de Barcelona (IRBB) The known as "difficult peptides", as well as those sequences that aggregate in solution, are some of those molecules with high applicability as nanomaterials or even in medicine field. This thesis has addressed to overcome the synthetic, as well as, the peptide manipulation in solution drawbacks associated to this kind of peptides. The strategies proposed and evaluated in the present work have been divided in three chap...

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

    Science.gov (United States)

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

    2012-01-01

    Suspended sediment is one of the major concerns regarding the quality of water entering the Chesapeake Bay. Some of the highest suspended-sediment concentrations occur on Piedmont streams, including Difficult Run, a tributary of the Potomac River draining urban and suburban parts of northern Virginia. Accurate information on catchment level sediment budgets is rare and difficult to determine. Further, the sediment trapping portion of sediment budget represents an important ecosystem service that profoundly affects downstream water quality. Our objectives, with special reference to human alterations to the landscape, include the documentation and estimation of floodplain sediment trapping (present and historic) and bank erosion along an urbanized Piedmont stream, the construction of a preliminary sediment balance, and the estimation of legacy sediment and recent development impacts. We used white feldspar markers to measure floodplain sedimentation rates and steel pins to measure erosion rates on floodplains and banks, respectively. Additional data were collected for/from legacy sediment thickness and characteristics, mill pond impacts, stream gaging station records, topographic surveying, and sediment density, texture, and organic content. Data were analyzed using GIS and various statistical programs. Results are interpreted relative to stream equilibrium affected by both post-colonial bottomland sedimentation (legacy) and modern watershed hardening associated with urbanization. Six floodplain/channel sites, from high to low in the watershed, were selected for intensive study. Bank erosion ranges from 0 to 470 kg/m/y and floodplain sedimentation ranges from 18 to 1369 kg/m/y (m refers to meters of stream reach). Upstream reaches are net erosional, while downstream reaches have a distinctly net depositional flux providing a watershed sediment balance of 2184 kg/m/y trapped within the system. The amounts of both deposition and erosion are large and suggest

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

    Science.gov (United States)

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

    2013-01-01

    Suspended sediment is one of the major concerns regarding the quality of water entering the Chesapeake Bay. Some of the highest suspended-sediment concentrations occur on Piedmont streams, including Difficult Run, a tributary of the Potomac River draining urban and suburban parts of northern Virginia. Accurate information on catchment level sediment budgets is rare and difficult to determine. Further, the sediment trapping portion of sediment budget represents an important ecosystem service that profoundly affects downstream water quality. Our objectives, with special reference to human alterations to the landscape, include the documentation and estimation of floodplain sediment trapping (present and historic) and bank erosion along an urbanized Piedmont stream, the construction of a preliminary sediment balance, and the estimation of legacy sediment and recent development impacts. We used white feldspar markers to measure floodplain sedimentation rates and steel pins to measure erosion rates on floodplains and banks, respectively. Additional data were collected for/from legacy sediment thickness and characteristics, mill pond impacts, stream gaging station records, topographic surveying, and sediment density, texture, and organic content. Data were analyzed using GIS and various statistical programs. Results are interpreted relative to stream equilibrium affected by both post-colonial bottomland sedimentation (legacy) and modern watershed hardening associated with urbanization. Six floodplain/channel sites, from high to low in the watershed, were selected for intensive study. Bank erosion ranges from 0 to 470 kg/m/y and floodplain sedimentation ranges from 18 to 1369 kg/m/y (m refers to meters of stream reach). Upstream reaches are net erosional, while downstream reaches have a distinctly net depositional flux providing a watershed sediment balance of 2184 kg/m/y trapped within the system. The amounts of both deposition and erosion are large and suggest

  6. Difficultly Extractable Fixed Ammonium in Some Soils of China

    Institute of Scientific and Technical Information of China (English)

    CHENBIYUN; CHENGLILI; 等

    1999-01-01

    Ninety-three soil samples and 19 sedimentary rock samples collected from 21 provinces of China were analyzed for their contents of fixed ammonium and total N by Kjeldahl-HF method.Results showed that amount of difficultly extractable fixed ammonium(the fixed ammonium that is not determinable by Kjeldahl procedures commonly used for soils) in soils ranged from 0 to 202 mg kg-1,It was generally more than 50 mg kg-1 in soils in Changji and Turpan districts,Xinjiang,accounting for 3.2%-36.8% with an average of 13.9% of the total N.For some Orthents derived from purple shale and purple sandstone in Sichuan and Hunan provinces and Chao soils derived from secondary loess in Henan Province and Ningxia Autonomous Region it was generally around 30 mg kg-1,accounting for 4%-7% of the total soil N,and for most of the rest of soils studied,with the exception of some subsoils,no or trace difficultly extractable fixed ammonium could be detected.It was sugested that the difficultly extractable fixed ammonium was originated from parent rock,and for slightly weathered soils derived from parent materials rich in this form of N the Kjeldahl method might give underestimation of total soil N.

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

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

    BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.

  8. Legal issues when a doctor's relationship with a "difficult" patient breaks down.

    Science.gov (United States)

    Skene, Loane L C

    2014-09-15

    The legal duties of a doctor attending a "difficult" patient with a serious condition do not end at the last consultation, especially in a small rural community. Doctors have a continuing obligation to ensure that the patient's health is not impaired because the clinical relationship has ended. This article suggests some steps that a doctor could take to fulfil the legal obligation in such a case.

  9. Emotional distance to so-called difficult patients

    DEFF Research Database (Denmark)

    Michaelsen, Jette Joost

    2012-01-01

    to 96 patients. During the following 3 months, 12 more participant observations were made with three nurses visiting 50 patients. Four of these patients whom the three nurses found difficult were selected and six interviews conducted with these patients. Eleven interviews were conducted with five nurses....... Patients' case records were studied and four meetings with the staff were arranged to discuss the findings. Data collection lasted 18 months in all. Findings: Three strategies were identified: persuasion, avoidance (emotional distance), and compromise. Interestingly, in the relationship with a particular...

  10. Tell me your story: recovering from a difficult birth.

    Science.gov (United States)

    Norriss, Roma; Dansby, Binnie

    2016-01-01

    The authors discuss their experience of running after birth workshops as an intervention for women struggling to come to terms with a difficult birth experience. Midwives can use this approach in their practice with women in the postnatal period and also when preparing for a subsequent birth or even during a labour that follows a challenging experience. This article explores the value of supporting women to tell their story and how to do that with suggestions to build on listening skills. It also offers suggestions for self care, so that midwives can be well resourced for emotional support.

  11. Recknagel/Sprenger/Hoenmann: Pocket book for heating and air conditioning including service water heating and refrigeration engineering 92/93. Recknagel/Sprenger/Hoenmann: Taschenbuch fuer Heizung und Klimatechnik einschliesslich Warmwasser- und Kaeltetechnik 92/93

    Energy Technology Data Exchange (ETDEWEB)

    Schramek, E.R. (Dortmund Univ. (Germany)) (ed.)

    1992-01-01

    The book comprises the following chapters: 1. Fundamentals of heating and air conditioning; 2. Heating engineering; 3. Ventilation and air conditioning engineering; 4. Service water heating; 5. Industrial forced ventilation systems; 6. Refrigeration engineering; 7. Appendix (laws, books, journals, associations, societies, schools, institutes, standards, legal regulations, etc.). (orig./HW) With 2082 figs., 356 tabs.

  12. Recknagel/Sprenger/Hoenmann: Pocket book for heating and air conditioning including service water heating and refrigeration engineering 88/89. 64. ed. Recknagel/Sprenger/Hoenmann: Taschenbuch fuer Heizung und Klimatechnik einschl. Brauchwassererwaermung und Kaeltetechnik 88/89

    Energy Technology Data Exchange (ETDEWEB)

    Hoenmann, W. (ed.)

    1987-01-01

    The book comprises the following chapters: 1. Fundamentals of heating and air conditioning; 2. Heating engineering; 3. Ventilation and air conditioning engineering; 4. Service water heating; 5. Industrial forced ventilation systems; 6. Refrigeration engineering; 7. Appendix (laws, books, journals, associations, societies, schools, institutes, standards, legal regulations, etc.). (orig./HW) With 2068 figs., 347 tabs.

  13. High Metal Removal Rate Process for Machining Difficult Materials

    Energy Technology Data Exchange (ETDEWEB)

    Bates, Robert; McConnell, Elizabeth

    2016-06-29

    Machining methods across many industries generally require multiple operations to machine and process advanced materials, features with micron precision, and complex shapes. The resulting multiple machining platforms can significantly affect manufacturing cycle time and the precision of the final parts, with a resultant increase in cost and energy consumption. Ultrafast lasers represent a transformative and disruptive technology that removes material with micron precision and in a single step manufacturing process. Such precision results from athermal ablation without modification or damage to the remaining material which is the key differentiator between ultrafast laser technologies and traditional laser technologies or mechanical processes. Athermal ablation without modification or damage to the material eliminates post-processing or multiple manufacturing steps. Combined with the appropriate technology to control the motion of the work piece, ultrafast lasers are excellent candidates to provide breakthrough machining capability for difficult-to-machine materials. At the project onset in early 2012, the project team recognized that substantial effort was necessary to improve the application of ultrafast laser and precise motion control technologies (for micromachining difficult-to-machine materials) to further the aggregate throughput and yield improvements over conventional machining methods. The project described in this report advanced these leading-edge technologies thru the development and verification of two platforms: a hybrid enhanced laser chassis and a multi-application testbed.

  14. Enjeux, difficultés et modalités de l’expression sur le travail : point de vue de la clinique médicale du travail Concerns in occupational medicine about stakes, difficulties and conditions of dispute about work Retos, dificultades y modalidades de la expresión sobre el trabajo : punto de vista de la clínica médica del trabajo

    Directory of Open Access Journals (Sweden)

    Philippe Davezies

    2012-11-01

    Full Text Available L’intensification du travail oblige les salariés de tous secteurs et de tous niveaux hiérarchiques à des arbitrages serrés entre les différents objectifs du travail. Faute d’espace de discussion, chacun se débrouille seul, avec comme conséquence une individualisation des questions, une montée des conflits et une dégradation de la performance. Cette situation appelle la mise en place des espaces d’expression sur le travail, prévus dans la loi française. Cette orientation se heurte cependant à une difficulté : l’activité du travailleur est en avance sur sa conscience et beaucoup plus riche que ce qu’il est capable d’exprimer. Des espaces autonomes d’élaboration des enjeux du travail sont nécessaires pour créer les conditions d’une discussion avec la hiérarchie susceptible de porter ses fruits dans le domaine de la santé au travail et dans celui de la performance globale de l’entreprise.Regardless of the job sector or hierarchical position, work intensification forces workers to make hard choices between the different goals they are expected to meet. Due to a lack of discussion, people have to manage by themselves. The consequences are a rising tide of interpersonal conflicts and occupational stress associated with a deterioration in overall performance. This situation requires that time and places be set aside for work disputes, in keeping with French law. Nevertheless, there is a serious difficulty in actualizing this law: the worker’s tacit knowledge of his work is much richer than his conscious ability to verbalize and describe the work activity. Self-governed, employee-reserved times and places for working out the stakes at issue are necessary before discussing with the administration if we are to arrive at favourable results for occupational health and overall company performance.La intensificación del trabajo obliga a los empleados, independientemente del sector o del nivel jerárquico al que

  15. Various applications of endoscopic scissors in difficult endoscopic interventions.

    Science.gov (United States)

    Kee, Won-Ju; Park, Chang-Hwan; Chung, Kyoung-Myeun; Park, Seon-Young; Jun, Chung-Hwan; Ki, Ho-seok; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun

    2014-05-01

    Endoscopic scissors offer a benefit over other devices by avoiding potential complications related to thermal and mechanical injury of surrounding structures. We describe our experience with endoscopic scissors in three difficult endoscopic interventions. A fishbone embedded in the esophageal wall penetrated very close to the pulsating aorta and the bronchus. The fishbone was cut in half by endoscopic scissors and removed without injury to adjacent organs. A gastric submucosal tumor with an insulated core that could not be resected by electrosurgical devices was cut using endoscopic scissors following endoloop placement. Extravascular coil migration after transcatheter arterial embolization resulted in a duodenal ulcer. The metallic coil on the duodenal ulcer was cut by endoscopic scissors without mechanical or thermal injury.

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

    Directory of Open Access Journals (Sweden)

    Barış Bulunmnaz

    2012-03-01

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

  17. Characterization of parameters and strategies used by physical therapists in difficult mechanical ventilation weaning

    Directory of Open Access Journals (Sweden)

    Fabíola Maria Sabino Meireles

    2013-03-01

    Full Text Available Objective: To characterize the main strategies and parameters used by physical therapists in difficult mechanical ventilation weaning. Methods: Cross-sectional study including all the physical therapists working in adult Intensive Care Units in three public hospitals in Fortaleza-CE. A questionnaire with closed questions related to difficult mechanical ventilation weaning was applied, with either one or multiple answers. The data was treated with descriptive and non-parametric analysis. Results: Among the parameters mostly used by the 56 interviewed physical therapists for the difficult weaning, were found: current volume reduction (26 - 46.4% and desaturation during aspiration (17 - 30.4%. It was observed that 38 (67.9% alternate T-tube and continuous positive airway pressure (CPAP as strategies for difficult weaning, and 28 (50% reported reducing the pressure support. There was no statistical difference between the strategies used in the studied hospitals, neither correlation between strategies and parameters. Conclusion: It was found that physical therapists have been performing similar strategies, which are also shown in the literature, but this is not the case with the parameters. The parameters used are not supported by the literature.

  18. Antiviral therapy for "difficult-to-treat" hepatitis C virus-infected patients

    Institute of Scientific and Technical Information of China (English)

    Tatsuo Kanda; Osamu Yokosuka; Masao Omata

    2013-01-01

    Objective To review the updated research on direct antiviral agents (DAAs)-including regimens for hepatitis C virus (HCV),and focus on "difficult-to-treat" HCV-infected patients.Data sources The literature concerning DAAs and hepatitis C cited in this review was collected from PubMed and Google Scholar databases published in English up to July 2013.Study selection Data from published articles regarding HCV and DAAs in clinical trials and in clinical use were identified and reviewed.Results It was recognized that some "difficult-to-treat" patients would still exist,even though stronger treatments using such as DAAs,including telaprevir and boceprevir,which lead to higher sustained virological response rates,are available.Such patients include those with advanced fibrosis/cirrhosis,elderly persons,children,HCV-human immunodeficiency virus co-infected patients,HCV-infected recipients,and so on.Conclusions Certain "difficult-to-treat" patients would still exist,even though stronger treatment is available.Although evidence from clinical trials is still lacking,interferon-sparing regimens could have stronger effects for eradicating HCV in such cases.

  19. Comparison of Mallampati test with lower jaw protrusion maneuver in predicting difficult laryngoscopy and intubation

    Directory of Open Access Journals (Sweden)

    Muhammad Irfan Ul Haq

    2013-01-01

    Full Text Available Background: Failure to maintain a patent airway is one of the commonest causes of anesthesia-related morbidity and mortality. Many protocols, algorithms, and different combinations of tested methods for airway assessment have been developed to predict difficult laryngoscopy and intubation. The reported incidence of a difficult intubation varies from 1.5% to 13%. The objective of this study was to compare Mallampati test (MT with lower jaw protrusion (LJP maneuver in predicting difficult laryngoscopy and intubation. Materials and Methods: Seven hundred and sixty patients were included in the study. All the patients underwent MT and LJP maneuver for their airway assessment. After a standardized technique of induction of anesthesia, primary anesthetist performed laryngoscopy and graded it according to the grades described by Cormack and Lehane. Sensitivity, specificity, accuracy, and positive predictive value (PPV and negative predictive value (NPV were calculated for both these tests with 95% confidence interval (CI using conventional laryngoscopy as gold standard. Area under curve was also calculated for both, MT and LJP maneuver. A P < 0.05 was taken as significant. Results: LJP maneuver had higher sensitivity (95.9% vs. 27.1%, NPV (98.7% vs. 82.0%, and accuracy (90.1% vs. 80.3% when compared to MT in predicting difficult laryngoscopy and intubation. Both tests, however, had similar specificity and PPV. There was marked difference in the positive and negative likelihood ratio between LJP and MT. Similarly, the area under the curve favored LJP maneuver over MT. Conclusion: The results of this study show that LJP maneuver is a better test to predict difficult laryngoscopy and tracheal intubation. We recommend the addition of this maneuver to the routine preoperative evaluation of airway.

  20. Comparison of Mallampati test with lower jaw protrusion maneuver in predicting difficult laryngoscopy and intubation

    Science.gov (United States)

    Ul Haq, Muhammad Irfan; Ullah, Hameed

    2013-01-01

    Background: Failure to maintain a patent airway is one of the commonest causes of anesthesia-related morbidity and mortality. Many protocols, algorithms, and different combinations of tested methods for airway assessment have been developed to predict difficult laryngoscopy and intubation. The reported incidence of a difficult intubation varies from 1.5% to 13%. The objective of this study was to compare Mallampati test (MT) with lower jaw protrusion (LJP) maneuver in predicting difficult laryngoscopy and intubation. Materials and Methods: Seven hundred and sixty patients were included in the study. All the patients underwent MT and LJP maneuver for their airway assessment. After a standardized technique of induction of anesthesia, primary anesthetist performed laryngoscopy and graded it according to the grades described by Cormack and Lehane. Sensitivity, specificity, accuracy, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both these tests with 95% confidence interval (CI) using conventional laryngoscopy as gold standard. Area under curve was also calculated for both, MT and LJP maneuver. A P < 0.05 was taken as significant. Results: LJP maneuver had higher sensitivity (95.9% vs. 27.1%), NPV (98.7% vs. 82.0%), and accuracy (90.1% vs. 80.3%) when compared to MT in predicting difficult laryngoscopy and intubation. Both tests, however, had similar specificity and PPV. There was marked difference in the positive and negative likelihood ratio between LJP and MT. Similarly, the area under the curve favored LJP maneuver over MT. Conclusion: The results of this study show that LJP maneuver is a better test to predict difficult laryngoscopy and tracheal intubation. We recommend the addition of this maneuver to the routine preoperative evaluation of airway. PMID:24106353

  1. Interactive removal and ground truth for difficult shadow scenes.

    Science.gov (United States)

    Gong, Han; Cosker, Darren

    2016-09-01

    A user-centric method for fast, interactive, robust, and high-quality shadow removal is presented. Our algorithm can perform detection and removal in a range of difficult cases, such as highly textured and colored shadows. To perform detection, an on-the-fly learning approach is adopted guided by two rough user inputs for the pixels of the shadow and the lit area. After detection, shadow removal is performed by registering the penumbra to a normalized frame, which allows us efficient estimation of nonuniform shadow illumination changes, resulting in accurate and robust removal. Another major contribution of this work is the first validated and multiscene category ground truth for shadow removal algorithms. This data set containing 186 images eliminates inconsistencies between shadow and shadow-free images and provides a range of different shadow types such as soft, textured, colored, and broken shadow. Using this data, the most thorough comparison of state-of-the-art shadow removal methods to date is performed, showing our proposed algorithm to outperform the state of the art across several measures and shadow categories. To complement our data set, an online shadow removal benchmark website is also presented to encourage future open comparisons in this challenging field of research. PMID:27607503

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-03-15

    To describe efficacy of percutaneous lithotripsy for removing difficult bile duct stones using endoscopy. A total of 88 patients with difficulties for the removal of bile duct stones using endoscopy (an impacted stone, stone size > 15 mm, intrahepatic duct (IHD) stone, stone size to bile duct diameter ratio > 1.0), were enrolled in this study. A 12 Fr sheath was inserted through the percutaneous transhepatic biliary drainage (PTBD) tract, and then nitrol stone baskets and a 0.035' snare wire were used to capture, fragment and remove the stones. The technical and clinical success rates were analyzed, together with an analysis of any complications. The overall technical success rate of stone removal was achieved in 79 of 88 patients (89.8%). In five of nine patients with failed stone removal, small residual IHD stones were noted on a cholangiogram. Even if stone removal failed in these cases, cholangitic symptoms were improved and the drainage catheter was successfully removed. Therefore, clinical success was achieved in 84 of 88 patients (95.5%). There were no significant procedure-related complications, except for sepsis in one case. Billiary stone removal using the stone basket and guide-wire snare technique through the PTBD tract is a safe and effective procedure that can be used as a primary method in patients with difficulties for the removal of bile duct stones using endoscopy.

  3. Interactive removal and ground truth for difficult shadow scenes.

    Science.gov (United States)

    Gong, Han; Cosker, Darren

    2016-09-01

    A user-centric method for fast, interactive, robust, and high-quality shadow removal is presented. Our algorithm can perform detection and removal in a range of difficult cases, such as highly textured and colored shadows. To perform detection, an on-the-fly learning approach is adopted guided by two rough user inputs for the pixels of the shadow and the lit area. After detection, shadow removal is performed by registering the penumbra to a normalized frame, which allows us efficient estimation of nonuniform shadow illumination changes, resulting in accurate and robust removal. Another major contribution of this work is the first validated and multiscene category ground truth for shadow removal algorithms. This data set containing 186 images eliminates inconsistencies between shadow and shadow-free images and provides a range of different shadow types such as soft, textured, colored, and broken shadow. Using this data, the most thorough comparison of state-of-the-art shadow removal methods to date is performed, showing our proposed algorithm to outperform the state of the art across several measures and shadow categories. To complement our data set, an online shadow removal benchmark website is also presented to encourage future open comparisons in this challenging field of research.

  4. Interactive removal and ground truth for difficult shadow scenes

    Science.gov (United States)

    Gong, Han; Cosker, Darren

    2016-09-01

    A user-centric method for fast, interactive, robust and high-quality shadow removal is presented. Our algorithm can perform detection and removal in a range of difficult cases: such as highly textured and colored shadows. To perform detection an on-the-fly learning approach is adopted guided by two rough user inputs for the pixels of the shadow and the lit area. After detection, shadow removal is performed by registering the penumbra to a normalized frame which allows us efficient estimation of non-uniform shadow illumination changes, resulting in accurate and robust removal. Another major contribution of this work is the first validated and multi-scene category ground truth for shadow removal algorithms. This data set containing 186 images eliminates inconsistencies between shadow and shadow-free images and provides a range of different shadow types such as soft, textured, colored and broken shadow. Using this data, the most thorough comparison of state-of-the-art shadow removal methods to date is performed, showing our proposed new algorithm to outperform the state-of-the-art across several measures and shadow category. To complement our dataset, an online shadow removal benchmark website is also presented to encourage future open comparisons in this challenging field of research.

  5. Application of Kinesio Taping method for newborn swallowing difficultly

    Science.gov (United States)

    Lin, Chien-Lin; Wu, Wei-Ting; Chang, Ke-Vin; Lin, Hong-Yi; Chou, Li-Wei

    2016-01-01

    Abstract Background: Preterm infants are at an increased risk of sucking problems, swallowing difficulty, and poor nourishment. During the neonatal period, the neurobehavioral organization of a preterm baby is poor compared with that of appropriate gestational age infants. Kinesio Taping has been widely used for edema control, joint protection, and proprioception training. With the help of augmentation of the sensory input for muscle facilitation and inhibition through tapping, the coordination of the target muscle groups can be improved. Until now, no research is available on the use of Kinesio Taping for the swallowing difficulty of infant. Methods: We reported a preterm infant suffering from brain edema at birth and swallowing difficultly until 40 weeks. The swallowing reflex was delayed. Moreover, lip closure and rooting reflex combined with the dysfunction grade of jaw movement were poor. We performed KT methods on the baby under the theory of the direction of the tape for facilitate or inhibit the muscle. Result: After the Kinesio Taping treatment, the sucking function was improved with good lip closure.One week later, the baby was discharged without the use of an oral gastric tube. Conclusion: Kinesio Taping contributed significantly to the improvement of impaired sucking and swallowing and could be implemented as a regular rehabilitative approach for infants suffering from these difficulties. PMID:27495080

  6. The Difficult-to-Control Asthmatic: A Systematic Approach

    Directory of Open Access Journals (Sweden)

    Le Annie V

    2006-09-01

    Full Text Available Abstract With the judicious use of inhaled corticosteroids, β2 agonists, and leukotriene modifiers, most patients with asthma are easily controlled and managed. However, approximately 5% of asthmatics do not respond to standard therapy and are classified as "difficult to control." 1 Typically, these are patients who complain of symptoms interfering with daily living despite long-term treatment with inhaled corticosteroids in doses up to 2,000 μg daily. Many factors can contribute to poor response to conventional therapy, and especially for these patients, a systematic approach is needed to identify the underlying causes. First, the diagnosis of asthma and adherence to the medication regimen should be confirmed. Next, potential persisting exacerbating triggers need to be identified and addressed. Concomitant disorders should be discovered and treated. Lastly, the impact and implications of socioeconomic and psychological factors on disease control can be significant and should be acknowledged and discussed with the individual patient. Less conventional and novel strategies for treating corticosteroid-resistant asthma do exist. However, their use is based on small studies that do not meet evidence-based criteria; therefore, it is essential to sort through and address the above issues before reverting to other therapy.

  7. Nuclear energy and public opinion - a difficult relationship

    International Nuclear Information System (INIS)

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

  8. CO_2 insufflation for potentially difficult colonoscopies:Efficacy when used by less experienced colonoscopists

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

    AIM: To clarify the effectiveness of CO_2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists. METHODS: One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO_2 or standard air insufflation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist (EC) group and a less experienced colonoscopist (LEC) group. Study measurements included a 100-mm visual analogue scale (VAS) for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times. RESULTS: Examination times did not differ, however, VAS scores in the CO_2 group were significantly better than in the air group (P < 0.001, two-way ANOVA) from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group (P = 0.29), however, VAS scores for CO_2 insufflation were significantly better than air insufflation in the LEC group (P = 0.023) immediately after colonoscopies and up to 4 h afterwards. CONCLUSION: CO_2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.

  9. The Difficult Way of Social Psychology in Russia

    Directory of Open Access Journals (Sweden)

    Galina M. Andreeva

    2009-01-01

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

  10. How difficult is inference of mammalian causal gene regulatory networks?

    Directory of Open Access Journals (Sweden)

    Djordje Djordjevic

    Full Text Available Gene regulatory networks (GRNs play a central role in systems biology, especially in the study of mammalian organ development. One key question remains largely unanswered: Is it possible to infer mammalian causal GRNs using observable gene co-expression patterns alone? We assembled two mouse GRN datasets (embryonic tooth and heart and matching microarray gene expression profiles to systematically investigate the difficulties of mammalian causal GRN inference. The GRNs were assembled based on > 2,000 pieces of experimental genetic perturbation evidence from manually reading > 150 primary research articles. Each piece of perturbation evidence records the qualitative change of the expression of one gene following knock-down or over-expression of another gene. Our data have thorough annotation of tissue types and embryonic stages, as well as the type of regulation (activation, inhibition and no effect, which uniquely allows us to estimate both sensitivity and specificity of the inference of tissue specific causal GRN edges. Using these unprecedented datasets, we found that gene co-expression does not reliably distinguish true positive from false positive interactions, making inference of GRN in mammalian development very difficult. Nonetheless, if we have expression profiling data from genetic or molecular perturbation experiments, such as gene knock-out or signalling stimulation, it is possible to use the set of differentially expressed genes to recover causal regulatory relationships with good sensitivity and specificity. Our result supports the importance of using perturbation experimental data in causal network reconstruction. Furthermore, we showed that causal gene regulatory relationship can be highly cell type or developmental stage specific, suggesting the importance of employing expression profiles from homogeneous cell populations. This study provides essential datasets and empirical evidence to guide the development of new GRN inference

  11. How difficult is inference of mammalian causal gene regulatory networks?

    Science.gov (United States)

    Djordjevic, Djordje; Yang, Andrian; Zadoorian, Armella; Rungrugeecharoen, Kevin; Ho, Joshua W K

    2014-01-01

    Gene regulatory networks (GRNs) play a central role in systems biology, especially in the study of mammalian organ development. One key question remains largely unanswered: Is it possible to infer mammalian causal GRNs using observable gene co-expression patterns alone? We assembled two mouse GRN datasets (embryonic tooth and heart) and matching microarray gene expression profiles to systematically investigate the difficulties of mammalian causal GRN inference. The GRNs were assembled based on > 2,000 pieces of experimental genetic perturbation evidence from manually reading > 150 primary research articles. Each piece of perturbation evidence records the qualitative change of the expression of one gene following knock-down or over-expression of another gene. Our data have thorough annotation of tissue types and embryonic stages, as well as the type of regulation (activation, inhibition and no effect), which uniquely allows us to estimate both sensitivity and specificity of the inference of tissue specific causal GRN edges. Using these unprecedented datasets, we found that gene co-expression does not reliably distinguish true positive from false positive interactions, making inference of GRN in mammalian development very difficult. Nonetheless, if we have expression profiling data from genetic or molecular perturbation experiments, such as gene knock-out or signalling stimulation, it is possible to use the set of differentially expressed genes to recover causal regulatory relationships with good sensitivity and specificity. Our result supports the importance of using perturbation experimental data in causal network reconstruction. Furthermore, we showed that causal gene regulatory relationship can be highly cell type or developmental stage specific, suggesting the importance of employing expression profiles from homogeneous cell populations. This study provides essential datasets and empirical evidence to guide the development of new GRN inference methods for

  12. Why is it so difficult to measure big G?

    Science.gov (United States)

    Faller, James

    2015-04-01

    The determination of the Newtonian constant of gravitation, big G, continues to be one of Nature's greatest challenges to the skills and cunning of experimental physicists. The reasons: Big G is small, scientists are human, and error budgets are flawed. In spite of the fact that on the scale of the Universe, big G's effects are so big as to single handedly hold everything together, on the scale of a single research laboratory, big G's effects are so small that they go unnoticed. And, it is this ``smallness'' that makes the determination of this (seemingly unrelated to the rest of physics) fundamental constant so difficult. Furthermore, because they are human, scientists want to get the ``right'' (read previously obtained) answer; and this goal can affect their otherwise good judgment. Finally, error budgets are fundamentally flawed because they cannot make allowances for error sources that have not been thought of. During its nearly 300 year measurement history, the accuracy with which G is known has barely increased by three orders of magnitude; during the past 30 years the progress, measured by agreement rather than claimed accuracy of individual measurements, has been essentially zero. Nevertheless, this Mount Everest of precision measurement continues to provide an experimental challenge upon which metrologists can hone their laboratory skills for generations to come. Finally, this presentation will be understandable and interesting for ``students of all ages.'' In this year of GR100, Einstein will be mentioned more than once, and my hope is that some of you who would not normally ``risk'' attending a talk outside of your own specialty or discipline will consider coming to this one.

  13. Optical modulator including grapene

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang

    2016-06-07

    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

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

    OpenAIRE

    Sonia Fleury

    2004-01-01

    In this article, the author analyses the first year of Luiz Inácio Lula da Silva’s Government and highlights the importance of this Government for the process of democratic consolidation in Brazil. The contradiction between maintaining an orthodox economic policy and the expectations of creating conditions for development and social inclusion have marked the first year of this Government, subordinating all public policies to the logic of controlling inflation, paying off public debt, and incr...

  15. Metaphors as Second Labels: Difficult for Preschool Children?

    Science.gov (United States)

    Rubio-Fernández, Paula; Grassmann, Susanne

    2016-08-01

    This study investigates the development of two cognitive abilities that are involved in metaphor comprehension: implicit analogical reasoning and assigning an unconventional label to a familiar entity (as in Romeo's 'Juliet is the sun'). We presented 3- and 4-year-old children with literal object-requests in a pretense setting (e.g., 'Give me the train with the hat'). Both age-groups succeeded in a baseline condition that used building blocks as props (e.g., placed either on the front or the rear of a train engine) and only required spatial analogical reasoning to interpret the referential expression. Both age-groups performed significantly worse in the critical condition, which used familiar objects as props (e.g., small dogs as pretend hats) and required both implicit analogical reasoning and assigning second labels. Only the 4-year olds succeeded in this condition. These results offer a new perspective on young children's difficulties with metaphor comprehension in the preschool years. PMID:26162307

  16. Intravascular Large B-Cell Lymphoma: A Difficult Diagnostic Challenge.

    Science.gov (United States)

    Khan, Maria S; McCubbin, Mark; Nand, Sucha

    2014-01-01

    anemic. About 20% have hepatic and renal dysfunction. The treatment consists of systemic chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone plus rituximab (CHOP-R) and central nervous system prophylaxis. Retrospective data suggests that, with treatment, 51% to 82% of the patients achieve a complete remission and 27% to 56% are alive at 2-year follow-up. Conclusion. IVLBCL is a difficult diagnosis to make as the disease remains confined to the vascular lumen. It may be associated with certain viral illnesses, and this association needs to be explored further. It is important to consider this diagnosis in the appropriate settings because patients may achieve durable remissions with therapy. PMID:26425595

  17. Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study

    Directory of Open Access Journals (Sweden)

    Basak Ceyda Meco

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: Preoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions. METHODS: Fifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software. RESULTS: The mean thyroid volume of the patients was 26.38 ± 14 mL. The median intubation difficulty scale was 1 (0-2. Thyromental distance (p = 0.011; r = 0.36; 95% CI 0.582-0.088, Mallampati score (p = 0.041; r = 0.29; 95% CI 0.013-0.526, compression or invasion signs (p = 0.041; r = 0.28; 95% CI 0.006-0.521 and tracheal deviation on chest X-ray (p = 0.041; r = 0.52; 95% CI 0.268-0.702 were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n = 19: intubation difficulty scale = 0; Group II, n = 31: 1 < intubation difficulty scale ≤ 5 and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (p = 0.025. CONCLUSION: The thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation.

  18. Occasional finding of mesenteric lipodystrophy during laparoscopy: A difficult diagnosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Mesenteric lipodystrophy is a rare pathological condition affecting the mesentery. Its initial presentation is typically asymptomatic. Pathological characteristics are unspecific, and generally attributed to inflammation, unless the diagnosis is suspected. Laparoscopy done for other reasons has been, as in this case, unsuccessful in providing evidence for the correct diagnosis, thus requiring laparotomy due to lack of diagnostic tissue. After 6 mo no further medical therapy is required, as the patient remains asymptomatic. Discussion of this case and a brief review of the literature are presented in the following paragraphs.

  19. 我国骨盆恶性肿瘤外科治疗面临的难点和挑战%The challenges and difficult issues on surgical management of malignant pelvic tumors in China

    Institute of Scientific and Technical Information of China (English)

    牛晓辉; 徐万鹏

    2013-01-01

    The prognosis of malignant pelvic tumor is very poor although the incidence of them is not so high. In recent years, the surgical management in China has made great progress in many institutions. However, the challenges and difficult issues still exist. In this commentary, some important issues including anatomy and imaging of the pelvis, diagnosis dilemma, resection with adequate surgical margin, reconstruction, recurrence, complications, as well as national conditions are reviewed.

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

    Science.gov (United States)

    Cimer, Atilla

    2012-01-01

    The present study aims to determine the biological topics that students have difficulties learning, the reasons why secondary school students have difficulties in learning biology, and ways to improve the effectiveness of students' biology learning. For these purposes, a self-administered questionnaire including three open-ended questions was…

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

    Directory of Open Access Journals (Sweden)

    Joanne Lester

    2015-03-01

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

  2. Analytic device including nanostructures

    KAUST Repository

    Di, Fabrizio, E.

    2015-07-02

    A device for detecting an analyte in a sample comprising: an array including a plurality of pixels, each pixel including a nanochain comprising: a first nanostructure, a second nanostructure, and a third nanostructure, wherein size of the first nanostructure is larger than that of the second nanostructure, and size of the second nanostructure is larger than that of the third nanostructure, and wherein the first nanostructure, the second nanostructure, and the third nanostructure are positioned on a substrate such that when the nanochain is excited by an energy, an optical field between the second nanostructure and the third nanostructure is stronger than an optical field between the first nanostructure and the second nanostructure, wherein the array is configured to receive a sample; and a detector arranged to collect spectral data from a plurality of pixels of the array.

  3. Aging clinical problems: a difficult balance between age and frailty.

    Science.gov (United States)

    Rozzini, Renzo

    2016-01-01

    Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults. Frailty is a condition associated with ageing with associated weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss. As a population ages, a central focus of geriatricians and public health practitioners is to understand, and then beneficially intervene on, the factors and processes that put elders at such risk, especially the increased vulnerability to stressors (e.g. extremes of heat and cold, infection, injury, or even changes in medication) that characterizes many older adults. The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. The empirical assessment of geriatric frailty in individuals seeks to capture this or related features. PMID:27374041

  4. Sea Ice Prediction Has Easy and Difficult Years

    Science.gov (United States)

    Hamilton, Lawrence C.; Bitz, Cecilia M.; Blanchard-Wrigglesworth, Edward; Cutler, Matthew; Kay, Jennifer; Meier, Walter N.; Stroeve, Julienne; Wiggins, Helen

    2014-01-01

    Arctic sea ice follows an annual cycle, reaching its low point in September each year. The extent of sea ice remaining at this low point has been trending downwards for decades as the Arctic warms. Around the long-term downward trend, however, there is significant variation in the minimum extent from one year to the next. Accurate forecasts of yearly conditions would have great value to Arctic residents, shipping companies, and other stakeholders and are the subject of much current research. Since 2008 the Sea Ice Outlook (SIO) (http://www.arcus.org/search-program/seaiceoutlook) organized by the Study of Environmental Arctic Change (SEARCH) (http://www.arcus.org/search-program) has invited predictions of the September Arctic sea ice minimum extent, which are contributed from the Arctic research community. Individual predictions, based on a variety of approaches, are solicited in three cycles each year in early June, July, and August. (SEARCH 2013).

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2013-12-01

    Biomineralized exo- or endoskeletons of fossil marine invertebrates are widespread and diverse components of the Phanerozoic rock record of Earth's past and present oceans. Exoskeletons serve as protection against environmental pressure or predators, whilst endoskeletons can act as support or serve as an attachment for muscles and ligaments and hence as a mechanism for transmitting muscular forces. Biogenic hard parts represent sophisticated products resulting from the hierarchical interaction of inorganic minerals (95%) and macromolecular organic matrices, forming commonly less than 5%. The significance of many biogenic carbonate archives lies in the time-resolved growth patterns and their ability to record ambient environmental conditions in the form of multiple geochemical properties (multi-proxy archives) that have been widely used to assess past oceanic seawater properties. Here, we compile and review published work dealing with crystallization pathways of skeletal hard parts secreted by mollusks (i.e., bivalves and cephalopods) as well as brachiopods as widely used archives of ancient neritic epeiric settings. Bivalves and cephalopods (e.g., extinct ammonoids and belemnites and extant Sepia, Nautilus and Spirula) all form accretionary calcitic, aragonitic or vateritic skeletal hard parts. Despite the fact that mollusks and brachiopods form part of very different branches of the animal phylogenetic tree, their biomineralization strategies are surprisingly similar. Our main focus lies in a critical assessment of the complex pathways of ions and aquo-complexes from their source (seawater) to the final product (biomineral). We do this as an attempt to critically test the commonly held hypothesis that many fossil hard parts precipitated (under favorable conditions and pending subsequent diagenetic alteration) in equilibrium with seawater. Two main observations stand out: (1) the present knowledge on pathways and mechanisms (e.g., ion channel trans-membrane or

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

    Directory of Open Access Journals (Sweden)

    Handa Sanjeev

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sonia Fleury

    2004-05-01

    Full Text Available In this article, the author analyses the first year of Luiz Inácio Lula da Silva’s Government and highlights the importance of this Government for the process of democratic consolidation in Brazil. The contradiction between maintaining an orthodox economic policy and the expectations of creating conditions for development and social inclusion have marked the first year of this Government, subordinating all public policies to the logic of controlling inflation, paying off public debt, and increasing credibility in the international market. The reality of this macroeconomic policy and the costs imposed on the Brazilian society reveal the discrepancies between the financial economy and the real economy. The public policies of the Lula Government have been marked by economic restrictions and conflicts between the different forces that make up the governing coalition. The Government introduced innovative measures with the creation of different channels of participation and social agreement. In 2004, the Government will have to confront the challenges involved in going from a monetarist policy to a policy ofdevelopment and distribution of income.

  9. Ultrasound: promoting electroanalysis in difficult real world media.

    Science.gov (United States)

    Banks, Craig E; Compton, Richard G

    2004-08-01

    This article outlines the recent progress in the field of sonoelectroanalysis with strong emphasis on 'real world media' analysis. General principles of stripping analysis and the effects of ultrasound are explained. A section on 'Electroanalysis in extreme media' presents several examples of applications including detection of copper in beer, manganese in tea, lead and cadmium in saliva. The benefits of diamond electrodes are described and in the final section 'Metal ion detection in blood' several novel approaches based on the use of power ultrasound and based on bismuth electrodes are discussed. Specifically it is shown that the combination of ultrasound with classical stripping voltammetry permits quantifiable measurements in media hitherto impossible to study using conventional methods.

  10. Methods for measuring denitrification: Diverse approaches to a difficult problem

    DEFF Research Database (Denmark)

    Groffman, Peter M.; Altabet, Mark A.; Böhlke, J. K.;

    2006-01-01

    , and global scales. Unfortunately, this process is very difficult to measure, and existing methods are problematic for different reasons in different places at different times. In this paper, we review the major approaches that have been taken to measure denitrification in terrestrial and aquatic environments...... balance and stoichiometric approaches that constrain estimates of denitrification at large scales with point measurements (made using multiple methods), in multiple systems, is likely to propel more improvement in denitrification methods over the next few years....... and discuss the strengths, weaknesses, and future prospects for the different methods. Methodological approaches covered include (1) acetylene-based methods, (2) 15N tracers, (3) direct N2 quantification, (4) N2:Ar ratio quantification, (5) mass balance approaches, (6) stoichiometric approaches, (7) methods...

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

    Directory of Open Access Journals (Sweden)

    Monali Bhosle

    2009-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Andrew Booth

    2007-03-01

    Full Text Available Objective This paper reviews developments in the consolidation and diversification of the evidence based library and information practice (EBLIP paradigm since publication of the authors’ book Evidence Based Practice for Information Professionals: a Handbook in 2004.Methods The authors provide an updated narrative review of key themes in the development of evidence based librarianship within the context of the new consensual term ‘EBLIP.’ Sources for this thematic framework included professional literature, Internet searches, and the authors’ personal experiences.Results ‐ While considerable achievements have been realized within a three‐year period, most notably the instigation of the journal known as EBLIP, a broadening of the paradigm to other library sectors, and increased availability of implementation studies, many challenges remain. Of particular concern is the lack of international strategic foresight in determining rotation of the biennial international conferences and distribution of influential EBLIP infrastructures and initiatives.Conclusion ‐ While the enthusiasms and energies of individual practitioners and work teams have made considerable progress in meeting short‐term objectives, uncertainty remains concerning how longer‐term objectives requiring infrastructure and resources might be realized. From its faltering steps as a toddler EBLIP has developed to a ‘prepubescent’ stage with the promise of ‘growth spurts’ and ‘emotional crises.’ The next three years should prove both challenging and demanding.

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

    Science.gov (United States)

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

    2002-06-13

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

  14. METHODOLOGY OF DETERMINATION OF ADMISSIBLE SPEEDS OF TRAIN MOVEMENT ON DIFFICULT SECTIONS OF RAILROAD PLAN

    Directory of Open Access Journals (Sweden)

    M. B. Kurhan

    2014-03-01

    Full Text Available Purpose. Determination of improvement ways of admissible speeds of train movement on the difficult sections of а railroad plan. Methodology. Mathematical modeling of the train traffic is used to achieve the purpose of research. The average weighted speed and elevation of outer rail is predicted on this basis. Findings. The case analysis of the speeds determination in curved sections of track was carried out. The above mentioned track sections adversely affect the ride comfort and the intensity of the way disorder, as well as the reasons that contribute to the speed limits traffic on the railways of Ukraine. The technique of performing the calculations for determining the permissible train speeds was developed and tested on real curves of railways, were the accelerated movement of trains was introduced. Proposals on automate calculations in distances and services by way of determining the permissible speeds in curves were developed. Originality. Methodology of determining the permissible motion speeds and elevation of outer rails on the difficult sections of the railway plan was developed. This approach allows you to get a rational decisions on reorganization of plan based on local conditions. Practical value. The developed technique of definition of admissible speeds of motion in curves was implemented as a program DopShvid. The program was tested on real railway sections, where the accelerated train motion was introduced.

  15. Hepatitis C: Treatment of difficult to treat patients

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Over the past several years, more so recently, treatmentoptions for hepatitis C virus (HCV) have seemed toexponentially grow. Up until recently, the regimen ofpegylated interferon (peg-IFN) and ribavirin (RBV) stoodas the standard of care. Direct acting antivirals, whichtarget nonstructural proteins involved in replicationand infection of HCV were first approved in 2011 as anaddition to the peg-IFN and RBV regimen and with themhave come increased sustained virological response rates(SVR). The previously reported 50%-70% SVR ratesusing the combination of peg-IFN and RBV are no longerthe standard of care with direct acting antiviral (DAA)based regimens now achieving SVR of 70%-90%. Peg-IFN free as well as "all oral" regimens are also available.The current randomized controlled trials available showfavorable SVRs in patients who are naive to treatment,non-cirrhotic, and not human immunodeficiency virus(HIV)-co-infected. What about patients who do notfit into these categories? In this review, we aim todiscuss the currently approved and soon to be approvedDAAs while focusing on their roles in patients that aretreatment experienced, cirrhotic, or co-infected with HIV.In this discussion, review of the clinical trials leadingto recent consensus guidelines as well as discussion ofbarriers to treatment will occur. A case will attempt willbe made that social services, including financial supportand drug/alcohol treatment, should be provided to allHCV infected patients to improve chances of cure andthus prevention of late stage sequela.

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Hongisto, M.; Nikula, A.

    1996-11-01

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

  18. Computer-driven automated weaning reduces weaning duration in difficult-to-wean patients

    Institute of Scientific and Technical Information of China (English)

    LIU Ling; XU Xiao-ting; YANG Yi; HUANG Ying-zi; LIU Song-qiao; QIU Hai-bo

    2013-01-01

    Background Weaning difficulties occur in 31% of total intubated patients,and result in prolonged weaning duration.A computer-driven automated weaning system can perform a spontaneous breathing trial (SBT) automatically and display a message when the trial is successfully passed.Such a system might have a beneficial effect on difficult-to-wean patients.The aim of this study was to examine whether the computer-driven automated weaning system can accelerate discontinuation of mechanical ventilation and improve outcomes in difficult-to-wean patients.Methods This randomized controlled study included 39 difficult-to-wean patients who failed their first spontaneous breathing trial.Before initiating weaning,eligible patients were randomly allocated to wean by computer-driven automated weaning system (CDW group,n=19) or a physician-controlled local protocol (PW group,n=20).Weaning duration,defined as the time from inclusion until first extubation,was the primary endpoint.Secondary endpoints were total duration of mechanical ventilation,the length of intensive care unit (ICU) stay,the number of reintubations,the mortality rate in the ICU,the number of noninvasive ventilations,the number of complications in the ICU,and the number of ventilator-associated pneumonia cases.Results The weaning duration was reduced with the computer-driven weaning as compared with the usual protocol (median 29.0 hours vs.45.5 hours,P=0.044).Total duration of mechanical ventilation and duration of the ICU stay did not differ between the CDW and PW groups.There was no difference in the number of reintubations between the CDW and PW groups (3 and 4 patients,P=-0.732).The study groups showed comparable numbers of tracheostomy,selfextubations,ventilator-associated pneumonia,and non-invasive ventilation.Mortality in the ICU was similar in the CDW and the PW groups (21.1% vs.20.0%,P=-0.935).Conclusion The computer-driven automated weaning system can reduce weaning duration in difficult

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

    Science.gov (United States)

    Hernandez, Luis; Smith, Connie Jo

    2009-01-01

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

  20. Predictive factors of difficult procedure in octogenarians undergoing elective laparoscopic cholecystectomy: a single center experience

    Science.gov (United States)

    GUIDA, F.; MONACO, L.; SCHETTINO, M.; PORFIDIA, R.; IAPICCA, G.

    2016-01-01

    Aim To assess the feasibility and safety of laparoscopic cholecystectomy (LC) in very elderly patients with particular attention to the predicitive factors of difficulty. Patients and methods All patients aged ≥ 80 undergoing elective LC for lithiasis at our institution since 1st January 2015 to 31st December 2015 were included in the study. Exclusion criteria were: a) acute cholecystitis; b) biliary pancreatitis; c) biliary tract neoplasms; d) urgent procedure. Pre-, intra- and postoperative data were recorded. Results During the study period, we performed 72 LC and we enrolled 17 patients aged ≥ 80 with a M:F = 5:12. Of these, 10 patients had a “difficult” cholecystectomy. In seven cases an intraoperative cholangiography (IOC) was performed. Postoperative course was regular but in two patients we had an Oddian spasm in 1st postoperative day. Female sex (p=0.03) and preoperative high level of serum amylase (p= 0.02) were significantly associated to difficult cholecystectomy in elderly patients. Conclusion LC in octogenarians is feasible and safe. However, sex and serum amylase can help the surgeon to predict a more difficult procedure in elective LC. In this group of patients an approach based on the individual risk is desirable and the patient could be referred to a multidisciplinary approach. PMID:27381691

  1. A case of meningococcal meningitis that was difficult to treat owing to concurrent ventriculitis.

    Science.gov (United States)

    Nakahara, Hiroaki; Oda, Toshimi; Fukao, Eri; Horiuchi, Izumi; Honma, Yutaka; Uchigata, Masanobu

    2016-05-31

    A 64-year-old male came to our hospital emergency department with fever and consciousness disturbance. Culture tests of blood and spinal fluid samples revealed meningococci (Neisseria meningitidis), and we made a diagnosis of meningococcal meningitis. Brain magnetic resonance imaging (MRI) findings revealed ventriculitis. Ceftriaxone was administered for 17 days, however, relapse was noted after that was discontinued, with neutropenia and renal impairment thought to be adverse reactions to the beta-lactam antibiotic. Hence, treatment was switched to oral administration of moxifloxacin for a total of 12 weeks, including in an outpatient setting. After moxifloxacin was discontinued, no side effects or relapse were seen, and treatment was ended. Although antibacterial agents generally show favorable effects for meningococcal meningitis, we consider that sufficient antimicrobial therapy is difficult in cases complicated with ventriculitis. PMID:27151225

  2. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Wen-Hsiung Chang; Cheng-Hsin Chu; Tsang-En Wang; Ming-Jen Chen; Ching-Chung Lin

    2005-01-01

    AIM: The usual bile duct stone may be removed by means of Dormia basket or balloon catheter, and results are quite good. However, the degree of difficulty is increased when stones are larger. Studies on the subject reported many cases where mechanical lithotripsy is combined with a second technique, e.g. electrohydraulic lithotripsy (EHL),where stones are crushed using baby-mother scope electric shock. The extracorporeal shock-wave lithotripsy (ESWL)or laser lithotripsy also yields an excellent success rate of greater than 90%. However, the equipment for these techniques are very expensive; hence we opted for the simple mechanical lithotripsy and evaluated its performance.METHODS: During the period from August 1996 to Decemberz 2002, Mackay Memorial Hospital treated 304 patients suffering from difficult bile duct stones (stone >1.5 cm or stones that could not be removed by the ordinary Dormia basket or balloon catheter). These patients underwent endoscopic papillotomy (EPT) procedure, and stones were removed by means of the Olympus BML-4Q lithotripsy. A follow-up was conducted on the post-treatment conditions and complications of the patients.RESULTS: Out of the 304 patients, bile duct stones were successfully removed from 272 patients, a success rate of about 90%. The procedure failed in 32 patients, for whom surgery was needed. Out of the 272 successfully treated patients, 8 developed cholangitis, 21 developed pancreatitis,and 10 patients had delayed bleeding, and no patient died.Among these 272 successful removal cases, successful bile duct stone removal was achieved after the first lithotripsy in 211 patients, whereas 61 patients underwent multiple sessions of lithotripsy. As for the 61 patients that underwent multiple sessions of mechanical lithotripsy, 6 (9.8%) had post-procedure cholangitis, 12 (19.6%) had pancreatitis,and 9 patients (14.7%) had delayed bleeding. Compared with the 211 patients undergoing a single session of mechanical lithotripsy, 3 (1

  3. An alternative method to achieve one-lung ventilation by surgical pneumothorax in difficult lung isolation patient: a case report.

    Science.gov (United States)

    Yeh, Pin-Hung; Hsu, Po-Kai

    2016-04-01

    It is challenging to establish one-lung ventilation in difficult airway patients. Surgical pneumothorax under spontaneous breathing to obtain well-collapsed lung is a feasible method for thoracic surgery. A 76-year-old man with right empyema was scheduled for decortication. The patient had limited mouth opening due to facial cellulitis extending from the left cheek to neck. Generally, lung isolation is achieved by double-lumen endotracheal tube or bronchial blocker. Double-lumen tube insertion is difficult for patients with limited mouth opening and right-side placement of bronchial blocker usually causes insufficient deflation. We introduce an alternative lung isolation technique by surgical pneumothorax under spontaneous breathing simply with an endotracheal tube placement. This technique has never been applied into the management of difficult one-lung ventilation. By this method, we provide an ideal surgical condition with safer, less time-consuming, and less skill-demanding anesthesia. It would be an alternative choice for management of one-lung ventilation in the difficult lung isolation patient. PMID:26721826

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

    Science.gov (United States)

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

    2013-06-01

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

  5. Hook removal from a loggerhead sea turtle (Caretta caretta: Report of a tricky surgery under difficult conditions

    Directory of Open Access Journals (Sweden)

    João Pedro Barreiros

    2015-08-01

    Full Text Available A sub adult Caretta caretta was found on the 23rd August, 2014 ca. 16 nautical miles south off S. Miguel Island, Azores (Northeast Atlantic, with a large pelagic trawl hook inside its mouth. The individual was kept in a basin of sea water and sent by boat to Terceira Island following instructions by the Azores Regional Government via the Environmental Authority in order to be examined by the author and, if possible, undergo the necessary hook removal procedures. In this note, we describe the surgical procedures and how the turtle was evaluated both pre- and post-surgery.

  6. Hook removal from a loggerhead sea turtle (Caretta caretta):Report of a tricky surgery under difficult conditions

    Institute of Scientific and Technical Information of China (English)

    João Pedro Barreiros

    2015-01-01

    A sub adult Caretta caretta was found on the 23rd August, 2014 ca. 16 nautical miles south off S. Miguel Island, Azores (Northeast Atlantic), with a large pelagic trawl hook inside its mouth. The individual was kept in a basin of sea water and sent by boat to Terceira Island following instructions by the Azores Regional Government via the Environmental Authority in order to be examined by the author and, if possible, undergo the necessary hook removal procedures. In this note, we describe the surgical procedures and how the turtle was evaluated both pre- and post-surgery.

  7. The Effect of a Gluten-Free Diet in Children With Difficult-to-Manage Nephrotic Syndrome

    Science.gov (United States)

    Lemley, Kevin V.; Faul, Christian; Schramm, Karla; Meyers, Kevin; Kaskel, Frederick; Dell, Katherine M.; Gipson, Debbie S.; Gibson, Keisha; Trachtman, Howard

    2016-01-01

    Case reports have linked childhood nephrotic syndrome to food sensitivity, including gluten. We report our experience with 8 children (6 boys, 2 girls; age at implementation of special diet 2–14 years) with difficult-to-manage nephrotic syndrome who were placed on a gluten-free diet for 3.4 ± 4.3 years (range, 0.6–14 years) and who had clinical improvement enabling reduction or discontinuation in steroid dosage. PMID:27338701

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

    Energy Technology Data Exchange (ETDEWEB)

    Ho, Kean F. (Academic Dept. of Radiation Oncology, Univ. of Manchester, Manchester (United Kingdom)); Fowler, Jack F. (Dept. of Human Oncology and Medical Physics, Univ. of Wisconsin, Wisconsin (United States)); Sykes, Andrew J.; Yap, Beng K.; Lee, Lip W.; Slevin, Nick J. (Dept. of Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester (United Kingdom))

    2009-04-15

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    Epner, Daniel E; Baile, Walter F

    2014-04-01

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

  11. Difficult action decisions reduce the sense of agency: A study using the Eriksen flanker task.

    Science.gov (United States)

    Sidarus, Nura; Haggard, Patrick

    2016-05-01

    The sense of agency refers to the feeling that we are in control of our actions and, through them, of events in the outside world. Much research has focused on the importance of retrospectively matching predicted and actual action outcomes for a strong sense of agency. Yet, recent studies have revealed that a metacognitive signal about the fluency of action selection can prospectively inform our sense of agency. Fluent, or easy, action selection leads to a stronger sense of agency over action outcomes than dysfluent, or difficult, selection. Since these studies used subliminal priming to manipulate action selection, it remained unclear whether supraliminal stimuli affecting action selection would have similar effects. We used supraliminal flankers to manipulate action selection in response to a central target. Experiment 1 revealed that conflict in action selection, induced by incongruent flankers and targets, led to reduced agency ratings over an outcome that followed the participant's response, relative to neutral and congruent flanking conditions. Experiment 2 replicated this result, and extended it to free choice between alternative actions. Finally, Experiment 3 varied the stimulus onset asynchrony (SOA) between flankers and target. Action selection performance varied with SOA. Agency ratings were always lower in incongruent than congruent trials, and this effect did not vary across SOAs. Sense of agency is influenced by a signal that tracks conflict in action selection, regardless of the visibility of stimuli inducing conflict, and even when the timing of the stimuli means that the conflict may not affect performance. PMID:27017411

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

    OpenAIRE

    Culpepper, Larry

    2013-01-01

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

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

    Science.gov (United States)

    Pandey, Jatin; Singh, Manjari

    2015-01-01

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

  14. Faculty Teaching Diversity through Difficult Dialogues: Stories of Challenges and Success

    Science.gov (United States)

    Gayles, Joy Gaston; Kelly, Bridget Turner; Grays, Shaefny; Zhang, Jing Jing; Porter, Kamaria P.

    2015-01-01

    Teaching diversity courses in graduate preparation programs is likely to trigger difficult dialogues that evoke a range of emotional responses. Difficult dialogues on diversity topics must be managed effectively in order to enhance multicultural competence. This interpretive study examined the experiences of faculty who teach diversity courses in…

  15. Identifying and Investigating Difficult Concepts in Engineering Mechanics and Electric Circuits. Research Brief

    Science.gov (United States)

    Streveler, Ruth; Geist, Monica; Ammerman, Ravel; Sulzbach, Candace; Miller, Ronald; Olds, Barbara; Nelson, Mary

    2007-01-01

    This study extends ongoing work to identify difficult concepts in thermal and transport science and measure students' understanding of those concepts via a concept inventory. Two research questions provided the focal point: "What important concepts in electric circuits and engineering mechanics do students find difficult to learn?"…

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

    Directory of Open Access Journals (Sweden)

    Smita Prakash

    2013-01-01

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

  17. Laparoscopic modified subtotal cholecystectomy for difficult gall bladders: A single-centre experience

    Science.gov (United States)

    Harilingam, Mohan Raj; Shrestha, Ashish Kiran; Basu, Sanjoy

    2016-01-01

    AIM: Laparoscopic cholecystectomy (LC) is considered the ‘gold standard’ intervention for gall bladder (GB) diseases. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot's triangle. The aim is to find out whether our technique of laparoscopic modified subtotal cholecystectomy (LMSC) is suitable, with an acceptable morbidity and outcome. PATIENTS AND METHODS: A retrospective analysis of prospectively collected data of 993 consecutive patients who underwent cholecystectomy was done at a large District General Hospital (DGH) between August 2007 and January 2015. The data are as follows: Patient's demographics, operative details including intra- and postoperative complications, postoperative stay including follow-up that was recorded and analysed. RESULTS: A total of 993 patients (263 males and 730 female) were included. The median age was 52*(18-89) years. Out of the 993 patients, 979 (98.5%) and 14 (1.5%) were listed for laparoscopic and open cholecystectomy, respectively. Of the 979 patients, 902 (92%) and 64 (6.5%) patients underwent LC ± on-table cholangiography (OTC) and LMSC ± OTC, respectively, with a median stay of 1* (0-15) days. Of the 64 patients, 55 (86%) had dense adhesions, 22 (34%) had acute inflammation, 19 (30%) had severe contraction, 12 (19%) had empyema, 7 (11%) had Mirizzi's syndrome and 2 (3%) had gangrenous GB. The mean operative time was 120 × (50-180) min [Table 1]. Six (12%) patients required endoscopic retrograde cholangiopancreatography (ERCP) postoperatively, and there were four (6%) readmissions in a follow-up of 30 × (8-76) months. The remaining 13 (1.3%) patients underwent laparoscopic cholecystectomy converted to an open cholecystectomy. The median stay for open/laparoscopic cholecystectomy converted to open cholecystectomy was 5 × (1-12) days. CONCLUSION: Our technique of LMSC avoided conversion in 6.5% patients and believe that it is feasible and safe for difficult GBs

  18. Hyomental distance in the different head positions and hyomental distance ratio in predicting difficult intubation

    Directory of Open Access Journals (Sweden)

    Nevena Kalezić

    2016-06-01

    Full Text Available The hyomental distance ratio (HMDR is the ratio between the hyomental distance (HMD (the distance between the hyoid bone and the tip of the chin at the extreme of head extension (HMDe and the one in the neutral position (HMDn. The objective of the study was to examine the predictive value, sensitivity, and specificity of HMDe, HMDn, and HMDR in predicting difficult endotracheal intubation (DI. A prospective study included 262 patients that underwent elective surgical operations. The following parameters were observed as possible predictors of DI: HMDR, HMDe, HMDn, Mallampati score, and body mass index (BMI. The cut-off points for the DI predictors were HMDe <5.3 cm, HMDn ≤5.5 cm, and HMDR ≤1.2. The assessment that DI existed was made by the anesthesiologist while performing laryngoscopy by applying the Cormack-Lehane classification. DI was present in 13 patients (5%. No significant difference was observed in the frequency of DI with regard to the sex, age, and BMI of the patients. Our research indicated HMDR as the best predictor of DI with a sensitivity of 95.6% and specificity of 69.2%. HMDR can be used in the everyday work of anesthesiologists because HMDR values ≤1.2 may reliably predict DI.

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

    Directory of Open Access Journals (Sweden)

    Osman Karakus

    2015-04-01

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

  20. Techniques for demonstrating radiation pathology in aquatic organisms including histology and autoradiography

    International Nuclear Information System (INIS)

    Laboratory research carried out under well-designed conditions can produce reproducible results. However, if there is any variation in the experimental conditions including physical, chemical and biological factors, it may be difficult to compare the results obtained in different laboratories. The factors affecting the manifestation of radiation pathology are specially emphasized here. Radiation effects on fish and aquatic invertebrates are also described briefly. Almost all techniques developed for radiobiological research in mammals and cultured cells can be applied to research into aquatic organisms. Histopathological examination of fish should focus on the observation of the cell-renewal systems at appropriate time intervals after irradiation. Some techniques for demonstrating radiation pathology including histology and autoradiography in aquatic organisms, especially in fish, are illustrated with examples. (author)

  1. Gastrointestinal bleeding from vascular malformations: Is octreotide effective to rescue difficult-to-treat patients?

    Science.gov (United States)

    Iannone, Andrea; Principi, Mariabeatrice; Barone, Michele; Losurdo, Giuseppe; Ierardi, Enzo; Di Leo, Alfredo

    2016-09-01

    Gastrointestinal vascular malformations are responsible for 2-8% of all cases of bleeding and 30-40% of all obscure hemorrhages, being the most frequent cause of occult bleeding in older people. The aim of this review was to provide an up-to-date report about the use of octreotide in bleeding from both hereditary and acquired vascular malformations of the gastrointestinal tract. A systematic literature search was performed, using the keywords "gastrointestinal vascular malformation", "octreotide", "angiodysplasia", "portal hypertensive gastropathy", "gastric antral vascular ectasia", and "hereditary vascular malformations". The first line therapy of acute/chronic bleeding from digestive vascular malformations is endoscopy, followed by angiographic embolization and surgical resection when this is unsuccessful. In the setting of difficult-to-treat patients, octreotide has been proposed as an alternative therapeutic strategy. Studies reported in the literature show a high efficacy and safety of octreotide, but described only a small number of enrolled patients, heterogeneous therapeutic schedules and short-term follow-up, with the exception of acute bleeding from esophageal varices. As a consequence, the use of octreotide is not approved in this setting and it is currently still prescribed as an off-label drug. Studies in larger populations are needed to confirm the promising results observed in the small case series reports, so as to provide physicians with a treatment option for patients without available alternatives. Octreotide could also determine a strong decrease in the management costs of these clinical conditions, and especially, could dramatically reduce hospital admission costs. PMID:27595456

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

    Science.gov (United States)

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

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

    LENUS (Irish Health Repository)

    Malik, M A

    2009-11-01

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

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

    OpenAIRE

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

    2011-01-01

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

  5. Difficult airway management patterns among anesthesiologists practicing in Cairo University Hospitals

    Directory of Open Access Journals (Sweden)

    Neamat I. Abdel rahman

    2016-01-01

    Conclusion: The practice of anesthesiologists in Cairo university hospitals is close to the recommendations of the ASA guidelines for management of difficult airway. There is increased skills in fiberoptic bronchoscopes and SGA with increased frequency of difficult airway managements training courses; however, they need to improve their skills in awake fiberoptic intubations technique and they need to be trained on invasive airway management access to close the discrepancy between their theoretical choices in different situations and their actual skills.

  6. Low-Dose Isotretinoin: An Option for Difficult-to-Treat Papulopustular Rosacea.

    Science.gov (United States)

    van Zuuren, Esther J; Fedorowicz, Zbys

    2016-06-01

    Rosacea is a chronic disease with a profound impact on quality of life. Although there are a range of treatments for its many manifestations, some cases are difficult to treat. Sbidian et al. show in this double-blind, randomized, placebo-controlled trial that low-dose isotretinoin can be effective in treating difficult-to-treat and frequently relapsing papulopustular rosacea. PMID:27212646

  7. A comparison of Mallampati scoring, upper lip bite test and sternomental distance in predicting difficult intubation

    OpenAIRE

    Arun Varghese; Taznim Mohamed

    2016-01-01

    Background: Difficult or failed tracheal intubation has been identified as one of the most important causes of death or permanent brain damage during anaesthesia. The present study has aimed to compare modified Mallampati score, Upper lip bite test and sternomental distance for predicting difficult intubation in adult patients. Methods: In this study 199 patients aged 18-60 years were recruited who were undergoing elective surgeries requiring endotracheal intubation. All patients were eva...

  8. [Quality assurance in airway management: education and training for difficult airway management].

    Science.gov (United States)

    Kaminoh, Yoshiroh

    2006-01-01

    Respiratory problem is one of the main causes of death or severe brain damage in perioperative period. Three major factors of respiratory problem are esophageal intubation, inadequate ventilation, and difficult airway. The wide spread of pulse oximeter and capnograph reduced the incidences of esophageal intubation and inadequate ventilation, but the difficult airway still occupies the large portion in the causes of adverse events during anesthesia. "Practice guideline for management of the difficult airway" was proposed by American Society of Anesthesiologists (ASA) in 1992 and 2002. Improvement of knowledge, technical skills, and cognitive skills are necessary for the education and training of the difficult airway management. "The practical seminar of difficult airway management (DAM practical seminar)" has been cosponsored by the Japanese Association of Medical Simulation (JAMS) in the 51 st and 52 nd annual meetings of Japanese Society of Anesthesiologists and the 24th annual meeting of Japanese Society for Clinical Anesthesia. The DAM practical seminar is composed of the lecture session for ASA difficult airway algorithm, the hands-on training session for technical skills, and the scenario-based training session for cognitive skills. Ninty six Japanese anesthesiologists have completed the DAM practical seminar in one year. "The DAM instructor course" should be immediately prepared to organize the seminar more frequently. PMID:16440705

  9. Advances in Rosetta structure prediction for difficult molecular-replacement problems

    International Nuclear Information System (INIS)

    Modeling advances using Rosetta structure prediction to aid in solving difficult molecular-replacement problems are discussed. Recent work has shown the effectiveness of structure-prediction methods in solving difficult molecular-replacement problems. The Rosetta protein structure modeling suite can aid in the solution of difficult molecular-replacement problems using templates from 15 to 25% sequence identity; Rosetta refinement guided by noisy density has consistently led to solved structures where other methods fail. In this paper, an overview of the use of Rosetta for these difficult molecular-replacement problems is provided and new modeling developments that further improve model quality are described. Several variations to the method are introduced that significantly reduce the time needed to generate a model and the sampling required to improve the starting template. The improvements are benchmarked on a set of nine difficult cases and it is shown that this improved method obtains consistently better models in less running time. Finally, strategies for best using Rosetta to solve difficult molecular-replacement problems are presented and future directions for the role of structure-prediction methods in crystallography are discussed

  10. Advances in Rosetta structure prediction for difficult molecular-replacement problems

    Energy Technology Data Exchange (ETDEWEB)

    DiMaio, Frank, E-mail: dimaio@u.washington.edu [University of Washington, UW Box 357350, Seattle, WA 98195 (United States)

    2013-11-01

    Modeling advances using Rosetta structure prediction to aid in solving difficult molecular-replacement problems are discussed. Recent work has shown the effectiveness of structure-prediction methods in solving difficult molecular-replacement problems. The Rosetta protein structure modeling suite can aid in the solution of difficult molecular-replacement problems using templates from 15 to 25% sequence identity; Rosetta refinement guided by noisy density has consistently led to solved structures where other methods fail. In this paper, an overview of the use of Rosetta for these difficult molecular-replacement problems is provided and new modeling developments that further improve model quality are described. Several variations to the method are introduced that significantly reduce the time needed to generate a model and the sampling required to improve the starting template. The improvements are benchmarked on a set of nine difficult cases and it is shown that this improved method obtains consistently better models in less running time. Finally, strategies for best using Rosetta to solve difficult molecular-replacement problems are presented and future directions for the role of structure-prediction methods in crystallography are discussed.

  11. The difficult patients in pain therapy: How to recognize and manage them

    Directory of Open Access Journals (Sweden)

    Giuseppe De Benedittis

    2005-05-01

    Full Text Available When physicians experience negative reactions to patients, they often perceive the patients as "difficult". Such patients make up 15% to 30% of primary care practice populations. They are those whom most physicians dread. The dependency of difficult patients heavily influences the doctor-patient relationship and the outcome of the treatment. These patients often present with physical symptoms that could not be medically explained. Pain is the most frequent complaint, though unrecognized psychopatological disorders are more prevalent among these patients. Conversely, difficult patients are rather common in chronic pain syndromes, particularly in back pain, failed back syndrome and atypical facial pain. Diagnosis can be achieved on phenomenological, psychopathological and psychodynamic grounds. The management of difficult patients can prove to be a tough task for both physicians and nurses, as they are time-consuming, draining the emotional resources of the therapist, and evoke feelings of aversion and frustration. Appropriate use of patient-doctor communication skills and an effort to improve relations with the patient through empathy, tolerance and non-judgemental listening are suggested as ways of transform a difficult encounter into a workable patient-doctor relationship.

  12. Assessing the effects of different dielectrics on environmentally conscious powder-mixed EDM of difficult-to-machine material (WC-Co)

    Science.gov (United States)

    Singh, Jagdeep; Sharma, Rajiv Kumar

    2016-06-01

    Electrical discharge machining (EDM) is a well-known nontraditional manufacturing process to machine the difficult-to-machine (DTM) materials which have unique hardness properties. Researchers have successfully performed hybridization to improve this process by incorporating powders into the EDM process known as powder-mixed EDM process. This process drastically improves process efficiency by increasing material removal rate, micro-hardness, as well as reducing the tool wear rate and surface roughness. EDM also has some input parameters, including pulse-on time, dielectric levels and its type, current setting, flushing pressure, and so on, which have a significant effect on EDM performance. However, despite their positive influence, investigating the effects of these parameters on environmental conditions is necessary. Most studies demonstrate the use of kerosene oil as dielectric fluid. Nevertheless, in this work, the authors highlight the findings with respect to three different dielectric fluids, including kerosene oil, EDM oil, and distilled water using one-variable-at-a-time approach for machining as well as environmental aspects. The hazard and operability analysis is employed to identify the inherent safety factors associated with powder-mixed EDM of WC-Co.

  13. The difficult intraoperative nasogastric tube intubation: A review of the literature and a novel approach.

    Science.gov (United States)

    Ching, Yiu-Hei; Socias, Stephanie M; Ciesla, David J; Karlnoski, Rachel A; Camporesi, Enrico M; Mangar, Devanand

    2014-01-01

    Nasogastric tube intubation of a patient under general anesthesia with an endotracheal tube in place can pose a challenge to the most experienced anesthesiologist. Physiologic and pathologic variations in a patient's functional anatomy can present further difficulty. While numerous techniques to the difficult nasogastric tube intubation have been described, there is no consensus for a standard approach. Therefore, selecting the most appropriate approach requires a working knowledge of the techniques available, mindful consideration of individual patient and clinical factors, and the operator's experience and preference. This article reviews the relevant literature regarding various approaches to the difficult nasogastric tube intubation with descriptions of techniques and results from comparative studies if available. Additionally, we present a novel approach using a retrograde technique for the difficult intraoperative nasogastric tube intubation.

  14. Incidence of unanticipated difficult airway using an objective airway score versus a standard clinical airway assessment

    DEFF Research Database (Denmark)

    Nørskov, Anders Kehlet; Rosenstock, Charlotte Valentin; Wetterslev, Jørn;

    2013-01-01

    the examination and registration of predictors for difficult mask ventilation with a non-specified clinical airway assessment on prediction of difficult mask ventilation.Method/Design: We cluster-randomized 28 Danish departments of anaesthesia to airway assessment either by the SARI or by usual non......-specific assessment. Data from patients' pre-operative airway assessment are registered in the Danish Anaesthesia Database. Objective scores for intubation and mask ventilation grade the severity of airway managements. The accuracy of predicting difficult intubation and mask ventilation is measured for each group...... reduction equalling a number needed to treat of 180. Sample size estimation is adjusted for the study design and based on standards for randomization on cluster-level. With an average cluster size of 2,500 patients, 70,000 patients will be enrolled over a 1-year trial period. The database is programmed so...

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

    CERN Document Server

    Shaw, Peter J A

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mary Breheny

    2011-01-01

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

  17. A Randomized-Controlled Trial of Oral Low-Dose Isotretinoin for Difficult-To-Treat Papulopustular Rosacea.

    Science.gov (United States)

    Sbidian, Emilie; Vicaut, Éric; Chidiack, Henri; Anselin, Elie; Cribier, Bernard; Dréno, Brigitte; Chosidow, Olivier

    2016-06-01

    Rosacea is a chronic inflammatory facial skin disease with psychosocial impact. Oral cyclines are recommended for moderate-to-severe papulopustular rosacea. Oral isotretinoin was found valuable for difficult-to-treat cases in several reports. This multicenter, double-blind, randomized-placebo-controlled trial compared oral isotretinoin (0.25 mg/kg/day) with placebo (2:1 ratio) for difficult-to-treat papulopustular rosacea. Included patients had at least eight papulopustular lesions. The primary endpoint after the 4-month treatment period was the response rate: at least 90% reduction of the number of papules/pustules compared with baseline. Secondary outcomes included measures on quality of life (Skindex score). Between February 2007 and August 2009, 156 patients were randomized to receive either isotretinoin (n = 108) or placebo (n = 48). In the intention-to-treat population, 57.4% of isotretinoin recipients reached the primary endpoint, compared with 10.4% of those taking the placebo (absolute difference, 47 percentage points; 95% confidence interval, 34.3-59.7; P Rosacea relapsed in 27 (58.3%) of 51 patients who accepted 4 months of continued follow-up, with a median of 15 weeks to recurrence. The percentages of patients in each arm who stopped their treatment because of adverse event(s) did not differ. Low-dose isotretinoin was an effective therapeutic option for difficult-to-treat papulopustular rosacea. Further studies should investigate the value of a minimal effective isotretinoin dose to maintain these remissions. PMID:26854486

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

    Energy Technology Data Exchange (ETDEWEB)

    Ringle, R., E-mail: ringle@nscl.msu.edu; Bachelet, C.; Barquest, B. R.; Block, M.; Bollen, G.; Campbell, C. M.; Facina, M.; Ferrer, R.; III, C. M. Folden; Guenaut, C.; Kwan, E.; Kwiatkowski, A. A.; Lincoln, D. L.; Morrissey, D. J.; Pang, G. K.; Prinke, A. M.; Savory, J.; Schury, P.; Schwarz, S.; Sumithrarachchi, C. S. [National Superconducting Cyclotron Laboratory (United States)

    2011-07-15

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

  19. Cutting Costs, Keeping Quality: Financing Strategies for Youth-Serving Organizations in a Difficult Economy

    Science.gov (United States)

    Keller, Eric

    2010-01-01

    This research brief highlights three effective financing strategies that successful youth-serving organizations are using to maintain quality services despite difficult economic times. The brief provides examples of how organizations have implemented these strategies and offers tips to help leaders consider how best to adapt these strategies to…

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

    Directory of Open Access Journals (Sweden)

    Mehmet Turan Inal

    2014-12-01

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

  1. Which Aspects of the English Language Do Distance Learners Find Difficult?

    Science.gov (United States)

    Teoh, George Boon Sai; Lin, Agnes Liau Wei; Belaja, Kathy

    2016-01-01

    This study reports the findings of a research carried out on distance learners at the School of Distance Education (SDE), University Sains Malaysia (USM). The study was explorative in nature with the purpose identifying the aspects of the English language which distance learners found difficult to learn. A quantitative survey questionnaire design…

  2. Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management

    DEFF Research Database (Denmark)

    Rosenstock, Charlotte Vallentin; Thøgersen, Bente; Afshari, Arash;

    2012-01-01

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

  3. Relapsing and difficult to control hypokalemia in a patient with acute lymphoid leukemia

    OpenAIRE

    Nieto-Ríos, John Fredy; Serna-Higuita, Lina María; Valencia-Chicué, Libardo Humberto; Ocampo-Kohn, Catalina; Aristizábal-Alzate, Arbey; Zuluaga-Valencia, Gustavo Adolfo

    2015-01-01

    Hypokalemia is an electrolytic disorder, in some occasions difficult to control. When severe, it may be life-threatening. We report the case of a patient with relapse of acute lymphoid leukemia, who presented to the hospital with flaccid paralysis associated with severe hypokalemia. The cause was a tubulopathy associated with leukemic infiltration of the kidneys.

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

    Science.gov (United States)

    Frost, Helen

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

  5. Incremental Learning of Difficult Words in Story Contexts: The Role of Spelling and Pronouncing New Vocabulary

    Science.gov (United States)

    Vadasy, Patricia F.; Sanders, Elizabeth A.

    2015-01-01

    In this exploratory study we examine the value of exposure to the spelling and pronunciation of word forms when introducing the meanings of new and difficult vocabulary words. Kindergarten English learners were randomly assigned to one of two types of storybook reading delivered by tutors. Students in both treatments listened to short stories…

  6. LARYNGEAL CHONDROSARCOMA: SUCCESSFUL USE OF VIDEO LARYNGOSCOPE IN ANTICIPATED DIFFICULT AIRWAY MANAGEMENT.

    Science.gov (United States)

    Dolinaj, Vladimir; Milošev, Sanja; Janjević, Dušanka

    2016-03-01

    Laryngeal chondrosarcoma is a rare mesenchymal tumor, most frequently affecting cricoid cartilage. The objective of this report is to present successful video laryngoscope usage in a patient with anticipated difficult airway who refused awake fiberoptic endotracheal intubation (AFOI). A 59-year-old male patient was admitted in our hospital due to difficulty breathing and swallowing. On clinical examination performed by ENT surgeon, preoperative endoscopic airway examination (PEAE) could not be performed properly due to the patient's uncooperativeness. Computed tomography revealed a spherical tumor that obstructed the subglottic area almost entirely. Due to the narrowed airway, the first choice for the anticipated difficult airway management was AFOI, which the patient refused. Consequently, we decided to perform endotracheal intubation with indirect laryngoscope using a C-MAC video laryngoscope (Karl Storz, Tuttlingen, Germany). Reinforced endotracheal tube (6.0 mm internal diameter) was placed gently between the tumor mass and the posterior wall of the trachea in the first attempt. Confirmation of endotracheal intubation was done by capnography. In a patient with subglottic area chondrosarcoma refusing PEAE and AFOI, video laryngoscope is a particularly helpful device for difficult airway management when difficult airway is anticipated. PMID:27276783

  7. Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation.

    Science.gov (United States)

    Nag, Deb Sanjay; Samaddar, Devi Prasad

    2016-01-01

    We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube. PMID:27591469

  8. Martin Award Paper: Development of Interactive Virtual Laboratories to Help Students Learn Difficult Concepts in Thermodynamics

    Science.gov (United States)

    Bowen, Alec S.; Reid, Daniel R.; Koretsky, Milo D.

    2015-01-01

    In this project, we explore the use of threshold concept theory as a design basis for development of Interactive Virtual Laboratories in thermodynamics. Thermodynamics is a difficult subject for chemical and biological engineering students to master. One reason for the difficulty is the diverse and challenging set of threshold concepts that they…

  9. Maternal Affective-Cognitive Processes in the Perception of Newborn Difficultness.

    Science.gov (United States)

    Wolke, Dieter; St. James-Roberts, Ian

    A short-term longitudinal study investigated the way parents come to perceive their infant's temperament as difficult, and to identify factors influencing parents' impression formation. Subjects were 40 middle and lower middle class breastfeeding mothers and their singleton newborns of 38 weeks gestation and 2500 grams birth weight. All mothers…

  10. "Chalepa Ta Kala," "Fine Things Are Difficult": Socrates' Insights into the Psychology of Teaching and Learning

    Science.gov (United States)

    Mintz, Avi I.

    2010-01-01

    The proverb "chalepa ta kala" ("fine things are difficult") is invoked in three dialogues in the Platonic corpus: "Hippias Major," "Cratylus" and "Republic." In this paper, I argue that the context in which the proverb arises reveals Socrates' considerable pedagogical dexterity as he uses the proverb to rebuke his interlocutor in one dialogue but…

  11. Information-Limited Parallel Processing in Difficult Heterogeneous Covert Visual Search

    Science.gov (United States)

    Dosher, Barbara Anne; Han, Songmei; Lu, Zhong-Lin

    2010-01-01

    Difficult visual search is often attributed to time-limited serial attention operations, although neural computations in the early visual system are parallel. Using probabilistic search models (Dosher, Han, & Lu, 2004) and a full time-course analysis of the dynamics of covert visual search, we distinguish unlimited capacity parallel versus serial…

  12. Generalization of Changes in Children's Preferences for Easy or Difficult Goals Induced through Peer Modeling.

    Science.gov (United States)

    Sagotsky, Gerald; Lepper, Mark R.

    1982-01-01

    Explores the generalization of changes in children's preferences for easy or difficult goals, when their preferences are induced by exposure to peer models playing a novel athletic game. Subjects played the same game immediately after exposure, participated in a "spelling bee" three weeks later, and chose puzzles of differing levels of difficulty…

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

    Directory of Open Access Journals (Sweden)

    R V Narayana

    2013-01-01

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

  14. Making Difficult History Public: The Pedagogy of Remembering and Forgetting in Two Washington DC Museums

    Science.gov (United States)

    Segall, Avner

    2014-01-01

    In this article, Avner Segall explores some pedagogical processes in the context of two museums in Washington, DC, that focus on difficult knowledge, the National Museum of the American Indian (NMAI) and the United States Holocaust Memorial Museum. In doing so, Segall's aim is not to explore the museums as a whole or provide a comprehensive…

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    A. Lesco

    2006-01-01

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

  17. "DIFFICULT AIRWAY MANAGEMENT IN A PATIENT WITH TREACHER-COLLIN’S SYNDROME WITH INTUBATING LARYNGEAL MASK AIRWAY "

    Directory of Open Access Journals (Sweden)

    M. Gharebaghian

    2006-08-01

    Full Text Available Treacher Collin’s syndrome (TCS is a rare inherited condition characterized by bilateral and symmetric abnormalities of structures within the first and second bronchial arches. Patients with TCS present a serious problem to anesthetists maintaining their airway as upper airway obstruction and difficult tracheal intubation due to severe facial deformity. Because of retrognathia, airway management of these patients is often challenging. We report the case of a 25-yr-old patient with TCS undergoing microtia repair under general anesthesia twice. In the first time he could not be intubated via direct laryngoscopy and was intubated via blind nasal intubation. In the second time, he was intubated through an ILMA using endotracheal tube.

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

    Science.gov (United States)

    Vidal-Fernández, Ana; Megías, Jesús L

    2014-01-01

    This study aimed to analyze the influence of victim-related and observer-related factors in victim blaming of battered women. Two hundred and forty six college students participated. They were asked to read a scenario describing a hypothetical case of physical violence perpetrated by a man against his partner. Depending on the experimental condition, the victim was described either as a feminist and/or as exhibiting difficulties in her relationship with others or not. A hierarchical regression analysis was performed with victim blaming as dependent variable. Participants' hostile sexism positively predicted victim blaming when the victim was described as a feminist and as a "difficult to deal with" woman (p feminist woman (p < .001). These results underscore the importance of victim-related and observer-related factors, and of their interaction, in blaming the victim of gender-based violence. PMID:25011491

  19. Methods of corrosion diagnosis for purposes of combustion of difficult fuels; Methoden der Korrosionsdiagnose bei der Verbrennung schwieriger Brennstoffe

    Energy Technology Data Exchange (ETDEWEB)

    Beckmann, Michael; Krueger, Sascha; Gebauer, Kathrin; Pohl, Martin [Technische Univ. Dresden (Germany). Fakultaet Maschinenwesen; Spiegel, Wolfgang; Mueller, Wolfgang [CheMin GmbH Chemische und Mineralogische Untersuchungen, Augsburg (Germany)

    2009-07-01

    Biomasses and substitute fuels classify as difficult fuels on account of their high scale formation and corrosion potential. The methods used for assessing this damage potential can be divided into three categories: diagnosis based on the fuel itself; diagnosis during operation of the energy production plant; and diagnosis by regular monitoring during downtimes. For the final assessment it is important to give due consideration to the characteristics of both the fuel and the firing process. Study of the fuel alone would not give a sufficiently accurate picture of the real situation. Setting the assessment on a broader basis provides greater leeway in decisions of fuel selection, conditioning and mix, selection and combination of protective measures, firing control and selection of parameters used to steer plant output and thus ultimately contributes to optimising energy efficiency.

  20. Laryngoscope and a new tracheal tube assist lightwand intubation in difficult airways due to unstable cervical spine.

    Directory of Open Access Journals (Sweden)

    Cai-neng Wu

    Full Text Available The WEI Jet Endotracheal Tube (WEI JET is a new tracheal tube that facilitates both oxygenation and ventilation during the process of intubation and assists tracheal intubation in patients with difficult airway. We evaluated the effectiveness and usefulness of the WEI JET in combination with lightwand under direct laryngoscopy in difficult tracheal intubation due to unstable cervical spine.Ninety patients with unstable cervical spine disorders (ASA I-III with general anaesthesia were included and randomly assigned to three groups, based on the device used for intubation: lightwand only, lightwand under direct laryngoscopy, lightwand with WEI JET under direct laryngoscopy.No statistically significant differences were detected among three groups with respect to demographic characteristics and C/L grade. There were statistically significant differences between three groups for overall intubation success rate (p = 0.015 and first attempt success rate (p = 0.000. The intubation time was significantly longer in the WEI group (110.8±18.3 s than in the LW group (63.3±27.5 s, p = 0.000 and DL group (66.7±29.4 s, p = 0.000, but the lowest SpO2 in WEI group was significantly higher than other two groups (p<0.01. The WEI JET significantly reduced successful tracheal intubation attempts compared to the LW group (p = 0.043. The severity of sore throat was similar in three groups (p = 0.185.The combined use of WEI JET under direct laryngoscopy helps to assist tracheal intubation and improves oxygenation during intubation in patients with difficult airway secondary to unstable spine disorders.Chinese Clinical Trial Registry ChiCTR-TRC-14005141.

  1. Pediatric Interstitial Lung Disease Masquerading as Difficult Asthma: Management Dilemmas for Rare Lung Disease in Children

    Directory of Open Access Journals (Sweden)

    EY Chan

    2005-01-01

    Full Text Available Idiopathic nontransplant-related childhood bronchiolitis obliterans is an uncommon disease. Most patients present with chronic recurrent dyspnea, cough and wheezing, which are also features of asthma, by far a much more common condition. The present case study reports on a six-year-old girl who presented to a tertiary care centre with recurrent episodes of respiratory distress on a background of baseline tachypnea, chronic hypoxemia and exertional dyspnea. Her past medical history revealed significant lung disease in infancy, including respiratory syncytial virus bronchiolitis and repaired gastroesophageal reflux. She was treated for 'asthma exacerbations' throughout her early childhood years. Bronchiolitis obliterans was subsequently diagnosed with an open lung biopsy. She did not have sustained improvement with systemic corticosteroids, hydroxychloroquine or clarithromycin. Cardiac catheterization confirmed the presence of secondary pulmonary hypertension. Treatment options remain a dilemma for this patient because there is no known effective treatment for this condition, and the natural history is not well understood. The present case demonstrates the need for careful workup in 'atypical asthma', and the urgent need for further research into the rare lung diseases of childhood.

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

    DEFF Research Database (Denmark)

    Halttunen, Jorma; Meisner, Søren; Aabakken, Lars;

    2014-01-01

    BACKGROUND: The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). AIMS: To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. PATIENTS AND METHODS: Prospective consecutive reco...

  3. Theory including future not excluded

    DEFF Research Database (Denmark)

    Nagao, K.; Nielsen, H.B.

    2013-01-01

    , Ehrenfest's theorem, and the conserved probability current density. In addition,we showthat the expectation value at the present time t of a future-included theory for large T - t and large t - T corresponds to that of a future-not-included theory with a proper inner product for large t - T. Hence, the CAT......We study a complex action theory (CAT) whose path runs over not only past but also future. We show that, if we regard a matrix element defined in terms of the future state at time T and the past state at time TA as an expectation value in the CAT, then we are allowed to have the Heisenberg equation...

  4. Perinatal risk factors including malformation

    International Nuclear Information System (INIS)

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

  5. The Difficult Patient Stress Scale: a new instrument to measure interpersonal stress in nursing.

    Science.gov (United States)

    Santamaria, N

    1995-01-01

    This study describes the development of the Difficult Patient Stress Scale, an instrument designed to investigate the stress that nurses experience when they are involved in interpersonal conflict with patients. The DPSS is based on the theoretical conceptualization of stress proposed by DeLongis, Lazarus and Folkman and on the personality theory of Individual Psychology. The DPSS utilises visual analog scales to measure nurses' responses to hypothetical scenarios that present typical, difficult nurse-patient situations. The DPSS has been tested over a period of two years with 228 nurses and the results to date indicate that it is valid, reliable and suitable for use in the clinical environment. It is proposed that it may provide a useful instrument for exploring the impact and frequency of interpersonal stressors in nursing and may assist in the development of educational programs to better equip nurses to deal with interpersonal nurse-patient conflict.

  6. Solid-phase peptide synthesis: from standard procedures to the synthesis of difficult sequences.

    Science.gov (United States)

    Coin, Irene; Beyermann, Michael; Bienert, Michael

    2007-01-01

    This protocol for solid-phase peptide synthesis (SPPS) is based on the widely used Fmoc/tBu strategy, activation of the carboxyl groups by aminium-derived coupling reagents and use of PEG-modified polystyrene resins. A standard protocol is described, which was successfully applied in our lab for the synthesis of the corticotropin-releasing factor (CRF), >400 CRF analogs and a countless number of other peptides. The 41-mer peptide CRF is obtained within approximately 80 working hours. To achieve the so-called difficult sequences, special techniques have to be applied in order to reduce aggregation of the growing peptide chain, which is the main cause of failure for peptide chemosynthesis. Exemplary application of depsipeptide and pseudoproline units is shown for synthesizing an extremely difficult sequence, the Asn(15) analog of the WW domain FBP28, which is impossible to obtain using the standard protocol.

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

    Directory of Open Access Journals (Sweden)

    Vijay Kumar Agrawal

    2014-01-01

    Full Text Available Potassium permanganate (KMnO 4 is rarely used for suicidal attempt. Its ingestion can lead to local as well as systemic toxicities due to coagulation necrosis and damage, caused by free radicals of permanganate. We recently managed a case of suicidal ingestion of KMnO 4 in a lethal dose. She had significant narrowing of upper airway leading to difficult intubation as well as hepatic dysfunction and coagulopathy as systemic manifestation. We suggest to keep ourselves ready to handle difficult airway with the aid of fiber optic bronchoscope or surgical airway management in such patients. Upper gastrointestinal (GI endoscopy should be done at the earliest to determine the extent of upper GI injury and further nutrition planning.

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

    OpenAIRE

    AndreasVon Leupoldt

    2010-01-01

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

  9. Role of locking plates in treatment of difficult ununited fractures: a clinical study

    Institute of Scientific and Technical Information of China (English)

    Ashok Kumar; Himanshu Gupta; Chandra Shekhar Yadav; Shah Alam Khan; Shishir Rastogi

    2013-01-01

    Objective:To present our experience in treatment of difficult ununited long bone fractures with locking plate.Methods:Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done.Fixation was done with locking plate for femoral shaft fracture (3 patients),supracondylar fracture of femur (gap nonunion),fracture of clavicle,fracture of both forearm bones (radius and ulna) fracture of ulna,fracture of shaft of humerus,fracture of tibial diaphysis and supracondylar fracture of humerus (one patient each).Five fractures had more than one previous failed internal fixation.One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks.Seven fractures were atrophic,two were oligotrophic,and one was hypertrophic.Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients.Results:Minimum follow-up was 6 months (range,6 months to 2.5 years).Average rime for union was 3.4 months (range 2.5 to 6 months).None of the patients had platerelated complications or postoperative wound infections.Conclusion:Along with achieving stability with locking compression plate,meticulous soft tissue dissection,acceptable reduction,good fixation technique and bone grafting can help achieve union in difficult nonunion cases.Though locking plate does not by itself ensure bony union,we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    on the frequency of unanticipated difficult airway management.To prevent outcome bias and selective reporting, we hereby present a detailed statistical analysis plan as an amendment (update) to the previously published protocol for the DIFFICAIR trial. METHOD/DESIGN: The DIFFICAIR trial is a stratified, parallel...... trial by an a priori publication of a statistical analysis plan. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01718561....

  11. The Origin and Age of Scallop Floodplain Benches from Difficult Run, Fairfax County, Virginia.

    Science.gov (United States)

    Scamardo, J. E.; Pizzuto, J. E.; Skalak, K.; Benthem, A.

    2015-12-01

    Sediment is deposited within scallop-shaped erosional scarps that form between trees armoring the banks of Difficult Run, a suburban watershed with a forested riparian zone. These deposits create small (surface area 85 m2, volume 300 m3), low-lying floodplain landforms this group terms Scallop Floodplain Benches (SFB). It is hypothesized that SFB formed within the past couple decades initially forming as transversal accretion deposits and eventually gaining floodplain features dominated by vertical accretion. Stratigraphic data supports that SFB deposits begin laterally as sand and gravel bars approximately 100 cm thick, and continue to grow by vertical accretion of sand, silt, and clay. As a SFB reaches its maximum height, a distinctive levee develops adjacent to the channel, and fine-grained silt and clay are deposited behind the levee. Core samples to a depth of 118 cm and additional samples from an overbank event that occurred on June 20, 2015 were collected from one of two SFB on Difficult Run near Leesburg Pike. The grain size distribution was measured using a Coulter Counter and activities of Pb-210, Cs-137, and Be-7 were measured using High Purity Germanium Detectors. Cs-137 activities are relatively constant with depth without a well-defined peak, suggesting that the SFB was deposited after 1963. Be-7 is present in the recent flood deposits, but is absent below the surface, suggesting that the SFB deposits are at least several years old. Excess Pb-210 activities decrease exponentially with depth, and can be fit using the Constant Rate of Supply method to determine an average age of approximately 13.5 years for the SFB. The SFB is storing sediment at a rate of 27 tons/year, which is equal to 0.35% of the annual sediment load of Difficult Run, based on this average age. SFB appear to be a significant component of the sediment storage of Difficult Run and therefore should be considered in the sediment budget.

  12. Simple solution for difficult face mask ventilation in children with orofacial clefts.

    Science.gov (United States)

    Veerabathula, Prardhana; Patil, Manajeet; Upputuri, Omkar; Durga, Padmaja

    2014-10-01

    Significant air leak from the facial cleft predisposes to difficult mask ventilation. The reported techniques of use of sterile gauze, larger face mask and laryngeal mask airway after intravenous induction have limited application in uncooperative children. We describe the use of dental impression material molded to the facial contour to cover the facial defect and aid ventilation with an appropriate size face mask in a child with a bilateral Tessier 3 anomaly.

  13. Mechanical lithotripsy and/or stenting in management of difficult common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Adem Akcakaya; Orhan Veli Ozkan; Gurhan Bas; Atilla Karakelleoglu; Orhan Kocaman; Ismail Okan; Mustafa Sahin

    2009-01-01

    BACKGROUND: Mechanical lithotripsy and/or stent insertion is the alternative therapeutic approach in difficult endoscopic retrograde cholangiopancreatography (ERCP) case. This study was designed to investigate the appropriate treatment for extraction of bile duct stones in difficult cases of ERCP. METHODS: Between 2000 and 2008, 744 ERCP procedures were performed in 592 patients with choledocholithiasis in our endoscopy unit. The demographic features, and clinical and laboratory findings were collected from a prospectively held database. Bile duct calculi were extracted by basket and/or balloon catheter following ERCP and sphincterotomy. Patients with retained stones were regarded as difficult cases. These patients were treated with mechanical lithotripsy and those with incomplete clearance of stones underwent stent placement. RESULTS: Two hundred and forty-five patients (41%) were male and 347 (59%) were female with a mean age of 58 years (range 19-95 years). Stones were impacted in 27 patients (5%). Stone extraction was performed by basket and/or balloon catheter in 610 ERCP procedures, and lithotripsy was performed in 70 ERCP procedures. Forty-four patients underwent stent insertion, and 20 underwent stent replacement. Morbidity occurred in 39 patients (5%), with no mortality associated with the procedure. Hemorrhage occurred in 9 patients and basket impaction in 4. Mild pancreatitis and cholangitis developed in 12 and 11 patients, respectively. CONCLUSION: Difficult cases of bile duct stones can be treated successfully with lithotripsy, and a stent should be applied when the common bile duct cannot be cleared completely.

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

    Directory of Open Access Journals (Sweden)

    Kundan Sandugir Gosavi

    2015-06-01

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

  15. The causes of difficult tracheal intubation and preoperative assessments in different age groups

    OpenAIRE

    Moon, Hyoung-Yong; Baek, Chong Wha; Kim, Jin-Seo; Koo, Gill Hoi; Kim, Jin-Yun; Woo, Young-Cheol; Jung, Yong Hun; Kang, Hyun; Shin, Hwa-Yong; Yang, So-Young

    2013-01-01

    Background We studied the differences in airway assessment factors among old, middle, and young age groups, and evaluated the frequency and causes of difficult intubation among these groups. Methods Patients were divided into young (< 40 yr, n = 75 ), middle (40-59 yr, n = 83), and old (≥ 60 yr, n = 89) group. Airway assessment factors such as head and neck movement, thyromental distance, interincisor gap, dentition, Mallampati score, and Arné score were assessed. After muscle relaxation, cer...

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

    Directory of Open Access Journals (Sweden)

    Kouhei Iwashita

    2014-07-01

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

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

    OpenAIRE

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

    2014-01-01

    Potassium permanganate (KMnO 4 ) is rarely used for suicidal attempt. Its ingestion can lead to local as well as systemic toxicities due to coagulation necrosis and damage, caused by free radicals of permanganate. We recently managed a case of suicidal ingestion of KMnO 4 in a lethal dose. She had significant narrowing of upper airway leading to difficult intubation as well as hepatic dysfunction and coagulopathy as systemic manifestation. We suggest to keep ourselves ready to handle difficul...

  18. Which Cicadellid Species (Homoptera) are Difficult to Find in a Heterogeneous Habitat?

    OpenAIRE

    Kamitani, Satoshi; Saito, Aya

    2001-01-01

    The factors that determine which cicadellid species are easy or difficult to find in a heterogeneous habitat are discussed. The probability of finding a cicadellid and the estimated true species richness were computed by the randomized species accumulation curve. The mean observed richness and estimated true species richness were 15.1 and 27.0 species, respectively. incidence, temporal abundance, annual abundance, and host plant type were used for the analyses. The most influential factor was...

  19. Determination of difficult concepts in the interpretation of musculoskeletal radiographs using a web-based learning/teaching tool

    Energy Technology Data Exchange (ETDEWEB)

    Nunn, Heidi, E-mail: heidi@imageinterpretation.co.uk [Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom); Nunn, David L. [Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom)

    2011-11-15

    Aim: To identify which aspects of musculoskeletal radiograph image interpretation users of a web-based learning resource found to be most difficult. Method: The resource provides modular online training, based on twelve musculoskeletal anatomical and pathological areas. At the end of each module is a multiple choice self-test, which users can utilize to consolidate their learning. There are 217 questions within the tests. The results for all questions answered on or before 1st February 2011 were analyzed, and the lowest scoring 25% of questions subsequently reviewed. A low-scoring question implies that the subject was difficult. Results: Users provided a total of 117,097 answers. The range of scores provided by the test questions varied significantly (P < 0.0001), from 15.8% to 93.8%. Topics appearing in the lowest quartile were analyzed in detail. They included interpretation of paediatric radiographs, the Salter-Harris classification, soft-tissue signs and the identification of multiple injuries. The lowest scoring modules were the shoulder and ankle. Conclusion: The results of this study will help to guide educators both within radiography and other health professions in providing more targeted teaching in musculoskeletal image interpretation.

  20. Determination of difficult concepts in the interpretation of musculoskeletal radiographs using a web-based learning/teaching tool

    International Nuclear Information System (INIS)

    Aim: To identify which aspects of musculoskeletal radiograph image interpretation users of a web-based learning resource found to be most difficult. Method: The resource provides modular online training, based on twelve musculoskeletal anatomical and pathological areas. At the end of each module is a multiple choice self-test, which users can utilize to consolidate their learning. There are 217 questions within the tests. The results for all questions answered on or before 1st February 2011 were analyzed, and the lowest scoring 25% of questions subsequently reviewed. A low-scoring question implies that the subject was difficult. Results: Users provided a total of 117,097 answers. The range of scores provided by the test questions varied significantly (P < 0.0001), from 15.8% to 93.8%. Topics appearing in the lowest quartile were analyzed in detail. They included interpretation of paediatric radiographs, the Salter-Harris classification, soft-tissue signs and the identification of multiple injuries. The lowest scoring modules were the shoulder and ankle. Conclusion: The results of this study will help to guide educators both within radiography and other health professions in providing more targeted teaching in musculoskeletal image interpretation.

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

    Science.gov (United States)

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

    1982-03-01

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

  2. Biodiversity conservation including uncharismatic species

    DEFF Research Database (Denmark)

    Muñoz, Joaquin

    2007-01-01

    Recent papers mention ideas on the topics of biodiversity conservation strategies and priorities (Redford et al. 2003; Lamoreux et al. 2006; Rodrı´guez et al. 2006), the current status of biodiversity (Loreau et al. 2006), the obligations of conservation biologists regarding management policies...... (Chapron 2006; Schwartz 2006), and the main threats to biodiversity (including invasive species) (Bawa 2006). I suggest, however, that these articles do not really deal with biodiversity. Rather, they all focus on a few obviously charismatic groups (mammals, birds, some plants, fishes, human culture...

  3. "Passive-bending colonoscope" significantly improves cecal intubation in difficult cases

    Institute of Scientific and Technical Information of China (English)

    Takeshi Mizukami; Haruhiko Ogata; Toshihumi Hibi

    2012-01-01

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

  4. EVALUATION AND MANAGEMENT OF DIFFICULT AIRWAY IN OBESITY A SINGLE CENTER RETROSPECTIVE STUDY.

    Science.gov (United States)

    Ayhan, Asude; Kaplan, Serife; Kayhan, Zeynep; Arslan, Gulnaz

    2016-03-01

    The primary aim of this single center retrospective study was to evaluate difficult mask ventilation (DMV) and difficult laryngoscopy (DL) in a unique group of obese patients. A total of 427 adult patients with body mass index (BMI) ≥ 25 and surgically treated for endometrial cancer from 2011 to 2014 were assessed. Additional increase in BMI, comorbidities, bedside screening tests for risk factors, and the tools used to manage the patients were noted and their effects on DMV and/or DL investigated. Every escalation in the number of risk factors increased the probability of DMV 2.2-fold, DL 1.8-fold and DMV+DL 3.0-fold. Among bedside tests, limited neck movement (LNM), short neck (SN) and absence of teeth were significant for DMV (p sleep apnea for DL (p risk factor when patients with BMI > 25% were considered. In conclusion, LNM and SN are independent risk factors for developing DMV and/or DL in obese endometrial cancer patients, while BMI increase over 30 was not additionally affecting difficult airway. PMID:27276769

  5. Defense Waste Management Plan for buried transuranic-contaminated waste, transuranic-contaminated soil, and difficult-to-certify transuranic waste

    International Nuclear Information System (INIS)

    GAO recommended that DOE provide specific plans for permanent disposal of buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste; cost estimates for permanent disposal of all TRU waste, including the options for the buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste; and specific discussions of environmental and safety issues for the permanent disposal of TRU waste. Purpose of this document is to respond to the GAO recommendations by providing plans and cost estimates for the long-term isolation of the buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste. This report also provides cost estimates for processing and certifying stored and newly generated TRU waste, decontaminating and decommissioning TRU waste processing facilities, and interim operations

  6. Families classification including multiopposition asteroids

    Science.gov (United States)

    Milani, Andrea; Spoto, Federica; Knežević, Zoran; Novaković, Bojan; Tsirvoulis, Georgios

    2016-01-01

    In this paper we present the results of our new classification of asteroid families, upgraded by using catalog with > 500,000 asteroids. We discuss the outcome of the most recent update of the family list and of their membership. We found enough evidence to perform 9 mergers of the previously independent families. By introducing an improved method of estimation of the expected family growth in the less populous regions (e.g. at high inclination) we were able to reliably decide on rejection of one tiny group as a probable statistical fluke. Thus we reduced our current list to 115 families. We also present newly determined ages for 6 families, including complex 135 and 221, improving also our understanding of the dynamical vs. collisional families relationship. We conclude with some recommendations for the future work and for the family name problem.

  7. Including Magnetostriction in Micromagnetic Models

    Science.gov (United States)

    Conbhuí, Pádraig Ó.; Williams, Wyn; Fabian, Karl; Nagy, Lesleis

    2016-04-01

    The magnetic anomalies that identify crustal spreading are predominantly recorded by basalts formed at the mid-ocean ridges, whose magnetic signals are dominated by iron-titanium-oxides (Fe3-xTixO4), so called "titanomagnetites", of which the Fe2.4Ti0.6O4 (TM60) phase is the most common. With sufficient quantities of titanium present, these minerals exhibit strong magnetostriction. To date, models of these grains in the pseudo-single domain (PSD) range have failed to accurately account for this effect. In particular, a popular analytic treatment provided by Kittel (1949) for describing the magnetostrictive energy as an effective increase of the anisotropy constant can produce unphysical strains for non-uniform magnetizations. I will present a rigorous approach based on work by Brown (1966) and by Kroner (1958) for including magnetostriction in micromagnetic codes which is suitable for modelling hysteresis loops and finding remanent states in the PSD regime. Preliminary results suggest the more rigorously defined micromagnetic models exhibit higher coercivities and extended single domain ranges when compared to more simplistic approaches.

  8. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem

    Energy Technology Data Exchange (ETDEWEB)

    Callstrom, Matthew R.; Charboneau, J. William; Atwell, Thomas D.; Farrell, Michael A.; Welch, Timothy J.; Maus, Timothy P. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Goetz, Matthew P.; Rubin, Joseph [Mayo Clinic, Department of Oncology, Rochester, MN (United States)

    2006-01-01

    Painful skeletal metastases are a common problem in cancer patients. Although external beam radiation therapy is the current standard of care for cancer patients who present with localized bone pain, 20-30% of patients treated with this modality do not experience pain relief, and few further options exist for these patients. For many patients with painful metastatic skeletal disease, analgesics remain the only alternative treatment option. Recently, image-guided percutaneous methods of tumor destruction have proven effective for treatment of this difficult problem. This review describes the application, limitations, and effectiveness of percutaneous ablative methods including ethanol, methyl methacrylate, laser-induced interstitial thermotherapy (LITT), cryoablation, and percutaneous radiofrequency ablation (RFA) for palliation of painful skeletal metastases. (orig.)

  9. Condition Monitoring

    DEFF Research Database (Denmark)

    Avenas, Yvan; Dupont, Laurent; Baker, Nick;

    2015-01-01

    Power conversion systems are dependent on the performance and reliability of static converters. However, they are subject to frequent functional and environmental strains, which can induce failures. The anticipation of these failures is difficult but important so the operation of a system can be ...

  10. History Matters: What Happens When African Americans Confront Their Difficult Past.

    Science.gov (United States)

    Seitz, Phillip

    2016-05-01

    History and Reconstruction is an interdisciplinary project to assess the impact of African American history education for black men. Under the theory of trauma recovery, leading scholars of African American history worked with a group of ten ex-offenders, supported by the services of a psychologist and an African American cultural expert and storyteller. Results based on psychological testing and qualitative feedback showed that history can be a catalyst for personal development and transformation. It also demonstrated that difficult history can be taught and assimilated for audience benefit. History and Reconstruction was supported by the Pew Center for Arts and Heritage.

  11. Percutaneous treatment of Lutembacher syndrome in a case with difficult mitral valve crossing.

    Science.gov (United States)

    Bhambhani, Anupam; Somanath, H S

    2012-03-01

    Most cases of combination congenital cardiac anomalies are treated with open-heart surgeries because the coexisting anomalies change the cardiac anatomy in an adverse way, making catheter manipulations complex. Lutembacher syndrome is a combination of acquired mitral stenosis and congenital ostium secundum atrial septal defect. The large defect in the septum makes an Inoue balloon catheter unstable, which provides excessive space for free floatation of the catheter, making its passage into the left ventricle difficult by Inoue technique. We present a case of elective definitive percutaneous treatment of Lutembacher syndrome, discussing the technical difficulties faced in mitral valve crossing and reviewing the possible strategies to improve chances of success. PMID:22388316

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

    OpenAIRE

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

    1992-01-01

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

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

    DEFF Research Database (Denmark)

    Vudayagiri, Sindhu; Skov, Anne Ladegaard

    2014-01-01

    permissible thickness is around 25–50 µm. The relatively small Young's modulus for these elastomers is a requirement for actuation capabilities. However, peeling and release of such films during manufacture processes are very difficult. To ease the release of the films, techniques such as the use of release...... agents like surfactants and detergents, incorporating resins in the silicone matrix and grafting/adding low surface energy functionalities to the silicone elastomer have been tested. The methods used are required not to interfere with the Young's modulus and the dielectric permittivity in a negative way...

  14. WHICH ASPECTS OF THE ENGLISH LANGUAGE DO DISTANCE LEARNERS FIND DIFFICULT?

    Directory of Open Access Journals (Sweden)

    George Boon Sai TEOH

    2016-07-01

    Full Text Available This paper reports the findings of a research carried out on distance learners at the School of Distance Education, Universiti Sains Malaysia. The research aimed to identify the aspects of the English language which distance learners found difficult to learn. A total of 512 students who enrolled in the JUE300 English II course responded to the quantitative questionnaire. Findings indicate that the distance learners reported that speaking, vocabulary and grammar were aspects they found most difficult when learning the English language. Based on the findings, the researchers made several recommendations for designers and instructors of English language learning courses in distance education. The course designers should 1 be aware of the particular needs of the distance learners 2 increase the number of contact hours via teleconferencing sessions or traveling to regional centres to meet the students and create opportunities for students to learn, interact and seek answers to their queries in the target language 3 guide and motivate the students to spend sufficient time on reading and enriching their vocabulary, practicing their communication skills and learning grammar.

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

    LENUS (Irish Health Repository)

    Maharaj, C H

    2008-02-01

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

  16. On the Improvement of Multi-Legged Locomotion over Difficult Terrains using a Balance Stabilization Method

    Directory of Open Access Journals (Sweden)

    Javaid Iqbal

    2012-03-01

    Full Text Available This paper deals with the real‐time walking of a multi-legged robot over difficult terrains using a balance stabilization method in order to achieve a fast speed and robust locomotion with minimal tracking errors. The stabilization method is described through a ZMP‐based online pattern‐generation scheme inspired by bio‐mimetic stepping leg transferences with an active balance control so as to reduce the propagation of instability while performing rapid stepping actions for a fast walking gait in the presence of external disturbances. The proposed control system uses a force‐position controller [14] which takes impact dynamics into consideration to compensate for the effect of external perturbations during walking by estimating impulsive forces in real‐time. Using the proposed stabilization method, the robot plans appropriate footholds on the ground in order to achieve a reasonable average walking speed over difficult terrains in a natural environment. The success and performance of the proposed method is realized through dynamic simulations and real‐world experiments using a six‐legged hexapod robot.

  17. Hypopituitarism and Legg-Calve-Perthes disease related to difficult delivery.

    Science.gov (United States)

    Baş, Veysel Nijat; Uytun, Salih; Vurdem, Ümit Erkan; Torun, Yasemin Altuner

    2015-07-01

    Legg-Calve-Perthes (LCP) disease is characterized by idiopathic avascular osteonecrosis of the epiphysis of the femur head. The main factor that plays a role in the etiology of the disease is decreased blood flow to the epiphysis. Many predisposing factors have been suggested in the etiology of LCP disease, and most have varying degrees of effects. Here we present the case of a boy aged 4 years and 10 months with complaints of short stature and a diagnosis of multiple hypophyseal hormone deficiency, in whom LCP disease and difficult birth-related pituitary stalk interruption syndrome were identified by anamnesis. The present case revealed that LCP disease and hypophyseal hormone deficiency could be secondary to difficult birth and that LCP disease could be secondary to insulin-like growth factor 1 deficiency. Additionally, to the best of our knowledge there is no published case on the relation between LCP disease and insulin-like growth factor 1 deficiency. Therefore, we believe that this case is worthy of presentation. PMID:26300943

  18. Les difficultés de la replantation. Quel avenir pour le cacao en Côte d’Ivoire ?

    Directory of Open Access Journals (Sweden)

    Ruf François

    2001-11-01

    Full Text Available La conférence internationale sur le thème « Quel avenir pour les cultures pérennes ? » est née de deux préoccupations. La première recouvre le champ des difficultés de la replantation, difficultés techniques, économiques mais aussi environnementales, sociales et politiques : comment replanter 1 ? La seconde est la baisse des cours, probablement structurelle, de la plupart des matières premières agricoles, notamment de celles produites par des cultures pérennes. Si les prix restent aussi bas de façon aussi durable, pourquoi replanter ? De même qu’il est toujours de bon aloi d’acheter des actions quand la bourse s’écroule, les économistes recommandent de planter quand les cours des matières premières sont à leur plancher. Toutefois, si des centaines de milliers d’hectares sont plantés par des producteurs qui anticipent une remontée des cours, celle-ci peut alors être fort retardée. Cette capacité à anticiper un retour à des prix élevés est ainsi une des causes du prolongement de la phase des très bas prix du cacao jusqu’en 2001, ce qui semble bien relever d’un échec du marché 2. Le pourquoi et le comment de la replantation sont bien indissociables. Face aux enjeux, de nombreux pays détenteurs du patrimoine « cultures pérennes tropicales » ne manquent-ils pas d’une véritable politique de replantation prenant acte des changements nécessaires dans les conditions de production, se remettant en cause, tout en faisant face aux difficultés à interpréter les marchés ? Les problèmes de replantation ne peuvent se surmonter qu’à partir d’une compréhension des processus en œuvre, sur le terrain, en commençant par les décisions des producteurs. Les exemples, les études de cas, par village, par région, restent donc des fondamentaux pour une réflexion globale, pour une anticipation des problèmes, une action nationale, voire internationale, sur la replantation. En même temps, la question de

  19. Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship

    Directory of Open Access Journals (Sweden)

    Lamba, Sangeeta

    2015-03-01

    Full Text Available Introduction: The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM clerkship. Methods: We supplemented two case-based simulated resuscitation scenarios (cardiac arrest and blunt trauma with role-play in order to teach medical students how to deliver news of death and poor prognosis to family of the critically ill or injured simulated patient. Quantitative outcomes were assessed with pre and post-clerkship surveys. Secondarily, students completed a written self-reflection (things that went well and why; things that did not go well and why to further explore learner experiences with communication around resuscitation. Qualitative analysis identified themes from written self-reflections. Results: A total of 120 medical students completed the pre and post-clerkship surveys. Majority of respondents reported that they had witnessed or role-played the delivery of difficult news, but only few had real-life experience of delivering news of death (20/120, 17% and poor prognosis (34/120, 29%. This communication module led to statistically significant increased scores for comfort, confidence, and knowledge with communicating difficult news of death and poor prognosis. Pre-post scores increased for those agreeing with statements (somewhat/very much for delivery of news of poor prognosis: comfort 69% to 81%, confidence 66% to 81% and knowledge 76% to 90% as well as for statements regarding delivery of news of death: comfort 52% to 68%, confidence 57% to 76% and knowledge 76% to 90%. Respondents report that patient resuscitations (simulated and/or real generated a variety of strong emotional responses such as anxiety, stress, grief and feelings of loss and failure. Conclusion: A structured communication module supplements simulated resuscitation training in an EM clerkship and leads to a self-reported increase in knowledge

  20. [Pancreatic injury in abdominal trauma in children: difficult to diagnose and treat].

    Science.gov (United States)

    Fennema, Eelco M; Nellensteijn, David R; Nieuwenhuijs, Vincent B; van Rheenen, Patrick F; ten Duis, Henk-Jan; Hulscher, Jan B F

    2011-01-01

    Traumatic injury of the pancreas is rare in children. It is often difficult to diagnose due to the lack of signs and symptoms, and shortly after trauma laboratory values may be normal. In addition, ultrasound and CT are often not specific. The treatment of grade 1 and 2 injury is non-operative. Although there seems to be a shift towards non-operative management of grade 3-5 injuries (with injury of the pancreatic duct), this is still a matter of debate. We describe 3 children, a girl of 2.5 years-old and a boy of 7 years-old, with grade 3 pancreatic injuries and an 8-year-old boy with a grade 2 injury. We demonstrate that the diagnosis is hard to establish, while the consequences of this injury can be serious. Thinking of pancreatic injury is most important to its diagnosis. We advocate referral to or consultation of specialized centres in these cases.

  1. A case of hepatic angiomyolipoma difficult to distinguish from hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Navratil Marta

    2013-01-01

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

  3. Is a sigh "just a sigh"? Sighs as emotional signals and responses to a difficult task.

    Science.gov (United States)

    Teigen, Karl Halvor

    2008-02-01

    Sighing and the interpretation of sighs in everyday life seem never to have been the subject of psychological research. A questionnaire study of sighing showed that people associate sighing mainly with negative, low-intensity and deactivated emotional states. A second study investigated self/other differences in the interpretation of sighs in four hypothetical situations, revealing that sighs in other people are primarily perceived as signs of sadness, whereas own sighs are more often believed to express a state of "giving up" something or somebody. In a third experimental study participants worked on difficult (insoluble) puzzles, which generated many futile solution attempts, often accompanied by sighs. It is concluded that sighs are often unintentional expressions of an activity, plan or desire that has to be discarded, creating a pause before it can be replaced by a novel initiative.

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

    Directory of Open Access Journals (Sweden)

    Shiv PS Rana

    2011-01-01

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

  5. Diabetes and Pancreas: Why So Difficult? Potential Mechanisms of Elevated Serum Pancreatic Enzymes.

    Science.gov (United States)

    Matteucci, Elena; Giampietro, Ottavio

    2016-01-01

    Diabetes mellitus has been associated with a higher risk of exocrine pancreas disorders despite inconsistencies among studies, presumably due to the presence of several (often unmeasured) confounding factors. As a direct consequence of this uncertainty, the relationship between anti-diabetic therapies and pancreatic adverse reactions is difficult to evaluate and remains far from being clarified. Indeed, the on going debate on the safety of incretin-based therapies does not lie in any definite conclusion. Serum level of amylases and lipase reflects the balance between production from different tissues and clearance, but it may be also influenced by numerous molecular, cellular, and systems mechanisms. The present review tries to provide an overview of potential biochemical pathways that may underlie pancreatic hyperenzymemia in health and diabetes mellitus.

  6. Predictions of space physics are difficult, especially when they are about the future

    Science.gov (United States)

    Cassak, P.

    2015-12-01

    This talk is about the future of space physics, the broad field of study addressing how the sun works, its interaction with Earth and other planets via the solar wind and solar eruptions, and the region of interplanetary space out to the edge of the solar system. It is the chief field feeding into the development of tools for space weather prediction. Space physics is at an exciting - yet critical - time in its evolution. Scientifically, the capabilities afforded by new ground- and space-based observations and the rapidly increasing speed of supercomputing resources are leading to unprecedented progress in the field. Recently launched missions such as the Van Allen Probes and the Magnetospheric MultiScale (MMS) mission, and upcoming missions such as Solar Probe Plus and Solar Orbiter, will open doors to science not previously accessible through observations. Predicting the future of space physics is difficult; this talk will offer thoughts on the road forward.

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

    DEFF Research Database (Denmark)

    Damgaard, Christian

    2011-01-01

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

  8. Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects.

    Science.gov (United States)

    Mahajan, Khushbu; Relhan, Vineet; Relhan, Aditi Kochhar; Garg, Vijay Kumar

    2016-01-01

    Pityriasis rosea (PR) is a benign papulosquamous disorder seen commonly in clinical practice. Despite its prevalence and benign nature, there are still times when this common disorder presents in an uncommon way or course posing diagnostic or management problems for the treating physician. The etiopathogenesis of PR has always been a dilemma, and extensive research is going on to elicit the exact cause. This review focuses mainly on the difficult aspects of this benign common disorder such as etiopathogenesis, atypical manifestations, recurrent cases, differential diagnosis, therapy and pregnancy considerations. Although we could not find a black and white solution to all these problems, we have tried to compile the related literature to draw out some conclusions. PMID:27512182

  9. 980nm laser for difficult-to-treat basal cell carcinoma

    Science.gov (United States)

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

    2013-06-01

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

  10. Characteristic aspects of the housing and utilitiescomplex as a difficult organizational and economic system

    Directory of Open Access Journals (Sweden)

    Butyrin Andrey Yur'evich

    2014-02-01

    Full Text Available The existing system of housing and utility services functioning is carried out for providing the relevant living environment standards to the population by means of effective functioning of the system of uninterrupted providing housing and utility services according to existing requirements of the Russian standards. Today there is a number of problems, which doesn't allow housing and utility services to function effectively. The main of them is providing high-quality housing and utility services to the population and system of their objective cost assessment. This problem is solved by means of reforming the housing and utility sphere with the possibility of attracting financial resources from private investors. Housing and Utility of the Russian Federation, the basis of which is the housing stock, has a very high specific weight in fixed assets of all the economy.Thus, Housing and Utility is a typical difficult organizational and economic system possessing characteristic features of openness, nonlinearity and dissipativity. In this re-gard, the reasonable approach to Housing and Utility development assumes the need to account for the principles of systemacity, focus and complexity, and also can be based on the existing in the theory and practice of management methodology by difficult organizational and economic systems.Now Housing and Utility development and financing investment programs of the municipal complex organizations is carried out according to the relevant Federal law, according to which the establishment system of limit indexes of change of tariffs and investment extra charges to tariffs for services of the organizations of a municipal complex. Also, innovative ways of energy efficiency increase and decrease in wear of funds is an attempt of the state to develop effective mechanisms of attracting private funds from investors.

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

    Directory of Open Access Journals (Sweden)

    Claire E Stevenson

    2014-08-01

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

  12. Tectonique globale. Quelques difficultés Global Tectonics. a Few Problems

    Directory of Open Access Journals (Sweden)

    Vitart M. J.

    2006-11-01

    Full Text Available On constate que malgré la brillante démonstration apportée par les forages dans le fond des océans, les praticiens de la géologie observent une certaine réserve face aux concepts de la Tectonique globale. C'est que d'une part, certaines hypothèses de base sont difficiles à comprendre et que d'autre part, la théorie aide assez peu à la résolution des problèmes qui se présentent au géologue praticien. Nous prendrons comme exemple - la difficulté de l'interprétation des anomalies magnétiques des océans; - le problème des « structures reliques » en milieu océanique; - le problème du changement de plaque et de l'inversion du mouvement; - les bassins intraplaques transverses aux ouvertures. Despite the brilliant demonstration of drilling into ocean beds, geologists seems ta be maintaining a certain reserve when confronted with concepts of global tectonics. On one hand, some basic assumptions are difficult ta understand, and on the other the theory is of relatively little help in solving the problems faced by practicing geologists. A few examples of such problems are - the difficulty in interpreting magnetic anomalies in oceans; - the problem of « relic structures » in on oceanic environment; - the problem of plate changes and inversion of movements; - intraplate basins bridging openings.

  13. Visual relations children find easy and difficult to process in figural analogies.

    Science.gov (United States)

    Stevenson, Claire E; Alberto, Rosa A; van den Boom, Max A; de Boeck, Paul A L

    2014-01-01

    Analogical reasoning, the ability to learn about novel phenomena by relating it to structurally similar knowledge, develops with great variability in children. Furthermore, the development of analogical reasoning coincides with greater working memory efficiency and increasing knowledge of the entities and relations present in analogy problems. In figural matrices, a classical form of analogical reasoning assessment, some features, such as color, appear easier for children to encode and infer than others, such as orientation. Yet, few studies have structurally examined differences in the difficulty of visual relations across different age-groups. This cross-sectional study of figural analogical reasoning examined which underlying rules in figural analogies were easier or more difficult for children to correctly process. School children (N = 1422, M = 7.0 years, SD = 21 months, range 4.5-12.5 years) were assessed in analogical reasoning using classical figural matrices and memory measures. The visual relations the children had to induce and apply concerned the features: animal, color, orientation, position, quantity and size. The role of age and memory span on the children's ability to correctly process each type of relation was examined using explanatory item response theory models. The results showed that with increasing age and/or greater memory span all visual relations were processed more accurately. The "what" visual relations animal, color, quantity and size were easiest, whereas the "where" relations orientation and position were most difficult. However, the "where" visual relations became relatively easier with age and increased memory efficiency. The implications are discussed in terms of the development of visual processing in object recognition vs. position and motion encoding in the ventral ("what") and dorsal ("where") pathways respectively. PMID:25140160

  14. Bayesian Sampling using Condition Indicators

    DEFF Research Database (Denmark)

    Faber, Michael H.; Sørensen, John Dalsgaard

    2002-01-01

    The problem of control quality of components is considered for the special case where the acceptable failure rate is low, the test costs are high and where it may be difficult or impossible to test the condition of interest directly. Based on the classical control theory and the concept...... of condition indicators introduced by Benjamin and Cornell (1970) a Bayesian approach to quality control is formulated. The formulation is then extended to the case where the quality control is based on sampling of indirect information about the condition of the components, i.e. condition indicators...

  15. Assesment of Macintosh Laryngoscope and Truview EVO2 Video-laryngoscope With Respect to Hemodynamic and Intubation Quality in Patients With Presumptive Difficult Intubation

    OpenAIRE

    ÇAĞLAR TORUN, Aysun; TÜR, Ayla; Özkan, Fatih; KELSAKA, Ebru; Karakaya, Deniz; Sarihasan, Binnur; TORTOP, Emişe

    2011-01-01

    ABSTRACT This study aims to compare Macintosh laryngoscope and Truview EVO2 video- laryngoscope with respect to the quality of glottic image, the success rate of intubation and their impact on the duration of intubation, hemodynamic responses and also related complications in patients with expected difficult intubation according to the Mallampati scoring system. Sixty patients in ASA I-II group ranging from 18-65 years of age were included in the study. Patients were randomly divided into ...

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

    Science.gov (United States)

    D'Ambrosio, Lia; Tadolini, Marina; Centis, Rosella; Duarte, Raquel; Sotgiu, Giovanni; Aliberti, Stefano; Dara, Masoud; Migliori, Giovanni Battista

    2015-03-01

    Multi-drug and extensively drug-resistant tuberculosis (MDR/XDR-TB) are considered a serious threat for TB control and elimination. The outcome of these patients is still largely unsatisfactory as of today, with treatment success rates being consistently below 50% at global level. The World Health Organization (WHO) recommends that management of MDR-TB cases is supported by a specialized team, including complementary medical professionals able to cover several perspectives (clinical, both for adults and children; surgical; radiological; public health; psychological; nursing, among others). Implementation of such a body (known as Consilium in most of the former Soviet Union countries) is often a pre-requisite to apply for international TB control funding and concessionally priced medicines to treat M/XDR-TB cases. The primary objective of the ERS/WHO TB Consilium is to provide clinical consultation for drug-resistant TB and other difficult-to-treat TB cases, including co-infection with HIV and paediatric cases. Through technical guidance to clinicians managing complex TB cases, the main contribution and outcome of the initiative will be a public health response aimed at achieving correct treatment of affected patients and preventing further development of drug resistance. The Consilum's secondary objective is to ensure monitoring and evaluation of clinical practices on the ground (diagnosis, treatment and prevention).

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

    Science.gov (United States)

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

    2015-09-01

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

  18. EXTRACORPOREAL SEPTOPLA S TY USING POLYDIO XANONE PLATES v/s CONVENTIONAL SEPTOPLASTY IN MANAGEMENT OF DIFFICULT SEPTUM

    OpenAIRE

    Somu; Prasanna Kumar; Ravi Kumar; Urvashi; Prem; Gokul Anand

    2015-01-01

    BACKGROUND: The technique and management of deviated nasal septum has evolved over the last few centuries. However, difficult and severely deviated septum still poses a surgical challenge. Difficult septum is characterized by severe malformations of cartilaginous, bon y or both components, with significant airway block. Extracorporeal septoplasty with reconstruction with polydioxanone plates can be recommended as a viable alternative to conventional methods in ma...

  19. Sensitivity of palm print, modified mallampati score and 3-3-2 rule in prediction of difficult intubation

    Directory of Open Access Journals (Sweden)

    Ata Mahmoodpoor

    2013-01-01

    Full Text Available Background: This study evaluated the performance of modified Mallampati score, 3-3-2 rule and palm print in prediction of difficult intubation. Methods: In a prospective descriptive study, data from 500 patients scheduled for elective surgery under general anesthesia were collected. An anesthesiologist evaluated the airway using mentioned tests and another anesthesiologist evaluated difficult intubation. Laryngoscopic views were determined by Cormack and Lehane score. Grades 3 and 4 were defined as difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and Youden index were determined for all tests. Results: Difficult intubation was reported in 8.9% of the patients. There was a significant correlation between body mass index and difficult intubation (P : 0.004; however, other demographic characteristics didn′t have a significant correlation with difficult intubation. Among three tests, palm print was of highest specificity (96.46% and modified Mallampati of highest sensitivity (98.40%. In a combination of the tests, the highest specificity, sensitivity and Youden index were observed when using all three tests together. Conclusions: Palm print has a high specificity for prediction of difficult intubation, but the best way for prediction of difficult intubation is using all three tests together.

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

    Directory of Open Access Journals (Sweden)

    Holland Carolyn

    2006-10-01

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

  1. Chromosomal Conditions

    Science.gov (United States)

    ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Tools & ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Ask ...

  2. New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To retrospectively investigate the effect and safety of various new type precut sphincterotomy techniques (VNTPST) in endoscopic retrograde cholangiopancreatography (ERCP) due to difficult biliary duct cannulation (DBC).METHODS: A plough-like pull-type sphincterotome (PLPTS) or improved short nose sphincterotome or improved needle knife was applied. VNTPST was carried out in 30 of 280 patients, whose biliary tract could not be exposed well or deep cannulation was difficult to perform during ERCP with traditional methods. Patients were followed up for short-term complications and the therapeutic effect of VNTPS was observed and compared with that of traditional endoscopic sphincterotomy (EST).RESULTS: A total 280 patients underwent ERCP, of which 3 failed in operation because of pathological features in stomch or duodenum, 247 successfully underwent traditional ERCP (89.1%, 247/277), 30 failed (10.8%, 30/277). VNTPS technique succeeded in 24(80%, 24/30) of 30 cases. The successful rate of deep biliary duct cannulation increased 8.6% (24/277), the total cannulation successful rate following precut was 97.7%. There was a significant difference between the two groups (97.7% vs 89.1%, χ2= 17.1, P < 0.01).The incidence of complications was 9.3% (26/277) for traditional ERCP group and 13.3% (4/30) for VNTPS technique group. Guideline tip was broken in pancreatic duct (KPDGP) of one patient, and there was no pancreatitis, slight or moderate bleeding postoperatively occurred in 2 patients, 1 patient had bleeding during operation (PDWN). There were no differences between VNTPS technique group and traditional ERCP(TRERCP)group (13.3% vs 9.3%,χ2 = 0.478, P > 0.05).CONCLUSION: VNTPS procedure and Deng's precut are highly effective methods to get biliary access during ERCP with DBC. With skillful techniques, it can increase the successful rate for deep cannulation of biliary duct and decrease complications. VNTPS technique, especially Deng's precut is as effective and

  3. Truth conditions

    Institute of Scientific and Technical Information of China (English)

    张丽

    2009-01-01

    Truth conditions are used to determine whether a sentence is true or not in semantics. This article gives some examples both in English and Japanese to analyze truth conditions. Besides, the importance and the application of truth conditions are also mentioned.

  4. Why is biological science difficult for first-year nursing students?

    Science.gov (United States)

    McKee, Gabrielle

    2002-04-01

    Many factors contribute to poor performance in examinations in nurse education. Some of these are specific to the biological science subject area. In this study the results of two cohorts of first-year nursing students' biological science examination results were analysed to see if entry criteria and study habits significantly affected examination results. chi(2) contingency tables were used. The following parameters were shown to have a significant effect on biological science examination results: 1. Studied biology previously, chi(2)=48.06, DF=20, n=112 (significant at 0.001); 2. Level of achievement in school biology, chi(2)=11.15, DF=8, n=104 (significant at 0.05); 3. Attendance in class, chi(2)=60.71, DF=36, n=201 (significant at 0.001); 4. Use of recommended readings, chi(2)=34.86, DF=20, n=119 (significant at 0.05). Are nursing students of today giving themselves a decent chance through their study and attendance behaviour in a busy demanding course? Is overloading within the curriculum leading to these behaviours? This study shows that poor previous theoretical biological science significantly influenced biological science examination results. Biological science will continue to prove difficult, particularly for students who have a poor biological background, unless appropriate strategies are put in place both within the course and prior to entry. PMID:12027607

  5. Difficult diagnosis: strangulated obturator hernia in an 88-year-old woman.

    Science.gov (United States)

    Leitch, Megan Kathleen; Yunaev, Michael

    2016-01-01

    The obturator hernia is a rare type of hernia that can present a diagnostic challenge for the clinician. We report a case of an 88-year-old woman who presented with a history of right iliac fossa pain, bilious vomiting and diarrhoea. Non-specific findings on examination and blood tests made the diagnosis difficult, however, a CT scan of her abdomen revealed the site of the obstruction and the patient was taken to theatre for emergency surgery. We review the literature with focus on the diagnosis of obturator hernias and the different surgical approaches used. The authors believe that this case is of educational value to healthcare professionals, particularly those working in general practice, emergency departments and on surgical teams. It highlights to doctors that patients with incarcerated obturator hernias can present with or without overt signs of intestinal obstruction and emphasises the fact that an obturator hernia can be an important cause of intestinal obstruction in a thin, elderly woman. PMID:27358098

  6. Primary Hepatic Lymphoma Is Difficult to Discriminate from a Liver Abscess

    Directory of Open Access Journals (Sweden)

    Nobuhiro Takeuchi

    2014-01-01

    Full Text Available An 82-year-old woman presented with a high-grade fever of 40°C and was admitted to our institution for intensive examination and treatment. Noncontrast abdominal computed tomography (CT revealed low-density masses at segments 5 and 8, suggestive of a liver abscess. On further examination, a contrast-enhanced abdominal CT showed a 30×30 mm mass with an enhanced margin at segment 8 in the arterial phase; the contrast agents were washed out in the venous phase. In addition, a 63×52 mm mass with a density lower than that of liver parenchyma was observed at segment 8 in the portal phase. On the basis of these findings, either a liver abscess or hepatocellular carcinoma was suspected. To confirm the diagnosis, a fine needle biopsy was scheduled. Histopathological analysis of the biopsied specimens confirmed the diagnosis of diffuse large B-cell lymphoma. Chemotherapy was not indicated owing to the patient’s age and poor performance status; thus, best supportive care was planned. On day 22 after admission, the patient died of pneumonia. We experienced a case of PHL that was difficult to discriminate from a liver abscess. Imaging alone is insufficient to diagnose PHL; therefore, fine needle biopsy is recommended for a definitive diagnosis.

  7. The Difficult Conceptualisation of Circular Migration between the EU and the MENA Region

    Directory of Open Access Journals (Sweden)

    Tamirace FAKHOURY

    2010-05-01

    Full Text Available This article examines the extent to which circular migration (CM can be framed first as a useful migration typology and second as an efficient migration strategy in the MENA region and between the latter and the EU. After discussing the difficult conceptualisation of the circular migration model, it alludes to the inherent discrepancies between the normative, empirical and prescriptive connotations of the concept, then it analyses different examples of circularity in the MENA region and between the latter and the EU. It concludes that since the very concept of circular migration (as proposed by the EU is still in its exploratory and genesis phases, it is advisable to refrain from conferring an overvalued significance on the CM approach and to consider it rather as a strategy inherent to a more global approach to labour migration in the EU-MENA context. On a more theoretical level, and beyond the specificities of the EU and MENA, this article would suggest caution in the normative use of circular migration. As much contention prevails over circular migration as a migration typology, it would be recommendable that CM be rather considered an option, a policy initiative suitable for some countries more than others, or a strategy to manage migration trends in transnational contexts.

  8. Cyanoacrylate spray as treatment in difficult-to-manage gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Liz; Toapanta-Yanchapaxi; Norberto; Chavez-Tapia; Félix; Téllez-ávila

    2014-01-01

    Gastrointestinal bleeding can be a life-treating event that is managed with standard endoscopic therapy in the majority of cases. However, up to 5%-10% of patients may have persistent bleeding that does not respond to conventional measures. Several endoscopic treatment techniques have been proposed as strategies to control such cases, such as epinephrine injection, hemoclips or argon plasma coagulation, but there are certain clinical scenarios where it is difficult to achieve hemostasis even though adequate use of the available resources is made. Reasons for these failures can be associated with the lesion features, such as extent or location. The use of long-standing techniques in nontraditional scenarios, such as with cyanoacrylate for gastric varices sclerosis, has been reported with favorable results. Although new products such as TC-325 or Ankaferd Blood Stopper hemosprays may be useful, their formulations are not available worldwide. Here we present two clinical cases with very different scenarios of gastrointestinal bleeding, where the use of cyanoac-rylate in spray had favorable results in uncommon indications. Cyanoacrylate used as a spray is a technique that can be used as an alternative method in emergent settings.

  9. Regulating Emotions during Difficult Multiattribute Decision Making: The Role of Pre-Decisional Coherence Shifting.

    Directory of Open Access Journals (Sweden)

    Stephanie M Carpenter

    Full Text Available Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional "coherence shifting," the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1, and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2. Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3. Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed.

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  11. Regulating Emotions during Difficult Multiattribute Decision Making: The Role of Pre-Decisional Coherence Shifting.

    Science.gov (United States)

    Carpenter, Stephanie M; Yates, J Frank; Preston, Stephanie D; Chen, Lydia

    2016-01-01

    Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional "coherence shifting," the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed. PMID:26986752

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

    Science.gov (United States)

    Gansel, Yannis; Lézé, Samuel

    2015-10-01

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

  13. Goldilocks models of higher-dimensional inflation (including modulus stabilization)

    Science.gov (United States)

    Burgess, C. P.; Enns, Jared J. H.; Hayman, Peter; Patil, Subodh P.

    2016-08-01

    We explore the mechanics of inflation within simplified extra-dimensional models involving an inflaton interacting with the Einstein-Maxwell system in two extra dimensions. The models are Goldilocks-like inasmuch as they are just complicated enough to include a mechanism to stabilize the extra-dimensional size (or modulus), yet simple enough to solve explicitly the full extra-dimensional field equations using only simple tools. The solutions are not restricted to the effective 4D regime with H ll mKK (the latter referring to the characteristic mass splitting of the Kaluza-Klein excitations) because the full extra-dimensional Einstein equations are solved. This allows an exploration of inflationary physics in a controlled calculational regime away from the usual four-dimensional lamp-post. The inclusion of modulus stabilization is important because experience with string models teaches that this is usually what makes models fail: stabilization energies easily dominate the shallow potentials required by slow roll and so open up directions to evolve that are steeper than those of the putative inflationary direction. We explore (numerically and analytically) three representative kinds of inflationary scenarios within this simple setup. In one the radion is trapped in an inflaton-dependent local minimum whose non-zero energy drives inflation. Inflation ends as this energy relaxes to zero when the inflaton finds its own minimum. The other two involve power-law scaling solutions during inflation. One of these is a dynamical attractor whose features are relatively insensitive to initial conditions but whose slow-roll parameters cannot be arbitrarily small; the other is not an attractor but can roll much more slowly, until eventually transitioning to the attractor. The scaling solutions can satisfy H > mKK, but when they do standard 4D fluctuation calculations need not apply. When in a 4D regime the solutions predict η simeq 0 and so r simeq 0.11 when ns simeq 0.96 and so

  14. Why is it difficult to embed employee participation in the factory practice?

    DEFF Research Database (Denmark)

    Buhl, Henrik

    1997-01-01

    The purpose of my study is to evaluate projects with employee participation and to analyze the conditions for employee participation and the way in which it can be rooted in a factory. My hypothesis is that communicative actions have to be developed and supported as a precondition for the...... establishment of employee participation. This will propably lead to a more innovative practice, a learning organization. In this way the discussion about conditions for the establishment of participation turn in to a discussion about how to use participation to develope an innovative practice, realized in a...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-08-15

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

  16. Working with "difficult" patients: an interview with Jorge García Badaracco, by Francesca Viola Borgogno.

    Science.gov (United States)

    Badaracco, Jorge Garcia

    2010-12-01

    Jorge García Badaracco's pioneering work is well-known in his native Argentina, but not so much elsewhere. Since he was appointed as Director of a service in the Borda Buenos Aires Neuro-Psychiatric Hospital in 1959, García Badaracco started to make use of all available resources to overcome the many problems that the analysis of "difficult patients" (often psychotic) entails. In later years, he developed his ground-breaking "multifamily groups", that is, therapeutic groups that included patients, their relatives, nurses, members of the staff, and that offered the possibility to work simultaneously, in one single therapeutic intervention, on the individual, familiar, and social dimension of the mind. In this interview with García Badaracco, Francesca Viola Borgogno introduces the reader to this distinguished figure, as well as to some of his most original theoretical and clinical concepts, such as "the maddening object", "the pathological and pathogenic interdependence", "the healthy virtuality", and so on. PMID:21116289

  17. 物理化学难教难学的应对方法%On Coping Methods of Difficult Teaching and Learning in Physical Chemistry

    Institute of Scientific and Technical Information of China (English)

    屈景年; 李俊华; 曾荣英; 刘兴; 聂雪

    2014-01-01

    该文介绍了物理化学公式多、数学推导多、公式使用条件多、抽象概念多、计算多等难教难学问题的教与学应对方法。%This paper introduced the coping methods of difficult teaching and learning in physical chemistry due to too many for-mula ,mathematical derivation ,formula using -conditions ,abstract concepts ,calculations and so on .

  18. La demande du tiers et la validité de l'hospitalisation à la demande d'un tiers: les difficultés à surmonter

    OpenAIRE

    Houssou, C.; Lachaux, B.

    2010-01-01

    Resume Cet article consecutif a un autre plus axe sur la mise ?uvre de l?hospitalisation a la demande d?un tiers (HDT) revele que la demande, condition sine qua non de validite du processus d?HDT, s?avere parfois une etape ardue, source de grandes difficultes et d?invalidations de plusieurs hospitalisations sans consentement, sinon de poursuites judiciaires. Le jargon et la rhetorique judiciaires revelent, apres leur exegese, un grand ecart entre l?esprit de la loi, la pratique des...

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

    Science.gov (United States)

    Mazar Atabaki, Mehdi

    There is a high interest for the high strength-to-weight ratio with good ductility for the welds of advanced alloys. The concern about the welding of thick materials (Advanced high strength steels (AHSS) and 5xxx and 6xxx series of aluminum alloys) has stimulated the development of manufacturing processes to overcome the associated issues. The need to weld the dissimilar materials (AHSS and aluminum alloys) is also required for some specific applications in different industries. Hence, the requirement in the development of a state-of-the-art welding procedure can be helpful to fulfill the constraints. Among the welding methods hybrid laser/arc welding (HLAW) has shown to be an effective method to join thick and difficult-to-weld materials. This process benefits from both advantages of the gas metal arc welding (GMAW) and laser welding processes. The interaction of the arc and laser can help to have enough penetration of weld in thick plates. However, as the welding of dissimilar aluminum alloys and steels is very difficult because of the formation of brittle intermetallics the present work proposed a procedure to effectively join the alloys. The reports showed that the explosively welded aluminum alloys to steels have the highest toughness, and that could be used as an "insert" (TRICLAD) for welding the thick plates of AHSS to aluminum alloys. Therefore, the HLAW of the TRICLAD-Flange side (Aluminum alloy (AA 5456)) to the Web side (Aluminum alloys (AA 6061 and AA 5456)) and the TRICLAD-Flange side (ASTM A516) to the Web side (AHSS) was studied in the present work. However, there are many issues related to HLAW of the dissimilar steels as well as dissimilar aluminum alloys that have to be resolved in order to obtain sound welds. To address the challenges, the most recent welding methods for joining aluminum alloys to steels were studied and the microstructural development, mechanical properties, and on-line monitoring of the welding processes were discussed as well

  20. Modeling temperature and moisture fields in conditioned spaces using zonal approach, including sorption phenomena in buildings materials; Modelisation thermo-hydro-aeraulique des locaux climatises selon l'approche zonale (prise en compte des phenomenes de sorption d'humidite)

    Energy Technology Data Exchange (ETDEWEB)

    Cordeiro Mendoca, K.

    2004-05-15

    Building simulation models represent in our days an important tool for building conception and performance analysis. Although moisture interacts in many ways with the whole building affecting therefore its behavior, frequently these models neglects the interactions between them. In addition, in most of them, indoor air conditions are considered uniform, which is a non-realistic assumption in conditioned spaces. In this work, a model to predict temperature and moisture fields in conditioned spaces, using zonal approach, is proposed. This method is based in dividing spatially a room in a relative small number of zones, typically on the order of tens to hundreds, where the state variables of air are considered uniform, with the exception of pressure that varies hydrostatically. While not as fine-grained as CFD simulation, zonal models do give useful information about temperature and moisture distributions that is important in comfort analysis. The proposed model was structured in three groups of sub-models representing the three building domains: indoor air, envelope and HVAC system. The indoor air sub-model is related to the indoor air space, where airflow speed can be considered weak. The envelope sub-model is related to the radiation exchanges between envelope and its neighborhood, and to the simultaneous heat and mass transfers across the envelope material. This latest can be represented by four sub-models of different complexity levels, with two of them taking into account moisture adsorption and desorption by building materials. Concerning to the HVAC system model, it refers to the whole system that means equipment, control and specific airflow from equipment. All sub-models were coupled into a modular simulation environment, SPARK, well-adapted to compare different models. The applicability of the proposed model is shown by two examples. The first one shows the importance of considering moisture sorption phenomena in the prediction of indoor air conditions

  1. Assessing the Extraction Potential of Tomsk Region’s Difficult-To-Obtain Oil Reserves

    Directory of Open Access Journals (Sweden)

    Irina Valeryevna Sharf

    2016-03-01

    Full Text Available A significant increase in oil production in the Tomsk region can be achieved by a better development of the license areas at the disposal of oil-producing companies, active prospecting, introduction of innovative technologies to increase the oil recovery, as well as active oil extraction from unconventional horizons. This article reviews the activities of the oil-producing companies of the Tomsk region for the past 10 years, and proves the potential of increasing oil production of both traditional and difficultto-obtain oil reserves, concentrated in the Bazhenov and Tyumen Formations and the Lower Jurassic sediments. Technologically, Russia is significantly lagging behind the economically developed countries in the extraction of hard unconventional hydrocarbon resources, primarily, the United States. The observed «shale revolution» was due to the complex of financial and tax breaks for oil companies, from which mainly medium and small companies were benefited. As a result, this requires an increase in investment on the part of economic entities and regional authorities, as well as additional tax benefits, considering the quality and types of actual and prospective raw materials produced in the region, in contrast to the declared benefits in Eastern Siberia. The introduction of tax incentives justified by the authors and the implementation of public-private partnership will ensure the profitability of the development of marginal and difficult-to-obtain oil deposits of the Tomsk region in the long term, which in turn should ensure the stability of economic development of the subject of the Russian Federation

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

    Science.gov (United States)

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

    2011-01-01

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

  3. Forming Competing Fear Learning and Extinction Memories in Adolescence Makes Fear Difficult to Inhibit

    Science.gov (United States)

    Baker, Kathryn D.; Richardson, Rick

    2015-01-01

    Fear inhibition is markedly impaired in adolescent rodents and humans. The present experiments investigated whether this impairment is critically determined by the animal's age at the time of fear learning or their age at fear extinction. Male rats (n = 170) were tested for extinction retention after conditioning and extinction at different ages.…

  4. Open Boundary Conditions for Dissipative MHD

    Energy Technology Data Exchange (ETDEWEB)

    Meier, E T

    2011-11-10

    In modeling magnetic confinement, astrophysics, and plasma propulsion, representing the entire physical domain is often difficult or impossible, and artificial, or 'open' boundaries are appropriate. A novel open boundary condition (BC) for dissipative MHD, called Lacuna-based open BC (LOBC), is presented. LOBC, based on the idea of lacuna-based truncation originally presented by V.S. Ryaben'kii and S.V. Tsynkov, provide truncation with low numerical noise and minimal reflections. For hyperbolic systems, characteristic-based BC (CBC) exist for separating the solution into outgoing and incoming parts. In the hyperbolic-parabolic dissipative MHD system, such separation is not possible, and CBC are numerically unstable. LOBC are applied in dissipative MHD test problems including a translating FRC, and coaxial-electrode plasma acceleration. Solution quality is compared to solutions using CBC and zero-normal derivative BC. LOBC are a promising new open BC option for dissipative MHD.

  5. 歌唱教学难点与对策%Difficult Points and Countermeasures in Singing Teaching

    Institute of Scientific and Technical Information of China (English)

    李艳婷

    2014-01-01

    Singing art is a profound,complicated and comprehensive performing art. In singing teaching,various ways need to be adopted to improve students' comprehensive quality. The difficult points in teaching lie in the abstract and professional nature of vocalization training,which determines the hard and long process of learning. The countermeasures are to teach and train students to build up confidence,know the difficulty correctly,pay great attention to basic training,have an excellent singing condition,develop a correct concept of voice,practice articulating correctly and clearly,control breath freely,feel and grasp emotions in the song,and realize the artistic distillation.%歌唱艺术是一门高深而复杂的综合性表演艺术,在教学中通过多方面的专业教学,提高学生的综合素质。发声训练的抽象性和专业性困难决定了学习过程的艰辛和漫长,让学生树立信心,正确认知难与易,注重基础训练,培养良好的歌唱状态,树立正确的声音概念,训练咬字的准确性,驾驭歌唱的气息,把握歌曲情感和艺术升华等要素是解决困难的对策。

  6. Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios

    DEFF Research Database (Denmark)

    Jepsen, Cecilie H; Gätke, Mona R; Thøgersen, Bente;

    2014-01-01

    BACKGROUND: Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy. OBJECTIVE: The aim of the study was to compare the performance of...

  7. Heuristic Optimization Applied to an Intrinsically Difficult Problem: Birds Formation Flight

    DEFF Research Database (Denmark)

    Filippone, Antonino

    1996-01-01

    The birds formation flight is studied by means oftheoretical aerodynamics, heuristic methods anddistributed systems. A simplified aerodynamic analog is presented, and calculations of drag savings and flight range are shown for sometypical cases, including the line abreast flightwith various...

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

    Science.gov (United States)

    Parakh, Jal S.; Slesnick, Irwin L.

    1989-01-01

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

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

    OpenAIRE

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

    2006-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-10-01

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

  11. The Reality of Myoelectric Prostheses: Understanding What Makes These Devices Difficult for Some Users to Control.

    Science.gov (United States)

    Chadwell, Alix; Kenney, Laurence; Thies, Sibylle; Galpin, Adam; Head, John

    2016-01-01

    Users of myoelectric prostheses can often find them difficult to control. This can lead to passive-use of the device or total rejection, which can have detrimental effects on the contralateral limb due to overuse. Current clinically available prostheses are "open loop" systems, and although considerable effort has been focused on developing biofeedback to "close the loop," there is evidence from laboratory-based studies that other factors, notably improving predictability of response, may be as, if not more, important. Interestingly, despite a large volume of research aimed at improving myoelectric prostheses, it is not currently known which aspect of clinically available systems has the greatest impact on overall functionality and everyday usage. A protocol has, therefore, been designed to assess electromyographic (EMG) skill of the user and predictability of the prosthesis response as significant parts of the control chain, and to relate these to functionality and everyday usage. Here, we present the protocol and results from early pilot work. A set of experiments has been developed. First, to characterize user skill in generating the required level of EMG signal, as well as the speed with which users are able to make the decision to activate the appropriate muscles. Second, to measure unpredictability introduced at the skin-electrode interface, in order to understand the effects of the socket-mounted electrode fit under different loads on the variability of time taken for the prosthetic hand to respond. To evaluate prosthesis user functionality, four different outcome measures are assessed. Using a simple upper limb functional task prosthesis users are assessed for (1) success of task completion, (2) task duration, (3) quality of movement, and (4) gaze behavior. To evaluate everyday usage away from the clinic, the symmetricity of their real-world arm use is assessed using activity monitoring. These methods will later be used to assess a prosthesis user cohort to

  12. The reality of myoelectric prostheses: Understanding what makes these devices difficult for some users to control

    Directory of Open Access Journals (Sweden)

    Alix Chadwell

    2016-08-01

    Full Text Available Users of myoelectric prostheses can often find them difficult to control. This can lead to passive-use of the device or total rejection, which can have detrimental effects on the contralateral limb due to overuse.Current clinically available prostheses are ‘open loop’ systems, and although considerable effort has been focused on developing biofeedback to close the loop, there is evidence from laboratory-based studies that other factors, notably improving predictability of response, may be as, if not more, important. Interestingly, despite a large volume of research aimed at improving myoelectric prostheses, it is not currently known which aspect of clinically available systems has the greatest impact on overall functionality and everyday usage. A protocol has therefore been designed to assess EMG skill of the user and predictability of the prosthesis response as significant parts of the control chain, and to relate these to functionality and everyday usage. Here we present the protocol and results from early pilot work.A set of experiments has been developed. Firstly to characterize user skill in generating the required level of EMG signal, as well as the speed with which users are able to make the decision to activate the appropriate muscles. Secondly, to measure unpredictability introduced at the skin-electrode interface, in order to understand the effects of the socket mounted electrode fit under different loads on the variability of time taken for the prosthetic hand to respond.To evaluate prosthesis user functionality, four different outcome measures are assessed. Using a simple upper limb functional task prosthesis users are assessed for (1 success of task completion, (2 task duration, (3 quality of movement, and (4 gaze behavior. To evaluate everyday usage away from the clinic, the symmetricity of their real-world arm use is assessed using activity monitoring.These methods will later be used to assess a prosthesis user cohort, to

  13. The Reality of Myoelectric Prostheses: Understanding What Makes These Devices Difficult for Some Users to Control

    Science.gov (United States)

    Chadwell, Alix; Kenney, Laurence; Thies, Sibylle; Galpin, Adam; Head, John

    2016-01-01

    Users of myoelectric prostheses can often find them difficult to control. This can lead to passive-use of the device or total rejection, which can have detrimental effects on the contralateral limb due to overuse. Current clinically available prostheses are “open loop” systems, and although considerable effort has been focused on developing biofeedback to “close the loop,” there is evidence from laboratory-based studies that other factors, notably improving predictability of response, may be as, if not more, important. Interestingly, despite a large volume of research aimed at improving myoelectric prostheses, it is not currently known which aspect of clinically available systems has the greatest impact on overall functionality and everyday usage. A protocol has, therefore, been designed to assess electromyographic (EMG) skill of the user and predictability of the prosthesis response as significant parts of the control chain, and to relate these to functionality and everyday usage. Here, we present the protocol and results from early pilot work. A set of experiments has been developed. First, to characterize user skill in generating the required level of EMG signal, as well as the speed with which users are able to make the decision to activate the appropriate muscles. Second, to measure unpredictability introduced at the skin–electrode interface, in order to understand the effects of the socket-mounted electrode fit under different loads on the variability of time taken for the prosthetic hand to respond. To evaluate prosthesis user functionality, four different outcome measures are assessed. Using a simple upper limb functional task prosthesis users are assessed for (1) success of task completion, (2) task duration, (3) quality of movement, and (4) gaze behavior. To evaluate everyday usage away from the clinic, the symmetricity of their real-world arm use is assessed using activity monitoring. These methods will later be used to assess a prosthesis user

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

    Directory of Open Access Journals (Sweden)

    Latypov Alisher B

    2011-12-01

    doctor and the treatment of drug addiction: "A difficult and most ungracious task". A Russian translation of an abstract of this article. Click here for file

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-15

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

  17. 76 FR 66741 - Statutorily Mandated Designation of Difficult Development Areas and Qualified Census Tracts for 2012

    Science.gov (United States)

    2011-10-27

    ..., rehabilitation, or new construction costs (depending on the type of LIHTC involved). These costs include amounts... by the Secretary of HUD as an area that has high construction, land, and utility costs relative to... FMR Areas as the measure of ``construction, land, and utility costs relative to area median...

  18. What works? Strategies to increase reproductive, maternal and child health in difficult to access mountainous locations: a systematic literature review.

    Directory of Open Access Journals (Sweden)

    Abbey Byrne

    Full Text Available BACKGROUND: Geography poses serious challenges to delivery of health services and is a well documented marker of inequity. Maternal, newborn and child health (MNCH outcomes are poorer in mountainous regions of low and lower-middle income countries due to geographical inaccessibility combined with other barriers: poorer quality services, persistent cultural and traditional practices and lower socioeconomic and educational status. Reaching universal coverage goals will require attention for remote mountain settings. This study aims to identify strategies to address barriers to reproductive MNCH (RMNCH service utilisation in difficult-to-reach mountainous regions in low and lower-middle income settings worldwide. METHODS: A systematic literature review drawing from MEDLINE, Web of Science, Scopus, Google Scholar, and Eldis. Inclusion was based on; testing an intervention for utilisation of RMNCH services; remote mountain settings of low- and lower-middle income countries; selected study designs. Studies were assessed for quality and analysed to present a narrative review of the key themes. FINDINGS: From 4,130 articles 34 studies were included, from Afghanistan, Bolivia, Ethiopia, Guatemala, Indonesia, Kenya, Kyrgyzstan, Nepal, Pakistan, Papua New Guinea and Tajikistan. Strategies fall into four broad categories: improving service delivery through selected, trained and supported community health workers (CHWs to act alongside formal health workers and the distribution of critical medicines to the home; improving the desirability of existing services by addressing the quality of care, innovative training and supervision of health workers; generating demand by engaging communities; and improving health knowledge for timely care-seeking. Task shifting, strengthened roles of CHWs and volunteers, mobile teams, and inclusive structured planning forums have proved effective. CONCLUSIONS: The review highlights where known evidence-based strategies have

  19. The Difficult Diagnosis of Ischaemic Papillary Muscle Rupture; Case report from an urban emergency department

    Directory of Open Access Journals (Sweden)

    Christian T. Braun

    2016-05-01

    Full Text Available We present a rare case of severe ischaemic papillary muscle rupture in a 67-year-old male patient who was admitted to the Emergency Department of the University Hospital Bern, Switzerland, in November 2013 with acute chest pain. On admission, the patient’s blood pressure was 60/40 mm/Hg, his pulse was 110 beats per minute and his respiratory rate was 20 breaths per minute. An electrocardiogram was normal and focused assessment with sonography in trauma was negative. Transthoracic echocardiography showed possible thickening of the mitral valve leaflet with no indications of severe mitral insufficiency or wall motion abnormalities. Triple-ruleout computed tomography angiography revealed no pulmonary emboli or aortic dissection, although coronary atherosclerosis was present. Finally, severe insufficiency of the mitral valve with rupture of the papillary muscle, likely due to ischaemia, was observed via transoesophageal echocardiography. The patient underwent a successful surgical intervention and was discharged 10 days later in stable condition.

  20. A lack of response of the financial behaviors of biodiversity conservation nonprofits to changing economic conditions.

    Science.gov (United States)

    Larson, Eric R; Boyer, Alison G; Armsworth, Paul R

    2014-12-01

    The effectiveness of conservation organizations is determined in part by how they adapt to changing conditions. Over the previous decade, economic conditions in the United States (US) showed marked variation including a period of rapid growth followed by a major recession. We examine how biodiversity conservation nonprofits in the US responded to these changes through their financial behaviors, focusing on a sample of 90 biodiversity conservation nonprofits and the largest individual organization (The Nature Conservancy; TNC). For the 90 sampled organizations, an analysis of financial ratios derived from tax return data revealed little response to economic conditions. Similarly, more detailed examination of conservation expenditures and land acquisition practices of TNC revealed only one significant relationship with economic conditions: TNC accepted a greater proportion of conservation easements as donated in more difficult economic conditions. Our results suggest that the financial behaviors of US biodiversity conservation nonprofits are unresponsive to economic conditions.

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

    Directory of Open Access Journals (Sweden)

    Namrata Maheshwari

    2012-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, P.; Glenn, L.A. [Lawrence Livermore National Lab., CA (United States)

    1993-11-01

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

  4. Modeling of tamped and decoupled explosions in salt (Simulation is easy. Prediction is difficult!)

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, P.; Glenn, L.A.

    1993-05-01

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

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

    International Nuclear Information System (INIS)

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

  6. Difficult Management of Coronary Artery Disease in a Patient with Thrombotic Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Fatemeh Jorfi

    2015-10-01

    Full Text Available Thrombotic thrombocytopenic purpura (TTP is a rare syndrome affecting multiple organs. There is no sufficient evidence regarding the clinical cardiac manifestations of TTP. Nonetheless, pathologic cardiac involvement is quite frequent in acute TTP, which is predominantly manifested as myocardial necrosis due to coronary arteriolar microthrombosis. The present case report describes a 43-year-old man with long-standing remitted TTP, who suffered from a sequence of refractory thrombotic epicardial coronary events. Aggressive medical and interventional therapies, including long-term dual antiplatelets and coronary angioplasty, were finally successful in remitting the thrombotic events. During his two-year follow up, he has been asymptomatic.

  7. A difficult diagnosis case of prolonged thrombocytopenia with sepsis and disseminated intravascular coagulation.

    Science.gov (United States)

    Yoshika, Masamichi; Komiyama, Yutaka; Hirakawa, Akihiko; Nakatani, Toshio; Takahashi, Hakuo

    2011-08-01

    A 19-year-old male was admitted because of the trauma due to sepsis-induced disseminated intravascular coagulation (DIC) and multiple organ failure (MOF). We treated with antibiotics, danaparoid, and continuous hemodiafiltration (CHDF). Once he recovered, but after several days, he had septic shock and MOF again. With treatment, the inflammation and MOF improved but the platelet count was less than 1.0 × 10( 4)/μL. Because of the usage of heparin, we suspected heparin-induced thrombocytopenia (HIT) and measured the HIT antibody and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13). Heparin-induced thrombocytopenia antibody was positive in the second sepsis but negative in the first sepsis. ADAMTS13 activity was low in both sepses. After stopping CHDF and the usage of heparin, his platelet count improved. Thrombocytopenia is the common and occasional condition for DIC. Heparin-induced thrombocytopenia and thrombotic thrombocytopenic purpura is rare but they must be ruled out in thrombocytopenia with nontypical clinical course, and the assays for HIT antibody and ADAMTS13 activity are useful tools. PMID:20530051

  8. Natural selection and the conditions for existence: representational vs. conditional teleology in biological explanation.

    Science.gov (United States)

    Reiss, John O

    2005-01-01

    Human intentional action, including the design and use of artifacts, involves the prior mental representation of the goal (end) and the means to achieve that goal. This representation is part of the efficient cause of the action, and thus can be used to explain both the action and the achievement of the end. This is intentional teleological explanation. More generally, teleological explanation that depends on the real existence of a representation of the goal (and the means to achieve it) can be called representational teleological explanation. Such explanations in biology can involve both external representations (e.g., ideas in the mind of God) and internal representations (souls, vital powers, entelechies, developmental programs, etc.). However, another type of explanation of intentional action (or any other process) is possible. Given that an action achieving a result occurs, the action can be explained as fulfilling the necessary conditions (means) for that result (end), and, reciprocally, the result explained by the occurrence of those necessary conditions. This is conditional teleological explanation. For organisms, natural selection is often understood metaphorically as the designer, intentionally constructing them for certain ends. Unfortunately, this metaphor is often taken rather too literally, because it has been difficult to conceive of another way to relate natural selection to the process of evolution. I argue that combining a conditional teleological explanation of organisms and of evolution provides such an alternative. This conditional teleology can be grounded in existence or survival. Given that an organism exists, we can explain its existence by the occurrence of the necessary conditions for that existence. This principle of the 'conditions for existence' was introduced by Georges Cuvier in 1800, and provides a valid, conditional teleological method for explaining organismal structure and behavior. From an evolutionary perspective, the

  9. Wire-guided (Seldinger technique intubation through a face mask in urgent, difficult and grossly distorted airways

    Directory of Open Access Journals (Sweden)

    Jake M Heier

    2012-01-01

    Full Text Available We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

  10. CONDITIONED SUPERPROCESSES

    Institute of Scientific and Technical Information of China (English)

    LICUNHANG; WURONG

    1997-01-01

    A class of superprocesses which dies out is investigated. Under the condition of norextinction, a new superprocess is COnstructed, its life time is infinite, and its distribution isdetermined by the moment function. Several limit theorems about this superprocess and its occulpation time process are obtained.

  11. Difficult to predict early failure after major lower-extremity amputations

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Holm, Gitte; Gebuhr, Peter

    2015-01-01

    INTRODUCTION: The successful outcome of a major amputation depends on several factors, including stump wound healing. The purpose of this study was to examine the criteria upon which the index amputation was based and to identify factors associated with early amputation failure after major non......-traumatic lower-extremity amputation. METHODS: We studied a consecutive one-year series of 36 men and 34 women with a median (25-75% quartiles) age of 72 (63-83) years who were treated in an acute orthopaedic ward; 44 below-knee and 26 above-knee amputees of whom 47 had an American Society of Anesthesiologists...... rating above two. Patient characteristics and other factors potentially influencing early amputation failure within 30 days were evaluated. RESULTS: Eleven patients died (16%) and 11 (16%) had a re-amputation at a higher level, whereas four (6%) had a major revision at the same level within 30 days...

  12. Why is it so difficult to evaluate nursing interventions in dementia?

    Science.gov (United States)

    Schwarzbach, Christoph; Förstl, Hans; Nocon, Marc; Mittendorf, Thomas

    2012-01-01

    Two recent health technology assessment (HTA) reports published in Germany focused on non-pharmacological interventions for patients with dementia. One of the major results was the poor methodological quality of the studies in this field. This paper concisely presents the main quantitative and qualitative findings of the HTA report published by the German Agency for HTA at the Institute of Medical Information and Documentation (dahta@DIMDI), followed by a detailed discussion of the major methodological problems observed for the inclusion criteria, interventions, the setting, number of patients included, duration of observation, comparators, clinical endpoints, health economics, and, most obvious, the impossibility of blinding and eliminating placebo effects for future clinical studies. We conclude with several suggestions addressing these challenges for future research in this field. PMID:22590475

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

    Energy Technology Data Exchange (ETDEWEB)

    Sabol, Jozef; Hudzietzova, Jana; Rosina, Jozef, E-mail: j.sabol44@gmail.com, E-mail: hudzijan@fbmi.cvut.cz, E-mail: rosina@fbmi.cvut.cz [Faculty of Biomedical Engineering, Czech Technical University in Prague (Czech Republic)

    2013-07-01

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

  14. Experience with simulator training for emergency conditions

    International Nuclear Information System (INIS)

    The training of operators by the use of simulators is common to most countries with nuclear power plants. Simulator training programmes are generally well developed, but their value can be limited by the age, type, size and capability of the simulator. Within these limits, most full scope simulators have a capability of training operators for a range of design basis accidents. It is recognized that human performance under accident conditions is difficult to predict or analyse, particularly in the area of severe accidents. These are rare events and by their very nature, unpredictable. Of importance, therefore, is to investigate the training of operators for severe accident conditions, and to examine ways in which simulators may be used in this task. The International Nuclear Safety Advisory Group (INSAG) has reviewed this field and the associated elements of human behaviour. It has recommended that activities are concentrated on this area. Initially it is encouraging the following objectives: i) To train operators for accident conditions including severe accidents and to strongly encourage the development and use of simulators for this purpose; ii) To improve the man-machine interface by the use of computer aids to the operator; iii) To develop human performance requirements for plant operating staff. As part of this work, the IAEA convened a technical committee on 15-19 September 1986 to review the experience with simulator training for emergency conditions, to review simulator modelling for severe accident training, to examine the role of human cognitive behaviour modelling, and to review guidance on accident scenarios. A substantial deviation may be a major fuel failure, a Loss of Coolant Accident (LOCA), etc. Examples of engineered safety features are: an Emergency Core Cooling System (ECCS), and Containment Systems. This report was prepared by the participants during the meeting and reviewed further in a Consultant's Meeting. It also includes papers which were

  15. Stressors rendering school coexistence difficult, personal variables and burnout: towards an explanatory model

    Directory of Open Access Journals (Sweden)

    José M. Otero-López

    2010-12-01

    Full Text Available The main objective of this study is analyze the inter-relationships between the main stressors posing difficulties for school coexistence (students’ disruptive behavior, the teachers’ perception of a lack of social support and conflict, different personal variables (Type A behavior pattern, optimism, hardiness and burnout. Furthermore, personal variables will be tested to see whether they mediate the influence of the different sources of stress analyzed in burnout. From the results obtained, using a sample of 1537 secondary education teachers, the covariation between the different sets of variables analyzed is not only confirmed but also significant support is given for the mediation hypothesis (stressors would have an indirect influence on burnout through personal variables. Another interesting finding is the need to include in the resulting model a direct effect between the students’ disruptive behavior and the teacher’s burnout experience. In short, the resulting path confirms the personal variables analyzed as a necessary filter in the analysis of the stressors-burnout link, while at the same time integrating the direct effect that students’ disruptive behavior has on teacher’s occupational malaise. .

  16. Total Hip Arthroplasty Using the S-ROM-A Prosthesis for Anatomically Difficult Asian Patients

    Directory of Open Access Journals (Sweden)

    Akira Hozumi

    2015-01-01

    Full Text Available Background. The S-ROM-A prosthesis has been designed for the Asian proximal femur with a small deformed shape and narrow canal. In this study, the clinical and radiological results using the S-ROM-A prosthesis for Japanese patients with severe deformity due to dysplasia and excessive posterior pelvic tilt were examined. Methods. 94 hips were followed up for a mean of 55 months, with a mean age at surgery of 61 years. The primary diagnoses were 94 coxarthritis cases, including 51 dysplasia and 37 primary OA, 1 avascular necrosis, 2 traumatic arthritis, and 3 Perthes disease. Thirty-one hips had been treated with osteotomy of the hip joints. Preoperative intramedullary canal shapes were stovepipe in 23 hips, normal in 51 hips, and champagne-flute in 5 hips. The maximum pelvic inclination angle was 56°. Results. The mean JOA score improved from 46 points preoperatively to 80 points at final follow-up. On radiological evaluation of the fixation of the implants according to the Engh classification, 92 (97% hips were classified as “bone ingrown fixation.” Conclusion. In primary THA, using the S-ROM-A prosthesis for Asian patients with proximal femoral deformity, even after osteotomy and with posterior pelvic tilt, provided good short- to midterm results.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-12-31

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

  18. Goldilocks Models of Higher-Dimensional Inflation (including modulus stabilization)

    CERN Document Server

    Burgess, C P; Hayman, Peter; Patil, Subodh P

    2016-01-01

    We explore the mechanics of inflation in simplified extra-dimensional models involving an inflaton interacting with the Einstein-Maxwell system in two extra dimensions. The models are Goldilocks-like in that they are just complicated enough to include a mechanism to stabilize the extra-dimensional size, yet simple enough to solve the full 6D field equations using basic tools. The solutions are not limited to the effective 4D regime with H m_KK, but when they do standard 4D fluctuation calculations need not apply. When in a 4D regime the solutions predict eta ~ 0 hence n_s ~ 0.96 and r ~ 0.096 and so are ruled out if tensor modes remain unseen. Analysis of general parameters is difficult without a full 6D fluctuation calculation.

  19. Easy and difficult performance-approach goals : Their moderating effect on the link between task interest and performance attainment

    NARCIS (Netherlands)

    Blaga, Monica; Van Yperen, N.W.

    2008-01-01

    The purpose of this study was to demonstrate that the positive link between task interest and performance attainment can he negatively affected by the pursuit of difficult performance-approach goals. This was tested in a sample of 60 undergraduate Students at a Dutch university, In line with expecta

  20. Can Islands of Effectiveness Thrive in Difficult Governance Settings? The Political Economy of Local-level Collaborative Governance

    OpenAIRE

    Levy, Brian

    2011-01-01

    Many low-income countries contend with a governance syndrome characterized by a difficult combination of seeming openness, weak institutions, and strong inter-elite contestation for power and resources. In such countries, neither broad-based policy nor public management reforms are likely to be feasible. But are broad-based approaches necessary? Theory and evidence suggest that in such set...

  1. Fluoroscopy assisted tracheal intubation in a case of anticipated difficult airway: Fail safe devices can also fail

    OpenAIRE

    Appavoo Arulvelan; Madhusudhan Soumya; Kannath Santhosh

    2015-01-01

    Difficulty in airway management is the most important cause of major anesthesia-related morbidity and mortality. Unexpected difficulties may arise even with proper preanesthesia planning. Here, we report a case of anticipated difficult airway primarily planned for flexible fibreoptic bronchoscope assisted intubation, but due to unexpected failure of light source, fluoroscopy was used, and the airway was successfully secured.

  2. Owning My Thoughts Was Difficult: Encouraging Students to Read and Write Critically in a Tertiary Qualitative Research Methods Course

    Science.gov (United States)

    Wiles, Janine L.; Allen, Ruth E. S.; Butler, Rachael

    2016-01-01

    This paper adds to the nascent literature on teaching research methods and what students learn from courses and assessment. Postgraduate students are often confronted with large amounts of reading, and the content of material can be intimidating. Convincing them also to engage critically with readings is even more difficult. We report on a…

  3. Using simulation to study difficult clinical issues: prenatal counseling at the threshold of viability across american and dutch cultures

    NARCIS (Netherlands)

    Geurtzen, R.; Hogeveen, M.; Rajani, A.K.; Chitkara, R.; Antonius, T.A.; Heijst, A.F. van; Draaisma, J.M.; Halamek, L.P.

    2014-01-01

    OBJECTIVE: Prenatal counseling at the threshold of viability is a challenging yet critically important activity, and care guidelines differ across cultures. Studying how this task is performed in the actual clinical environment is extremely difficult. In this pilot study, we used simulation as a met

  4. What Are We Going to Do with You? Gastroenterology Service Providers’ Perception of ‘Difficult to Manage’ IBD Patients

    Directory of Open Access Journals (Sweden)

    T Michael Vallis

    2002-01-01

    Full Text Available BACKGROUND: This paper reports the results of a systematic survey of members of a clinical gastroenterology service to determine their perceptions of patients with inflammatory bowel disease (IBD who were deemed to function poorly and were difficult to manage clinically.

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

    Directory of Open Access Journals (Sweden)

    Vani V

    2000-04-01

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

  6. Politeness Strategies in Healthcare Communication at "Difficult Times": A Pragmatic Analysis of the "Manga" Discourse in "Nurse Aoi"

    Science.gov (United States)

    Matsuoka, Rieko; Poole, Gregory

    2015-01-01

    This paper examines the ways in which healthcare professionals interact with patients' family members, and/or colleagues. The data are from healthcare discourses at difficult times found in the manga series entitled Nurse AOI. As the first step, we selected several communication scenes for analysis in terms of politeness strategies. From these…

  7. Faster Wound Healing With Topical Negative Pressure Therapy in Difficult-to-Heal Wounds: A Prospective Randomized Controlled Trial

    NARCIS (Netherlands)

    Laat, E.H. de; Boogaard, M.H.W.A. van den; Spauwen, P.H.M.; Kuppevelt, D.H. van; Goor, H. van; Schoonhoven, L.

    2011-01-01

    OBJECTIVE: : A randomized clinical trial was conducted to determine the effectiveness and safety of topical negative pressure therapy in patients with difficult-to-heal wounds. METHODS: : A total of 24 patients were randomly assigned to either treatment with topical negative pressure therapy or trea

  8. EXTRACORPOREAL SEPTOPLA S TY USING POLYDIO XANONE PLATES v/s CONVENTIONAL SEPTOPLASTY IN MANAGEMENT OF DIFFICULT SEPTUM

    Directory of Open Access Journals (Sweden)

    Somu

    2015-09-01

    Full Text Available BACKGROUND: The technique and management of deviated nasal septum has evolved over the last few centuries. However, difficult and severely deviated septum still poses a surgical challenge. Difficult septum is characterized by severe malformations of cartilaginous, bon y or both components, with significant airway block. Extracorporeal septoplasty with reconstruction with polydioxanone plates can be recommended as a viable alternative to conventional methods in management of such difficult septum. OBJECTIVE: To assess the clinical results and functional outcome of extracorporeal decortication septoplasty using polydioxanone (PDS plate and compare the outcome with conventional septoplasty . METHODS: This is a prospective study of 60 patients who were managed by extracorp oreal decortication septoplasty using PDS plates and conventional septoplasty. Preoperative and postoperative subjective assessment in the form of ‘Nasal Outcome and Septoplasty Effectiveness scale’ (NOSE score and a modified ‘Sinonasal Outcome Test’ (SNO T score was done. Patients were followed up using diagnostic nasal endoscopy. The functional outcome and complications were assessed. RESULTS: In our study we found a statistically significant reduction between preoperative and postoperative score in pati ents who underwent extr a - corpo r e al decortication septoplasty using PDS plate when compared to the results of those who underwent conventional septoplasty with a p - value of 0.000. CONCLUSION: Extracorporeal decortication septoplasty can be recommended as a suitable alternate in the management of difficult septum where conventional septoplasty may fail to achieve a good functional outcome .

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

    Directory of Open Access Journals (Sweden)

    Gruenbaum Shaun E

    2012-04-01

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

  10. Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study.

    Directory of Open Access Journals (Sweden)

    Søren Meisner

    Full Text Available BACKGROUND: Peristomal skin complications (PSCs are the most common post-operative complications following creation of a stoma. Living with a stoma is a challenge, not only for the patient and their carers, but also for society as a whole. Due to methodological problems of PSC assessment, the associated health-economic burden of medium to longterm complications has been poorly described. AIM: The aim of the present study was to create a model to estimate treatment costs of PSCs using the standardized assessment Ostomy Skin Tool as a reference. The resultant model was applied to a real-life global data set of stoma patients (n = 3017 to determine the prevalence and financial burden of PSCs. METHODS: Eleven experienced stoma care nurses were interviewed to get a global understanding of a treatment algorithm that formed the basis of the cost analysis. The estimated costs were based on a seven week treatment period. PSC costs were estimated for five underlying diagnostic categories and three levels of severity. The estimated treatment costs of severe cases of PSCs were increased 2-5 fold for the different diagnostic categories of PSCs compared with mild cases. French unit costs were applied to the global data set. RESULTS: The estimated total average cost for a seven week treatment period (including appliances and accessories was 263€ for those with PSCs (n = 1742 compared to 215€ for those without PSCs (n = 1172. A co-variance analysis showed that leakage level had a significant impact on PSC cost from 'rarely/never' to 'always/often' p<0.00001 and from 'rarely/never' to 'sometimes' p = 0.0115. CONCLUSION: PSCs are common and troublesome and the consequences are substantial, both for the patient and from a health economic viewpoint. PSCs should be diagnosed and treated at an early stage to prevent long term, debilitating and expensive complications.

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

    Science.gov (United States)

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

    2009-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Dionne Francois

    2011-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Wallace Paul

    2011-01-01

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

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

    International Nuclear Information System (INIS)

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

  15. Article Including Environmental Barrier Coating System

    Science.gov (United States)

    Lee, Kang N. (Inventor)

    2015-01-01

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

  16. Static, Lightweight Includes Resolution for PHP

    NARCIS (Netherlands)

    Hills, M.A.; Klint, P.; Vinju, J.J.

    2014-01-01

    Dynamic languages include a number of features that are challenging to model properly in static analysis tools. In PHP, one of these features is the include expression, where an arbitrary expression provides the path of the file to include at runtime. In this paper we present two complementary analy

  17. Electron Microprobe Analysis of Hf in Zircon: Suggestions for Improved Accuracy of a Difficult Measurement

    Science.gov (United States)

    Fournelle, J.; Hanchar, J. M.

    2013-12-01

    La with the accelerating voltage under 18 keV (e.g. 17 keV is optimal), and also with synthetic stoichiometric hafnon as the standard. We have developed useful standards that are to be distributed to the community for those researchers working on this problem and can be obtained from the second author at jhanchar@mun.ca. The standards include synthetic stoichiometric undoped zircon and hafnon, and synthetic zircon doped with 2 wt. % Hf. Donovan et al. (2002) Probe for Windows: User's Guide and Reference Wiedenbeck, M., et al. (2004) Further characterisation of the 91500 zircon crystal. Geostandards and Geoanatytical Research, 28: 9-39.

  18. Strategies for attraction and retention of health workers in remote and difficult-to-access areas of Chhattisgarh, India: Do they work?

    Directory of Open Access Journals (Sweden)

    Suchitra Lisam

    2015-01-01

    Full Text Available Background: To address the acute shortages of health workers in underserved, remote, and difficult-to-access areas, the Government of Chhattisgarh and the National Rural Health Mission (NRHM launched the Chhattisgarh Rural Medical Corps (CRMC in 2009. CRMC has enabled provisions such as financial incentives, residential accommodation, life insurance, and extra marks during admission at the postgraduate (PG level to eligible doctors for the attraction and retention of health workers, i.e., doctors, staff nurses, auxiliary nurse midwives (ANMs, and rural medical assistants (RMAs in underserved areas. Objectives: This study aims to understand the CRMC scheme in terms of implementation, challenges, gaps, and outcome in achieving the attraction and retention of health workers in the remote and difficult-to-access areas of Chhattisgarh. Materials and Methods: The study adopts a mix of both qualitative and quantitative research methods. The purposive sampling method was used for the selection of three districts having normal, difficult, and inaccessible areas. Data were collected through key informant (KI interviews with beneficiaries and non-beneficiaries of CRMC or district and state government officials, and reviews of document were analyzed using a thematic analysis approach. Results: CRMC has made positive outcome as 1319 health workers, including doctors, have joined the service in 2010-11, reducing the vacancy of doctors from 90% to 45%. The scope of CRMC was primarily limited to payment of monthly financial incentives. The fund utilization rate of CRMC has increased (from 27% in 2009-10 to 98% in 2011-12, though there are delays in payment of incentives. The majority of staff lack awareness about CRMC during job applications. The payment of incentives based on facility performance has demotivated staff. Conclusions: Establishment of a performance management system, activating the CRMC cell to make it functional, and wide publicity of CRMC

  19. CORPORATE SOCIAL RESPONSIBILITY AS CONDITION OF INCLUDING UKRAINE IN EUROPE AND WORLD ECONOMIC SPACE

    Directory of Open Access Journals (Sweden)

    T. Lytvynenko

    2013-09-01

    Full Text Available The thesis that companies’ activities for introduction of corporate social responsibility stimulates the speed of to the processes of the technical upgrade, modernization of company’s activity and increase of its profitability is proved within the article. Those Ukrainian companies, which have high index of activities transparency, are also the most profitable. However, we can’t observe any significant increment of number of companies joining the Global agreement. One of the explanations we could name is the unproved idea supported by some politicians and economists about a shadow (‘black’ market that allegedly allows creating workplaces and taking off social tension in society on the certain stage. Insignificant values of index of citizens’ trust to activity of industries holds on the development socially of responsible business. Trust considered as a part of the general social capital. The Government of Ukraine must support initiative of companies to introduce social responsibility of business, as many European governments do it. It is also important to inform society of advantages of CSR.

  20. 76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-02-17

    ... Budget Office CDC Centers for Disease Control and Prevention DVT Deep vein thrombosis ESRD End-stage renal disease DRA Deficit Reduction Act of 2005 (Pub. L. 109-171, enacted on February 8, 2006) FFP... Restrictive Surgery. + Orthopedic Procedures. - Spine. - Neck. - Shoulder. ] - Elbow. Deep Vein...

  1. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-06-06

    ... Office CDC Centers for Disease Control and Prevention DVT Deep vein thrombosis ESRD End-stage renal.... --Elbow. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE). + Total Knee Replacement. + Hip Replacement... defined as the full list of Medicare's HAC, with the exception of Deep Vein Thrombosis/Pulmonary...

  2. Sharing the Focus: Engaging with Support Workers to Include People with Communication Needs in Research

    Science.gov (United States)

    Lutz, Deborah; Fisher, Karen R.; Robinson, Sally

    2016-01-01

    Inclusive research is an increasing expectation to value and include people's voice in research and evaluations intended to benefit them. The active participation of people with communication support needs can be difficult due to the practical constraints of evaluations. One technique is to engage with workers who are familiar with the person, but…

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

    Directory of Open Access Journals (Sweden)

    Healy David W

    2012-06-01

    Full Text Available Abstract Background Videolaryngoscopy presents a new approach for the management of the difficult and rescue airway. There is little available evidence to compare the performance features of these devices in true difficult laryngoscopy. Methods A prospective randomized crossover study was performed comparing the performance features of the Macintosh Laryngoscope, Glidescope, Storz CMAC and Storz DCI videolaryngoscope. Thirty anesthesia providers attempted intubation with each of the 4 laryngoscopes in a high fidelity difficult laryngoscopy manikin. The time to successful intubation (TTSI was recorded for each device, along with failure rate, and the best view of the glottis obtained. Results Use of the Glidescope, CMAC and Storz videolaryngoscopes improved the view of the glottis compared with use of the Macintosh blade (GEE, p = 0.000, p = 0.002, p = 0.000 respectively. Use of the CMAC resulted in an improved view compared with use of the Storz VL (Fishers, p = 0.05. Use of the Glidescope or Storz videolaryngoscope blade resulted in a longer TTSI compared with either the Macintosh (GLM, p = 0.000, p = 0.029 respectively or CMAC blades (GLM, p = 0.000, p = 0.033 respectively. Conclusions Unsurprisingly, when used in a simulated difficult laryngoscopy, all the videolaryngoscopes resulted in a better view of the glottis than the Macintosh blade. However, interestingly the CMAC was found to provide a better laryngoscopic view that the Storz DCI Videolaryngoscope. Additionally, use of either the Glidescope or Storz DCI Videolaryngoscope resulted in a prolonged time to successful intubation compared with use of the CMAC or Macintosh blade. The use of the CMAC during manikin simulated difficult laryngoscopy combined the efficacy of attainment of laryngoscopic view with the expediency of successful intubation. Use of the Macintosh blade combined expedience with success, despite a limited laryngoscopic view. The

  4. Composite Pressure Vessel Including Crack Arresting Barrier

    Science.gov (United States)

    DeLay, Thomas K. (Inventor)

    2013-01-01

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

  5. Systematizing semishortening conditions

    Science.gov (United States)

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

    2014-12-01

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

  6. Les difficultés d'exécution des contrats de Private Finance Initiative britanniques

    OpenAIRE

    Marty, Frédéric; Voisin, Arnaud

    2007-01-01

    document de travail Alors que de nombreux travaux se sont penchés sur l'optimalité du recours aux partenariats public-privé ou sur les enjeux posés par la structure d'attribution des risques entre les parties, les difficultés d'exécution des contrats de partenariats public-privé n'ont fait jusqu'à présent l'objet que de rares analyses. Les principaux travaux développés sur les difficultés d'exécution des contrats de partenariat public-privé portent sur le cas des pays en développement et c...

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

    Science.gov (United States)

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

    2011-10-01

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

  8. Neuromuscular blockade for improvement of surgical conditions during laparotomy

    DEFF Research Database (Denmark)

    Madsen, Matias Vested; Scheppan, Susanne; Kissmeyer, Peter;

    2015-01-01

    INTRODUCTION: During laparotomy, surgeons frequently experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. This issue is particularly pertinent while closing the fascia and placing the intestines into the abdominal cavity. Establishment of a deep neuromus......INTRODUCTION: During laparotomy, surgeons frequently experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. This issue is particularly pertinent while closing the fascia and placing the intestines into the abdominal cavity. Establishment of a deep...

  9. Evaluation of Truview evo2® Laryngoscope In Anticipated Difficult Intubation-A Comparison To Macintosh Laryngoscope

    OpenAIRE

    Ishwar Singh; Abhijit Khaund; Abhishek Gupta

    2009-01-01

    Summary The aim of the study was to assess and compare laryngoscopic view of Truview evo2 laryngoscope with that of Macintosh laryngoscope in patients with one or more predictors of difficult intubation (PDI). Moreover ease of intubation with Truview evo2 in terms of absolute time requirement was also aimed at. Patients for elective surgery requiring endotracheal intubation were initially assessed for three PDI parameters – modified Mallampati test, thyro-mental distance & Atlanto-occipital (...

  10. GlideScope Video Laryngoscope for Difficult Intubation in Emergency Patients: a Quasi-Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Koorosh Ahmadi

    2015-12-01

    Full Text Available Macintosh direct laryngoscope has been the most widely used device for tracheal intubation. GlideScope video laryngoscope (GVL has been recently introduced as an alternative device for performing intubation; however, its validity in emergency settings has not been thoroughly evaluated. The aim of this study was to compare Macintosh direct laryngoscope versus GVL for emergency endotracheal intubation. This quasi-randomized clinical trial was performed on 97 patients referred to Imam Reza Hospital whom all needed emergency intubation in 2011. Patients were divided into two groups of the easy airway and difficult airway; intubation was performed for patients with direct laryngoscopy or GVL. Then, the patients were evaluated in terms of demographic characteristics, successful intubation rate and intubation time. Data was analyzed by SPSS software 16. There was no significant difference in demographic characteristics of the patients in both easy airway and difficult airway groups who intubated with direct laryngoscopy and GVL methods (P>0.05. In difficult airway group, a significant difference was found in successful intubation at the first attempt (60.9% vs. 87.5%; P=0.036, overall intubation time (32.7 ± 14.58 vs. 22.5±7.88; P<0.001 and first attempt intubation time (28.43 ± 12.51 vs. 21.48±7.8; P=0.001 between direct laryngoscopy and GVL. These variables were not significantly different between two methods in easy airway group. According to the results, GVL can be a useful alternative to direct laryngoscopy in emergency situations and especially in cases with a difficult airway.

  11. Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study

    Directory of Open Access Journals (Sweden)

    Kam Wa Jessica Mok

    2016-01-01

    Full Text Available Introduction: Both converted and difficult laparoscopic cholecystectomies (LC have impact on operating time and training of juniors. The aim of this study is to evaluate parameters that predict difficult LC or conversion (C, and find predictive values for different cut-off points of C-reactive protein (CRP for conversion. Materials and Methods: A retrospective cohort study of cholecystectomies performed from January 2011 to December 2012 at NHS trust was undertaken. Association of intra-operative difficulties or conversion with the following factors was studied: Age, gender, CRP, white blood cell count (WBC, history of pancreatitis, and endoscopic retrograde cholangiopancreatography (ERCP. Results: Two hundred and ninety one patients were analysed (222 laparoscopic, 45 difficult LC and 24 C. Only 141 patients had a recorded CRP. Median CRP was highest for patients who were converted (286.20 compared to those who had difficult LC (67.40 or LC (7.05. Those patients who did not have preoperative CRP (8/150, 5.3% had less chance of conversion than those who had CRP (16/141, 11.34% (P = 0.063. Patients with CRP of ≤220 (3/91, 3.2% had significantly less chance of conversion than those with CRP >220 (13/21, 61.9% (P < 0.001. High preoperative CRP, WBC count and ERCP, were predictors of conversion. These factors were only marginally better than CRP alone in predicting conversion. Conclusion: CRP can be a strong predictor of conversion of LC. Further validation of the results is needed.

  12. Central venous catheter malposition in the azygos vein and difficult endotracheal intubation in severe ankylosing spondylitis: a case report

    OpenAIRE

    Moon, Eunjin; Jeong, Hyungmo; Chung, Junyoung; Yi, Jaewoo

    2015-01-01

    Ankylosing spondylitis (AS) can be challenging for anesthesiologists because central venous access can be difficult, and the airway can be blocked due to the fixed flexion deformity of the spine. In this case, we attempted central access via the right subclavian vein, but the catheter was repeatedly inserted into the azygos vein, which was confirmed by radiology. After several attempts, the catheter position was corrected at the superior vena cava-atrial junction. Although several useful devi...

  13. Management of Difficult Airway With Laryngeal Mask in a Child With Mucopolysaccharidosis and Mitral Regurgitation: A Case Report

    Science.gov (United States)

    Ziyaeifard, Mohsen; Azarfarin, Rasoul; Ferasatkish, Rasoul; Dashti, Majid

    2014-01-01

    Introduction: Mucopolysaccharidoses (MPSs) are a group of heredity storage diseases, transmitted in an autosomal recessive manner, associated with the accumulation of glycosaminoglycans (GAGs) in various tissues and organs. The concerned patients have multiple concomitant hereditary anomalies. Considering the craniofacial abnormality in these patients, airway management may be difficult for anesthesiologists. In these patients, preanesthetic assessment is necessary and performed with the accurate assessment of airways, consisting of the physical exam and radiography, MRI or CT of head and neck. An anesthesiologist should set up a “difficult intubation set” with a flexible fiber-optic bronchoscope and also, it may be necessary to discuss with an ear-nose and throat (ENT) specialist if required, for unpredicted emergency situations. Case Presentation: In this case-report we presented a 2-year-old boy with known MPSs with psychomotor retardation, bilateral corneal opacities, impaired hearing and vision, inguinal hernia, severe mitral regurgitation, micrognathia, coarse facial feature, stiff and short neck and restricted mouth opening. He scheduled for left inguinal hernia repair surgery. Discussion: The patient’s difficult airway was managed successfully and the anesthesia of his surgical procedure had an uneventful course. PMID:25478534

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

    Directory of Open Access Journals (Sweden)

    Nobuyasu Komasawa

    2015-01-01

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

  15. 3D seismic experiment in difficult area in Japan; Kokunai nanchiiki ni okeru sanjigen jishin tansa jikken

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-05-27

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

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

    Directory of Open Access Journals (Sweden)

    Bhavdip Patel

    2014-01-01

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

  17. 28 CFR 20.32 - Includable offenses.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Includable offenses. 20.32 Section 20.32 Judicial Administration DEPARTMENT OF JUSTICE CRIMINAL JUSTICE INFORMATION SYSTEMS Federal Systems and Exchange of Criminal History Record Information § 20.32 Includable offenses. (a) Criminal history...

  18. A Difficult Decision

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The financial outlook began to look a bit more optimistic in September,as some economic indicators,such as the DOW Jones Industrial Average and the prices of physical assets,showed signs of recovery one year after the outbreak of the financial tsunami triggered by the bankruptcy of Lehman Brothers.But does the numeric

  19. A Difficult Diagnosis

    DEFF Research Database (Denmark)

    Primholdt, Nina; Primdahl, Jette; Hendricks, Oliver

    2016-01-01

    OBJECTIVES: The majority of patients with ankylosing spondylitis (AS) are young men, and there is limited knowledge about how these men live their everyday lives with the disease. The aim of the present study was to generate knowledge and an understanding of how this group of patients live from day...

  20. Difficult Decisions: Acid Rain.

    Science.gov (United States)

    Miller, John A.; Slesnick, Irwin L.

    1989-01-01

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

  1. A difficult encounter

    DEFF Research Database (Denmark)

    Martinsen, Dorte Sindbjerg; Vasev, Nikolay Rumenov

    2015-01-01

    This article examines the institutional output and preliminary outcome of the EU Patients' Rights Directive in two health care models: the Beveridge and Bismarck models in Denmark and Bulgaria, respectively. The study applies a most dissimilar system design to explain a similar transposition outp...

  2. Difficult Decisions: Euthanasia.

    Science.gov (United States)

    Parakh, Jal S.; Slesnick, Irwin L.

    1992-01-01

    Focuses on the moral arguments for and against the controversial topic of voluntary active euthanasia. Discusses the question of legalization and decriminalization of the practice. Provides a student worksheet with questions to stimulate discussion on the issue. (MDH)

  3. Difficult wounds: radiation wounds

    International Nuclear Information System (INIS)

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

  4. A difficult beginning

    OpenAIRE

    Suneth Agampodi; Sisira Siribaddana

    2013-01-01

    Anuradhapura clinical society (ACS) took a momentous decision this year to improve the quality of Anuradhapura Medical Journal (AMJ), the official journal of ACS. Moving away from the tradition of appointing an editor annually with the change of office bearers of ACS, the society appointed two of us as editors for unlimited period to elevate the quality of AMJ. Previously AMJ was a part of annual scientific sessions and from this year, it was decided to go for a proper journal rather than a c...

  5. Haemophilus influenzae Disease (Including Hib) Symptoms

    Science.gov (United States)

    ... is considered invasive. Symptoms of pneumonia usually include: Fever and chills Cough Shortness of breath or difficulty breathing Sweating ... the blood. It can cause symptoms such as: Fever and chills Excessive tiredness Pain in the belly Nausea with ...

  6. What Does Long-Term Care Include?

    Medline Plus

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

  7. Births and deaths including fetal deaths

    Data.gov (United States)

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

  8. Including Indigenous Minorities in Decision-Making

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

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

  9. Including excitons in semiconductor solar cell modelling

    OpenAIRE

    Burgelman, Marc; Minnaert, Ben

    2005-01-01

    Excitons are marginally important in classical semiconductor device physics, and their treatment is not included in standard solar cell modelling. However, in organic semiconductors and solar cells, the role of excitons is essential, as the primary effect of light absorption is exciton generation, and free electrons and holes are created by exciton dissociation. First steps to include excitons in solar cell modelling were presented by Green 1996 and Zhang 1998. Their model was restricted to a...

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

    Science.gov (United States)

    Patel, A; Nouraei, S A R

    2015-03-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-29

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

  12. [ДX11538a: The remnant Dunhuang Codex's of the Classic of Difficult Issues collected in Russia].

    Science.gov (United States)

    Shen, Shunong

    2014-07-01

    The finalized edition of the Classic of Difficult Issues was collected by Yang Xuancao in the early Tang dynasty and is the only extant version so far. No earlier versions were seen since then. However, ДX11538a, one of the Russian Collection of DUNHUANG remnant papers, was verified to be a segment of the said Classic. Compared with the now circulated edition, this version is randomly arranged and irregular in its text. Even so, it still reflects, to some extent, the old picture of that ancient Classic, with some points even better than the latter. This version is significant to the researchers of this Classic even today. PMID:25429882

  13. Feasibility of transient elastography versus real-time two-dimensional shear wave elastography in difficult-to-scan patients

    DEFF Research Database (Denmark)

    Staugaard, Benjamin; Christensen, Peer Brehm; Mössner, Belinda;

    2016-01-01

    BACKGROUND AND AIMS: Transient elastography (TE) is hampered in some patients by failures and unreliable results. We hypothesized that real time two-dimensional shear wave elastography (2D-SWE), the FibroScan XL probe, and repeated TE exams, could be used to obtain reliable liver stiffness...... skin-capsule distance (OR = 0.77, 95% CI 0.67-0.98). CONCLUSIONS: Transient elastography can be accomplished in nearly all patients by use of the FibroScan XL probe and repeated examinations. In difficult-to-scan patients, the feasibility of TE is superior to 2D-SWE....

  14. Le syndrome des brides amniotiques et ses difficultés diagnostiques et de prise en charge au Burkina Faso

    OpenAIRE

    Nagalo, Kisito; Badiel, Roger; Kouéta, Fla; Tall, François Housséini; Yé, Diarra

    2015-01-01

    Le syndrome des brides amniotiques est une embryo-foetopathie rare, d’étiopathogénie encore inconnue, caractérisé par des malformations crânio-faciales, thoraco-abdominales, des membres et des extrémités. Afin de discuter des difficultés diagnostiques et thérapeutiques du syndrome des brides amniotiques, nous rapportons cinq cas de ce syndrome. Ces cas représentaient autant de phénotypes de la maladie mais avec quelques singularités. Les deux premiers étaient des cas de maladie des brides amn...

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

    Science.gov (United States)

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

    2015-03-01

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

  16. 34 CFR 300.20 - Include.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Include. 300.20 Section 300.20 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH...

  17. 46 CFR 289.2 - Vessels included.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Vessels included. 289.2 Section 289.2 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS AFFECTING SUBSIDIZED VESSELS AND OPERATORS INSURANCE OF... of this part are: (a) All vessels which may in the future be constructed or sold with...

  18. 42 CFR 409.10 - Included services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Included services. 409.10 Section 409.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Inpatient Hospital Services and Inpatient Critical Access Hospital...

  19. Numerical simulation of spark ignition including ionization

    NARCIS (Netherlands)

    Thiele, M; Selle, S; Riedel, U; Warnatz, J; Maas, U

    2000-01-01

    A detailed understanding of the processes associated Midi spark ignition, as a first step during combustion, is of great importance fur clean operation of spark ignition engines. In the past 10 years. a growing concern for environmental protection, including low emission of pollutants, has increased

  20. Difficult Airway Management Algorithm in Emergency Medicine: Do Not Struggle against the Patient, Just Skip to Next Step

    Directory of Open Access Journals (Sweden)

    Jérôme Sudrial

    2010-01-01

    Full Text Available We report a case of prehospital “cannot intubate” and “cannot ventilate” scenarios successfully managed by strictly following a difficult airway management algorithm. Five airway devices were used: the Macintosh laryngoscope, the gum elastic Eschmann bougie, the LMA Fastrach, the Melker cricothyrotomy cannula, and the flexible fiberscope. Although several airway devices were used, overall airway management duration was relatively short, at 20 min, because for each scenario, failed primary and secondary backup devices were quickly abandoned after 2 failed attempts, each attempt of no more than 2 min in duration, in favor of the tertiary rescue device. Equally, all three of these rescue devices failed, an uncuffed cricothyroidotomy cannula was inserted to restore optimal arterial oxygenation until a definitive airway was secured in the ICU using a flexible fiberscope. Our case reinforces the need to strictly follow a difficult airway management algorithm that employs a limited number of effective devices and techniques, and highlights the imperative for early activation of successive preplanned steps of the algorithm.

  1. Long-term follow-up of metil aminolevulinate (MAL)-PDT in difficult-to-treat cutaneous Bowen's disease.

    Science.gov (United States)

    Cavicchini, Stefano; Serini, Stefano Maria; Fiorani, Roberta; Girgenti, Valentina; Ghislanzoni, Massimo; Sala, Francesco

    2011-08-01

    Bowen's disease (BD) is a form of intraepidermal squamous cell carcinoma, which is clinically characterized by gradually enlarging, well-demarcated erythematous plaques with irregular borders and surface crusting or scaling, affecting primarily the elderly. BD often presents with lesions difficult to treat with standard therapy as surgery, cryosurgery, or 5-fluorouracil (5-FU) for the risk of significantly poor cosmetic outcome, failure rate, and adverse events, related mainly to the age of the patients. Topical PDT with methyl aminolevulinate (MAL) represents a valid and approved therapy for BD lesions in many cases, especially for lesions located at poor healing sites or for large patches of disease, due to its high efficacy coupled with good tolerability and tissue-sparing attitude. In this study, we sought to investigate the efficacy, safety, and cosmetic outcome of MAL-PDT in a series of patients with BD lesions which were challenging to treat for clinical, surgical, and patient-related reasons, such as size of the lesion, difficult surgical approach for anatomical sites, or age of patients and request of the best cosmetic result. We also performed a long-term follow-up to assess recurrence rates and eventual late-onset adverse events.

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

    Energy Technology Data Exchange (ETDEWEB)

    Mathews, Fiona

    2011-07-01

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

  3. Successful cases of difficult inferior vena cava filter retrieval with the use of biopsy forceps: Biopsy forceps technique

    Directory of Open Access Journals (Sweden)

    Masaya Nakashima

    2014-12-01

    Full Text Available Objectives: For treatment and prevention of deep vein thrombosis(DVT and pulmonary embolism(PE, retrievable inferior vena cava(IVC filters have commonly been used as an effective bridge to anticoagulation. However, we experienced unexpected difficulty in endovascular retrieval of some IVC filters. Most problems were due to endovascular treatment devices issues, filter intimal migration, filter disintegration, filter-associated thrombosis, and right atrium/ventricle migration. Methods: Disposable biopsy forceps was used to engage the filter hook and reform the shape of the filter struts. Endovascular retrieval assisted by use of the biopsy forceps via a similar vein was effective and provided a less-invasive, low cost method for removal of problematic IVC filters. Results: We described easily performed methods that uses disposable biopsy forceps for the retrieval of IVC filters that are difficult to remove because of filter hook migration into the caval wall. Conclusion: We developed an easily performed method that uses intestine biopsy forceps for the retrieval of IVC filter that are difficult to remove.

  4. [Biophysical Characterization of Biopharmaceuticals, Including Antibody Drugs].

    Science.gov (United States)

    Uchiyama, Susumu

    2016-01-01

    Biopharmaceuticals, including antibody drugs, are now popular because of their high specificity with low adverse effects, especially in the treatment of cancer and autoimmune diseases. However, because the active pharmaceutical ingredients of biopharmaceuticals are proteins, biophysical characterization of these therapeutic proteins should be required. In this manuscript, methods of chemical and physical characterization of therapeutic proteins are described. In terms of chemical characterization, analysis of chemical modifications of the constituent amino acids is explained. Physical characterization includes higher order structural analysis and assessment of protein aggregates. Quantification methods of aggregates with different sizes, recently encouraged by the U.S. Food and Drug Administration (FDA), are introduced. As for the stability of therapeutic proteins, the importance of chemical and physical stability is explained. Finally, the contribution of colloidal and structural stability to the production of an antibody drug less prone to aggregation is introduced.

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

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-17

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

  6. Including knowledge creation & enabling in risk management

    OpenAIRE

    Hop, Eirik

    2015-01-01

    As a contribution to Statoil Technical Efficiency Programme (STEP), has the thesis looked at how to improve the risk management process in Statoil ASA. Through theoretical research was the primary research question created: “How can knowledge creation & enabling improve our understanding of risk management?” To create a theoretical foundation, the thesis looked at principles, methods, and models for the adequate assessment and management of risk. This includes a new perspective on ri...

  7. Rotor assembly including superconducting magnetic coil

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-01-01

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

  8. Including heavy flavour production in PDF fits

    OpenAIRE

    A.M. Cooper-Sarkar

    2007-01-01

    AT HERA heavy quarks may contribute up to 30% of the structure function $F_2$. The introduction of heavy quarks requires an extension of the DGLAP formalism. The effect of using different heavy flavour number schemes, and different approaches to the running of $\\alpha_s$, are compared using the ZEUS PDF fit formalism. The potential of including charm data in the fit is explored, using $D^*$ double differential cross-sections rather than the inclusive quantity $F_2^{c\\bar{c}}$.

  9. Can Certain Genotypes Predispose to Poor Asthma Control in Children? A Pharmacogenetic Study of 9 Candidate Genes in Children with Difficult Asthma

    OpenAIRE

    Basima Almomani; Hawwa, Ahmed F; Millership, Jeffrey S; Liam Heaney; Isabella Douglas; McElnay, James C.; Shields, Michael D.

    2013-01-01

    Objective: We tested the hypothesis that patients with difficult asthma have an increased frequency of certain genotypes that predispose them to asthma exacerbations and poor asthma control. Methods: A total of 180 Caucasian children with confirmed asthma diagnosis were selected from two phenotypic groups; difficult (n = 112) versus mild/moderate asthma (n = 68) groups. All patients were screened for 19 polymorphisms in 9 candidate genes to evaluate their association with difficult asthma. Ke...

  10. A kicked quantum system including the continuum

    International Nuclear Information System (INIS)

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

  11. Drug delivery device including electrolytic pump

    KAUST Repository

    Foulds, Ian G.

    2016-03-31

    Systems and methods are provided for a drug delivery device and use of the device for drug delivery. In various aspects, the drug delivery device combines a “solid drug in reservoir” (SDR) system with an electrolytic pump. In various aspects an improved electrolytic pump is provided including, in particular, an improved electrolytic pump for use with a drug delivery device, for example an implantable drug delivery device. A catalytic reformer can be incorporated in a periodically pulsed electrolytic pump to provide stable pumping performance and reduced actuation cycle.

  12. Musculoskeletal ultrasound including definitions for ultrasonographic pathology

    DEFF Research Database (Denmark)

    Wakefield, RJ; Balint, PV; Szkudlarek, Marcin;

    2005-01-01

    Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints...... pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis....

  13. Inlet Guide Vane Wakes Including Rotor Effects

    Science.gov (United States)

    Johnston, R. T.; Fleeter, S.

    2001-02-01

    Fundamental experiments are described directed at the investigation of forcing functions generated by an inlet guide vane (IGV) row, including interactions with the downstream rotor, for application to turbomachine forced response design systems. The experiments are performed in a high-speed research fan facility comprised of an IGV row upstream of a rotor. IGV-rotor axial spacing is variable, with the IGV row able to be indexed circumferentially, thereby allowing measurements to be made across several IGV wakes. With an IGV relative Mach number of 0.29, measurements include the IGV wake pressure and velocity fields for three IGV-rotor axial spacings. The decay characteristics of the IGV wakes are compared to the Majjigi and Gliebe empirical correlations. After Fourier decomposition, a vortical-potential gust splitting analysis is implemented to determine the vortical and potential harmonic wake gust forcing functions both upstream and downstream of the rotor. Higher harmonics of the vortical gust component of the IGV wakes are found to decay at a uniform rate due to viscous diffusion.

  14. Aerosol simulation including chemical and nuclear reactions

    Energy Technology Data Exchange (ETDEWEB)

    Marwil, E.S.; Lemmon, E.C.

    1985-01-01

    The numerical simulation of aerosol transport, including the effects of chemical and nuclear reactions presents a challenging dynamic accounting problem. Particles of different sizes agglomerate and settle out due to various mechanisms, such as diffusion, diffusiophoresis, thermophoresis, gravitational settling, turbulent acceleration, and centrifugal acceleration. Particles also change size, due to the condensation and evaporation of materials on the particle. Heterogeneous chemical reactions occur at the interface between a particle and the suspending medium, or a surface and the gas in the aerosol. Homogeneous chemical reactions occur within the aersol suspending medium, within a particle, and on a surface. These reactions may include a phase change. Nuclear reactions occur in all locations. These spontaneous transmutations from one element form to another occur at greatly varying rates and may result in phase or chemical changes which complicate the accounting process. This paper presents an approach for inclusion of these effects on the transport of aerosols. The accounting system is very complex and results in a large set of stiff ordinary differential equations (ODEs). The techniques for numerical solution of these ODEs require special attention to achieve their solution in an efficient and affordable manner. 4 refs.

  15. Conditional E-Cash

    Science.gov (United States)

    Shi, Larry; Carbunar, Bogdan; Sion, Radu

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

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

    Directory of Open Access Journals (Sweden)

    Firsova V.G.,

    2011-12-01

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

  17. Criteria of an estimation statodynamic stability of sportsman body and system of bodies in difficult coordination sports.

    Directory of Open Access Journals (Sweden)

    Boloban V.N.

    2012-04-01

    Full Text Available Criteria of an estimation statodynamic stability of sportsman body and system of bodies in difficult coordination sports are developed and experimentally proved. It is established that length of the general center of pressure trajectory of a body on a support, frequency of fluctuations of a body, a parity of amplitude of fluctuations of a body and frequency, symmetry and asymmetry of movements in the course of a body pose regulation, length of a trajectory of a control point moving on a trunk in the field of a sacrum in system of cooperating bodies are authentic signs of sports orientation, an estimation of sports technics of exercises and training by it. Criteria are a criterion of an estimation of a body balance in the course of sports exercises performance; allow to carry out effective sports preparation.

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

    Science.gov (United States)

    Vogel, Tobias; Genschow, Oliver

    2013-04-01

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

  19. 脊柱手术难题的解决方法%METHODS FOR DIFFICULT SPINAL PROBLEMS

    Institute of Scientific and Technical Information of China (English)

    梁智仁; 张姝江

    2011-01-01

    @@ THE CERVICOTHORACIC JUNCTION (C7-T4) is difficult to approach anteriorly. We have recently described a unilateral or bilateral inverted-T MANUBRIOTOMY. Midline longitudinal incision from the manubrial notch to 3cm caudad to the manubriosternal angle. The internal thoracic artery is then identified by blunt dissection in the second intercostal space, carefully isolated and divided between ligatures. The posterior surface of the manubrium is freed by blunt dissection. The manubrium is osteotomized, and the transverse limb should exit at the second intercostal space. Exposure to the spine is in between the major blood vessels. The right recurrent laryngeal nerve, which loops around the subclavian artery, should be isolated and protected. An 8 cm wide exposure to the spine is possible with a bilateral manubriotomy. Exposure of the 7th cervical to the 4th thoracic vertebrae is possible, and by retracting the left innominate vein, down to the 5th thoracic vertebra.

  20. The long shadows of the difficult past? How young people in Denmark, Finland and Germany remember WWII

    DEFF Research Database (Denmark)

    Wolnik, Kevin; Busse, Britta; Tholen, Jochen;

    2016-01-01

    half of the twentieth century (e.g. parents and grandparents, schools, the media) are examined. The theoretical basis chosen for addressing these questions is the work of Mannheim (1928) on the formation of successive generations, and the theories of collective memories and identities of Eisenstadt...... and his followers. Our empirical evidence comes from a transnational comparison of young people’s memories of this difficult past in Denmark, Finland and Germany. From a historical perspective a comparison of the three countries is particularly interesting as they played different roles during the Second...... World War. The evidence highlights the different perceptions of history among youth and points to the absence of a common European understanding of what happened between 1939 and 1945. The empirical evidence comes from a research project (2011–2015) funded by the European Commission and covering 14...

  1. Models of bovine babesiosis including juvenile cattle.

    Science.gov (United States)

    Saad-Roy, C M; Shuai, Zhisheng; van den Driessche, P

    2015-03-01

    Bovine Babesiosis in cattle is caused by the transmission of protozoa of Babesia spp. by ticks as vectors. Juvenile cattle (resistance to Bovine Babesiosis, rarely show symptoms, and acquire immunity upon recovery. Susceptibility to the disease varies between breeds of cattle. Models of the dynamics of Bovine Babesiosis transmitted by the cattle tick that include these factors are formulated as systems of ordinary differential equations. Basic reproduction numbers are calculated, and it is proved that if these numbers are below the threshold value of one, then Bovine Babesiosis dies out. However, above the threshold number of one, the disease may approach an endemic state. In this case, control measures are suggested by determining target reproduction numbers. The percentage of a particular population (for example, the adult bovine population) needed to be controlled to eradicate the disease is evaluated numerically using Columbia data from the literature. PMID:25715822

  2. CLIC expands to include the Southern Hemisphere

    CERN Multimedia

    Roberto Cantoni

    2010-01-01

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

  3. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

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

  4. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

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

  5. CERN Technical Training: LABVIEW courses include RADE

    CERN Multimedia

    HR Department

    2009-01-01

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

  6. Critical point anomalies include expansion shock waves

    Energy Technology Data Exchange (ETDEWEB)

    Nannan, N. R., E-mail: ryan.nannan@uvs.edu [Mechanical Engineering Discipline, Anton de Kom University of Suriname, Leysweg 86, PO Box 9212, Paramaribo, Suriname and Process and Energy Department, Delft University of Technology, Leeghwaterstraat 44, 2628 CA Delft (Netherlands); Guardone, A., E-mail: alberto.guardone@polimi.it [Department of Aerospace Science and Technology, Politecnico di Milano, Via La Masa 34, 20156 Milano (Italy); Colonna, P., E-mail: p.colonna@tudelft.nl [Propulsion and Power, Delft University of Technology, Kluyverweg 1, 2629 HS Delft (Netherlands)

    2014-02-15

    From first-principle fluid dynamics, complemented by a rigorous state equation accounting for critical anomalies, we discovered that expansion shock waves may occur in the vicinity of the liquid-vapor critical point in the two-phase region. Due to universality of near-critical thermodynamics, the result is valid for any common pure fluid in which molecular interactions are only short-range, namely, for so-called 3-dimensional Ising-like systems, and under the assumption of thermodynamic equilibrium. In addition to rarefaction shock waves, diverse non-classical effects are admissible, including composite compressive shock-fan-shock waves, due to the change of sign of the fundamental derivative of gasdynamics.

  7. Including electronic effects in damage cascade simulations

    International Nuclear Information System (INIS)

    A method for including the effects of electronic losses and electron-phonon coupling in radiation damage simulations has been developed and implemented for 10 keV cascades in Fe. The MD simulations are coupled to a continuum model for the electronic energy and energy lost by the atoms, due to electronic friction and electron-phonon coupling, is gained by electronic system. Electronic energy transport is described by the heat diffusion equation and energy is returned to the lattice via a stochastic force. Thus the temperature of the atomic system is controlled by a Langevin thermostat at the local electronic temperature, which varies with time and space. The results of simulations with this inhomogeneous thermostat are compared with those of homogeneous (constant temperature) thermostat simulations for a range of electron-phonon coupling strengths. The residual defect concentration was found to have a non-monotonic variation with coupling strength.

  8. The surgery of peripheral nerves (including tumors)

    DEFF Research Database (Denmark)

    Fugleholm, Kåre

    2013-01-01

    Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved...... surgical techniques and better outcome after peripheral nerve injury. Decision making in peripheral nerve surgery continues to be a complex challenge, where the mechanism of injury, repeated clinical evaluation, neuroradiological and neurophysiological examination, and detailed knowledge of the peripheral...... nervous system response to injury are prerequisite to obtain the best possible outcome. Surgery continues to be the primary treatment modality for peripheral nerve tumors and advances in adjuvant oncological treatment has improved outcome after malignant peripheral nerve tumors. The present chapter...

  9. ACCREDITATION FOR TECHNICAL ABILITIES INCLUDING COMPUTER SKILLS

    Directory of Open Access Journals (Sweden)

    Halit Hami OZ

    2013-01-01

    Full Text Available Sector Skills are defined by state-sponsored, employer-led organizations that cover specific economic sectors in the European Union and other countries in the world to reduce skills gaps and shortages, improve productivity, boost the skills of their sector workforces and improve learning supply. The accreditation and registration systems used by professional bodies raise the profile of the profession. In many countries including the European Union, professional associations are beginning to accept practice-based accreditation, generally as an alternative to their mainstream systems. Besides studying the certain agencies in the European Union for assessing/accreditating practical abilities , Accreditation for practical abilities of Information Communication Technology and Business Management/Language domains developed by Accreditation Council for Practical abilities are also studied in detail as an example to establish a similar agency in Turkey.

  10. AMS at the ANU including biomedical applications

    Energy Technology Data Exchange (ETDEWEB)

    Fifield, L.K.; Allan, G.L.; Cresswell, R.G.; Ophel, T.R. [Australian National Univ., Canberra, ACT (Australia); King, S.J.; Day, J.P. [Manchester Univ. (United Kingdom). Dept. of Chemistry

    1993-12-31

    An extensive accelerator mass spectrometry program has been conducted on the 14UD accelerator at the Australian National University since 1986. In the two years since the previous conference, the research program has expanded significantly to include biomedical applications of {sup 26}Al and studies of landform evolution using isotopes produced in situ in surface rocks by cosmic ray bombardment. The system is now used for the measurement of {sup 10}Be, {sup 14}C, {sup 26}Al, {sup 36}Cl, {sup 59}Ni and {sup 129}I, and research is being undertaken in hydrology, environmental geochemistry, archaeology and biomedicine. On the technical side, a new test system has permitted the successful off-line development of a high-intensity ion source. A new injection line to the 14UD has been established and the new source is now in position and providing beams to the accelerator. 4 refs.

  11. Thermovoltaic semiconductor device including a plasma filter

    Science.gov (United States)

    Baldasaro, Paul F.

    1999-01-01

    A thermovoltaic energy conversion device and related method for converting thermal energy into an electrical potential. An interference filter is provided on a semiconductor thermovoltaic cell to pre-filter black body radiation. The semiconductor thermovoltaic cell includes a P/N junction supported on a substrate which converts incident thermal energy below the semiconductor junction band gap into electrical potential. The semiconductor substrate is doped to provide a plasma filter which reflects back energy having a wavelength which is above the band gap and which is ineffectively filtered by the interference filter, through the P/N junction to the source of radiation thereby avoiding parasitic absorption of the unusable portion of the thermal radiation energy.

  12. Evaluation of Truview evo2® Laryngoscope In Anticipated Difficult Intubation-A Comparison To Macintosh Laryngoscope

    Directory of Open Access Journals (Sweden)

    Ishwar Singh

    2009-01-01

    Full Text Available The aim of the study was to assess and compare laryngoscopic view of Truview evo2 laryngoscope with that of Macintosh laryngoscope in patients with one or more predictors of difficult intubation (PDI. Moreover ease of intubation with Truview evo2 in terms of absolute time requirement was also aimed at. Patients for elective surgery requiring endotracheal intubation were initially assessed for three PDI parameters - modified Mallampati test, thyro-mental distance& Atlanto-occipital (AO joint extension. Patients with cumulative PDI scores of 2 to 5 (in a scale of 0 to 8 were evaluated for Cormack& Lehane (CL grading by Macintosh blade after standard induction. Cases with CL grade of two or more were further evaluated by Truview evo2 laryngoscope and corresponding CL grades were assigned. Intubation attempted under Truview evo2 vision and time required for each successful tracheal intubation (i.e. tracheal intubation completed within one minute was noted. Total fifty cases were studied. The CL grades assigned by Macintosh blade correlated well with the cumulative PDI scores assigned preoperatively, confirming there predictability. Truview evo2 improved laryngeal view in 92 % cases by one or more CL grade. Intubation with Truview evo2 was possible in 88% cases within stipulated time of one minute and mean time of 28.6 seconds with SD of 11.23 was reasonably quick. No significant complication like oro- pharyngeal trauma or extreme pressor response to laryngoscopy was noticed. To conclude, Truview evo2 proved to be a better tool than conventional laryngoscope in anticipated difficult situations.

  13. Fundamentals for remote condition monitoring of offshore wind turbines

    DEFF Research Database (Denmark)

    McGugan, Malcolm; Larsen, Gunner Chr.; Sørensen, Bent F.;

    necessary for the use of sensors as a structural health monitoring system for wind turbine blades. This includes creating knowledge that will allow sensor signals to be used for remotely identifying the presence and position of any damage, the damage type and severity, and a structural condition assessment......In the future, large wind turbines will be placed offshore in considerable numbers. Since access will be difficult and costly, it is preferable to use monitoring systems to reduce the reliance on manual inspection. The motivation for the effort reported here is to create the fundamental basis...... regimes. The application of sensors is addressed during a full-scale blade test and recommendations are made regarding improvement to the commercial blade certification process of test and inspection, sensor use for monitoring in-service structural response, and the need for dedicated research facilities...

  14. Biological control of Polymyxa betae, fungal vector of rhizomania disease of sugar beets in greenhouse conditions

    OpenAIRE

    Naraghi Laleh; Heydari Asghar; Askari Hassan; Pourrahim Reza; Marzban Rasoul

    2014-01-01

    Rhizomania is one of the most important diseases of sugar beet around the world – including in Iran. The disease causes a severe decrease in sugar yield and is a limiting factor in sugar beet cultivation. Control of the disease is very difficult due to the long-term survival of its fungal vector (Polymyxa betae) in the soil. In this study, we investigated the effects of antagonistic fungal isolates on the population of the resting structure (cystosorus) of P. betae, under greenhouse condition...

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

    OpenAIRE

    Reuter, I.; Mehnert, S.; Sammer, G.; Oechsner, M.; Engelhardt, M.

    2012-01-01

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

  16. Input parameters and scenarios, including economic inputs

    DEFF Research Database (Denmark)

    Boklund, Anette; Hisham Beshara Halasa, Tariq

    2012-01-01

    Geographical locations of the farms are the core in these models. We used geographical data, number of animals and specification of herd types for the 50,853 herds in the Danish Husbandry Register (CHR) in 2007. For each herd, the daily probability of moving animals, to another herd or to the aba......Geographical locations of the farms are the core in these models. We used geographical data, number of animals and specification of herd types for the 50,853 herds in the Danish Husbandry Register (CHR) in 2007. For each herd, the daily probability of moving animals, to another herd......, disease was simulated to spread via direct contacts (movements of animals), indirect contacts (trucks and persons) and local spread (mice, birds, airborne spread in limited distances). Furthermore, in some scenarios airborne spread was included. For all contact types, when a contact was simulated to take...... place, a receiving herd needed to be found. The distance, in which the receiving herd should be found, was calculated from movement data for animals and from data from trucks and abattoirs for movements to slaughter and milk tankers. For persons visiting herds, we used a combination of expert opinions...

  17. Sommerfeld radiation condition at threshold

    DEFF Research Database (Denmark)

    Skibsted, Erik

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

  18. An Integrated Biochemistry Laboratory, Including Molecular Modeling

    Science.gov (United States)

    Hall, Adele J. Wolfson Mona L.; Branham, Thomas R.

    1996-11-01

    The dilemma of designing an advanced undergraduate laboratory lies in the desire to teach and reinforce basic principles and techniques while at the same time exposing students to the excitement of research. We report here on a one-semester, project-based biochemistry laboratory that combines the best features of a cookbook approach (high success rate, achievement of defined goals) with those of an investigative, discovery-based approach (student involvement in the experimental design, excitement of real research). Individual modules may be selected and combined to meet the needs of different courses and different institutions. The central theme of this lab is protein purification and design. This laboratory accompanies the first semester of biochemistry (Structure and Function of Macromolecules, a course taken mainly by junior and senior chemistry and biological chemistry majors). The protein chosen as the object of study is the enzyme lysozyme, which is utilized in all projects. It is suitable for a student lab because it is easily and inexpensively obtained from egg white and is extremely stable, and its high isoelectric point (pI = 11) allows for efficient separation from other proteins by ion-exchange chromatography. Furthermore, a literature search conducted by the resourceful student reveals a wealth of information, since lysozyme has been the subject of numerous studies. It was the first enzyme whose structure was determined by crystallography (1). Hendrickson et al. (2) have previously described an intensive one-month laboratory course centered around lysozyme, although their emphasis is on protein stability rather than purification and engineering. Lysozyme continues to be the focus of much exciting new work on protein folding and dynamics, structure and activity (3 - 5). This lab course includes the following features: (i) reinforcement of basic techniques, such as preparation of buffers, simple enzyme kinetics, and absorption spectroscopy; (ii

  19. Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

    DEFF Research Database (Denmark)

    Kehlet Nørskov, Anders; Wetterslev, J; Rosenstock, C V;

    2016-01-01

    BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI w...

  20. SEEPAGE MODEL FOR PA INCLUDING DRIFT COLLAPSE

    Energy Technology Data Exchange (ETDEWEB)

    C. Tsang

    2004-09-22

    The purpose of this report is to document the predictions and analyses performed using the seepage model for performance assessment (SMPA) for both the Topopah Spring middle nonlithophysal (Tptpmn) and lower lithophysal (Tptpll) lithostratigraphic units at Yucca Mountain, Nevada. Look-up tables of seepage flow rates into a drift (and their uncertainty) are generated by performing numerical simulations with the seepage model for many combinations of the three most important seepage-relevant parameters: the fracture permeability, the capillary-strength parameter 1/a, and the percolation flux. The percolation flux values chosen take into account flow focusing effects, which are evaluated based on a flow-focusing model. Moreover, multiple realizations of the underlying stochastic permeability field are conducted. Selected sensitivity studies are performed, including the effects of an alternative drift geometry representing a partially collapsed drift from an independent drift-degradation analysis (BSC 2004 [DIRS 166107]). The intended purpose of the seepage model is to provide results of drift-scale seepage rates under a series of parameters and scenarios in support of the Total System Performance Assessment for License Application (TSPA-LA). The SMPA is intended for the evaluation of drift-scale seepage rates under the full range of parameter values for three parameters found to be key (fracture permeability, the van Genuchten 1/a parameter, and percolation flux) and drift degradation shape scenarios in support of the TSPA-LA during the period of compliance for postclosure performance [Technical Work Plan for: Performance Assessment Unsaturated Zone (BSC 2002 [DIRS 160819], Section I-4-2-1)]. The flow-focusing model in the Topopah Spring welded (TSw) unit is intended to provide an estimate of flow focusing factors (FFFs) that (1) bridge the gap between the mountain-scale and drift-scale models, and (2) account for variability in local percolation flux due to

  1. Including lifestyle medicine in undergraduate medical curricula

    Directory of Open Access Journals (Sweden)

    Edward Phillips

    2015-02-01

    Full Text Available Purpose: Currently, there is no model to integrate the discipline of lifestyle medicine (LM into undergraduate medical education. Furthermore, there are no guidelines, validated assessment tools, or evaluation or implementation plans in place. Background: The World Health Organization predicts that by 2020, two-thirds of disease worldwide will be the result of poor lifestyle choices. Fewer than 50% of US primary care physicians routinely provide specific guidance on nutrition, physical activity, or weight control. Methods: We are establishing a plan to integrate LM into medical school education in collaboration with the investing stakeholders, including medical school deans and students, medical curriculum developers and researchers, medical societies, governing bodies, and policy institutes. Three planning and strategy meetings are being held to address key areas of focus – with a particular interest in nutrition, physical activity, student self-care, and behavior change – to develop specific implementation guidelines and landmarks. Results: After the first two meetings, the proposed areas of focus were determined to be: 1 supporting of deans and key personnel, 2 creation of federal and state policy commitments, 3 use of assessment as a driver of LM, 4 provision of high-quality evidence-based curricular material on an easily navigated site, and 5 engaging student interest. Implementation strategies for each focus area will be addressed in an upcoming planning meeting in early 2015. Conclusion: This initiative is expected to have important public health implications by efficiently promoting the prevention and treatment of non-communicable chronic disease with a scalable and sustainable model to educate physicians in training and practice.

  2. 公立医院改革难点与对策探讨%Exploration of Difficult Points and Countermeasures on Public Hospital Reform

    Institute of Scientific and Technical Information of China (English)

    龚祖康; 韦波

    2011-01-01

    在认澳学习和贯彻领会国务院的基础上,结合医院管理工作实际,分析和探讨当前公立医院改革存在的一些难点问题,包括坚持公立医院的公益性质需要各级政府转变执政理念和承担责任;改革公立医院的管理体制需要有关职能部门理清管办职责;政府在财力有限的情况下需要转变补偿政策和调整补偿方式;因人事制度改革中编制和岗位绩效工资难以解决的原因而造成广大医护人员参与改革积极性不高等等.提出了转变政府职能、完善投入机制、维护公立医院公益性质;实施区城卫生规划、优化布局、实行属地化管理;完善补偿政策、加强监管、解决"以药补医"问题;科学设I岗位、切实实施绩效工资、规范医师多点执业等对策建议.%According to The Reform Guidance on Public Hospital by the State Council, some difficult points of public hospital reform are discussed, which include insisting on public welfare of public hospital, all levels of government need to change concept of governance and take responsibility, reforming public hospital management system, the department' s managing duties need to sort out ,in the case of limited financial resources, government need to change compensation policies and compensation adjustments,personnel system and job performance wage are difficult to resolve,the initiative of medical staff involved in the reform is not high. Some countermeasures are put forward, which include transformation of government functions, improving the investment mechanism, maintaining characteristic of public welfare of public hospital, implementation of regional health planning, optimizing the layout, the localization of management, improving the compensation policy, implementation of performance wage and standardized multi-physician practice.

  3. Predicting difficult laryngoscopy in acromegalic patients undergoing surgery for excision of pituitary tumors: A comparison of extended Mallampati score with modified Mallampati classification

    Directory of Open Access Journals (Sweden)

    Ashish Bindra

    2013-01-01

    Full Text Available Background: There are numerous reports of difficult laryngoscopy and intubation in patients with acromegaly. To date, no study has assessed the application of extended Mallampati score (EMS for predicting difficult intubation in acromegalics. The primary aim of this study was to compare EMS with modified Mallampati classification (MMP in predicting difficult laryngoscopy in acromegalic patients. We hypothesized that since EMS has been reported to be more specific and better predictor than MMP, it may be superior to the MMP to predict difficult laryngoscopy in acromegalic patients. Materials and Methods: For this prospective cohort study with matched controls, acromegalic patients scheduled to undergo pituitary surgery over a period of 3 years (January 2008-December 2010 were enrolled. Preoperative airway assessment was performed by experienced anesthesiologists and involved a MMP and the EMS. Under anesthesia, laryngoscopic view was assessed using Cormack-Lehane (CL grading. MMP and CL grades of I and II were defined "easy" and III and IV as "difficult". EMS grade of I and II were defined "easy" and III as "difficult". Data were used to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MMP and EMS in predicting difficult laryngoscopy. Results: Seventy eight patients participated in the study (39 patients in each group. Both MMP and EMS failed to detect difficult laryngoscopy in seven patients. Only one laryngoscopy was predicted to be difficult by both tests which was in fact, difficult. Conclusion: We found that addition of neck extension did not improve the predictive value of MMP.

  4. Bucket wheel excavators for varying mining conditions

    Energy Technology Data Exchange (ETDEWEB)

    Schachtschneider, H.; Seliger, E.

    1987-06-01

    TAKRAF bucket wheel excavators have proven their efficiency through the achievement of daily production rates in excess of 300,000 bcm, and have accomplished this under the most difficult geological and climatic conditions. Even heavy, plastic, very sticky clays, very abrasive soils, and rocky partings have been successfully mined with bucket wheel excavators. The use of BWEs to mine the hard coal deposits at the Ekibastus surface mine in the U.S.S.R., has broadened the field of application of these machines. Based on the experience gained in heavy-duty service, the bucket wheel excavators designed in the future will be capable of successfully coping with even more difficult site conditions.

  5. Synthesis of Gd2O3:Ho3+/Yb3+ upconversion nanoparticles for latent fingermark detection on difficult surfaces

    Science.gov (United States)

    Kumar, A.; Tiwari, S. P.; Singh, A. K.; Kumar, K.

    2016-07-01

    Infrared to visible upconversion fluorescent nanoparticles of Gd2O3 codoped with Ho3+/Yb3+ ions are synthesized via thermal decomposition process. The X-ray diffraction analysis of as-synthesized nanoparticles and annealed sample at 1000 °C has shown body-centered cubic phase of Gd2O3. The synthesized phosphor has shown intense green emission upon 980-nm excitation. High-contrast latent fingermarks on some difficult semi-porous and non-porous surfaces under 980-nm diode laser excitation were developed through powder dusting and colloidal solution spraying techniques and the results are compared with the commercial green luminescent fingermark powder. The latent fingermarks were developed on transparent (biological glass slides), single-color (aluminum foil) and multicolor (plywood, plastic bottle and book cover page) background surfaces. The present study depicts that the upconversion-based latent fingermarks detection using Gd2O3:Ho3+/Yb3+ phosphor material is suitable over the other conventional powders and has potential for practical applications in forensic science.

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

    Directory of Open Access Journals (Sweden)

    Adel Salah Bediwy

    2011-01-01

    Full Text Available Objectives. To assess the induced sputum substance P (ISSP levels in children having difficult-to-treat asthma (DA with and without gastroesophageal reflux (GER. We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT, FEV1, peak expiratory flow (PEF variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV1 in children with DA. Methods. Spirometry, C-ACT, upper gastrointestinal endoscopy, and ISSP measurement were done for children with DA compared to healthy controls. Results. ISSP was high in DA with higher levels in the group having associated GER. In the latter group, ISSP and C-ACT improved significantly after esomeprazole treatment while FEV1 and PEF variability did not improve. Reflux severity was positively correlated with ISSP and negatively correlated with FEV1. Conclusions. GER was found in 49% of our patients with childhood DA. Very high ISSP levels in children with DA may be used as a marker for presence of GERD. Esomeprazole therapy improved asthma symptoms but did not improve lung function.

  7. Endophytic bacteria in plant tissue culture: differences between easy- and difficult-to-propagate Prunus avium genotypes.

    Science.gov (United States)

    Quambusch, Mona; Pirttilä, Anna Maria; Tejesvi, Mysore V; Winkelmann, Traud; Bartsch, Melanie

    2014-05-01

    The endophytic bacterial communities of six Prunus avium L. genotypes differing in their growth patterns during in vitro propagation were identified by culture-dependent and culture-independent methods. Five morphologically distinct isolates from tissue culture material were identified by 16S rDNA sequence analysis. To detect and analyze the uncultivable fraction of endophytic bacteria, a clone library was established from the amplified 16S rDNA of total plant extract. Bacterial diversity within the clone libraries was analyzed by amplified ribosomal rDNA restriction analysis and by sequencing a clone for each identified operational taxonomic unit. The most abundant bacterial group was Mycobacterium sp., which was identified in the clone libraries of all analyzed Prunus genotypes. Other dominant bacterial genera identified in the easy-to-propagate genotypes were Rhodopseudomonas sp. and Microbacterium sp. Thus, the community structures in the easy- and difficult-to-propagate cherry genotypes differed significantly. The bacterial genera, which were previously reported to have plant growth-promoting effects, were detected only in genotypes with high propagation success, indicating a possible positive impact of these bacteria on in vitro propagation of P. avium, which was proven in an inoculation experiment. PMID:24812040

  8. Do depressive symptoms "blunt" effort? An analysis of cardiac engagement and withdrawal for an increasingly difficult task.

    Science.gov (United States)

    Silvia, Paul J; Mironovová, Zuzana; McHone, Ashley N; Sperry, Sarah H; Harper, Kelly L; Kwapil, Thomas R; Eddington, Kari M

    2016-07-01

    Research on depression and effort has suggested "depressive blunting"-lower cardiovascular reactivity in response to challenges and stressors. Many studies, however, find null effects or higher reactivity. The present research draws upon motivational intensity theory, a broad model of effort that predicts cases in which depressive symptoms should increase or decrease effort. Because depressive symptoms can influence task-difficulty appraisals-people see tasks as subjectively harder-people high in depressive symptoms should engage higher effort at objectively easier levels of difficulty but also quit sooner. A sample of adults completed a mental effort challenge with four levels of difficulty, from very easy to difficult-but-feasible. Depressive symptoms were assessed with the CESD and DASS; effort-related cardiac activity was assessed via markers of contractility (e.g., the cardiac pre-ejection period [PEP]) obtained with impedance cardiography. The findings supported the theory's predictions. When the task was relatively easier, people high in depressive symptoms showed higher contractility (shorter PEP), consistent with greater effort. When the task was relatively harder, people high in depressive symptoms showed diminished contractility, consistent with quitting. The results suggest that past research has been observing a small part of a larger trajectory of trying and quitting, and they illustrate the value of a theoretically grounded analysis of depressive symptoms and effort-related cardiac activity. PMID:27174723

  9. Using internally cooled cutting tools in the machining of difficult-to-cut materials based on Waspaloy

    Directory of Open Access Journals (Sweden)

    Yahya Isik

    2016-05-01

    Full Text Available Nickel-based superalloys such as Waspaloy are used for engine components and in the nuclear industry, where considerable strength and corrosion resistance at high operating temperatures are called for. These characteristics of such alloys cause increases in cutting temperature and resultant tool damage, even at low cutting speeds and low feed rates. Thus, they are classified as difficult-to-cut materials. This article presents a cooling method to be used in metal cutting based on a tool holder with a closed internal cooling system with cooling fluid circulating inside. Hence, a green cooling method that does not harm the environment and is efficient in removing heat from the cutting zone was developed. A series of cutting experiments were conducted to investigate the practicality and effectiveness of the internally cooled tool model. The developed system achieved up to 13% better surface quality than with dry machining, and tool life was extended by 12%. The results clearly showed that with the reduced cutting temperature of the internal cooling, it was possible to control the temperature and thus prevent reaching the critical cutting temperature during the turning process, which is vitally important in extending tool life during the processing of Waspaloy.

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

    Science.gov (United States)

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

    2015-10-01

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

  11. Do depressive symptoms "blunt" effort? An analysis of cardiac engagement and withdrawal for an increasingly difficult task.

    Science.gov (United States)

    Silvia, Paul J; Mironovová, Zuzana; McHone, Ashley N; Sperry, Sarah H; Harper, Kelly L; Kwapil, Thomas R; Eddington, Kari M

    2016-07-01

    Research on depression and effort has suggested "depressive blunting"-lower cardiovascular reactivity in response to challenges and stressors. Many studies, however, find null effects or higher reactivity. The present research draws upon motivational intensity theory, a broad model of effort that predicts cases in which depressive symptoms should increase or decrease effort. Because depressive symptoms can influence task-difficulty appraisals-people see tasks as subjectively harder-people high in depressive symptoms should engage higher effort at objectively easier levels of difficulty but also quit sooner. A sample of adults completed a mental effort challenge with four levels of difficulty, from very easy to difficult-but-feasible. Depressive symptoms were assessed with the CESD and DASS; effort-related cardiac activity was assessed via markers of contractility (e.g., the cardiac pre-ejection period [PEP]) obtained with impedance cardiography. The findings supported the theory's predictions. When the task was relatively easier, people high in depressive symptoms showed higher contractility (shorter PEP), consistent with greater effort. When the task was relatively harder, people high in depressive symptoms showed diminished contractility, consistent with quitting. The results suggest that past research has been observing a small part of a larger trajectory of trying and quitting, and they illustrate the value of a theoretically grounded analysis of depressive symptoms and effort-related cardiac activity.

  12. Significance exaggerated of the activity of the construction in Spain; inflection and current decline? The difficult to their sostenibilitiy

    Directory of Open Access Journals (Sweden)

    José María Serrano

    2010-04-01

    Full Text Available For some time the activity of the construction, in its different sections, (housings, works with non residential ends, transport, public works… has had special significance inside the productive system in Spain. During the last decade it has reached an exaggerated weight, so much in their participation in the GDP like of people occupied in her. The some regions that proportion represents exaggerated ends. The current economic crisis has affected with intensity to the group of the sector of the construction, making more intense the consequences of the economic recession. Everything it, is not only as a consequence of a crisis of the situation. Rather she is due to structural reasons. It seems probable that, from now on, the group of the Spanish economic system, it should be articulated with a new organization, a new productive model, where the construction only means a more reduced part of the same one. That is easy to say, but very difficult of getting it. It represents a great challenge face to the future.

  13. Using on-line video clips to enhance self-efficacy toward dealing with difficult situations among nursing students.

    Science.gov (United States)

    McConville, Sally A; Lane, Andrew M

    2006-04-01

    The aim of the study was twofold. The first aim was to develop on-line video clip material that showed examples of nurses dealing with potentially difficult and delicate patient groups. The second aim was to evaluate the effectiveness of video clip materials for enhancing nursing student's self-efficacy to effectively communicate with the type of patients described above. The production of contextually relevant video clip material involved the identification of relevant material based on real experiences, writing appropriate scripts, recruiting actors, recording the performances and producing them in a form that could be accessed on-line. Self-report questionnaires were used to assess the effectiveness of video clip material. Level 1 (n = 145) nursing students completed a self-efficacy measure that assessed confidence to deal with situations such as breaking news of death, working with children, people with disability and aggressive behaviour at the start and the end of the module. Results indicated that student's self-efficacy increased noticeably over the course of the module. Differences between increases in self-efficacy attributed to watching videos or attending lectures were marginal. Findings suggest that using video clips that show students effectively coping with adverse situations provide an effective teaching approach for enhancing self-efficacy. Future research is needed to test the extent to which self-efficacy measures relate with nursing performance. PMID:16300862

  14. Weak energy condition violation and superluminal travel

    OpenAIRE

    Lobo, Francisco; Crawford, Paulo

    2002-01-01

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

  15. Collective Atomic Recoil Lasing Including Friction and Diffusion Effects

    CERN Document Server

    Robb, G R M; Ferraro, A; Bonifacio, R; Courteille, P W; Zimmermann, C; Courteille, Ph.W.

    2003-01-01

    We extend the Collective Atomic Recoil Lasing (CARL) model including the effects of friction and diffusion forces acting on the atoms due to the presence of optical molasses fields. The results from this model are consistent with those from a recent experiment by Kruse et al. [Phys. Rev. Lett. 91, 183601 (2003)]. In particular, we obtain a threshold condition above which collective backscattering occurs. Using a nonlinear analysis we show that the backscattered field and the bunching evolve to a steady-state, in contrast to the non-stationary behaviour of the standard CARL model. For a proper choice of the parameters, this steady-state can be superfluorescent.

  16. Preventing the development of metabolic syndrome in people with psychotic disorders--difficult, but possible: experiences of staff working in psychosis outpatient care in Sweden.

    Science.gov (United States)

    Bergqvist, Anette; Karlsson, Maria; Foldemo, Anniqa; Wärdig, Rikard; Hultsjö, Sally

    2013-05-01

    The aim of this study was to explore mental health staffs' experiences of assisting people with psychotic disorders to implement lifestyle changes in an effort to prevent metabolic syndrome. Qualitative interviews were conducted with 12 health care professionals working in psychosis outpatient care in Sweden. Data were analysed using a qualitative content analysis. The results illustrate that implementation of lifestyle changes among people with psychotic disorders was experienced as difficult, but possible. The greatest obstacles experienced in this work were difficulties due to the reduction of cognitive functions associated with the disease. Guidelines available to staff in order to help them identify and prevent physical health problems in the group were not always followed and the content was not always relevant. Staff further described feelings of uncertainty about having to motivate people to take anti-psychotic medication while simultaneously being aware of the risks of metabolic deviations. Nursing interventions focusing on organising daily routines before conducting a more active prevention of metabolic syndrome, including information and practical support, were experienced as necessary. The importance of healthy eating and physical activity needs to be communicated in such a way that it is adjusted to the person's cognitive ability, and should be repeated over time, both verbally and in writing. Such efforts, in combination with empathic and seriously committed community-based social support, were experienced as having the best effect over time. Permanent lifestyle changes were experienced as having to be carried out on the patient's terms and in his or her home environment.

  17. Biomechanical conditions of walking

    CERN Document Server

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

    2015-01-01

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

  18. Management of radioactive waste from reprocessing including disposal aspects

    International Nuclear Information System (INIS)

    Based on a hypothetical scenario including a reactor park of 20 GWe consisting of Pressurised-Water-Reactors with a resulting annual production of 600 tonnes of heavy metal of spent fuel, all aspects of management of resulting wastes are studied. Waste streams from reprocessing include gaseous and liquid effluents, and a number of solid conditioned waste types. Disposal of waste is supposed to be performed either in a near-surface engineered repository, as long as the content of alpha-emitting radionuclides is low enough, and in a deep geological granite formation. After having estimated quantities, cost and radiological consequences, the sensitivity of results to modification in reactor park size, burn-up and the introduction of mixed-oxide fuel (MOX) is evaluated

  19. Ionic liquids, electrolyte solutions including the ionic liquids, and energy storage devices including the ionic liquids

    Energy Technology Data Exchange (ETDEWEB)

    Gering, Kevin L.; Harrup, Mason K.; Rollins, Harry W.

    2015-12-08

    An ionic liquid including a phosphazene compound that has a plurality of phosphorus-nitrogen units and at least one pendant group bonded to each phosphorus atom of the plurality of phosphorus-nitrogen units. One pendant group of the at least one pendant group comprises a positively charged pendant group. Additional embodiments of ionic liquids are disclosed, as are electrolyte solutions and energy storage devices including the embodiments of the ionic liquid.

  20. Model-directed engineering of "difficult-to-express" monoclonal antibody production by Chinese hamster ovary cells.

    Science.gov (United States)

    Pybus, Leon P; Dean, Greg; West, Nathan R; Smith, Andrew; Daramola, Olalekan; Field, Ray; Wilkinson, Stephen J; James, David C

    2014-02-01

    Despite improvements in volumetric titer for monoclonal antibody (MAb) production processes using Chinese hamster ovary (CHO) cells, some "difficult-to-express" (DTE) MAbs inexplicably reach much lower process titers. These DTE MAbs require intensive cell line and process development activity, rendering them more costly or even unsuitable to manufacture. To rapidly and rationally identify an optimal strategy to improve production of DTE MAbs, we have developed an engineering design platform combining high-yielding transient production, empirical modeling of MAb synthesis incorporating an unfolded protein response (UPR) regulatory loop with directed expression and cell engineering approaches. Utilizing a panel of eight IgG1 λ MAbs varying >4-fold in volumetric titer, we showed that MAb-specific limitations on folding and assembly rate functioned to induce a proportionate UPR in host CHO cells with a corresponding reduction in cell growth rate. Derived from comparative empirical modeling of cellular constraints on the production of each MAb we employed two strategies to increase production of DTE MAbs designed to avoid UPR induction through an improvement in the rate/cellular capacity for MAb folding and assembly reactions. Firstly, we altered the transfected LC:HC gene ratio and secondly, we co-expressed a variety of molecular chaperones, foldases or UPR transactivators (BiP, CypB, PDI, and active forms of ATF6 and XBP1) with recombinant MAbs. DTE MAb production was significantly improved by both strategies, although the mode of action was dependent upon the approach employed. Increased LC:HC ratio or CypB co-expression improved cell growth with no effect on qP. In contrast, BiP, ATF6c and XBP1s co-expression increased qP and reduced cell growth. This study demonstrates that expression-engineering strategies to improve production of DTE proteins in mammalian cells should be product specific, and based on rapid predictive tools to assess the relative impact of

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

    International Nuclear Information System (INIS)

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

  2. FPC conditioning cart at BNL

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-03-28

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

  3. A socioeconomic and behavioral survey of patients with difficult-to-control type 2 diabetes mellitus reveals an association between diabetic retinopathy and educational attainment

    Directory of Open Access Journals (Sweden)

    Emoto N

    2016-10-01

    Full Text Available Naoya Emoto,1,2 Fumitaka Okajima,1,2 Hitoshi Sugihara,2 Rei Goto3 1Department of Endocrinology, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, 2Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, 3Graduate School of Business Administration, Keio University, Kanagawa, Japan Background: We have recently reported that the attitude of patients toward risk could be a factor in the progression of diabetic complications. In general, risk preference is closely related to socioeconomic status (SES, which includes factors such as age, sex, income, and educational attainment.Objective: We aimed to determine the effect of SES and behavioral propensity on the progress of diabetic complications in patients with type 2 diabetes mellitus (T2DM.Methods: We conducted a survey of 238 patients with difficult-to-control T2DM treated at a hospital in Japan using a modified behavioral economics questionnaire that included questions related to SES. The patients had been referred by general practitioners or other departments in the hospital because of poor metabolic control or unstable complications.Results: Educational attainment was significantly associated with progression of retinopathy in patients <65 years of age. Educational attainment of a high school diploma (12 years of education or lower was a significant risk factor, but there were no differences among levels of attainment beyond high school (13–16 years or more of education. Behavioral propensities were also weakly associated with complications, but not as much as educational attainment. Personal income level and economic status did not show an association with the retinopathy levels.Conclusion: Lower educational attainment is a strong risk factor for diabetic retinopathy, and it is independent of the economic status. The result suggests that cognitive function may play an important role in the progression of diabetic retinopathy in

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

    Directory of Open Access Journals (Sweden)

    Jon M. Hanifin

    2007-02-01

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

  5. Use of versapoint to refashion the cervical canal to overcome unusually difficult embryo transfers and improve in-vitro fertilization-embryo transfer outcome: A case series

    OpenAIRE

    Nalini Mahajan; Ila Gupta

    2011-01-01

    Background : Smooth atraumatic embryo transfer is paramount for the success of in-vitro fertilization (IVF). In difficult cases, cervical canal manipulation may be required. Aim : To see if surgical correction of the cervical canal or cervical canal refashioning could improve ease of embryo transfer. Setting : Private infertility and IVF hospital. Design : Prospective study. Materials and Methods : Patients: 11 women with failed 1-3 IVF cycles with history of extremely difficult embryo transf...

  6. Identification of difficult topics in the teaching and learning of Chemistry in Irish schools and the development of an intervention programme to target some of these difficulties

    OpenAIRE

    2010-01-01

    non-peer-reviewed The purpose of this investigation was to identify the topics in Chemistry that the majority of Irish pupils find difficult from Junior Certificate level right through to Third Level. It was then hoped to determine the reasons why pupils find these topics difficult. Finally it was intended to develop, implement and evaluate materials and strategies that aimed to alleviate difficulties in the learning and understanding of these topics for pupils studying Chemistry in Irelan...

  7. Making the practically impossible "Merely difficult"--Cryogenic FIB lift-out for "Damage free" soft matter imaging.

    Science.gov (United States)

    Parmenter, Christopher D J; Fay, Michael W; Hartfield, Cheryl; Eltaher, Hoda M

    2016-04-01

    The preparation of thinned lamellae from bulk samples for transmission electron microscopy (TEM) analysis has been possible in the focussed ion beam scanning electron microscope (FIB-SEM) for over 20 years via the in situ lift-out method. Lift-out offers a fast and site specific preparation method for TEM analysis, typically in the field of materials science. More recently it has been applied to a low-water content biological sample (Rubino 2012). This work presents the successful lift-out of high-water content lamellae, under cryogenic conditions (cryo-FIB lift-out) and using a nanomanipulator retaining its full range of motion, which are advances on the work previously done by Rubino (2012). Strategies are explored for maintaining cryogenic conditions, grid attachment using cryo-condensation of water and protection of the lamella when transferring to the TEM. PMID:26875988

  8. Initial Cladding Condition

    International Nuclear Information System (INIS)

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

  9. Initial Cladding Condition

    Energy Technology Data Exchange (ETDEWEB)

    E. Siegmann

    2000-08-22

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

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

    Science.gov (United States)

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

    2015-12-01

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

  11. Pathologic conditions in pregnancy

    International Nuclear Information System (INIS)

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

  12. Including People with Intellectual Disabilities in Qualitative Research

    Science.gov (United States)

    Hall, Sarah A.

    2013-01-01

    The voice of people with intellectual disabilities (ID) is needed in the literature to best understand their unique experiences and perspectives. Researchers face challenges in conducting interviews with people with ID who are limited in conceptual and verbal language skills. It can also be difficult to obtain participants with ID because of…

  13. Evaluative conditioning of food technologies

    DEFF Research Database (Denmark)

    Loebnitz, Natascha; Grunert, Klaus G

    2015-01-01

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

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

    NARCIS (Netherlands)

    Vourliotakis, George; Katsargyris, Athanasios; Tielliu, Ignace F. J.; Zeebregts, Clark J.; Verhoeven, Eric L. G.

    2015-01-01

    Complex iliac anatomy including extreme tortuosity constitutes a relative contraindication for endovascular abdominal aortic aneurysm repair with additional risk of limb-graft occlusion. The Gore Excluder limb-graft is a flexible stent-graft, which adapts easily to iliac tortuosity. Nevertheless, th

  15. Numerical modelling of coal spontaneous combustion with moisture included

    Energy Technology Data Exchange (ETDEWEB)

    Arisoy, A. [Istanbul Technical University, Istanbul (Turkey). Mechanical Engineering Faculty

    2005-07-01

    A mathematical model for spontaneous combustion of coal with moisture included is presented. The one-dimensional unsteady state model consists of conservation equations for oxygen, water vapour and inherent moisture of coal and energy for both gaseous and solid phases. A first order Arrhenius reaction rate for oxidation under both pore diffusion and chemically controlled reaction regime is considered. The rate of evaporation or condensation is also considered as a function of temperature of coal, water content of coal and gas streams. The equation of the model is solved numerically by the finite difference technique. Influences of different parameters on the process of spontaneous combustion can be examined by using this model. Also the model can be used to simulate full-scale storage conditions. 4 refs., 5 figs., 1 tab.

  16. Loan Products Included in the Offer of Commercial Banks

    Directory of Open Access Journals (Sweden)

    Vasile Dedu

    2009-04-01

    Full Text Available A bank loan is the main form of economical credit. It is for corporate activities – for medium and big companies and for retail activities – for small companies and individuals. The conditions for credit mainly depend on the quality of customers, it means their ability to perform a profitable activity and to be able to pay back the credits. For reasons which are mainly connected to marketing, bank practice has developed a large range of credit names, trying to emphasize some of the parts of the products or to take profit of some competition advantages in relation with customers’ products. We are trying to include the offer of bank loans in a typology which takes into account the law, the bank field rules and the main technical features of the offered products.

  17. Dynamic Analysis of Wind Turbines Including Soil-Structure Interaction

    DEFF Research Database (Denmark)

    Harte, M.; Basu, B.; Nielsen, Søren R.K.

    2012-01-01

    for displacement of the turbine system are obtained and the modal frequencies of the combined turbine-foundation system are estimated. Simulations are presented for the MDOF turbine structure subjected to wind loading for different soil stiffness conditions. Steady state and turbulent wind loading, developed using......This paper investigates the along-wind forced vibration response of an onshore wind turbine. The study includes the dynamic interaction effects between the foundation and the underlying soil, as softer soils can influence the dynamic response of wind turbines. A Multi-Degree-of-Freedom (MDOF......) horizontal axes onshore wind turbine model is developed for dynamic analysis using an Euler–Lagrangian approach. The model is comprised of a rotor blade system, a nacelle and a flexible tower connected to a foundation system using a substructuring approach. The rotor blade system consists of three rotating...

  18. Efficient Algorithms for Electrostatic Interactions Including Dielectric Contrasts

    Directory of Open Access Journals (Sweden)

    Christian Holm

    2013-10-01

    Full Text Available Coarse-grained models of soft matter are usually combined with implicit solvent models that take the electrostatic polarizability into account via a dielectric background. In biophysical or nanoscale simulations that include water, this constant can vary greatly within the system. Performing molecular dynamics or other simulations that need to compute exact electrostatic interactions between charges in those systems is computationally demanding. We review here several algorithms developed by us that perform exactly this task. For planar dielectric surfaces in partial periodic boundary conditions, the arising image charges can be either treated with the MMM2D algorithm in a very efficient and accurate way or with the electrostatic layer correction term, which enables the user to use his favorite 3D periodic Coulomb solver. Arbitrarily-shaped interfaces can be dealt with using induced surface charges with the induced charge calculation (ICC* algorithm. Finally, the local electrostatics algorithm, MEMD(Maxwell Equations Molecular Dynamics, even allows one to employ a smoothly varying dielectric constant in the systems. We introduce the concepts of these three algorithms and an extension for the inclusion of boundaries that are to be held fixed at a constant potential (metal conditions. For each method, we present a showcase application to highlight the importance of dielectric interfaces.

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

    CERN Document Server

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

    2011-01-01

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

  20. Chronic Obstructive Pulmonary Disease and Weaning of Difficult-to-wean Patients from Mechanical Ventilation: Randomized Prospective Study

    OpenAIRE

    Matić, Ivo; Đanić, Davorin; MAJERIĆ-KOGLER, VIŠNJA; Jurjević, Matija; Mirković, Ivan; Mrzljak Vučinić, Natalija

    2007-01-01

    Aim To compare T-tube and pressure support ventilation (PSV) as two methods of mechanical ventilation weaning of patients with chronic obstructive pulmonary disease (COPD) after failed extubation. Methods A prospective randomized trial carried out at the multidisciplinary intensive care unit (ICU) over 2 years included 136 patients with COPD who required mechanical ventilation longer than 24 h. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube ...