Rules and technical tricks in extremely difficult laparoscopic cholecystectomies

Directory of Open Access Journals (Sweden)

Liviu Drăghici

2017-11-01

Full Text Available We remind you of some technical artifices required in order to resolve difficult cases, such as: antegrade laparoscopic cholecystectomy (LC, subtotal laparoscopic cholecystectomy (SLC and the “stairs” clipping of the cystic duct. Also we acknowledge the closing of the cystic duct. We analyzed the medical records of 15251 laparoscopic cholecystectomies performed during 1994-2015, with emphasis on: surgical technique, conversion rate, hemorrhage, postoperative bile leaking, iatrogenic MBD injuries and mortality. We divided the cases in 5 study groups, group 1 (1994- 2004 N= 5138, group 2 (2005-2015 N= 10113, group 3 (fundus first cholecystectomies, N=2348, group 4 (retrograde cholecystectomies, N=12889 and group 5 (subtotal laparoscopic cholecystectomy-SLC, N=14 which we compared regarding the main parameters. We prefer to perform a “step by step” clipping each time the length of the clip does not cover all the circumference of the cystic duct. This artifices, is a simple laparoscopic gesture easy to perform and has the advantage of avoiding a large excessive and risky laparoscopic dissection in the vicinity of the main biliary duct. More seldom we appeal to the suture of the cystic stump using the intracorporeal knots or a simple stump ligation with an extracorporeal preformed not. We did not encounter any late or early complications following the implementation of this technical laparoscopic artifice. Laborious laparoscopic cholecystectomies performed by a well-trained surgical team ensure the premises of a good performance even while adopting laparoscopic ingenious and difficile gestures that also respect the intraoperatory rules and principals.

Quantifying the daily economic impact of extreme space weather due to failure in electricity transmission infrastructure

Science.gov (United States)

Oughton, Edward J.; Skelton, Andrew; Horne, Richard B.; Thomson, Alan W. P.; Gaunt, Charles T.

2017-01-01

Extreme space weather due to coronal mass ejections has the potential to cause considerable disruption to the global economy by damaging the transformers required to operate electricity transmission infrastructure. However, expert opinion is split between the potential outcome being one of a temporary regional blackout and of a more prolonged event. The temporary blackout scenario proposed by some is expected to last the length of the disturbance, with normal operations resuming after a couple of days. On the other hand, others have predicted widespread equipment damage with blackout scenarios lasting months. In this paper we explore the potential costs associated with failure in the electricity transmission infrastructure in the U.S. due to extreme space weather, focusing on daily economic loss. This provides insight into the direct and indirect economic consequences of how an extreme space weather event may affect domestic production, as well as other nations, via supply chain linkages. By exploring the sensitivity of the blackout zone, we show that on average the direct economic cost incurred from disruption to electricity represents only 49% of the total potential macroeconomic cost. Therefore, if indirect supply chain costs are not considered when undertaking cost-benefit analysis of space weather forecasting and mitigation investment, the total potential macroeconomic cost is not correctly represented. The paper contributes to our understanding of the economic impact of space weather, as well as making a number of key methodological contributions relevant for future work. Further economic impact assessment of this threat must consider multiday, multiregional events.

Statistical techniques for modeling extreme price dynamics in the energy market

International Nuclear Information System (INIS)

Mbugua, L N; Mwita, P N

2013-01-01

Extreme events have large impact throughout the span of engineering, science and economics. This is because extreme events often lead to failure and losses due to the nature unobservable of extra ordinary occurrences. In this context this paper focuses on appropriate statistical methods relating to a combination of quantile regression approach and extreme value theory to model the excesses. This plays a vital role in risk management. Locally, nonparametric quantile regression is used, a method that is flexible and best suited when one knows little about the functional forms of the object being estimated. The conditions are derived in order to estimate the extreme value distribution function. The threshold model of extreme values is used to circumvent the lack of adequate observation problem at the tail of the distribution function. The application of a selection of these techniques is demonstrated on the volatile fuel market. The results indicate that the method used can extract maximum possible reliable information from the data. The key attraction of this method is that it offers a set of ready made approaches to the most difficult problem of risk modeling.

Changes in extreme regional sea surface height due to an abrupt weakening of the Atlantic meridional overturning circulation

NARCIS (Netherlands)

Brunnabend, S.-E.; Dijkstra, H. A.; Kliphuis, M. A.; van Werkhoven, B.J.C.; Bal, H. E.; Seinstra, F.; Maassen, J.; van Meersbergen, M.

2014-01-01

As an extreme scenario of dynamical sea level changes, regional sea surface height (SSH) changes that occur in the North Atlantic due to an abrupt weakening of the Atlantic meridional overturning circulation (AMOC) are simulated. Two versions of the same ocean-only model are used to study the effect

Climate Change Impacts on Flood risk in Urban Areas due to Combined Effects of Extreme Precipitation and Sea Surges

DEFF Research Database (Denmark)

Larsen, A. N.; Mikkelsen, Peter Steen; Arnbjerg-Nielsen, Karsten

Climate change will impact the hydrological cycle greatly and lead to increases in flood hazards due to both pluvial and fluvial floods as well as sea surges in many regions. The impacts of the individual effects are analysed for a catchment in Greater Copenhagen. Based on both the present...... surges. Presently the most important hazard is due to extreme precipitation. However, due to climate change impacts the future most important hazard is due to sea surges. The increase in probability of floods is substantial over a 70 year horizon and actions must be taken to decrease either the hazards...

Obstructive jaundice due to tuberculosis of distal CBD and periampullary region mimickcholangiocarcinoma

Directory of Open Access Journals (Sweden)

Sumantra Ray

2012-01-01

Full Text Available Abdominal tuberculosis (TB commonly affects the intestinal tract, lymph nodes, peritoneum, and solid organs in varying combinations. Hepatobiliary or pancreatic TB is rare and the preoperative diagnosis is difficult. Though rare, there have been a few citations of intrahepatic tuberculosis, but isolated bile duct tuberculosis is extremely rare. Here we report a case of obstructive jaundice which was initially thought to be due to lower-end cholangiocarcinoma but postoperatively it was found to be tuberculosis.

Extreme Events in Nature and Society

CERN Document Server

Albeverio, Sergio; Kantz, Holger

2006-01-01

Significant, and usually unwelcome, surprises, such as floods, financial crisis, epileptic seizures, or material rupture, are the topics of Extreme Events in Nature and Society. The book, authored by foremost experts in these fields, reveals unifying and distinguishing features of extreme events, including problems of understanding and modelling their origin, spatial and temporal extension, and potential impact. The chapters converge towards the difficult problem of anticipation: forecasting the event and proposing measures to moderate or prevent it. Extreme Events in Nature and Society will interest not only specialists, but also the general reader eager to learn how the multifaceted field of extreme events can be viewed as a coherent whole.

A Fiducial Approach to Extremes and Multiple Comparisons

Science.gov (United States)

Wandler, Damian V.

2010-01-01

Generalized fiducial inference is a powerful tool for many difficult problems. Based on an extension of R. A. Fisher's work, we used generalized fiducial inference for two extreme value problems and a multiple comparison procedure. The first extreme value problem is dealing with the generalized Pareto distribution. The generalized Pareto…

Impact of extreme load requirements and quality assurance on nuclear power plant costs

International Nuclear Information System (INIS)

Stevenson, J.D.

1993-01-01

Definitive costs, applicable to nuclear power plant concrete structures, as a function of National Regulatory Requirements, standardization, the effect of extreme load design associated with both design basis accidents and extreme external events and quality assurance are difficult to develop since such effects are interrelated and not only differ widely from country to country, project to project but also vary in time. Table 1 shows an estimate of the of the overall plant cost effects of external event extreme load design on nuclear power plant design for the U.S -and selected foreign countries for which experience with LWRs exist- Germany is the most expensive primarily due to a military aircraft crash resistance. However, the German requirement for 4 safeguards trains rather than 2 and the containment design requirement to consider one Steam Generator blowdown concurrent with a RCS blowdown. This presentation will concentrate on the direct current impact extreme load design and quality assurance have on concrete structures, systems and components for nuclear plants. This presentation is considered timely due to the increased interest in the c potential backfit of Eastern European nuclear power stations of the WWER 440 and WWER 1000 types which typically did not consider the extreme loads identified in Table 1 and accident loads in Table 3 and quality assurance in Table 5 in their original design. Concrete structures in particular are highlighted because they typically form the last barrier to radioactive release from the containment and other Safety Related Structures

Rosetta Structure Prediction as a Tool for Solving Difficult Molecular Replacement Problems.

Science.gov (United States)

DiMaio, Frank

2017-01-01

Molecular replacement (MR), a method for solving the crystallographic phase problem using phases derived from a model of the target structure, has proven extremely valuable, accounting for the vast majority of structures solved by X-ray crystallography. However, when the resolution of data is low, or the starting model is very dissimilar to the target protein, solving structures via molecular replacement may be very challenging. In recent years, protein structure prediction methodology has emerged as a powerful tool in model building and model refinement for difficult molecular replacement problems. This chapter describes some of the tools available in Rosetta for model building and model refinement specifically geared toward difficult molecular replacement cases.

Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners

Science.gov (United States)

Kahanov, Leamor; Eberman, Lindsey E; Games, Kenneth E; Wasik, Mitch

2015-01-01

Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence. PMID:25848327

Extremely elevated alpha-fetoprotein due to acute exacerbation of chronic hepatitis B without malignancy: a case report.

Science.gov (United States)

Yoon, Young-Min; Kang, Da-Yeong; Kim, Da-Young; Seo, Jun-Won; Lim, Hyun-Jong; Lee, Hee-Jeong; Park, Sang-Gon

2016-06-01

Alpha-fetoprotein is produced by a variety of tumors such as hepatocellular carcinoma, hepatoblastoma, and germ cell tumors of the ovary and testes. However, we present a case of significantly elevated serum alpha-fetoprotein without evidence of malignant disease in a patient who is a carrier of chronic hepatitis B. A 60-year-old Korean man presented with markedly increased alpha-fetoprotein (2350 ng/mL; normal 7 × 105 IU/mL). Our patient was diagnosed with acute exacerbation of chronic hepatitis B, and we presumed that this condition might be related to extremely elevated alpha-fetoprotein. When our patient was treated with entecavir, the serum alpha-fetoprotein level immediately decreased, in parallel with the hepatitis B virus deoxyribonucleic acid copy number. We report a rare case of extremely elevated alpha-fetoprotein due to acute exacerbation of chronic hepatitis B without any malignancy, and a decrease in this tumor marker simultaneous with a decrease in hepatitis B virus deoxyribonucleic acid copy number on entecavir treatment. This case report is important due to the rarity of the case; furthermore, it provides details of a diagnostic process for a variety of benign diseases and malignant tumors that should be considered in patients with elevated alpha-fetoprotein. Thus, we present a case report, along with a review, that will be helpful for diagnosis and treatment of patients with elevated alpha-fetoprotein.

Estimation of extreme risk regions under multivariate regular variation

NARCIS (Netherlands)

Cai, J.; Einmahl, J.H.J.; de Haan, L.F.M.

2011-01-01

When considering d possibly dependent random variables, one is often interested in extreme risk regions, with very small probability p. We consider risk regions of the form {z ∈ Rd : f (z) ≤ β}, where f is the joint density and β a small number. Estimation of such an extreme risk region is difficult

Clinical review: Management of difficult airways

OpenAIRE

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

2006-01-01

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

Evolution caused by extreme events.

Science.gov (United States)

Grant, Peter R; Grant, B Rosemary; Huey, Raymond B; Johnson, Marc T J; Knoll, Andrew H; Schmitt, Johanna

2017-06-19

Extreme events can be a major driver of evolutionary change over geological and contemporary timescales. Outstanding examples are evolutionary diversification following mass extinctions caused by extreme volcanism or asteroid impact. The evolution of organisms in contemporary time is typically viewed as a gradual and incremental process that results from genetic change, environmental perturbation or both. However, contemporary environments occasionally experience strong perturbations such as heat waves, floods, hurricanes, droughts and pest outbreaks. These extreme events set up strong selection pressures on organisms, and are small-scale analogues of the dramatic changes documented in the fossil record. Because extreme events are rare, almost by definition, they are difficult to study. So far most attention has been given to their ecological rather than to their evolutionary consequences. We review several case studies of contemporary evolution in response to two types of extreme environmental perturbations, episodic (pulse) or prolonged (press). Evolution is most likely to occur when extreme events alter community composition. We encourage investigators to be prepared for evolutionary change in response to rare events during long-term field studies.This article is part of the themed issue 'Behavioural, ecological and evolutionary responses to extreme climatic events'. © 2017 The Author(s).

Atomic collisions under extreme conditions in space

International Nuclear Information System (INIS)

Itikawa, Yukikazu

1987-01-01

In space, atoms and molecules are often placed under the extreme conditions which are very difficult to be realized on Earth. For instance, extremely hot and dense plasmas are found in and around various stellar objects (e.g., neutron stars) on one hand and extremely cold and diffuse gases prevail in interstellar space on the other. There is so strong a magnetic field that electron clouds in atoms and molecules are distorted. The study of atomic collisions under the extreme conditions is not only helpful in understanding the astrophysical environment but also reveals new aspects of the physics of atoms and molecules. This paper is an invitation to the study. (References are not exhaustive but only provide a clue with which more details can be found.) (author)

Convergence of Extreme Value Statistics in a Two-Layer Quasi-Geostrophic Atmospheric Model

Directory of Open Access Journals (Sweden)

Vera Melinda Gálfi

2017-01-01

Full Text Available We search for the signature of universal properties of extreme events, theoretically predicted for Axiom A flows, in a chaotic and high-dimensional dynamical system. We study the convergence of GEV (Generalized Extreme Value and GP (Generalized Pareto shape parameter estimates to the theoretical value, which is expressed in terms of the partial information dimensions of the attractor. We consider a two-layer quasi-geostrophic atmospheric model of the mid-latitudes, adopt two levels of forcing, and analyse the extremes of different types of physical observables (local energy, zonally averaged energy, and globally averaged energy. We find good agreement in the shape parameter estimates with the theory only in the case of more intense forcing, corresponding to a strong chaotic behaviour, for some observables (the local energy at every latitude. Due to the limited (though very large data size and to the presence of serial correlations, it is difficult to obtain robust statistics of extremes in the case of the other observables. In the case of weak forcing, which leads to weaker chaotic conditions with regime behaviour, we find, unsurprisingly, worse agreement with the theory developed for Axiom A flows.

Nerve transfers for restoration of upper extremity motor function in a child with upper extremity motor deficits due to transverse myelitis: case report.

Science.gov (United States)

Dorsi, Michael J; Belzberg, Allan J

2012-01-01

Transverse myelitis (TM) may result in permanent neurologic dysfunction. Nerve transfers have been developed to restore function after peripheral nerve injury. Here, we present a case report of a child with permanent right upper extremity weakness due to TM that underwent nerve transfers. The following procedures were performed: double fascicle transfer from median nerve and ulnar nerve to the brachialis and biceps branches of the musculocutaneous nerve, spinal accessory to suprascapular nerve, and medial cord to axillary nerve end-to-side neurorraphy. At 22 months, the patient demonstrated excellent recovery of elbow flexion with minimal improvement in shoulder abduction. We propose that the treatment of permanent deficits from TM represents a novel indication for nerve transfers in a subset of patients. Copyright © 2011 Wiley Periodicals, Inc.

The Damage To The Armour Layer Due To Extreme Waves

Science.gov (United States)

Oztunali Ozbahceci, Berguzar; Ergin, Aysen; Takayama, Tomotsuka

2010-05-01

The sea waves are not regular but random and chaotic. In order to understand this randomness, it is common to make individual wave analysis in time domain or spectral analysis in frequency domain. Characteristic wave heights like Hmax, H%2,H1-10, H1-3, Hmean are obtained through individual wave analysis in time domain. These characteristic wave heights are important because they are used in the design of different type of coastal structures. It is common to use significant wave height, H1-3,for the design of rubble mound structures. Therefore, only spectrally derived or zero-crossing significant wave height is usually reported for the rubble mound breakwaters without any information on larger waves. However, even the values of H1-3are similar; some train of irregular waves may exhibit a large fluctuation of instantaneous wave energy, while another train may not show such a fluctuation (Goda, 1998). Moreover, freak or rogue wave, simply defined as the wave exceeding at least twice the significant wave height may also occur. Those larger waves were called as extreme waves in this study and the effect of extreme waves on the damage to the armour layer of rubble mound breakwaters was investigated by means of hydraulic model experiment. Rock armored rubble mound breakwater model with 1:1.5 slope was constructed in the wave channel of Hydraulics Laboratory of the Disaster Prevention Research Institute of Kyoto University, Japan. The model was consisted of a permeable core layer, a filter and armour layer with two stones thicknesses. Size of stones were same for both of the slopes as Dn50(armour)=0.034m, Dn50(filter)=0.021m and Dn50(core)=0.0148m for armour, filter and core layers, respectively. Time series which are approximately equal to 1000 waves, with similar significant wave height but different extreme wave height cases were generated. In order to generate necessary time series in the wave channel, they were firstly computed by numerically. For the numerical

Legacies from extreme drought increase ecosystem sensitivity to future extremes

Science.gov (United States)

Smith, M. D.; Knapp, A.; Hoover, D. L.; Avolio, M. L.; Felton, A. J.; Wilcox, K. R.

2016-12-01

Climate extremes, such as drought, are increasing in frequency and intensity, and the ecological consequences of these extreme events can be substantial and widespread. Although there is still much to be learned about how ecosystems will respond to an intensification of drought, even less is known about the factors that determine post-drought recovery of ecosystem function. Such knowledge is particularly important because post-drought recovery periods can be protracted depending on the extent to which key plant populations, community structure and biogeochemical processes are affected. These drought legacies may alter ecosystem function for many years post-drought and may impact future sensitivity to climate extremes. We experimentally imposed two extreme growing season droughts in a central US grassland to assess the impacts of repeated droughts on ecosystem resistance (response) and resilience (recovery). We found that this grassland was not resistant to the first extreme drought due to reduced productivity and differential sensitivity of the co-dominant C4 grass (Andropogon gerardii) and C3 forb (Solidago canadensis) species. This differential sensitivity led to a reordering of species abundances within the plant community. Yet, despite this large shift in plant community composition, which persisted post-drought, the grassland was highly resilient post-drought, due to increased abundance of the dominant C4 grass. Because of this shift to increased C4 grass dominance, we expected that previously-droughted grassland would be more resistant to a second extreme drought. However, contrary to these expectations, previously droughted grassland was more sensitive to drought than grassland that had not experienced drought. Thus, our result suggest that legacies of drought (shift in community composition) may increase ecosystem sensitivity to future extreme events.

Extremes in random fields a theory and its applications

CERN Document Server

Yakir, Benjamin

2013-01-01

Presents a useful new technique for analyzing the extreme-value behaviour of random fields Modern science typically involves the analysis of increasingly complex data. The extreme values that emerge in the statistical analysis of complex data are often of particular interest. This book focuses on the analytical approximations of the statistical significance of extreme values. Several relatively complex applications of the technique to problems that emerge in practical situations are presented.  All the examples are difficult to analyze using classical methods, and as a result, the author pr

The investigation of the Japanese black cattle as well as their rearing environment inside the 'difficult-to-return zone' due to Fukushima nuclear power plant disaster

International Nuclear Information System (INIS)

Okada, K.

2016-01-01

We are continuously investigating the effect of persistent exposure to low level radiation on Japanese Black cattle kept on 3 ranches as well as their rearing environment inside the 'difficult-to-return zone' due to Fukushima nuclear power plant disaster. The spatial radiation dose rate at 1 m above ground was 40 μSv/h in the spring of 2013 but it decreased to about 20 μSv/h after 1 year 7 months. Accumulated spatial radiation dose throughout the year of was 220 mSv and exposure dose of cattle throughout that year was 170 mSv. The effect of radiation exposure due to the nuclear power plant disaster has not been clearly recognized in cattle. (author)

Distant Galaxy Clusters Hosting Extreme Central Galaxies

Science.gov (United States)

McDonald, Michael

2014-09-01

The recently-discovered Phoenix cluster harbors the most star-forming central cluster galaxy of any cluster in the known Universe, by nearly a factor of 10. This extreme system appears to be fulfilling early cooling flow predictions, although the lack of similar systems makes any interpretation difficult. In an attempt to find other "Phoenix-like" clusters, we have cross-correlated archival all-sky surveys (in which Phoenix was detected) and isolated 4 similarly-extreme systems which are also coincident in position and redshift with an overdensity of red galaxies. We propose here to obtain Chandra observations of these extreme, Phoenix-like systems, in order to confirm them as relaxed, rapidly-cooling galaxy clusters.

Past and future changes in extreme sea levels and waves

Digital Repository Service at National Institute of Oceanography (India)

Lawe, J.A.; Woodworth, P.L.; Knutson, T.; McDonald, R.E.; Mclnnes, K.L.; Woth, K.; Von Storch, H.; Wolf, J.; Swail, V.; Bernier, N.B.; Gulev, S.; Horsburgh, K.J.; Unnikrishnan, A.S.; Hunter, J.R.; Weisse, R.

of Extreme Sea Level 11.3.1 An Introduction to Storms Both mid-latitude and tropical storms are associated with extremes of sea level. Storm surges are generated by low atmospheric pressure and intense winds over the ocean. The latter also cause high wave... timescales, extremes and mean-sea-level change are both major factors in determining coastal evolution including the development of coastal ecosystems. It will be seen below that, although it is difficult to determine how mean sea level has changed...

Temporal changes in morality attributed to heat extremes for 57 cities in Northeast Asia.

Science.gov (United States)

Lee, Whanhee; Choi, Hayon Michelle; Kim, Dahye; Honda, Yasushi; Guo, Yue-Liang Leon; Kim, Ho

2018-03-01

Recent studies have reported that heat-related mortality decreased by adaptation during decades. However, since the frequency of extreme heat events is increasing, it is difficult to conclude with certainty that the heat mortality burden is decreasing. To examine temporal changes in mortality attributed to heat extremes in Northeast Asia, we collected temperature and mortality data covering the years 1972-2012 from 57 cities of 3 countries (Taiwan, Korea, and Japan) in Northeast Asia. Poisson regression curves were fitted to the data from each city. The temporal changes in heat-mortality association were estimated with a time-varying distributed lag non-linear model. Heat extremes were defined as temperatures greater than the 97.5th percentiles of city-specific average temperatures. Attributable deaths were calculated considering temporal variations in exposure and relative risk. The estimates were then pooled through meta-analysis. The results show that the mortality risk on extreme heat days declined during the study period in all countries. However, as summer temperatures in Japan have shown more heat extremes over time, the mortality risk attributed to heat increased during 2003-2012 (0.32%) compared with 1972-1981 (0.19%). Thus, to assess the total health burden due to heat extremes related to climate change, public health strategies should focus on the temporal variation in heat-mortality association as well as changes in the distribution of heat extremes overtime. Copyright © 2017 Elsevier B.V. All rights reserved.

Performance testing of extremity dosimeters, Study 2

International Nuclear Information System (INIS)

Harty, R.; Reece, W.D.; Hooker, C.D.

1990-04-01

The Health Physics Society Standards Committee (HPSSC) Working Group on Performance Testing of Extremity Dosimeters has issued a draft of a proposed standard for extremity dosimeters. The draft standard proposes methods to be used for testing dosimetry systems that determine occupational radiation dose to the extremities and the performance criterion used to determine compliance with the standard. Pacific Northwest Laboratory (PNL) has conducted two separate evaluations of the performance of extremity dosimeter processors to determine the appropriateness of the draft standard, as well as to obtain information regarding the performance of extremity dosimeters. Based on the information obtained during the facility visits and the results obtained from the performance testing, it was recommended that changes be made to ensure that the draft standard is appropriate for extremity dosimeters. The changes include: subdividing the mixture category and the beta particle category; eliminating the neutron category until appropriate flux-to-dose equivalent conversion factors are derived; and changing the tolerance level for the performance criterion to provide consistency with the performance criterion for whole body dosimeters, and to avoid making the draft standard overly difficult for processors of extremity dosimeters to pass. 20 refs., 10 figs., 6 tabs

Deformation of extremal black holes from stringy interactions

Science.gov (United States)

Chen, Baoyi; Stein, Leo C.

2018-04-01

Black holes are a powerful setting for studying general relativity and theories beyond GR. However, analytical solutions for rotating black holes in beyond-GR theories are difficult to find because of the complexity of such theories. In this paper, we solve for the deformation to the near-horizon extremal Kerr metric due to two example string-inspired beyond-GR theories: Einstein-dilaton-Gauss-Bonnet and dynamical Chern-Simons theory. We accomplish this by making use of the enhanced symmetry group of NHEK and the weak-coupling limit of EdGB and dCS. We find that the EdGB metric deformation has a curvature singularity, while the dCS metric is regular. From these solutions, we compute orbital frequencies, horizon areas, and entropies. This sets the stage for analytically understanding the microscopic origin of black hole entropy in beyond-GR theories.

Extreme Wind, Rain, Storm Surge, and Flooding: Why Hurricane Impacts are Difficult to Forecast?

Science.gov (United States)

Chen, S. S.

2017-12-01

The 2017 hurricane season is estimated as one of the costliest in the U.S. history. The damage and devastation caused by Hurricane Harvey in Houston, Irma in Florida, and Maria in Puerto Rico are distinctly different in nature. The complexity of hurricane impacts from extreme wind, rain, storm surge, and flooding presents a major challenge in hurricane forecasting. A detailed comparison of the storm impacts from Harvey, Irma, and Maria will be presented using observations and state-of-the-art new generation coupled atmosphere-wave-ocean hurricane forecast model. The author will also provide an overview on what we can expect in terms of advancement in science and technology that can help improve hurricane impact forecast in the near future.

[Effectiveness of the GlideScope video laryngoscope in a case of unexpected difficult airway due to lingual tonsil hypertrophy].

Science.gov (United States)

Cruz, P; Alarcón, L; Del Castillo, T; Cabrerizo, P; Díaz, S

2015-05-01

Lingual tonsil hypertrophy can cause varying degrees of airway obstruction and is considered a risk factor for difficult mask ventilation and tracheal intubation. We report a case of unexpected difficult airway in a patient with unknown lingual tonsil hypertrophy that was solved with the use of the GlideScope video laryngoscope. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Lymphoscintigraphy of the lower extremity

International Nuclear Information System (INIS)

Abbasi, N.Z.

1990-01-01

Fifty one lower extremities of 26 normal healthy volunteers and 26 extremities of 13 patients with oedema have been studied. Dynamic quantitative lymphoscintigraphy using 99Tc-m antimony sulphide colloid during passive exercise as well as before and after active exercise was performed. parameters of lymphatic function including percentage of radioactivity cleared from the injection site, the percentage uptake by the inguinal lymph nodes, the time of arrival of activity at the regional lymph nodes and the lymphatic reserve index have been evaluated. The percentage clearance of activity from the injection site was found technically difficult to standardize and proved to be an unreliable parameter of lymphatic function. However, the quantitation of nodal uptake, the lymphatic transit time and the lymphatic reserve capacity accurately depicted the lymphatic functional status of an individual. The physiologic parameters of lymphatic function of the contralateral lower extremities were compared and a physiologic difference in the lymphatic capacity of the two limbs was scintigraphically documented. (author)

Lower-Extremity Weakness in a Teenager Due to Thyrotoxic Periodic Paralysis.

Science.gov (United States)

Thornton, Matthew D

2017-04-01

Thyrotoxic hypokalemic paralysis is the hallmark of thyrotoxic periodic paralysis (TPP). TPP is a potentially deadly complication of hyperthyroidism that occurs because of rapid and dramatic intracellular shift of potassium. This transference results in severe hypokalemia and clinically manifests itself as muscle weakness or paralysis. This condition predominantly affects males of Asian descent, and its presentation can range from mild to severe, as seen in our case. We present the case of a 15-year-old Asian-American male who presented to a tertiary-care pediatric emergency department complaining of generalized weakness and flaccid paralysis of his lower extremities. The differential for such a complaint is extremely broad, and the symptoms can result from etiologies arising from the cerebral cortex, the spinal cord, peripheral nerves, the neuromuscular junction, or even the muscles themselves. Our patient was found to have an extremely low serum potassium concentration, as well as an electrocardiogram that revealed a prolonged QT interval and right bundle branch block. The etiology of these abnormalities and the patient's symptoms was found to be undiagnosed and uncontrolled hyperthyroidism from Grave's disease, which resulted in this dramatic presentation of thyrotoxic hypokalemic paralysis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This entity is common in Asia but still somewhat rare in the United States and other Western countries. Our case illustrates that careful history taking and a focused diagnostic evaluation, in conjunction with having an awareness of this disease, can help expedite diagnosis and management, as well as avoid unnecessary and potential harmful testing in the emergency department setting. Copyright © 2016 Elsevier Inc. All rights reserved.

A note on extreme sets

Directory of Open Access Journals (Sweden)

Radosław Cymer

2017-10-01

Full Text Available In decomposition theory, extreme sets have been studied extensively due to its connection to perfect matchings in a graph. In this paper, we first define extreme sets with respect to degree-matchings and next investigate some of their properties. In particular, we prove the generalized Decomposition Theorem and give a characterization for the set of all extreme vertices in a graph.

How do extreme streamflow due to hurricane IRMA compare during 1938-2017 in South Eastern US?

Science.gov (United States)

Anandhi, A.

2017-12-01

The question related to Irma, Harvey, Maria, and other hurricanes is: are hurricane more frequent and intense than they have been in the past. Recent hurricanes were unusually strong hitting the US Coastline or territories as a category 4 or 5, dropping unusually large amounts of precipitation on the affected areas creating extreme high-flow events in rivers and streams in affected areas. The objective of the study is to determine how extreme are streamflows from recent hurricanes (e.g. IRMA) when compared to streamflow's during 1938-2017 time-period. Additionally, in this study, the extreme precipitations are also compared during IRMA. Extreme high flows are selected from Indicators of Hydrologic Alteration (IHA). They are distributions, timing, duration, frequency, magnitude, pulses, and days of extreme events in rivers of the southeastern United States and Gulf of Mexico Hydrologic Region—03. Streamflow data from 30 stations in the region with at least 79 years of record (1938-2017) are used. Historical precipitation changes is obtained from meta-analysis of published literature. Our preliminary results indicate the extremeness of streamflow from recent hurricanes vary with the IHA indicator selected. Some potential implications of these extreme events on the region's ecosystem are also discussed using causal chains and loops.

Extremal black holes in dynamical Chern–Simons gravity

International Nuclear Information System (INIS)

McNees, Robert; Stein, Leo C; Yunes, Nicolás

2016-01-01

Rapidly rotating black hole (BH) solutions in theories beyond general relativity (GR) play a key role in experimental gravity, as they allow us to compute observables in extreme spacetimes that deviate from the predictions of GR. Such solutions are often difficult to find in beyond-general-relativity theories due to the inclusion of additional fields that couple to the metric nonlinearly and non-minimally. In this paper, we consider rotating BH solutions in one such theory, dynamical Chern–Simons (dCS) gravity, where the Einstein–Hilbert action is modified by the introduction of a dynamical scalar field that couples to the metric through the Pontryagin density. We treat dCS gravity as an effective field theory and work in the decoupling limit, where corrections are treated as small perturbations from GR. We perturb about the maximally rotating Kerr solution, the so-called extremal limit, and develop mathematical insight into the analysis techniques needed to construct solutions for generic spin. First we find closed-form, analytic expressions for the extremal scalar field, and then determine the trace of the metric perturbation, giving both in terms of Legendre decompositions. Retaining only the first three and four modes in the Legendre representation of the scalar field and the trace, respectively, suffices to ensure a fidelity of over 99% relative to full numerical solutions. The leading-order mode in the Legendre expansion of the trace of the metric perturbation contains a logarithmic divergence at the extremal Kerr horizon, which is likely to be unimportant as it occurs inside the perturbed dCS horizon. The techniques employed here should enable the construction of analytic, closed-form expressions for the scalar field and metric perturbations on a background with arbitrary rotation. (paper)

The attitudes of neonatal nurses towards extremely preterm infants.

Science.gov (United States)

Gallagher, Katie; Marlow, Neil; Edgley, Alison; Porock, Davina

2012-08-01

The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants. Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest with the infant and their family, their potential influence is usually ignored when determining how parents come to decisions about future care for their extremely premature infant. A Q methodology was employed to explore the attitudes of neonatal nurses towards caring for extremely preterm infants. Data were collected between 2007 and 2008 and analysed using PQMethod and Card Content Analysis. Thirty-six nurses from six neonatal units in the United Kingdom participated. Although there was consensus around the professional role of the nurse, when faced with the complexities of neonatal nursing three distinguishing factors emerged: the importance of parental choice in decision-making, the belief that technology should be used to assess response to treatment, and the belief that healthcare professionals should undertake difficult decisions. Neonatal nurses report unexpected difficulties in upholding their professionally defined role through highly complex and ever varied decision-making processes. Recognition of individual attitudes to the care of extremely preterm infants and the role of the family in the face of difficult decisions should facilitate more open communication between the nurse and the parents and improve the experience of both the nurse and the family during these emotional situations. © 2011 Blackwell Publishing Ltd.

Extreme lateral approach in a case of acute-onset quadriplegia due to high cervical neurenteric cyst.

Science.gov (United States)

Abhishek, Agrawal; Anushree, Agrawal; Patir, Rana; Sehgal, A D

2007-01-01

Spinal neurenteric cysts are very rare intradural developmental lesions, predominantly localized anterior to the cervical cord and arising from misplaced endodermal cells in the 3rd week of embryonic life. An acute onset of symptoms can occur due to hemorrhage, but has not as yet been reported in relation to infection in the cyst. We report an 18-year-old male who presented with a rapid onset of respiratory distress and quadriplegia over a period of 6 h requiring intubation and ventilatory support. There was no respiratory effort with a dense sensory level from the neck. MRI of the cervical spine revealed an intradural extramedullary ventrally located cystic lesion at the C(2-3) level. There was no evidence of systemic infection elsewhere in the body. The lesion was radically excised using an extreme lateral approach as it provided excellent visualization of the cyst, thus permitting safe dissection without retraction of the cord. The cyst was tense and the contents turbid, thick, creamy and mucinous without any evidence of fresh or altered blood. Histopathological examination confirmed the cyst to be a neurenteric cyst. The cystic fluid, which was sent for culture, grew coagulase-negative Staphylococcus aureus. This is the first documented case of rapid neurological deterioration due to infection in a neurenteric cyst. In spite of an early effective surgical management, outcome was poor due to the rapid and profound neurological deficit. Copyright (c) 2007 S. Karger AG, Basel.

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.

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.

Computational discovery of extremal microstructure families

Science.gov (United States)

Chen, Desai; Skouras, Mélina; Zhu, Bo; Matusik, Wojciech

2018-01-01

Modern fabrication techniques, such as additive manufacturing, can be used to create materials with complex custom internal structures. These engineered materials exhibit a much broader range of bulk properties than their base materials and are typically referred to as metamaterials or microstructures. Although metamaterials with extraordinary properties have many applications, designing them is very difficult and is generally done by hand. We propose a computational approach to discover families of microstructures with extremal macroscale properties automatically. Using efficient simulation and sampling techniques, we compute the space of mechanical properties covered by physically realizable microstructures. Our system then clusters microstructures with common topologies into families. Parameterized templates are eventually extracted from families to generate new microstructure designs. We demonstrate these capabilities on the computational design of mechanical metamaterials and present five auxetic microstructure families with extremal elastic material properties. Our study opens the way for the completely automated discovery of extremal microstructures across multiple domains of physics, including applications reliant on thermal, electrical, and magnetic properties. PMID:29376124

Identification of Climate Change with Generalized Extreme Value (GEV) Distribution Approach

International Nuclear Information System (INIS)

Rahayu, Anita

2013-01-01

Some events are difficult to avoid and gives considerable influence to humans and the environment is extreme weather and climate change. Many of the problems that require knowledge about the behavior of extreme values and one of the methods used are the Extreme Value Theory (EVT). EVT used to draw up reliable systems in a variety of conditions, so as to minimize the risk of a major disaster. There are two methods for identifying extreme value, Block Maxima with Generalized Extreme Value (GEV) distribution approach and Peaks over Threshold (POT) with Generalized Pareto Distribution (GPD) approach. This research in Indramayu with January 1961-December 2003 period, the method used is Block Maxima with GEV distribution approach. The result showed that there is no climate change in Indramayu with January 1961-December 2003 period.

Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners

Directory of Open Access Journals (Sweden)

Kahanov L

2015-03-01

Full Text Available Leamor Kahanov,1 Lindsey E Eberman,2 Kenneth E Games,2 Mitch Wasik2 1College of Health Science, Misericordia University, Dallas, PA, USA; 2Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA Abstract: Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence. Keywords: medial tibial stress syndrome, stress injury, nonunion stress fracture

Soft tissue masses of extremities: MR findings

Energy Technology Data Exchange (ETDEWEB)

Son, Seok Hyun; Yang, Seoung Oh; Choi, Jong Chul; Park, Byeong Ho; Lee, Ki Nam; Choi, Sun Seob; Chung, Duck Hwan [Dong-A University College of Medicine, Pusan (Korea, Republic of)

1993-11-15

To evaluate MR findings of soft tissue masses in extremities and to find the helpful findings of distinguish benignity from malignancy, 28 soft tissue masses (22 benign and 6 malignant) in extremities were reviewed. TI-weighted, proton density, T2-weighted and Gd-DTPA enhanced images were obtained. MR images allowed a specific diagnosis in large number of benign masses, such as hemangioma(8/9), lipoma(2/2), angiolipoma(1/1), epidermoid cyst(2/2), myositis ossificans(1/1), synovial chondromatosis(1/1) and pigmented villonodular synovitis(1/2). Specific diagnosis was difficult in the rest of the masses including malignancy. However, inhomogeneous signal intensities with necrosis and inhomogeneous enhancement may suggest malignant masses.

Effective communication during difficult conversations.

Science.gov (United States)

Polito, Jacquelyn M

2013-06-01

A strong interest and need exist in the workplace today to master the skills of conducting difficult conversations. Theories and strategies abound, yet none seem to have found the magic formula with universal appeal and success. If it is such an uncomfortable skill to master is it better to avoid or initiate such conversations with employees? Best practices and evidence-based management guide us to the decision that quality improvement dictates effective communication, even when difficult. This brief paper will offer some suggestions for strategies to manage difficult conversations with employees. Mastering the skills of conducting difficult conversations is clearly important to keeping lines of communication open and productive. Successful communication skills may actually help to avert confrontation through employee engagement, commitment and appropriate corresponding behavior

Spatial extreme value analysis to project extremes of large-scale indicators for severe weather.

Science.gov (United States)

Gilleland, Eric; Brown, Barbara G; Ammann, Caspar M

2013-09-01

Concurrently high values of the maximum potential wind speed of updrafts ( W max ) and 0-6 km wind shear (Shear) have been found to represent conducive environments for severe weather, which subsequently provides a way to study severe weather in future climates. Here, we employ a model for the product of these variables (WmSh) from the National Center for Atmospheric Research/United States National Center for Environmental Prediction reanalysis over North America conditioned on their having extreme energy in the spatial field in order to project the predominant spatial patterns of WmSh. The approach is based on the Heffernan and Tawn conditional extreme value model. Results suggest that this technique estimates the spatial behavior of WmSh well, which allows for exploring possible changes in the patterns over time. While the model enables a method for inferring the uncertainty in the patterns, such analysis is difficult with the currently available inference approach. A variation of the method is also explored to investigate how this type of model might be used to qualitatively understand how the spatial patterns of WmSh correspond to extreme river flow events. A case study for river flows from three rivers in northwestern Tennessee is studied, and it is found that advection of WmSh from the Gulf of Mexico prevails while elsewhere, WmSh is generally very low during such extreme events. © 2013 The Authors. Environmetrics published by JohnWiley & Sons, Ltd.

Defining Extreme Events: A Cross-Disciplinary Review

Science.gov (United States)

McPhillips, Lauren E.; Chang, Heejun; Chester, Mikhail V.; Depietri, Yaella; Friedman, Erin; Grimm, Nancy B.; Kominoski, John S.; McPhearson, Timon; Méndez-Lázaro, Pablo; Rosi, Emma J.; Shafiei Shiva, Javad

2018-03-01

Extreme events are of interest worldwide given their potential for substantial impacts on social, ecological, and technical systems. Many climate-related extreme events are increasing in frequency and/or magnitude due to anthropogenic climate change, and there is increased potential for impacts due to the location of urbanization and the expansion of urban centers and infrastructures. Many disciplines are engaged in research and management of these events. However, a lack of coherence exists in what constitutes and defines an extreme event across these fields, which impedes our ability to holistically understand and manage these events. Here, we review 10 years of academic literature and use text analysis to elucidate how six major disciplines—climatology, earth sciences, ecology, engineering, hydrology, and social sciences—define and communicate extreme events. Our results highlight critical disciplinary differences in the language used to communicate extreme events. Additionally, we found a wide range in definitions and thresholds, with more than half of examined papers not providing an explicit definition, and disagreement over whether impacts are included in the definition. We urge distinction between extreme events and their impacts, so that we can better assess when responses to extreme events have actually enhanced resilience. Additionally, we suggest that all researchers and managers of extreme events be more explicit in their definition of such events as well as be more cognizant of how they are communicating extreme events. We believe clearer and more consistent definitions and communication can support transdisciplinary understanding and management of extreme events.

A child with a difficult airway: what do I do next?

Science.gov (United States)

Engelhardt, Thomas; Weiss, Markus

2012-06-01

Difficulties in pediatric airway management are common and continue to result in significant morbidity and mortality. This review reports on current concepts in approaching a child with a difficult airway. Routine airway management in healthy children with normal airways is simple in experienced hands. Mask ventilation (oxygenation) is always possible and tracheal intubation normally simple. However, transient hypoxia is common in these children usually due to unexpected anatomical and functional airway problems or failure to ventilate during rapid sequence induction. Anatomical airway problems (upper airway collapse and adenoid hypertrophy) and functional airway problems (laryngospasm, bronchospasm, insufficient depth of anesthesia and muscle rigidity, gastric hyperinflation, and alveolar collapse) require urgent recognition and treatment algorithms due to insufficient oxygen reserves. Early muscle paralysis and epinephrine administration aids resolution of these functional airway obstructions. Children with an 'impaired' normal (foreign body, allergy, and inflammation) or an expected difficult (scars, tumors, and congenital) airway require careful planning and expertise. Training in the recognition and management of these different situations as well as a suitably equipped anesthesia workstation and trained personnel are essential. The healthy child with an unexpected airway problem requires clear strategies. The 'impaired' normal pediatric airway may be handled by anesthetists experienced with children, whereas the expected difficult pediatric airway requires dedicated pediatric anesthesia specialist care and should only be managed in specialized centers.

The application of DSA bolus chase technology in diagnosing the vascular disorders of lower extremities due to diabetes mellitus

International Nuclear Information System (INIS)

Ren Chongyang; Di Zhenhai; Mao Xuequn; Zou Rong; Zhang Jian; Wang Meirong; Li Quan

2010-01-01

Objective: To retrospectively evaluate the digital subtraction angiography (DSA) bolus chase technology in diagnosing the vascular disorders of lower extremities due to diabetes mellitus. Methods: From January 2004 to March 2010, DSA was performed in forty-five diabetes patients with suspicious vascular diseases of lower extremities. Among them, 24 cases (31 lower limbs)were examined with DSA bolus chase technology and the remaining 21 cases (21 lower limbs)were examined with traditional segmentational technique. The contrast dosage used in angiography, the total exposure time, the examination time and the imaging value for making diagnosis were analyzed and compared between two techniques. Results: For DSA bolus chase technology group, the contrast dosage used in angiography, the total exposure time and the examination time were 25.26 ml, 13.23 s and 37.26 min, respectively,with an average exposure of 101.65 pictures. For traditional segmentational technique group, the contrast dosage used in angiography, the total exposure time and the examination time were 130.00 ml, 52.38 s and 50.48 min, respectively, with an average exposure of 118.33 pictures. The percentage of high quality images in bolus chase technology group and in traditional segmentational technique group were 90.3% and 90.5%, respectively. All the images could meet the requirements for making a reliable diagnosis. Conclusion: Digital subtraction angiography by using bolus-chase technology can well demonstrate the vascular pathology of lower extremities caused by diabetes mellitus, obtain sufficient imaging information necessary for making a reliable diagnosis. DSA bolus chase technology is superior to traditional segmentational technique in shortening procedure time, reducing contrast medium dosage and decreasing radiation dose. (authors)

To the fringe and back: Violent extremism and the psychology of deviance.

Science.gov (United States)

Kruglanski, Arie W; Jasko, Katarzyna; Chernikova, Marina; Dugas, Michelle; Webber, David

2017-04-01

We outline a general psychological theory of extremism and apply it to the special case of violent extremism (VE). Extremism is defined as motivated deviance from general behavioral norms and is assumed to stem from a shift from a balanced satisfaction of basic human needs afforded by moderation to a motivational imbalance wherein a given need dominates the others. Because motivational imbalance is difficult to sustain, only few individuals do, rendering extreme behavior relatively rare, hence deviant. Thus, individual dynamics translate into social patterns wherein majorities of individuals practice moderation, whereas extremism is the province of the few. Both extremism and moderation require the ability to successfully carry out the activities that these demand. Ability is partially determined by the activities' difficulty, controllable in part by external agents who promote or oppose extremism. Application of this general framework to VE identifies the specific need that animates it and offers broad guidelines for addressing this pernicious phenomenon. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Maritime Military Decision Making in Environments of Extreme Information Ambiguity: An Initial Exploration

National Research Council Canada - National Science Library

Reeves, Andrew T

2005-01-01

... to make effective decisions. An environment of extreme information ambiguity, a dependent variable, is one of the most difficult components of a battle where the decision maker may reach a confusing and debilitating point...

Probabilistic analysis of extreme wind events

Energy Technology Data Exchange (ETDEWEB)

Chaviaropoulos, P.K. [Center for Renewable Energy Sources (CRES), Pikermi Attikis (Greece)

1997-12-31

A vital task in wind engineering and meterology is to understand, measure, analyse and forecast extreme wind conditions, due to their significant effects on human activities and installations like buildings, bridges or wind turbines. The latest version of the IEC standard (1996) pays particular attention to the extreme wind events that have to be taken into account when designing or certifying a wind generator. Actually, the extreme wind events within a 50 year period are those which determine the ``static`` design of most of the wind turbine components. The extremes which are important for the safety of wind generators are those associated with the so-called ``survival wind speed``, the extreme operating gusts and the extreme wind direction changes. A probabilistic approach for the analysis of these events is proposed in this paper. Emphasis is put on establishing the relation between extreme values and physically meaningful ``site calibration`` parameters, like probability distribution of the annual wind speed, turbulence intensity and power spectra properties. (Author)

[Blunt force injuries due to martial arts in children--a diagnostic problem? Delayed diagnosis of an infected hematoma].

Science.gov (United States)

Kruppa, C; Goericke, S L; Matheney, T; Ozokyay, L; Schildhauer, T A; Muhr, G; Dudda, M

2010-10-01

Blunt force injuries in martial arts occur frequently but isolated hematoma of muscles in the extremities is rare. Even minor trauma of the lower extremities due to throwing techniques in judo and other forms of Asian martial arts can lead to major pathologies. A 9-year-old girl presented with an unclear swelling and soreness of the calf muscle. The patient could not remember an obvious traumatic event. She was admitted 4 days later because of increased swelling, pain and erythema. The parents reported a minor trauma at judo training 1 week ago. Further investigation was performed with MRI and confirmed a massive hematoma much greater than previously shown by sonography. Histologic and microbiologic evaluation demonstrated florid inflammation and proof of Staphylococcus aureus was found intra-operatively. The diagnosis of blunt force injuries due to martial arts is difficult in childhood because often children do not remember a traumatic event. Therefore, it is important to obtain a thorough history from caregivers. Because sonography depends highly on the experience of the investigator MRI is considered to be a better diagnostic modality to diagnose and guide treatment in this age group.

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.

Extremely large nonsaturating magnetoresistance and ultrahigh mobility due to topological surface states in the metallic Bi2Te3 topological insulator

Science.gov (United States)

Shrestha, K.; Chou, M.; Graf, D.; Yang, H. D.; Lorenz, B.; Chu, C. W.

2017-05-01

Weak antilocalization (WAL) effects in Bi2Te3 single crystals have been investigated at high and low bulk charge-carrier concentrations. At low charge-carrier density the WAL curves scale with the normal component of the magnetic field, demonstrating the dominance of topological surface states in magnetoconductivity. At high charge-carrier density the WAL curves scale with neither the applied field nor its normal component, implying a mixture of bulk and surface conduction. WAL due to topological surface states shows no dependence on the nature (electrons or holes) of the bulk charge carriers. The observations of an extremely large nonsaturating magnetoresistance and ultrahigh mobility in the samples with lower carrier density further support the presence of surface states. The physical parameters characterizing the WAL effects are calculated using the Hikami-Larkin-Nagaoka formula. At high charge-carrier concentrations, there is a greater number of conduction channels and a decrease in the phase coherence length compared to low charge-carrier concentrations. The extremely large magnetoresistance and high mobility of topological insulators have great technological value and can be exploited in magnetoelectric sensors and memory devices.

Extreme climatic events in relation to global change and their impact on life histories

Directory of Open Access Journals (Sweden)

Juan MORENO, Anders Pape Møller

2011-06-01

Full Text Available Extreme weather conditions occur at an increasing rate as evidenced by higher frequency of hurricanes and more extreme precipitation and temperature anomalies. Such extreme environmental conditions will have important implications for all living organisms through greater frequency of reproductive failure and reduced adult survival. We review examples of reproductive failure and reduced survival related to extreme weather conditions. Phenotypic plasticity may not be sufficient to allow adaptation to extreme weather for many animals. Theory predicts reduced reproductive effort as a response to increased stochasticity. We predict that patterns of natural selection will change towards truncation selection as environmental conditions become more extreme. Such changes in patterns of selection may facilitate adaptation to extreme events. However, effects of selection on reproductive effort are difficult to detect. We present a number of predictions for the effects of extreme weather conditions in need of empirical tests. Finally, we suggest a number of empirical reviews that could improve our ability to judge the effects of extreme environmental conditions on life history [Current Zoology 57 (3: 375–389, 2011].

Design, fabrication, and characterization of high-efficiency extreme ultraviolet diffusers

Energy Technology Data Exchange (ETDEWEB)

Naulleau, Patrick P.; Liddle, J. Alexander; Salmassi, Farhad; Anderson, Erik H.; Gullikson, Eric M.

2004-02-19

As the development of extreme ultraviolet (EUV) lithography progresses, interest grows in the extension of traditional optical components to the EUV regime. The strong absorption of EUV by most materials and its extremely short wavelength, however, makes it very difficult to implement many components that are commonplace in the longer wavelength regimes. One such example is the diffuser often implemented with ordinary ground glass in the visible light regime. Here we demonstrate the fabrication of reflective EUV diffusers with high efficiency within a controllable bandwidth. Using these techniques we have fabricated diffusers with efficiencies exceeding 10% within a moderate angular single-sided bandwidth of approximately 0.06 radians.

Consistency of extreme flood estimation approaches

Science.gov (United States)

Felder, Guido; Paquet, Emmanuel; Penot, David; Zischg, Andreas; Weingartner, Rolf

2017-04-01

Estimations of low-probability flood events are frequently used for the planning of infrastructure as well as for determining the dimensions of flood protection measures. There are several well-established methodical procedures to estimate low-probability floods. However, a global assessment of the consistency of these methods is difficult to achieve, the "true value" of an extreme flood being not observable. Anyway, a detailed comparison performed on a given case study brings useful information about the statistical and hydrological processes involved in different methods. In this study, the following three different approaches for estimating low-probability floods are compared: a purely statistical approach (ordinary extreme value statistics), a statistical approach based on stochastic rainfall-runoff simulation (SCHADEX method), and a deterministic approach (physically based PMF estimation). These methods are tested for two different Swiss catchments. The results and some intermediate variables are used for assessing potential strengths and weaknesses of each method, as well as for evaluating the consistency of these methods.

Extreme-scale Algorithms and Solver Resilience

Energy Technology Data Exchange (ETDEWEB)

Dongarra, Jack [Univ. of Tennessee, Knoxville, TN (United States)

2016-12-10

A widening gap exists between the peak performance of high-performance computers and the performance achieved by complex applications running on these platforms. Over the next decade, extreme-scale systems will present major new challenges to algorithm development that could amplify this mismatch in such a way that it prevents the productive use of future DOE Leadership computers due to the following; Extreme levels of parallelism due to multicore processors; An increase in system fault rates requiring algorithms to be resilient beyond just checkpoint/restart; Complex memory hierarchies and costly data movement in both energy and performance; Heterogeneous system architectures (mixing CPUs, GPUs, etc.); and Conflicting goals of performance, resilience, and power requirements.

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

Determining extreme parameter correlation in ground water models

DEFF Research Database (Denmark)

Hill, Mary Cole; Østerby, Ole

2003-01-01

can go undetected even by experienced modelers. Extreme parameter correlation can be detected using parameter correlation coefficients, but their utility depends on the presence of sufficient, but not excessive, numerical imprecision of the sensitivities, such as round-off error. This work...... investigates the information that can be obtained from parameter correlation coefficients in the presence of different levels of numerical imprecision, and compares it to the information provided by an alternative method called the singular value decomposition (SVD). Results suggest that (1) calculated...... correlation coefficients with absolute values that round to 1.00 were good indicators of extreme parameter correlation, but smaller values were not necessarily good indicators of lack of correlation and resulting unique parameter estimates; (2) the SVD may be more difficult to interpret than parameter...

Will climate change increase the risk for critical infrastructure failures in Europe due to extreme precipitation?

Science.gov (United States)

Nissen, Katrin; Ulbrich, Uwe

2016-04-01

An event based detection algorithm for extreme precipitation is applied to a multi-model ensemble of regional climate model simulations. The algorithm determines extent, location, duration and severity of extreme precipitation events. We assume that precipitation in excess of the local present-day 10-year return value will potentially exceed the capacity of the drainage systems that protect critical infrastructure elements. This assumption is based on legislation for the design of drainage systems which is in place in many European countries. Thus, events exceeding the local 10-year return value are detected. In this study we distinguish between sub-daily events (3 hourly) with high precipitation intensities and long-duration events (1-3 days) with high precipitation amounts. The climate change simulations investigated here were conducted within the EURO-CORDEX framework and exhibit a horizontal resolution of approximately 12.5 km. The period between 1971-2100 forced with observed and scenario (RCP 8.5 and RCP 4.5) greenhouse gas concentrations was analysed. Examined are changes in event frequency, event duration and size. The simulations show an increase in the number of extreme precipitation events for the future climate period over most of the area, which is strongest in Northern Europe. Strength and statistical significance of the signal increase with increasing greenhouse gas concentrations. This work has been conducted within the EU project RAIN (Risk Analysis of Infrastructure Networks in response to extreme weather).

Difficult management of posterior urethra gunshot wound combined with urethro-rectal fistula

OpenAIRE

Walid Kerkeni; Ahmed Saadi; Mohamed Hédi Rebai; Abderrazak Bouzouita; Mohamed Cherif; Amine Derouiche; Tahar Khalfallah; Mohamed Riadh Ben Slama; Mohamed Chebil

2015-01-01

Posterior urethra gunshot wounds are poorly described in the literature. They are often associated with pelvic vital lesions making difficult early repair of urethral injuries. They can be complicated by urethro-rectal fistula, which makes their management more complicated. We report a new case of posterior urethra disruption due to a gunshot wound and complicated by urethro-rectal fistula.

Vegetation Cover and Furrow Erosion due to Extreme Rain Events in Semiarid Environments

Directory of Open Access Journals (Sweden)

Belén Cárceles-Rodríguez

2017-05-01

Full Text Available The conservation of the soil resource in semi-arid environments is one of the major challenges of agricultural systems, particularly in the Mediterranean region. In the present study, two types of soil management were compared: minimum tillage (ML and minimum tillage with spontaneous vegetation cover (MLVE. The comparison was conducted in a rainfed almond plantation at slope (35%, under an extraordinary event in 2015 (91.3 mm and EI30 of 2,719.89 mm ha-1 h-1. In this situation in MLVE plots, the development of furrows in contrast to ML were not recorded; the total soil loss was more than 12 times lower than that recorded in the latter. This fact demonstrated the effectiveness of the vegetal cover in the protection of the agricultural soil against the erosion during extreme events. Also, for ML management, furrow erosion represented more than 60% of the total soil loss, demonstrating the dominance of this type of erosion. Finally, it should be noted that this event represents the almost total loss of soil recorded in the experimental plots during the period 2012-2015; and this consequently shows the significant impact of extreme events on erosion rates in the Mediterranean region.

Malignant bone tumors of the pelvis and of the extremities

International Nuclear Information System (INIS)

Gullotta, U.; Reiser, M.; Feuerbach, S.; Biehl, T.; Technische Univ. Muenchen

1981-01-01

Bone tumors of the extremities are usually diagnosed by conventional radiography. A good angiogram may render information not only about intra- and extraosseous extension of the tumor, but often also about the biological dignity. CT is usually not necessary, especially since it is sometimes difficult to define the extraosseous borders of these extremity tumors with this method. In bone tumors of the pelvis, however, neither conventional radiography nor angiography render reliable information about the extent of the tumor, which CT is very well able to do. Therefore CT is primarily indicated for evaluation of bone tumors in this region. Angiography is done only for preoperative evaluation of the vascular architecture or for potential therapeutic embolisation. (orig.) [de

Difficult management of posterior urethra gunshot wound combined with urethro-rectal fistula

Directory of Open Access Journals (Sweden)

Walid Kerkeni

2015-06-01

Full Text Available Posterior urethra gunshot wounds are poorly described in the literature. They are often associated with pelvic vital lesions making difficult early repair of urethral injuries. They can be complicated by urethro-rectal fistula, which makes their management more complicated. We report a new case of posterior urethra disruption due to a gunshot wound and complicated by urethro-rectal fistula.

Two centuries of extreme events over the Baltic Sea and North Sea regions

Science.gov (United States)

Stendel, Martin; den Besselaar Else, van; Abdel, Hannachi; Jaak, Jaagus; Elizabeth, Kent; Christiana, Lefebvre; Gudrun, Rosenhagen; Anna, Rutgersson; Frederik, Schenk; der Schrier Gerard, van; Tim, Woolings

2017-04-01

Two centuries of extreme events over the Baltic Sea and North Sea regions In the framework of the BACC 2 (for the Baltic Sea) and NOSCCA projects (for the North Sea region), studies of past and present variability and changes in atmospheric variables within the North Sea region over the instrumental period (roughly the past 200 years) have been investigated. Findings on trends in temperature and precipitation have already been presented. Here we focus on data homogeneity issues and examine how reliable reanalyses are in this context. Unlike most other regions in the world, there is a wealth of old observations available for the Baltic and North Sea regions, most of it in handwritten form in meteorological journals and other publications. These datasets need to be carefully digitised and homogenized. For this, a thorough quality control must be applied; otherwise the digitised datasets may prove useless or even counterproductive. We present evidence that this step cannot be conducted without human interference and thus cannot be fully automated. Furthermore, inhomogeneities due to e.g. instrumentation and station relocations need to be addressed. A wealth of reanalysis products is available, which can help detect such inhomogeneities in observed time series, but at the same time are prone to biases and/or spurious trends themselves e.g. introduced by changes in the availability and quality of the underlying assimilated data. It therefore in general remains unclear in how far we can simulate the pre-satellite era with respect to homogeneity with reanalyses based only on parts of the observing system. Extreme events and changes in extreme situations are more important and of greater (societal) significance than changes in mean climate. However, changes in extreme weather events are difficult to assess not only because they are, per definition, rare events, but also due to the homogeneity issues outlined above. Taking these into account, we present evidence for changes

Effects of Extreme Events on Arsenic Cycling in Salt Marshes

Science.gov (United States)

Northrup, Kristy; Capooci, Margaret; Seyfferth, Angelia L.

2018-03-01

Extreme events such as storm surges, intense precipitation, and supermoons cause anomalous and large fluctuations in water level in tidal salt marshes, which impacts the sediment biogeochemistry that dictates arsenic (As) cycling. In addition to changes in water level, which impacts soil redox potential, these extreme events may also change salinity due to freshwater inputs from precipitation or saltwater inputs due to surge. It is currently unknown how As mobility in tidal salt marshes will be impacted by extreme events, as fluctuations in salinity and redox potential may act synergistically to mobilize As. To investigate impacts of extreme events on As cycling in tidal salt marshes, we conducted a combined laboratory and field investigation. We monitored pore water and soil samples before, during, and after two extreme events: a supermoon lunar eclipse followed by a storm surge and precipitation induced by Hurricane Joaquin in fall 2015 at the St. Jones Reserve in Dover, Delaware, a representative tidal salt marsh in the Mid-Atlantic United States. We also conducted soil incubations of marsh sediments in batch and in flow-through experiments in which redox potential and/or salinity were manipulated. Field investigations showed that pore water As was inversely proportional to redox potential. During the extreme events, a distinct pulse of As was observed in the pore water with maximum salinity. Combined field and laboratory investigations revealed that this As pulse is likely due to rapid changes in salinity. These results have implications for As mobility in the face of extreme weather variability.

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.

Ergotamine-induced upper extremity ischemia: a case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Man Deuk; Lee, Gun [Bundang CHA General Hospital, Pochon (China); Shin, Sung Wook [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2005-06-15

Ergotamine-induced limb ischemia is an extremely rare case. We present a case of a 64-year-old man, who developed ischemia on the right upper extremity due to long-term use of Ergot for migraine headache. Angiography revealed diffused, smooth, and tapered narrowing of the brachial artery. The patient was successfully treated with intravenous nitroprusside.

Changes in extreme regional sea level under global warming

NARCIS (Netherlands)

Brunnabend, S. E.; Dijkstra, H. A.; Kliphuis, Michael; Bal, Henri E.; Seinstra, Frank J.; van Werkhoven, Ben; Maassen, J.; van Meersbergen, Maarten

2017-01-01

An important contribution to future changes in regional sea level extremes is due to the changes in intrinsic ocean variability, in particular ocean eddies. Here, we study a scenario of future dynamic sea level (DSL) extremes using a high-resolution version of the Parallel Ocean Program and

Arm Volumetry Versus Upper Extremity Lymphedema Index: Validity of Upper Extremity Lymphedema Index for Body-Type Corrected Arm Volume Evaluation.

Science.gov (United States)

Yamamoto, Nana; Yamamoto, Takumi; Hayashi, Nobuko; Hayashi, Akitatsu; Iida, Takuya; Koshima, Isao

2016-06-01

Volumetry, measurement of extremity volume, is a commonly used method for upper extremity lymphedema (UEL) evaluation. However, comparison between different patients with different physiques is difficult with volumetry, because body-type difference greatly affects arm volume. Seventy arms of 35 participants who had no history of arm edema or breast cancer were evaluated. Arm volume was calculated using a summed truncated cone model, and UEL index was calculated using circumferences and body mass index (BMI). Examinees' BMI was classified into 3 groups, namely, low BMI (BMI, 25 kg/m). Arm volume and UEL index were compared with corresponding BMI groups. Mean (SD) arm volume was 1090.9 (205.5) mL, and UEL index 96.9 (5.6). There were significant differences in arm volume between BMI groups [low BMI vs middle BMI vs high BMI, 945.2 (107.4) vs 1045.2 (87.5) vs 1443.1 (244.4) mL, P 0.5]. Arm volume significantly increased with increase of BMI, whereas UEL index stayed constant regardless of BMI. Upper extremity lymphedema index would allow better body-type corrected arm volume evaluation compared with arm volumetry.

Climate extremes and challenges to infrastructure development in coastal cities in Bangladesh

Directory of Open Access Journals (Sweden)

Sowmen Rahman

2015-03-01

Full Text Available Most of the coastal cities in Bangladesh are situated on the riverbanks of low-lying tidal zones at an average elevation of 1.0–1.5 m from the sea level. Construction and management of buildings, roads, power and telecommunication transmission lines, drainage and sewerage and waste management are very difficult and vulnerable to climate change disasters. Cyclonic storms associated with tidal floods impact seriously the infrastructures and thus the livelihoods. Although coastal cities are the ultimate shelters of the coastal people during the extremes events, the coastal cities are not safe and cannot support them due to poor infrastructure. This study analyses the challenges coastal urbanization faces under different situations like cyclones, floods and water-logging, salinity, land-sliding and erosion etc. during the disasters and their effects on city lives for water supply and sanitation, power and electricity and waste management etc., and puts forward recommendations towards sustainable planning of coastal cities.

Difficult factors in Management of Impacted Dental Prosthesis in Esophagus

Directory of Open Access Journals (Sweden)

Efiaty A. Soepardi

2005-03-01

Full Text Available A dental prosthesis which ingested and impacted in esophagus, is an emergency case and life threatening, so require immediate esophagoscopy intervention for removing. The objective of this study is to assess some factors can caused dtfficulties in diagnosing and treating the ingested and impacted dental prosthesis in the esophagus and their complications. This retrospective study analyzed patient’s chart whose underwent esophagoscopy for removing the impacted dental prosthesis in Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia during a period between January 1997 and December 2003. Neck-chest X-ray and esophagoscopy were performed in all patients to identify the existence of the dental prosthesis as a diagnostic and treatment procedure. The length of time for removing the dental prosthesis was recorded and stated as a less difficult esophagoscopy when it takes time less than 60 minutes and as a difficult  esophagoscopy takes 60 minutes or longer. Some risk difficulties factors were statistically analyzed. There were 53 patients of ingested dental prosthesis in esophagus. Only 51 cases were analyzed According to the length of time for removing the dental prosthesis by esophagoscopy, 22 patients were recorded as less difficult cases and 29 patients as difficult cases. Two cases among the cases needed cervicotomy after unsuccessful esophagoscopy removal. The difficulties to diagnose an impacted dental prosthesis in the esophagus caused by unreliable clinical history, unclear signs and symptoms, unable to be detected by X-ray and was not found during esophagoscopy. The difficulties in treating due to mucosal laceration, edema, bleeding, failure of the first extraction and conformity with the size and shape, the wire outside the dental prosthesis and the length of time stayed in the esophagus. (Med J Indones 2005; 14: 33-6Keywords: ingested dental prosthesis, radioluscent foreign body, length of time of esophagoscopy

An overview on extremity dosimetry in medical applications

International Nuclear Information System (INIS)

Vanhavere, F.; Carinou, E.; Donadille, L.; Ginjaume, M.; Jankowski, J.; Rimpler, A.; Sans Merce, M.

2008-01-01

Some activities of EURADOS Working Group 9 (WG9) are presently funded by the European Commission (CONRAD project). The objective of WG9 is to promote and co-ordinate research activities for the assessment of occupational exposures to staff at workplaces in interventional radiology (IR) and nuclear medicine. For some of these applications, the skin of the fingers is the limiting organ for individual monitoring of external radiation. Therefore, sub-group 1 of WG9 deals with the use of extremity dosemeters in medical radiation fields. The wide variety of radiation field characteristics present in a medical environment together with the difficulties in measuring a local dose that is representative for the maximum skin dose, usually with one single detector, makes it difficult to perform accurate extremity dosimetry. Sub-group 1 worked out a thorough literature review on extremity dosimetry issues in diagnostic and therapeutic nuclear medicine and positron emission tomography, interventional radiology and interventional cardiology and brachytherapy. Some studies showed that the annual dose limits could be exceeded if the required protection measures are not taken, especially in nuclear medicine. The continuous progress in new applications and techniques requires an important effort in radiation protection and training. (authors)

Management of the difficult airway.

Science.gov (United States)

Schwartz, D E; Wiener-Kronish, J P

1991-09-01

For clinicians involved in airway management, a plan of action for dealing with the difficult airway or a failed intubation should be developed well in advance of encountering a patient in whom intubation is not routine. When difficulty is anticipated, the equipment necessary for performing a difficult intubation should be immediately available. It also is prudent to have a surgeon skilled in performing a tracheotomy and a criothyroidotomy stand by. The intubation should be attempted in the awake state, preferably using the fiberoptic bronchoscope. The more challenging situation is when the difficult airway is confronted unexpectedly. After the first failed attempt at laryngoscopy, head position should be checked and the patient ventilated with oxygen by mask. A smaller styletted tube and possibly a different laryngoscope blade should be selected for a second attempt at intubation. The fiberoptic bronchoscope and other equipment for difficult intubation should be obtained. A second attempt should then be made. If this is unsuccessful, the patient should be reoxygenated, and assistance including a skilled anesthesiologist and surgeon should be summoned. On a third attempt, traction to the tongue can be applied by an assistant, a tube changer could be used to enter the larynx, or one of the other special techniques previously described can be used. If this third attempt fails, it may be helpful to have a physician more experienced in airway management attempt intubation after oxygen has been administered to the patient. If all attempts are unsuccessful, then invasive techniques to secure the airway will have to be performed.

Interevent Time Distribution of Renewal Point Process, Case Study: Extreme Rainfall in South Sulawesi

Science.gov (United States)

Sunusi, Nurtiti

2018-03-01

The study of time distribution of occurrences of extreme rain phenomena plays a very important role in the analysis and weather forecast in an area. The timing of extreme rainfall is difficult to predict because its occurrence is random. This paper aims to determine the inter event time distribution of extreme rain events and minimum waiting time until the occurrence of next extreme event through a point process approach. The phenomenon of extreme rain events over a given period of time is following a renewal process in which the time for events is a random variable τ. The distribution of random variable τ is assumed to be a Pareto, Log Normal, and Gamma. To estimate model parameters, a moment method is used. Consider Rt as the time of the last extreme rain event at one location is the time difference since the last extreme rainfall event. if there are no extreme rain events up to t 0, there will be an opportunity for extreme rainfall events at (t 0, t 0 + δt 0). Furthermore from the three models reviewed, the minimum waiting time until the next extreme rainfall will be determined. The result shows that Log Nrmal model is better than Pareto and Gamma model for predicting the next extreme rainfall in South Sulawesi while the Pareto model can not be used.

Changing precipitation extremes and flood risk over the conterminous U.S.

Science.gov (United States)

Lettenmaier, D. P.

2017-12-01

On the basis of first principles, precipitation extremes should increase in a warming climate. Effectively, the atmospheric "heat engine" is expected to turn over more rapidly as the climate warms, due to increased water holding capacity of the atmosphere. Most climate models reflect this behavior, and project that precipitation extremes should increase, at roughly the Clausius-Clapyron rate. From a societal standpoint though, changing precipitation extremes in and of themselves aren't necessarily a concern - rather, the question of societal interest is "are and/or will flood extremes change". Flood extremes of course respond to precipitation extremes, but they are affected by a number of other factors, among them being the duration of precipitation relative to catchment size and channel features, storm orientation relative to catchment orientation, soil characteristics, and antecedent hydrologic conditions. Various studies have shown that over both the conterminous U.S. and globally, there have been slight increases in precipitation extremes (i.e., more than would be expected due to chance. On the other hand, evidence for increases in flooding are less pervasive. I review past work in this area, and suggest the nature of studies that might be conducted going forward to better understand the likely signature of changing precipitation extremes on flooding.

Psychopathology in difficult asthma

NARCIS (Netherlands)

Prins, L.C.; van Son, M.J.M.; Keimpema, A.R.; van Ranst, D; Pommer, A; Meijer, J.W.; Pop, V.J.M.

2015-01-01

OBJECTIVE: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed

Technology improves upper extremity rehabilitation.

Science.gov (United States)

Kowalczewski, Jan; Prochazka, Arthur

2011-01-01

Stroke survivors with hemiparesis and spinal cord injury (SCI) survivors with tetraplegia find it difficult or impossible to perform many activities of daily life. There is growing evidence that intensive exercise therapy, especially when supplemented with functional electrical stimulation (FES), can improve upper extremity function, but delivering the treatment can be costly, particularly after recipients leave rehabilitation facilities. Recently, there has been a growing level of interest among researchers and healthcare policymakers to deliver upper extremity treatments to people in their homes using in-home teletherapy (IHT). The few studies that have been carried out so far have encountered a variety of logistical and technical problems, not least the difficulty of conducting properly controlled and blinded protocols that satisfy the requirements of high-level evidence-based research. In most cases, the equipment and communications technology were not designed for individuals with upper extremity disability. It is clear that exercise therapy combined with interventions such as FES, supervised over the Internet, will soon be adopted worldwide in one form or another. Therefore it is timely that researchers, clinicians, and healthcare planners interested in assessing IHT be aware of the pros and cons of the new technology and the factors involved in designing appropriate studies of it. It is crucial to understand the technical barriers, the role of telesupervisors, the motor improvements that participants can reasonably expect and the process of optimizing IHT-exercise therapy protocols to maximize the benefits of the emerging technology. Copyright © 2011 Elsevier B.V. All rights reserved.

Dynamical properties and extremes of Northern Hemisphere climate fields over the past 60 years

Science.gov (United States)

Faranda, Davide; Messori, Gabriele; Alvarez-Castro, M. Carmen; Yiou, Pascal

2017-12-01

Atmospheric dynamics are described by a set of partial differential equations yielding an infinite-dimensional phase space. However, the actual trajectories followed by the system appear to be constrained to a finite-dimensional phase space, i.e. a strange attractor. The dynamical properties of this attractor are difficult to determine due to the complex nature of atmospheric motions. A first step to simplify the problem is to focus on observables which affect - or are linked to phenomena which affect - human welfare and activities, such as sea-level pressure, 2 m temperature, and precipitation frequency. We make use of recent advances in dynamical systems theory to estimate two instantaneous dynamical properties of the above fields for the Northern Hemisphere: local dimension and persistence. We then use these metrics to characterize the seasonality of the different fields and their interplay. We further analyse the large-scale anomaly patterns corresponding to phase-space extremes - namely time steps at which the fields display extremes in their instantaneous dynamical properties. The analysis is based on the NCEP/NCAR reanalysis data, over the period 1948-2013. The results show that (i) despite the high dimensionality of atmospheric dynamics, the Northern Hemisphere sea-level pressure and temperature fields can on average be described by roughly 20 degrees of freedom; (ii) the precipitation field has a higher dimensionality; and (iii) the seasonal forcing modulates the variability of the dynamical indicators and affects the occurrence of phase-space extremes. We further identify a number of robust correlations between the dynamical properties of the different variables.

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.)

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

International Nuclear Information System (INIS)

Hongisto, M.; Nikula, A.

1996-01-01

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.)

Validated questionnaires heighten detection of difficult asthma comorbidities.

Science.gov (United States)

Radhakrishna, Naghmeh; Tay, Tunn Ren; Hore-Lacy, Fiona; Stirling, Robert; Hoy, Ryan; Dabscheck, Eli; Hew, Mark

2017-04-01

Multiple extra-pulmonary comorbidities contribute to difficult asthma, but their diagnosis can be challenging and time consuming. Previous data on comorbidity detection have focused on clinical assessment, which may miss certain conditions. We aimed to locate relevant validated screening questionnaires to identify extra-pulmonary comorbidities that contribute to difficult asthma, and evaluate their performance during a difficult asthma evaluation. MEDLINE was searched to identify key extra-pulmonary comorbidities that contribute to difficult asthma. Screening questionnaires were chosen based on ease of use, presence of a cut-off score, and adequate validation to help systematically identify comorbidities. In a consecutive series of 86 patients referred for systematic evaluation of difficult asthma, questionnaires were administered prior to clinical consultation. Six difficult asthma comorbidities and corresponding screening questionnaires were found: sinonasal disease (allergic rhinitis and chronic rhinosinusitis), vocal cord dysfunction, dysfunctional breathing, obstructive sleep apnea, anxiety and depression, and gastro-oesophageal reflux disease. When the questionnaires were added to the referring clinician's impression, the detection of all six comorbidities was significantly enhanced. The average time for questionnaire administration was approximately 40 minutes. The use of validated screening questionnaires heightens detection of comorbidities in difficult asthma. The availability of data from a battery of questionnaires prior to consultation can save time and allow clinicians to systematically assess difficult asthma patients and to focus on areas of particular concern. Such an approach would ensure that all contributing comorbidities have been addressed before significant treatment escalation is considered.

Extreme Weather and Climate: Workshop Report

Science.gov (United States)

Sobel, Adam; Camargo, Suzana; Debucquoy, Wim; Deodatis, George; Gerrard, Michael; Hall, Timothy; Hallman, Robert; Keenan, Jesse; Lall, Upmanu; Levy, Marc;

Variable effects of climate on forest growth in relation to climate extremes, disturbance, and forest dynamics.

Science.gov (United States)

Itter, Malcolm S; Finley, Andrew O; D'Amato, Anthony W; Foster, Jane R; Bradford, John B

2017-06-01

Changes in the frequency, duration, and severity of climate extremes are forecast to occur under global climate change. The impacts of climate extremes on forest productivity and health remain difficult to predict due to potential interactions with disturbance events and forest dynamics-changes in forest stand composition, density, size and age structure over time. Such interactions may lead to non-linear forest growth responses to climate involving thresholds and lag effects. Understanding how forest dynamics influence growth responses to climate is particularly important given stand structure and composition can be modified through management to increase forest resistance and resilience to climate change. To inform such adaptive management, we develop a hierarchical Bayesian state space model in which climate effects on tree growth are allowed to vary over time and in relation to past climate extremes, disturbance events, and forest dynamics. The model is an important step toward integrating disturbance and forest dynamics into predictions of forest growth responses to climate extremes. We apply the model to a dendrochronology data set from forest stands of varying composition, structure, and development stage in northeastern Minnesota that have experienced extreme climate years and forest tent caterpillar defoliation events. Mean forest growth was most sensitive to water balance variables representing climatic water deficit. Forest growth responses to water deficit were partitioned into responses driven by climatic threshold exceedances and interactions with insect defoliation. Forest growth was both resistant and resilient to climate extremes with the majority of forest growth responses occurring after multiple climatic threshold exceedances across seasons and years. Interactions between climate and disturbance were observed in a subset of years with insect defoliation increasing forest growth sensitivity to water availability. Forest growth was particularly

Variable effects of climate on forest growth in relation to climate extremes, disturbance, and forest dynamics

Science.gov (United States)

Itter, Malcolm S.; Finley, Andrew O.; D'Amato, Anthony W.; Foster, Jane R.; Bradford, John B.

2017-01-01

Changes in the frequency, duration, and severity of climate extremes are forecast to occur under global climate change. The impacts of climate extremes on forest productivity and health remain difficult to predict due to potential interactions with disturbance events and forest dynamics—changes in forest stand composition, density, size and age structure over time. Such interactions may lead to non-linear forest growth responses to climate involving thresholds and lag effects. Understanding how forest dynamics influence growth responses to climate is particularly important given stand structure and composition can be modified through management to increase forest resistance and resilience to climate change. To inform such adaptive management, we develop a hierarchical Bayesian state space model in which climate effects on tree growth are allowed to vary over time and in relation to past climate extremes, disturbance events, and forest dynamics. The model is an important step toward integrating disturbance and forest dynamics into predictions of forest growth responses to climate extremes. We apply the model to a dendrochronology data set from forest stands of varying composition, structure, and development stage in northeastern Minnesota that have experienced extreme climate years and forest tent caterpillar defoliation events. Mean forest growth was most sensitive to water balance variables representing climatic water deficit. Forest growth responses to water deficit were partitioned into responses driven by climatic threshold exceedances and interactions with insect defoliation. Forest growth was both resistant and resilient to climate extremes with the majority of forest growth responses occurring after multiple climatic threshold exceedances across seasons and years. Interactions between climate and disturbance were observed in a subset of years with insect defoliation increasing forest growth sensitivity to water availability. Forest growth was particularly

Reconstruction of Lower Extremity Primary Malignant and Metastatic ...

African Journals Online (AJOL)

2017-10-26

Oct 26, 2017 ... Lower extremity tumors and endoprosthesis. 1130. Nigerian Journal of Clinical Practice ¦ Volume 20 ¦ Issue 9 ¦ September 2017 renal failure, and the other patients died due to advanced metastatic disease. None of our patients who received radiotherapy and chemotherapy died due to oncologic treatment.

Consideration of Task Performance for Robots Engaged in Extremely Dangerous Environment in Nuclear Power Plants

Energy Technology Data Exchange (ETDEWEB)

Hong, Seung Mo; Han, Kee Soo; Yi, Sung Deok; Kim, Seoung Rae [Nuclear Engineering Service and Solution Co. Ltd., Daejeon (Korea, Republic of); Choi, Young [KAERI, Daejeon (Korea, Republic of)

2015-05-15

After Fukushima Daiichi Nuclear Accident, it is started to pay more attention to operation and accident of nuclear power plants (NPPs). For domestic nuclear industry, it was recommended to establish corresponding strategies against accidents due to extremely dangerous natural disasters. Each nuclear power plant is also preparing to establish strategies to secure nuclear safety functions by estimating the counterplans for extreme accidents. Robots are particularly being used to access the areas where those are dangerous for human beings to access or to restore the accident. Robot technologies in NPPs are emerging cutting-edge technologies that are just a start except the developed countries like USA, Japan, etc. But they are carefully considered because they have the advantages of performing tasks in extremely dangerous environment in NPPs instead of human beings. In this study, the applicability of robots will be considered in extremely dangerous environment in NPPs. Accurate judgment of the inside situation of the plant and quick actions in the extreme condition like earthquake accompanied by loss of all AC powers should be considered as major function in terms of prevention of accident spread. According to the reported stress test results of domestic NPPs, the difficult things for operators to carry out in extreme conditions can be predictable, therefore the active use of robots as accident mitigation strategies will be helpful to reduce the unnecessary spending for facility improvement. Current trend of domestic and foreign robot technology development focuses on the information search of the inside of the plant and development of preventive maintenance of NPPs. As seen actually in Fukushima Daiichi, main roles of robots place emphasis on measuring the inside radiation level accessing to the area where operator cannot access and delivering information which can support operator's decision-making and actions. Therefore, it is considered that development of

Causes of Glacier Melt Extremes in the Alps Since 1949

Science.gov (United States)

Thibert, E.; Dkengne Sielenou, P.; Vionnet, V.; Eckert, N.; Vincent, C.

2018-01-01

Recent record-breaking glacier melt values are attributable to peculiar extreme events and long-term warming trends that shift averages upward. Analyzing one of the world's longest mass balance series with extreme value statistics, we show that detrending melt anomalies makes it possible to disentangle these effects, leading to a fairer evaluation of the return period of melt extreme values such as 2003, and to characterize them by a more realistic bounded behavior. Using surface energy balance simulations, we show that three independent drivers control melt: global radiation, latent heat, and the amount of snow at the beginning of the melting season. Extremes are governed by large deviations in global radiation combined with sensible heat. Long-term trends are driven by the lengthening of melt duration due to earlier and longer-lasting melting of ice along with melt intensification caused by trends in long-wave irradiance and latent heat due to higher air moisture.

Impacts of Extreme Events on Human Health. Chapter 4

Science.gov (United States)

Bell, Jesse E.; Herring, Stephanie C.; Jantarasami, Lesley; Adrianopoli, Carl; Benedict, Kaitlin; Conlon, Kathryn; Escobar, Vanessa; Hess, Jeremy; Luvall, Jeffrey; Garcia-Pando, Carlos Perez;

Crisis management during anaesthesia: difficult intubation.

Science.gov (United States)

Paix, A D; Williamson, J A; Runciman, W B

2005-06-01

Anaesthetists may experience difficulty with intubation unexpectedly which may be associated with difficulty in ventilating the patient. If not well managed, there may be serious consequences for the patient. A simple structured approach to this problem was developed to assist the anaesthetist in this difficult situation. To examine the role of a specific sub-algorithm for the management of difficult intubation. The potential performance of a structured approach developed by review of the literature and analysis of each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. There were 147 reports of difficult intubation capable of analysis among the first 4000 incidents reported to AIMS. The difficulty was unexpected in 52% of cases; major physiological changes occurred in 37% of these cases. Saturation fell below 90% in 22% of cases, oesophageal intubation was reported in 19%, and an emergency transtracheal airway was required in 4% of cases. Obesity and limited neck mobility and mouth opening were the most common anatomical contributing factors. The data confirm previously reported failures to predict difficult intubation with existing preoperative clinical tests and suggest an ongoing need to teach a pre-learned strategy to deal with difficult intubation and any associated problem with ventilation. An easy-to-follow structured approach to these problems is outlined. It is recommended that skilled assistance be obtained (preferably another anaesthetist) when difficulty is expected or the patient's cardiorespiratory reserve is low. Patients should be assessed postoperatively to exclude any sequelae and to inform them of the difficulties encountered. These should be clearly documented and appropriate steps taken to warn future anaesthetists.

Automatic residue removal for high-NA extreme illumination

Science.gov (United States)

Moon, James; Nam, Byong-Sub; Jeong, Joo-Hong; Kong, Dong-Ho; Nam, Byung-Ho; Yim, Dong Gyu

2007-10-01

An epidemic for smaller node has been that, as the device architecture shrinks, lithography process requires high Numerical Aperture (NA), and extreme illumination system. This, in turn, creates many lithography problems such as low lithography process margin (Depth of Focus, Exposure Latitude), unstable Critical Dimension (CD) uniformity and restricted guideline for device design rule and so on. Especially for high NA, extreme illumination such as immersion illumination systems, above all the related problems, restricted design rule due to forbidden pitch is critical and crucial issue. This forbidden pitch is composed of numerous optical effects but majority of these forbidden pitch compose of photo resist residue and these residue must be removed to relieve some room for already tight design rule. In this study, we propose automated algorithm to remove photo resist residue due to high NA and extreme illumination condition. This algorithm automatically self assembles assist patterns based on the original design layout, therefore insuring the safety and simplicity of the generated assist pattern to the original design and removes any resist residue created by extreme illumination condition. Also we tested our automated algorithm on full chip FLASH memory device and showed the residue removal effect by using commercial verification tools as well as on actual test wafer.

A new extremity dosemeter for beta and gamma radiation

International Nuclear Information System (INIS)

Heinzelmann, M.; Pagenkamper, M.

1988-01-01

An extremity dosemeter developed at the Juelich Nuclear Research Centre is very well suited for the precise and energy-independent measurement of the skin dose generated by beta or gamma radiation. This is also confirmed by the results of this intercomparison programme. The dosemeter contains three TLDs of LiF in Teflon mounted behind a window of 0.9 mg/cm 2 . The great advantage of this dosemeter is three TLD's enabling statements about the radiation quality. However, the dosemeter has two disadvantages The dosemeter is complicated to manufacture. A very thin plastic foil of 0.9 mg/cm 2 must be attached to a support. This work is difficult and time-consuming and cannot be automated. The window in front of the TLD is not sturdy enough and is occasionally destroyed when the dosemeter is being worn. These two disadvantages prevent this extremity dosemeter from being used more frequently. For this reason, work was begun on developing a new extremity dosemeter without these two disadvantages. The great advantage of the previous dosemeter of obtaining statements about the type of radiation with the aid of readings from three TLD's was to be retained. The improved extremity dosemeter has a more sturdy and thicker window with a similar response as the previous dosemeter with a thinner window

38 CFR 4.58 - Arthritis due to strain.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Arthritis due to strain... FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.58 Arthritis due to strain. With service incurred lower extremity amputation or shortening, a disabling arthritis, developing in...

How extreme is enough to cause a threshold response of ecosystem

Science.gov (United States)

Niu, S.; Zhang, F.; Yang, Q.; Song, B.; Sun, J.

2017-12-01

Precipitation is a primary determinant of terrestrial ecosystem productivity over much of the globe. Recent studies have shown asymmetric or threshold responses of ecosystem productivity to precipitation gradient. However, it's not clear how extreme is enough to cause a threshold response of ecosystem. We conducted a global meta-analysis of precipitation experiments, a site level precipitation gradient experiment, and a remote sensing data mining on the relationship between precipitation extreme vs NDVI extreme. The meta-analysis shows that ANPP, BNPP, NEE, and other carbon cycle variables, showed similar response magnitudes to either precipitation increase or decrease when precipitation levels were normalized to the medium value of treatments (40%) across all the studies. Overall, the response ratios of these variables were linearly correlated with changes in precipitation amounts and soil water content. In the field gradient study with treatments of 1/12, 1/8. 1/4, 1/2, control, and 5/4 of ambient precipitation, the threshold of NPP, SR, NEE occurred when precipitation was reduced to the level of 1/8-1/12 of ambient precipitation. This means that only extreme drought can induce a threshold response of ecosystem. The regional remote sensing data showed that climate extremes with yearly low precipitation from 1982 to 2013 rarely cause extreme responses of vegetation, further suggesting that it is very difficult to detect threshold responses to natural climatic fluctuation. Our three studies together indicate that asymmetrical responses of vegetation to precipitation are likely detected, but only in very extreme precipitation events.

The Contribution of Extreme Precipitation to the Total Precipitation in China

Institute of Scientific and Technical Information of China (English)

SUN Jian-Qi

2012-01-01

Using daily precipitation data from weather stations in China, the variations in the contribution of extreme precipitation to the total precipitation are analyzed. It is found that extreme precipitation accounts for approximately one third of the total precipitation based on the overall mean for China. Over the past half century, extreme precipitation has played a dominant role in the year-to-year variability of the total precipitation. On the decadal time scale, the extreme precipitation makes different contributions to the wetting and drying regions of China. The wetting trends of particular regions are mainly attributed to increases in extreme precipitation; in contrast, the drying trends of other regions are mainly due to decreases in non-extreme precipitation.

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

DEFF Research Database (Denmark)

Thorup, Signe Strann; Darvann, T.A.; Hermann, N.V.

2010-01-01

from pre- to post-surgery using thin-plate spline warping. The registration results are convincing and represent a first move towards an automatic registration method for dealing with difficult deformations due to this type of surgery. New or breakthrough work to be presented: The method provides...... was needed. We have previously demonstrated that non-rigid registration using B-splines is able to provide automated determination of point correspondences in populations of infants without cleft lip. However, this type of registration fails when applied to the task of determining the complex deformation...

Hypothyroid-induced acute compartment syndrome in all extremities.

Science.gov (United States)

Musielak, Matthew C; Chae, Jung Hee

2016-12-20

Acute compartment syndrome (ACS) is an uncommon complication of uncontrolled hypothyroidism. If unrecognized, this can lead to ischemia, necrosis and potential limb loss. A 49-year-old female presented with the sudden onset of bilateral lower and upper extremity swelling and pain. The lower extremity anterior compartments were painful and tense. The extensor surface of the upper extremities exhibited swelling and pain. Motor function was intact, however, limited due to pain. Bilateral lower extremity fasciotomies were performed. Postoperative Day 1, upper extremity motor function decreased significantly and paresthesias occurred. She therefore underwent bilateral forearm fasciotomies. The pathogenesis of hypothyroidism-induced compartment syndrome is unclear. Thyroid-stimulating hormone-induced fibroblast activation results in increased glycosaminoglycan deposition. The primary glycosaminoglycan in hypothyroid myxedematous changes is hyaluronic acid, which binds water causing edema. This increases vascular permeability, extravasation of proteins and impaired lymphatic drainage. These contribute to increased intra-compartmental pressure and subsequent ACS. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

So small, so loud: extremely high sound pressure level from a pygmy aquatic insect (Corixidae, Micronectinae).

Science.gov (United States)

Sueur, Jérôme; Mackie, David; Windmill, James F C

2011-01-01

To communicate at long range, animals have to produce intense but intelligible signals. This task might be difficult to achieve due to mechanical constraints, in particular relating to body size. Whilst the acoustic behaviour of large marine and terrestrial animals has been thoroughly studied, very little is known about the sound produced by small arthropods living in freshwater habitats. Here we analyse for the first time the calling song produced by the male of a small insect, the water boatman Micronecta scholtzi. The song is made of three distinct parts differing in their temporal and amplitude parameters, but not in their frequency content. Sound is produced at 78.9 (63.6-82.2) SPL rms re 2.10(-5) Pa with a peak at 99.2 (85.7-104.6) SPL re 2.10(-5) Pa estimated at a distance of one metre. This energy output is significant considering the small size of the insect. When scaled to body length and compared to 227 other acoustic species, the acoustic energy produced by M. scholtzi appears as an extreme value, outperforming marine and terrestrial mammal vocalisations. Such an extreme display may be interpreted as an exaggerated secondary sexual trait resulting from a runaway sexual selection without predation pressure.

So small, so loud: extremely high sound pressure level from a pygmy aquatic insect (Corixidae, Micronectinae.

Directory of Open Access Journals (Sweden)

Jérôme Sueur

Full Text Available To communicate at long range, animals have to produce intense but intelligible signals. This task might be difficult to achieve due to mechanical constraints, in particular relating to body size. Whilst the acoustic behaviour of large marine and terrestrial animals has been thoroughly studied, very little is known about the sound produced by small arthropods living in freshwater habitats. Here we analyse for the first time the calling song produced by the male of a small insect, the water boatman Micronecta scholtzi. The song is made of three distinct parts differing in their temporal and amplitude parameters, but not in their frequency content. Sound is produced at 78.9 (63.6-82.2 SPL rms re 2.10(-5 Pa with a peak at 99.2 (85.7-104.6 SPL re 2.10(-5 Pa estimated at a distance of one metre. This energy output is significant considering the small size of the insect. When scaled to body length and compared to 227 other acoustic species, the acoustic energy produced by M. scholtzi appears as an extreme value, outperforming marine and terrestrial mammal vocalisations. Such an extreme display may be interpreted as an exaggerated secondary sexual trait resulting from a runaway sexual selection without predation pressure.

Study on the effectiveness of Extreme Cold Mist MQL system on turning process of stainless steel AISI 316

Science.gov (United States)

Jamaludin, A. S.; Hosokawa, A.; Furumoto, T.; Koyano, T.; Hashimoto, Y.

2018-03-01

Cutting process of difficult-to-cut material such as stainless steel, generates immensely excessive heat, which is one of the major causes related to shortening tool life and lower quality of surface finish. It is proven that application of cutting fluid during the cutting process of difficult-to-cut material is able to improve the cutting performance, but excessive application of cutting fluid leads to another problem such as increasing processing cost and environmental hazardous pollution of workplace. In the study, Extreme Cold Mist system is designed and tested along with various Minimum Quantity Lubrication (MQL) systems on turning process of stainless steel AISI 316. In the study, it is obtained that, Extreme Cold Mist system is able to reduce cutting force up to 60N and improve the surface roughness of the machined surface significantly.

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...

Dynamical properties and extremes of Northern Hemisphere climate fields over the past 60 years

Directory of Open Access Journals (Sweden)

D. Faranda

2017-12-01

Full Text Available Atmospheric dynamics are described by a set of partial differential equations yielding an infinite-dimensional phase space. However, the actual trajectories followed by the system appear to be constrained to a finite-dimensional phase space, i.e. a strange attractor. The dynamical properties of this attractor are difficult to determine due to the complex nature of atmospheric motions. A first step to simplify the problem is to focus on observables which affect – or are linked to phenomena which affect – human welfare and activities, such as sea-level pressure, 2 m temperature, and precipitation frequency. We make use of recent advances in dynamical systems theory to estimate two instantaneous dynamical properties of the above fields for the Northern Hemisphere: local dimension and persistence. We then use these metrics to characterize the seasonality of the different fields and their interplay. We further analyse the large-scale anomaly patterns corresponding to phase-space extremes – namely time steps at which the fields display extremes in their instantaneous dynamical properties. The analysis is based on the NCEP/NCAR reanalysis data, over the period 1948–2013. The results show that (i despite the high dimensionality of atmospheric dynamics, the Northern Hemisphere sea-level pressure and temperature fields can on average be described by roughly 20 degrees of freedom; (ii the precipitation field has a higher dimensionality; and (iii the seasonal forcing modulates the variability of the dynamical indicators and affects the occurrence of phase-space extremes. We further identify a number of robust correlations between the dynamical properties of the different variables.

A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses

Energy Technology Data Exchange (ETDEWEB)

Tyng, Chiang J., E-mail: chiangjengtyng@gmail.com; Amoedo, Maurício K.; Bohrer, Yves; Bitencourt, Almir G. V.; Barbosa, Paula N. V.; Almeida, Maria Fernanda A.; Zurstrassen, Charles E. [AC Camargo Cancer Center, Department of Imaging (Brazil); Coimbra, Felipe J. F.; Costa, Wilson L. da [AC Camargo Cancer Center, Department of Abdominal Surgery (Brazil); Chojniak, Rubens [AC Camargo Cancer Center, Department of Imaging (Brazil)

2017-05-15

PurposeComputed tomography (CT) is commonly used to guide drainage of deep-seated abdominal fluid collections. However, in some cases, these collections seem to be inaccessible due to surrounding organs or their being in difficult locations. The aim of this study is to describe a modified Trocar technique to drain collections in difficult locations, especially those in the subphrenic space, without passing through intervening organs.Materials and MethodsThis retrospective case series study describes seven inpatients who underwent CT-guided drainage using a modified Trocar technique for abscesses that are difficult to access percutaneously. All patients provided written informed consent prior to the procedure. After placement of a 12–14F catheter inside the peritoneum, the Trocar stylet was removed so that the tip of the catheter became blunt and flexible to avoid injury to organs and structures in the catheter route, and the catheter was slowly advanced towards the collection using CT guidance and tactile sensation. After reaching the target, the stylet was reintroduced to enter the abscess wall.ResultsAll procedures were performed using an anterior abdominal wall access with adequate catheter positioning and resulted in clinical status improvement in the days after the drainage. No complications related to the procedure were identified in any of the patients.ConclusionsThe modified Trocar technique for percutaneous CT-guided drainage of abdominal abscesses may be feasible for lesions that are difficult to access with conventional methods.

Leptospermum Honey for Wound Care in an Extremely Premature Infant.

Science.gov (United States)

Esser, Media

2017-02-01

Neonatal wound care is challenging due to the fragility and vulnerable skin structure. Neonates are often left susceptible to the forces of their environment, leaving them open to infection when skin injury occurs. Leptospermum honey has been used successfully in adult patients, with evidence lacking in the neonatal population. This case demonstrates the management of a difficult-to-heal wound in a 23-week gestation infant. Selecting the proper treatment and products for wound healing is challenging, with little evidence-based research available for the treatment of neonatal wounds. Leptospermum honey and other adult-driven dressings have been used for neonatal wound care as well as other adult-driven dressings. This case demonstrates the benefits of Leptospermum honey as an option for neonatal wounds. This case presents the treatment and healing of an extensive wound of a 23-week gestation neonate using a hydrogel product initially and then transitioning to a Leptospermum honey dressing due to suboptimal healing. Results of this treatment included quick healing time, little to no scarring, and no loss of movement or function to the affected extremities. The incorporation of Leptospermum honey for wound care has the potential to promote faster wound healing, with less scarring in the neonatal population. Adult wound care principles have been applied in the face of a weak evidence base relating to neonatal-specific cases. There is a need for continued research related to moist wound healing in the neonatal population, with resulting product and practice recommendations.

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)...

Prediction and discovery of extremely strong hydrodynamic instabilities due to a velocity jump: theory and experiments

International Nuclear Information System (INIS)

Fridman, A M

2008-01-01

The theory and the experimental discovery of extremely strong hydrodynamic instabilities are described, viz. the Kelvin-Helmholtz, centrifugal, and superreflection instabilities. The discovery of the last two instabilities was predicted and the Kelvin-Helmholtz instability in real systems was revised by us. (reviews of topical problems)

Extreme total solar irradiance due to cloud enhancement at sea level of the NE Atlantic coast of Brazil

Energy Technology Data Exchange (ETDEWEB)

Piacentini, Ruben D. [Instituto de Fisica Rosario (CONICET-Universidad Nacional de Rosario), 27 de Febrero 210bis, 2000 Rosario (Argentina); Facultad de Ciencias Exactas, Ingenieria y Agrimensura, Universidad Nacional de Rosario, Pellegrini 250, 2000 Rosario (Argentina); Salum, Graciela M. [Instituto de Fisica Rosario (CONICET-Universidad Nacional de Rosario), 27 de Febrero 210bis, 2000 Rosario (Argentina); Facultad Regional Concepcion del Uruguay, Universidad Tecnologica Nacional, Concepcion del Uruguay (Argentina); Fraidenraich, Naum; Tiba, Chigueru [Grupo de Pesquisas em Fontes Alternativas de Energia, Universidade Federal de Pernambuco, Av. Prof. Luiz Freire, 1000 - 50.740-540, Recife, PE (Brazil)

2011-01-15

Extraterrestrial total solar irradiance, usually called Solar Constant, is attenuated by the atmosphere in different proportions, depending mainly on solar zenith angle and altitude of the measurement point. In this work, it is presented very high and extreme horizontal plane measurements of global solar irradiance that in some days overpassed the Solar Constant corrected by the actual Sun-Earth distance (CSC). They were obtained at sea level of the intertropical Atlantic coast, in the city of Recife, Brazil, in the period February 2008-January 2009. Extreme total solar irradiance values larger than CSC were measured during 3.4% of the days of the total registered period. This percentage increases to 7.4% for global solar irradiance within 95.1-100% of the CSC and to 15.3% within 90.1-95% of the CSC. The largest extreme total solar irradiance value, 1477 {+-} 30 W/m{sup 2}, was registered the 28th of March 2008 at 11:34 local time (UT - 3h). It overpassed by 7.9% the CSC value for this day (1369.4 W/m{sup 2}) and by 42.3% the estimated value of the clear sky Iqbal C radiation model (1037.7 W/m{sup 2}). The observation of extreme values should be taken into account in the study of solar radiation effects related to materials exposed to the outside, UV index and biological effects, among others. Also, the detailed knowledge of this interesting effect may contribute significantly to clarify physical aspects about the interaction of global solar radiation with the ecosystem and climate change. (author)

Extreme Variability in a Broad Absorption Line Quasar

Energy Technology Data Exchange (ETDEWEB)

Stern, Daniel; Jun, Hyunsung D. [Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Mail Stop 169-221, Pasadena, CA 91109 (United States); Graham, Matthew J.; Djorgovski, S. G.; Donalek, Ciro; Drake, Andrew J.; Mahabal, Ashish A.; Steidel, Charles C. [California Institute of Technology, 1200 E. California Boulevard, Pasadena, CA 91125 (United States); Arav, Nahum; Chamberlain, Carter [Department of Physics, Virginia Tech, Blacksburg, VA 24061 (United States); Barth, Aaron J. [Department of Physics and Astronomy, 4129 Frederick Reines Hall, University of California, Irvine, CA 92697 (United States); Glikman, Eilat, E-mail: daniel.k.stern@jpl.nasa.gov [Department of Physics, Middlebury College, Middlebury, VT 05753 (United States)

2017-04-20

CRTS J084133.15+200525.8 is an optically bright quasar at z = 2.345 that has shown extreme spectral variability over the past decade. Photometrically, the source had a visual magnitude of V ∼ 17.3 between 2002 and 2008. Then, over the following five years, the source slowly brightened by approximately one magnitude, to V ∼ 16.2. Only ∼1 in 10,000 quasars show such extreme variability, as quantified by the extreme parameters derived for this quasar assuming a damped random walk model. A combination of archival and newly acquired spectra reveal the source to be an iron low-ionization broad absorption line quasar with extreme changes in its absorption spectrum. Some absorption features completely disappear over the 9 years of optical spectra, while other features remain essentially unchanged. We report the first definitive redshift for this source, based on the detection of broad H α in a Keck/MOSFIRE spectrum. Absorption systems separated by several 1000 km s{sup −1} in velocity show coordinated weakening in the depths of their troughs as the continuum flux increases. We interpret the broad absorption line variability to be due to changes in photoionization, rather than due to motion of material along our line of sight. This source highlights one sort of rare transition object that astronomy will now be finding through dedicated time-domain surveys.

Difficult to control atopic dermatitis

NARCIS (Netherlands)

U. Darsow (U.); A. Wollenberg (A.); D. Simon; A. Taieb; T. Werfel; A.P. Oranje (Arnold); C. Gelmetti (C.); Ã. Svensson (Ãke); M. Deleuran (M.); A.M. Calza; F. Giusti; J. Lübbe (Jann); S. Seidenari (Stefania); J. Ring (J.)

2013-01-01

textabstractDifficult 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

Committee VI.1. Extreme Hull Girder Loading

DEFF Research Database (Denmark)

Jensen, Jørgen Juncher

2000-01-01

Committee Mandate. Evaluate and develop direct calculation procedures for extreme wawe loads on ship hull girders. Due consideration shall be given to stochastic and non-linear effects. The procedures shall be assessed by comparison with in-service experiences, model tests and more refined...

How Difficult It Is to Be God

DEFF Research Database (Denmark)

Wilson, Fiona

2014-01-01

Book review of Carlos Iván Degregori, How Difficult It Is to Be God: Shining Path's Politics of War in Peru,1980–1999 (Madison, WI: University of Wisconsin Press, 2012)......Book review of Carlos Iván Degregori, How Difficult It Is to Be God: Shining Path's Politics of War in Peru,1980–1999 (Madison, WI: University of Wisconsin Press, 2012)...

Determining the Extremes of the Cellular NAD(H) Level by Using an Escherichia coli NAD+-Auxotrophic Mutant ▿

OpenAIRE

Zhou, Yongjin; Wang, Lei; Yang, Fan; Lin, Xinping; Zhang, Sufang; Zhao, Zongbao K.

2011-01-01

NAD (NAD+) and its reduced form (NADH) are omnipresent cofactors in biological systems. However, it is difficult to determine the extremes of the cellular NAD(H) level in live cells because the NAD+ level is tightly controlled by a biosynthesis regulation mechanism. Here, we developed a strategy to determine the extreme NAD(H) levels in Escherichia coli cells that were genetically engineered to be NAD+ auxotrophic. First, we expressed the ntt4 gene encoding the NAD(H) transporter in the E. co...

How Spoken Language Comprehension is Achieved by Older Listeners in Difficult Listening Situations.

Science.gov (United States)

Schneider, Bruce A; Avivi-Reich, Meital; Daneman, Meredyth

2016-01-01

Comprehending spoken discourse in noisy situations is likely to be more challenging to older adults than to younger adults due to potential declines in the auditory, cognitive, or linguistic processes supporting speech comprehension. These challenges might force older listeners to reorganize the ways in which they perceive and process speech, thereby altering the balance between the contributions of bottom-up versus top-down processes to speech comprehension. The authors review studies that investigated the effect of age on listeners' ability to follow and comprehend lectures (monologues), and two-talker conversations (dialogues), and the extent to which individual differences in lexical knowledge and reading comprehension skill relate to individual differences in speech comprehension. Comprehension was evaluated after each lecture or conversation by asking listeners to answer multiple-choice questions regarding its content. Once individual differences in speech recognition for words presented in babble were compensated for, age differences in speech comprehension were minimized if not eliminated. However, younger listeners benefited more from spatial separation than did older listeners. Vocabulary knowledge predicted the comprehension scores of both younger and older listeners when listening was difficult, but not when it was easy. However, the contribution of reading comprehension to listening comprehension appeared to be independent of listening difficulty in younger adults but not in older adults. The evidence suggests (1) that most of the difficulties experienced by older adults are due to age-related auditory declines, and (2) that these declines, along with listening difficulty, modulate the degree to which selective linguistic and cognitive abilities are engaged to support listening comprehension in difficult listening situations. When older listeners experience speech recognition difficulties, their attentional resources are more likely to be deployed to

Extreme seismicity and disaster risks: Hazard versus vulnerability (Invited)

Science.gov (United States)

Ismail-Zadeh, A.

2013-12-01

Although the extreme nature of earthquakes has been known for millennia due to the resultant devastation from many of them, the vulnerability of our civilization to extreme seismic events is still growing. It is partly because of the increase in the number of high-risk objects and clustering of populations and infrastructure in the areas prone to seismic hazards. Today an earthquake may affect several hundreds thousand lives and cause significant damage up to hundred billion dollars; it can trigger an ecological catastrophe if occurs in close vicinity to a nuclear power plant. Two types of extreme natural events can be distinguished: (i) large magnitude low probability events, and (ii) the events leading to disasters. Although the first-type events may affect earthquake-prone countries directly or indirectly (as tsunamis, landslides etc.), the second-type events occur mainly in economically less-developed countries where the vulnerability is high and the resilience is low. Although earthquake hazards cannot be reduced, vulnerability to extreme events can be diminished by monitoring human systems and by relevant laws preventing an increase in vulnerability. Significant new knowledge should be gained on extreme seismicity through observations, monitoring, analysis, modeling, comprehensive hazard assessment, prediction, and interpretations to assist in disaster risk analysis. The advanced disaster risk communication skill should be developed to link scientists, emergency management authorities, and the public. Natural, social, economic, and political reasons leading to disasters due to earthquakes will be discussed.

Hydrodynamic modelling of extreme flood events in the Kashmir valley in India

Science.gov (United States)

Jain, Manoj; Parvaze, Sabah

2017-04-01

Floods are one of the most predominant, costly and deadly hazards of all natural vulnerabilities. Every year, floods exert a heavy toll on human life and property in many parts of the world. The prediction of river stages and discharge during flood extremes plays a vital role in planning structural and non-structural measures of flood management. The predictions are also valuable to prepare the flood inundation maps and river floodplain zoning. In the Kashmir Valley, floods occur mainly and very often in the Jhelum Basin mostly due to extreme precipitation events and rugged mountainous topography of the basin. These floods cause extreme damage to life and property in the valley from time to time. Excessive rainfall, particularly in higher sub-catchments causes the snow to melt resulting in excessive runoff downhill to the streams causing floods in the Kashmir Valley where Srinagar city is located. However, very few hydrological studies have been undertaken for the Jhelum Basin mainly due to non-availability of hydrological data due to very complex mountainous terrain. Therefore, the present study has been conducted to model the extreme flood events in the Jhelum Basin in Kashmir Valley. An integrated NAM and MIKE 11 HD model has been setup for Jhelum basin up to Ram Munshi Bagh gauging site and then four most extreme historical flood events in the time series has been analyzed separately including the most recent and most extreme flood event of 2014. In September 2014, the Kashmir Valley witnessed the most severe flood in the past 60 years due to catastrophic rainfall from 1st to 6th September wherein the valley received unprecedented rainfall of more than 650 mm in just 3 days breaking record of many decades. The MIKE 11 HD and NAM model has been calibrated using 21 years (1985-2005) data and validated using 9 years (2006-2014) data. The efficiency indices of the model for calibration and validation period is 0.749 and 0.792 respectively. The model simulated

Psychopathology in difficult asthma : Review

NARCIS (Netherlands)

Prins, L.C.J.; van Son, M.A.C.; van Keimpema, A.R.J.; van Ranst, D.; Antonissen-Pommer, A.M.; Meijer, J.W.G.; Pop, V.J.M.

2015-01-01

Objective: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed

Cause and Properties of the Extreme Space Weather Event of 2012 July 23

Science.gov (United States)

Liu, Y. D.; Luhmann, J. G.; Kajdic, P.; Kilpua, E.; Lugaz, N.; Nitta, N.; Lavraud, B.; Bale, S. D.; Farrugia, C. J.; Galvin, A. B.

2013-12-01

Extreme space weather refers to extreme conditions in space driven by solar eruptions and subsequent disturbances in interplanetary space, or otherwise called solar superstorms. Understanding extreme space weather events is becoming ever more vital, as the vulnerability of our society and its technological infrastructure to space weather has increased dramatically. Instances of extreme space weather, however, are very rare by definition and therefore are difficult to study. Here we report and investigate an extreme event, which occurred on 2012 July 23 with a maximum speed of about 3050 km/s near the Sun. This event, with complete modern remote sensing and in situ observations from multiple vantage points, provides an unprecedented opportunity to study the cause and consequences of extreme space weather. It produced a superfast shock with a peak solar wind speed of 2246 km/s and a superstrong magnetic cloud with a peak magnetic field of 109 nT observed near 1 AU at STEREO A. The record solar wind speed and magnetic field would produce a record geomagnetic storm since the space era with a minimum Dst of -1200 - -600 nT, if this event hit the Earth. We demonstrate how successive coronal mass ejections (CMEs) can be enhanced into a solar superstorm as they interact en route from the Sun to 1 AU. These results not only provide a benchmark for studies of extreme space weather, but also present a new view of how an extreme space weather event can be generated from usual solar eruptions.

Palaeoflood hydrology in Europe: towards a better understanding of extreme floods

Science.gov (United States)

Benito, G.; Thorndycraft, V. R.; Rico, M.; Sheffer, N.; Enzel, Y.

2003-04-01

Floods are the most common natural disasters in Europe and, in terms of economic damage, costs are increasing spectacularly with time. Flood risk assessment associated with extreme floods is difficult due to the scarcity of hydrological measurements, that rarely go beyond 1000 years, which is clearly not sufficient for flood management in urban and industrial areas. Besides the use of conventional hydrologic data, the pre-instrumental record can be completed from palaeoflood hydrology or from documentary flood information, or through the combined use of both these tools. Recent developments of palaeoflood hydrology in Europe provide (1) major improvements in flood risk assessment, and (2) a better understanding of long-term flood-climate relationships. Palaeoflood hydrology has been successfully applied in large, medium rivers as well as small ungauged mountain drainage basins. Long-term palaeoflood records from Spain and France show that recent extraordinary flooding (causing huge economic damages) are not the largest ones, but that similar or even greater floods occurred several times in the past. In addition, clusters of floods coinciding in time at several European rivers point out to climatic factors as responsible mechanisms, although in recent time flood magnitude can be magnified by increasing human activity.

[Inadequate management of a difficult airway. Case SENSAR of the trimester].

Science.gov (United States)

2015-01-01

A clinical case reported to SENSAR is presented (www.sensar.org). A patient came to the operating room for surgery for parathyroidectomy. She had several predictors of difficult airway management, including a story of difficulties in previous intubations in other hospitals, as the patient reported. Therefore, after evaluation in preoperative consultation, fibreoptic bronchoscopy intubation was recommended. The day of surgery after induction of general anesthesia direct laryngoscopy was performed, without recognizing any glottic structure (Cormack-Lehane grade iv). Conventional laryngoscope was changed to a videolaryngoscope (Airtraq(®)) to try to improve the laryngoscopic view, but there were difficulties with handling and insertion of it, causing minor injuries to the lingual mucosa. Finally, tracheal intubation was achieved after several attempts. Analysis of the incident revealed the active error due to lack of experience of the professional who performed intubation maneuvers, favored by latent factors or contributors as were the complex pathology of the patient and the absence of protocols to difficult airway management in the hospital. Communication and analysis of this incident served to highlight the importance of the security protocols in Anesthesia, and as a result a working group that conducted the current algorithm approach to a difficult airway management was formed, established guidelines for further information patient and deals since clinical training and professional practice for the management of airway devices availables in the hospital. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Guidelines and algorithms for managing the difficult airway.

Science.gov (United States)

Gómez-Ríos, M A; Gaitini, L; Matter, I; Somri, M

2018-01-01

The difficult airway constitutes a continuous challenge for anesthesiologists. Guidelines and algorithms are key to preserving patient safety, by recommending specific plans and strategies that address predicted or unexpected difficult airway. However, there are currently no "gold standard" algorithms or universally accepted standards. The aim of this article is to present a synthesis of the recommendations of the main guidelines and difficult airway algorithms. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

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

OpenAIRE

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

2015-01-01

The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent ...

How to manage a child with difficult asthma?

Science.gov (United States)

Saglani, Sejal; Fleming, Louise

2016-08-01

Children with difficult asthma have significant morbidity and fail to achieve asthma control despite being prescribed high dose maintenance treatment. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Underlying modifiable factors including non-adherence to medication, persistent environmental exposures that trigger asthma symptoms and psychosocial factors contribute to poor control in these patients. The focus of this review is to provide a practical approach to the diagnosis and management of difficult asthma including an overview of long term assessments to identify potential progression to true, severe asthma. A multi-disciplinary team is critical to enable modifiable factors to be identified and addressed. Significant resources are required to manage paediatric difficult asthma optimally and only specialist centres should be tasked with the assessment of these patients. Although this may have an impact on healthcare resources, long term benefits for lung health are significant. Expert commentary: The management of paediatric difficult asthma is not simple and involves numerous professionals with varied expertise. However, if it is not undertaken with the appropriate skills, there is a significant risk of children receiving inappropriate invasive investigations and therapies that will have no impact on morbidity.

The Relation Between Visual Impairment and Extremity Fractures

Directory of Open Access Journals (Sweden)

Berrak Şekeryapan

2013-08-01

Full Text Available Purpose: To evaluate the association between the development of extremity fracture and visual impairment in adults. Material and Method: This study included 56 patients (patient group aged 18 years or older who had extremity fractures due to a fall. The control group (n=42 was selected from visitors who had regular medical check-ups at our hospital. Each participant underwent a full ophthalmologic examination. Mean age was compared by Student’s t test. The other variables were compared by chi-square test. Results: The prevalence of subjects with visual impairment was significantly higher in the patients group (78.6% than in the control group (38.1% (p<0.05. The prevalence of treatable eye diseases such as cataract and refractive errors were significantly higher in the patient group than in the control group (p<0.05 for both. Twenty-eight patients (50% in the patient group and 8 subjects in the control group had visual acuities lower than 0.5 (p<0.05. Discussion: We have found that the prevalence of visual impairment was significantly higher in adults with extremity fractures due to falls than in the control group. Hence, we believe that regular ophthalmological examination in adults, providing regular use of eyeglasses in patients with refractive errors, and timely treatment of treatable eye diseases such as cataract could decrease the extremity fractures from falls in adults. (Turk J Ophthalmol 2013; 43: 250-2

Common Bile Duct Perforation Due to Tuberculosis: A Case Report

OpenAIRE

Razman Jarmin; Shaharin Shaharuddin

2004-01-01

A young man with HIV presented with biliary peritonitis secondary to spontaneous common bile duct perforation. Investigation revealed that the perforation was due to Mycobacterium tuberculosis. Tuberculosis of the bile duct is uncommon and usually presents with obstructive jaundice due to stricture. Bile duct perforation due to tuberculosis is extremely rare. Its management is discussed.

The Difficult Chore of Measuring Coordination by EXAFS

International Nuclear Information System (INIS)

Ravel, B.; Kelly, S. D.

2007-01-01

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

Freight economic vulnerabilities due to flooding events.

Science.gov (United States)

2016-12-01

Extreme weather events, and flooding in particular, have been occurring more often and with increased severity over the past decade, and there is reason to expect this trend will continue in the future due to a changing climate. Flooding events can u...

Defining Political Extremism in the Balkans. The Case of Serbia

Directory of Open Access Journals (Sweden)

Babić Marko

2015-12-01

Full Text Available Political extremism (and particularly right wing political extremism remains relatively insufficiently explored due to the fact that the phenomenon is controversial and hard to define. Its ambiguity and variability depending on time and spatial point of view further complicates its definition. Its structure is amorphous and eclectic as it often includes elements from different ideologies and connects incompatible ideas. A multidimensional conceptualization and an interdisciplinary approach - sociological, social, psychological and historical, are the Author’s tools in explaining the phenomenon of political extremism in Serbia, hopefully contributing to its clarification and laying a foundation for its further explanatory theoretical studies.

Investigating NARCCAP Precipitation Extremes via Bivariate Extreme Value Theory (Invited)

Science.gov (United States)

Weller, G. B.; Cooley, D. S.; Sain, S. R.; Bukovsky, M. S.; Mearns, L. O.

2013-12-01

We introduce methodology from statistical extreme value theory to examine the ability of reanalysis-drive regional climate models to simulate past daily precipitation extremes. Going beyond a comparison of summary statistics such as 20-year return values, we study whether the most extreme precipitation events produced by climate model simulations exhibit correspondence to the most extreme events seen in observational records. The extent of this correspondence is formulated via the statistical concept of tail dependence. We examine several case studies of extreme precipitation events simulated by the six models of the North American Regional Climate Change Assessment Program (NARCCAP) driven by NCEP reanalysis. It is found that the NARCCAP models generally reproduce daily winter precipitation extremes along the Pacific coast quite well; in contrast, simulation of past daily summer precipitation extremes in a central US region is poor. Some differences in the strength of extremal correspondence are seen in the central region between models which employ spectral nudging and those which do not. We demonstrate how these techniques may be used to draw a link between extreme precipitation events and large-scale atmospheric drivers, as well as to downscale extreme precipitation simulated by a future run of a regional climate model. Specifically, we examine potential future changes in the nature of extreme precipitation along the Pacific coast produced by the pineapple express (PE) phenomenon. A link between extreme precipitation events and a "PE Index" derived from North Pacific sea-surface pressure fields is found. This link is used to study PE-influenced extreme precipitation produced by a future-scenario climate model run.

Short-Term Distribution System State Forecast Based on Optimal Synchrophasor Sensor Placement and Extreme Learning Machine

Energy Technology Data Exchange (ETDEWEB)

Jiang, Huaiguang; Zhang, Yingchen

2016-11-14

This paper proposes an approach for distribution system state forecasting, which aims to provide an accurate and high speed state forecasting with an optimal synchrophasor sensor placement (OSSP) based state estimator and an extreme learning machine (ELM) based forecaster. Specifically, considering the sensor installation cost and measurement error, an OSSP algorithm is proposed to reduce the number of synchrophasor sensor and keep the whole distribution system numerically and topologically observable. Then, the weighted least square (WLS) based system state estimator is used to produce the training data for the proposed forecaster. Traditionally, the artificial neural network (ANN) and support vector regression (SVR) are widely used in forecasting due to their nonlinear modeling capabilities. However, the ANN contains heavy computation load and the best parameters for SVR are difficult to obtain. In this paper, the ELM, which overcomes these drawbacks, is used to forecast the future system states with the historical system states. The proposed approach is effective and accurate based on the testing results.

Solving Component Structural Dynamic Failures Due to Extremely High Frequency Structural Response on the Space Shuttle Program

Science.gov (United States)

Frady, Greg; Nesman, Thomas; Zoladz, Thomas; Szabo, Roland

2010-01-01

For many years, the capabilities to determine the root-cause failure of component failures have been limited to the analytical tools and the state of the art data acquisition systems. With this limited capability, many anomalies have been resolved by adding material to the design to increase robustness without the ability to determine if the design solution was satisfactory until after a series of expensive test programs were complete. The risk of failure and multiple design, test, and redesign cycles were high. During the Space Shuttle Program, many crack investigations in high energy density turbomachines, like the SSME turbopumps and high energy flows in the main propulsion system, have led to the discovery of numerous root-cause failures and anomalies due to the coexistences of acoustic forcing functions, structural natural modes, and a high energy excitation, such as an edge tone or shedding flow, leading the technical community to understand many of the primary contributors to extremely high frequency high cycle fatique fluid-structure interaction anomalies. These contributors have been identified using advanced analysis tools and verified using component and system tests during component ground tests, systems tests, and flight. The structural dynamics and fluid dynamics communities have developed a special sensitivity to the fluid-structure interaction problems and have been able to adjust and solve these problems in a time effective manner to meet budget and schedule deadlines of operational vehicle programs, such as the Space Shuttle Program over the years.

Expected impacts of climate change on extreme climate events

International Nuclear Information System (INIS)

Planton, S.; Deque, M.; Chauvin, F.; Terray, L.

2008-01-01

An overview of the expected change of climate extremes during this century due to greenhouse gases and aerosol anthropogenic emissions is presented. The most commonly used methodologies rely on the dynamical or statistical down-scaling of climate projections, performed with coupled atmosphere-ocean general circulation models. Either of dynamical or of statistical type, down-scaling methods present strengths and weaknesses, but neither their validation on present climate conditions, nor their potential ability to project the impact of climate change on extreme event statistics allows one to give a specific advantage to one of the two types. The results synthesized in the last IPCC report and more recent studies underline a convergence for a very likely increase in heat wave episodes over land surfaces, linked to the mean warming and the increase in temperature variability. In addition, the number of days of frost should decrease and the growing season length should increase. The projected increase in heavy precipitation events appears also as very likely over most areas and also seems linked to a change in the shape of the precipitation intensity distribution. The global trends for drought duration are less consistent between models and down-scaling methodologies, due to their regional variability. The change of wind-related extremes is also regionally dependent, and associated to a poleward displacement of the mid-latitude storm tracks. The specific study of extreme events over France reveals the high sensitivity of some statistics of climate extremes at the decadal time scale as a consequence of regional climate internal variability. (authors)

The cause of fever and pulmonary infiltrate: a difficult etiological diagnosis

Directory of Open Access Journals (Sweden)

Bahjat Barakat

2017-04-01

Full Text Available Adult-onset Still’s disease is a rare condition that typically presents itself with intermittent fever, arthralgia and salmon colored rash. The involvement of the in lung is less common and very rare. Diagnosis is relatively difficult because of the presence of non-specific symptoms and the lack of serological markers specific to the disease. We report the case of a patient having a pulmonary infiltrate/infiltration compatible with pneumonia, cutaneous/skin rash and persistence of fever with multiple admissions to the Emergency Room due to the failure of treatment with antibiotics. After an appropriate work-up, a diagnosis of adult-onset Still’s disease was made.

Common Bile Duct Perforation Due to Tuberculosis: A Case Report

Directory of Open Access Journals (Sweden)

Razman Jarmin

2004-10-01

Full Text Available A young man with HIV presented with biliary peritonitis secondary to spontaneous common bile duct perforation. Investigation revealed that the perforation was due to Mycobacterium tuberculosis. Tuberculosis of the bile duct is uncommon and usually presents with obstructive jaundice due to stricture. Bile duct perforation due to tuberculosis is extremely rare. Its management is discussed.

[Malnutrition due to an extremely 'healthy' diet; a new eating disorder?].

Science.gov (United States)

Nauta, K; Toxopeus, K; Eekhoff, E M W

2016-01-01

A 71-year-old male was admitted to our hospital with heart failure, cachexia and biochemical disturbances due to a diet consisting of exclusively vegetables, oil and water. Our investigations showed that this diet was a consequence of an excessive preoccupation with health. The patient did not meet criteria for an eating disorder or other DSM-IV psychiatric disorder. We conclude that malnutrition due to health fad diets may be an underestimated medical problem. There is no specific psychopathological disorder that covers this behaviour, and there is no knowledge of its epidemiology. Popular literature is paying a great deal attention to orthorexia nervosa, an alleged eating disorder that describes a pathological obsession with healthy food. In medical literature this concept has been largely neglected, although eating disorder specialists frequently observe this behaviour in their practice. More clinical and scientific attention for this phenomenon is necessary to determine its epidemiology, validity and clinical picture.

Allergic contact dermatitis due to highly reactive halogenated compounds

Energy Technology Data Exchange (ETDEWEB)

Pickering, F C; Ive, F A

1983-11-01

Ten cases of dermatitis in a fine organic chemicals plant are reported. These cases were all due to exposure to chemical compounds with reactive bromine or chlorine atoms. This type of chemical is always extremely irritant, but evidence is put forward to suggest that these cases were the result of allergic sensitization. Chemicals with reactive halogen atoms should always be handled with extreme care and patch testing should be approached with caution.

Do changes in the frequency, magnitude and timing of extreme climatic events threaten the population viability of coastal birds?

NARCIS (Netherlands)

van de Pol, Martijn; Ens, Bruno J.; Heg, Dik; Brouwer, Lyanne; Krol, Johan; Maier, Martin; Exo, Klaus-Michael; Oosterbeek, Kees; Lok, Tamar; Eising, Corine M.; Koffijberg, Kees

P>1. Climate change encompasses changes in both the means and the extremes of climatic variables, but the population consequences of the latter are intrinsically difficult to study. 2. We investigated whether the frequency, magnitude and timing of rare but catastrophic flooding events have changed

Nutrition security under extreme events

Science.gov (United States)

Martinez, A.

2017-12-01

Nutrition security under extreme events. Zero hunger being one of the Sustainable Development Goal from the United Nations, food security has become a trending research topic. However extreme events impact on global food security is not yet 100% understood and there is a lack of comprehension of the underlying mechanisms of global food trade and nutrition security to improve countries resilience to extreme events. In a globalized world, food is still a highly regulated commodity and a strategic resource. A drought happening in a net food-exporter will have little to no effect on its own population but the repercussion on net food-importers can be extreme. In this project, we propose a methodology to describe and quantify the impact of a local drought to human health at a global scale. For this purpose, nutrition supply and global trade data from FAOSTAT have been used with domestic food production from national agencies and FAOSTAT, global precipitation from the Climate Research Unit and health data from the World Health Organization. A modified Herfindahl-Hirschman Index (HHI) has been developed to measure the level of resilience of one country to a drought happening in another country. This index describes how a country is dependent of importation and how diverse are its importation. Losses of production and exportation due to extreme events have been calculated using yield data and a simple food balance at country scale. Results show that countries the most affected by global droughts are the one with the highest dependency to one exporting country. Changes induced by droughts also disturbed their domestic proteins, fat and calories supply resulting most of the time in a higher intake of calories or fat over proteins.

Infrared spectrum of an extremely cool white-dwarf star

Science.gov (United States)

Hodgkin; Oppenheimer; Hambly; Jameson; Smartt; Steele

2000-01-06

White dwarfs are the remnant cores of stars that initially had masses of less than 8 solar masses. They cool gradually over billions of years, and have been suggested to make up much of the 'dark matter' in the halo of the Milky Way. But extremely cool white dwarfs have proved difficult to detect, owing to both their faintness and their anticipated similarity in colour to other classes of dwarf stars. Recent improved models indicate that white dwarfs are much more blue than previously supposed, suggesting that the earlier searches may have been looking for the wrong kinds of objects. Here we report an infrared spectrum of an extremely cool white dwarf that is consistent with the new models. We determine the star's temperature to be 3,500 +/- 200 K, making it the coolest known white dwarf. The kinematics of this star indicate that it is in the halo of the Milky Way, and the density of such objects implied by the serendipitous discovery of this star is consistent with white dwarfs dominating the dark matter in the halo.

Regional frequency analysis of extreme rainfall in Belgium based on radar estimates

Directory of Open Access Journals (Sweden)

E. Goudenhoofdt

2017-10-01

Full Text Available In Belgium, only rain gauge time series have been used so far to study extreme rainfall at a given location. In this paper, the potential of a 12-year quantitative precipitation estimation (QPE from a single weather radar is evaluated. For the period 2005–2016, 1 and 24 h rainfall extremes from automatic rain gauges and collocated radar estimates are compared. The peak intensities are fitted to the exponential distribution using regression in Q-Q plots with a threshold rank which minimises the mean squared error. A basic radar product used as reference exhibits unrealistic high extremes and is not suitable for extreme value analysis. For 24 h rainfall extremes, which occur partly in winter, the radar-based QPE needs a bias correction. A few missing events are caused by the wind drift associated with convective cells and strong radar signal attenuation. Differences between radar and gauge rainfall values are caused by spatial and temporal sampling, gauge underestimations and radar errors. Nonetheless the fit to the QPE data is within the confidence interval of the gauge fit, which remains large due to the short study period. A regional frequency analysis for 1 h duration is performed at the locations of four gauges with 1965–2008 records using the spatially independent QPE data in a circle of 20 km. The confidence interval of the radar fit, which is small due to the sample size, contains the gauge fit for the two closest stations from the radar. In Brussels, the radar extremes are significantly higher than the gauge rainfall extremes, but similar to those observed by an automatic gauge during the same period. The extreme statistics exhibit slight variations related to topography. The radar-based extreme value analysis can be extended to other durations.

Modelling the increased frequency of extreme sea levels in the Ganges-Brahmaputra-Meghna delta due to sea level rise and other effects of climate change.

Science.gov (United States)

Kay, S; Caesar, J; Wolf, J; Bricheno, L; Nicholls, R J; Saiful Islam, A K M; Haque, A; Pardaens, A; Lowe, J A

2015-07-01

Coastal flooding due to storm surge and high tides is a serious risk for inhabitants of the Ganges-Brahmaputra-Meghna (GBM) delta, as much of the land is close to sea level. Climate change could lead to large areas of land being subject to increased flooding, salinization and ultimate abandonment in West Bengal, India, and Bangladesh. IPCC 5th assessment modelling of sea level rise and estimates of subsidence rates from the EU IMPACT2C project suggest that sea level in the GBM delta region may rise by 0.63 to 0.88 m by 2090, with some studies suggesting this could be up to 0.5 m higher if potential substantial melting of the West Antarctic ice sheet is included. These sea level rise scenarios lead to increased frequency of high water coastal events. Any effect of climate change on the frequency and severity of storms can also have an effect on extreme sea levels. A shelf-sea model of the Bay of Bengal has been used to investigate how the combined effect of sea level rise and changes in other environmental conditions under climate change may alter the frequency of extreme sea level events for the period 1971 to 2099. The model was forced using atmospheric and oceanic boundary conditions derived from climate model projections and the future scenario increase in sea level was applied at its ocean boundary. The model results show an increased likelihood of extreme sea level events through the 21st century, with the frequency of events increasing greatly in the second half of the century: water levels that occurred at decadal time intervals under present-day model conditions occurred in most years by the middle of the 21st century and 3-15 times per year by 2100. The heights of the most extreme events tend to increase more in the first half of the century than the second. The modelled scenarios provide a case study of how sea level rise and other effects of climate change may combine to produce a greatly increased threat to life and property in the GBM delta by the end

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.

Dealing with difficult pasts

DEFF Research Database (Denmark)

McAtackney, Laura

2013-01-01

develop. I argue that such politically loaded manifestations of difficult pasts are highly significant during post-conflict renegotiations of society. They act as reminders of what happened, a commentary on how far society has – or has not moved on – and the potential for future relations and directions....... Using Robben Island and Long Kesh / Maze as case-studies this paper will explore the physical manifestations of political imprisonment, their experiences in the post-conflict context and reveal contestations of meaning at these dark heritage sites....

Vertical structure of extreme currents in the Faroe-Bank Channel

Directory of Open Access Journals (Sweden)

C. Carollo

2005-09-01

Full Text Available Extreme currents are studied with the aim of understanding their vertical and spatial structures in the Faroe-Bank Channel. Acoustic Doppler Current Profiler time series recorded in 3 deployments in this channel were investigated. To understand the main features of extreme events, the measurements were separated into their components through filtering and tidal analysis before applying the extreme value theory to the surge component. The Generalized Extreme Value (GEV distribution and the Generalized Pareto Distribution (GPD were used to study the variation of surge extremes from near-surface to deep waters. It was found that this component alone is not able to explain the extremes measured in total currents, particularly below 500 m. Here the mean residual flow enhanced by tidal rectification was found to be the component feature dominating extremes. Therefore, it must be taken into consideration when applying the extreme value theory, not to underestimate the return level for total currents. Return value speeds up to 250 cm s–1 for 50/250 years return period were found for deep waters, where the flow is constrained by the topography at bearings near 300/330° It is also found that the UK Meteorological Office FOAM model is unable to reproduce either the magnitude or the form for the extremes, perhaps due to its coarse vertical and horizontal resolution, and is thus not suitable to model extremes on a regional scale. Keywords. Oceanography: Physical (Currents; General circulation; General or miscellaneous

Advances in Rosetta structure prediction for difficult molecular-replacement problems

International Nuclear Information System (INIS)

DiMaio, Frank

2013-01-01

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

[Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

Science.gov (United States)

Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

2016-04-01

We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery.

On the nonlinearity of spatial scales in extreme weather attribution statements

Science.gov (United States)

Angélil, Oliver; Stone, Daíthí; Perkins-Kirkpatrick, Sarah; Alexander, Lisa V.; Wehner, Michael; Shiogama, Hideo; Wolski, Piotr; Ciavarella, Andrew; Christidis, Nikolaos

2018-04-01

In the context of ongoing climate change, extreme weather events are drawing increasing attention from the public and news media. A question often asked is how the likelihood of extremes might have changed by anthropogenic greenhouse-gas emissions. Answers to the question are strongly influenced by the model used, duration, spatial extent, and geographic location of the event—some of these factors often overlooked. Using output from four global climate models, we provide attribution statements characterised by a change in probability of occurrence due to anthropogenic greenhouse-gas emissions, for rainfall and temperature extremes occurring at seven discretised spatial scales and three temporal scales. An understanding of the sensitivity of attribution statements to a range of spatial and temporal scales of extremes allows for the scaling of attribution statements, rendering them relevant to other extremes having similar but non-identical characteristics. This is a procedure simple enough to approximate timely estimates of the anthropogenic contribution to the event probability. Furthermore, since real extremes do not have well-defined physical borders, scaling can help quantify uncertainty around attribution results due to uncertainty around the event definition. Results suggest that the sensitivity of attribution statements to spatial scale is similar across models and that the sensitivity of attribution statements to the model used is often greater than the sensitivity to a doubling or halving of the spatial scale of the event. The use of a range of spatial scales allows us to identify a nonlinear relationship between the spatial scale of the event studied and the attribution statement.

Mandelbrot's Extremism

NARCIS (Netherlands)

Beirlant, J.; Schoutens, W.; Segers, J.J.J.

2004-01-01

In the sixties Mandelbrot already showed that extreme price swings are more likely than some of us think or incorporate in our models.A modern toolbox for analyzing such rare events can be found in the field of extreme value theory.At the core of extreme value theory lies the modelling of maxima

CO2-DSA in lower extremity veins: a clinical application

International Nuclear Information System (INIS)

Guo Jinhe; Teng Gaojun; Zhu Guangyu; Liu Zhensheng; Li Guozhao; Ding Huijuan; Shen Zhiping; He Shicheng; Deng Gang; Fang Wen

2005-01-01

Objective: To explore the feasibility and usefulness of carbon dioxide digital subtraction angiography (CO 2 -DSA) in deep veins of lower extremity via the dorsal is pedis vein. Methods: CO 2 -DSA in lower extremity veins was performed in 15 patients (15 limbs affected, male 9, female 6) by injection of CO 2 via the dorsal is pedis vein. Among them, 8 patients were suspected with deep venous thrombosis (DVT), 6 patients with saphena magna dilation, and 1 patient with a follow-up after thrombolysis due to DVT. Results: Excellent image was obtained in 12 cases, which showed branches of the venous system clearly, as well as the details of DVT. Good image was obtained in 2 cases. Technical failure was encountered in one patient due to inaccessible puncture veins. Mild discomfort (transient pain at the percutaneous site) during the procedure was demonstrated in 11 patients. There was no severe side effects or complications in this series. Conclusion: CO 2 -DSA in lower extremity veins is feasible and safe, the preliminary result is satisfactory. (authors)

Why Translation Is Difficult

DEFF Research Database (Denmark)

Carl, Michael; Schaeffer, Moritz Jonas

2017-01-01

The paper develops a definition of translation literality that is based on the syntactic and semantic similarity of the source and the target texts. We provide theoretical and empirical evidence that absolute literal translations are easy to produce. Based on a multilingual corpus of alternative...... translations we investigate the effects of cross-lingual syntactic and semantic distance on translation production times and find that non-literality makes from-scratch translation and post-editing difficult. We show that statistical machine translation systems encounter even more difficulties with non-literality....

More tornadoes in the most extreme U.S. tornado outbreaks.

Science.gov (United States)

Tippett, Michael K; Lepore, Chiara; Cohen, Joel E

2016-12-16

Tornadoes and severe thunderstorms kill people and damage property every year. Estimated U.S. insured losses due to severe thunderstorms in the first half of 2016 were $8.5 billion (US). The largest U.S. effects of tornadoes result from tornado outbreaks, which are sequences of tornadoes that occur in close succession. Here, using extreme value analysis, we find that the frequency of U.S. outbreaks with many tornadoes is increasing and that it is increasing faster for more extreme outbreaks. We model this behavior by extreme value distributions with parameters that are linear functions of time or of some indicators of multidecadal climatic variability. Extreme meteorological environments associated with severe thunderstorms show consistent upward trends, but the trends do not resemble those currently expected to result from global warming. Copyright © 2016, American Association for the Advancement of Science.

Therapist reactions in self-experienced difficult situations: an exploration

NARCIS (Netherlands)

Smith, A.J.M.; Kleijn, W.C.; Hutschemaekers, G.J.M.

2007-01-01

This article describes a qualitative study of 63 difficult therapeutic situations described by 26 therapists. The study was part of research on specific reactions of therapists to traumatized clients. The research questions for the current analyses focused on the categorization of difficult

How extreme is extreme hourly precipitation?

Science.gov (United States)

Papalexiou, Simon Michael; Dialynas, Yannis G.; Pappas, Christoforos

2016-04-01

The importance of accurate representation of precipitation at fine time scales (e.g., hourly), directly associated with flash flood events, is crucial in hydrological design and prediction. The upper part of a probability distribution, known as the distribution tail, determines the behavior of extreme events. In general, and loosely speaking, tails can be categorized in two families: the subexponential and the hyperexponential family, with the first generating more intense and more frequent extremes compared to the latter. In past studies, the focus has been mainly on daily precipitation, with the Gamma distribution being the most popular model. Here, we investigate the behaviour of tails of hourly precipitation by comparing the upper part of empirical distributions of thousands of records with three general types of tails corresponding to the Pareto, Lognormal, and Weibull distributions. Specifically, we use thousands of hourly rainfall records from all over the USA. The analysis indicates that heavier-tailed distributions describe better the observed hourly rainfall extremes in comparison to lighter tails. Traditional representations of the marginal distribution of hourly rainfall may significantly deviate from observed behaviours of extremes, with direct implications on hydroclimatic variables modelling and engineering design.

A compliant mechanism for inspecting extremely confined spaces

Science.gov (United States)

Mascareñas, David; Moreu, Fernando; Cantu, Precious; Shields, Daniel; Wadden, Jack; El Hadedy, Mohamed; Farrar, Charles

2017-11-01

We present a novel, compliant mechanism that provides the capability to navigate extremely confined spaces for the purpose of infrastructure inspection. Extremely confined spaces are commonly encountered during infrastructure inspection. Examples of such spaces can include pipes, conduits, and ventilation ducts. Often these infrastructure features go uninspected simply because there is no viable way to access their interior. In addition, it is not uncommon for extremely confined spaces to possess a maze-like architecture that must be selectively navigated in order to properly perform an inspection. Efforts by the imaging sensor community have resulted in the development of imaging sensors on the millimeter length scale. Due to their compact size, they are able to inspect many extremely confined spaces of interest, however, the means to deliver these sensors to the proper location to obtain the desired images are lacking. To address this problem, we draw inspiration from the field of endoscopic surgery. Specifically we consider the work that has already been done to create long flexible needles that are capable of being steered through the human body. These devices are typically referred to as ‘steerable needles.’ Steerable needle technology is not directly applicable to the problem of navigating maze-like arrangements of extremely confined spaces, but it does provide guidance on how this problem should be approached. Specifically, the super-elastic nitinol tubing material that allows steerable needles to operate is also appropriate for the problem of navigating maze-like arrangements of extremely confined spaces. Furthermore, the portion of the mechanism that enters the extremely confined space is completely mechanical in nature. The mechanical nature of the device is an advantage when the extremely confined space features environmental hazards such as radiation that could degrade an electromechanically operated mechanism. Here, we present a compliant mechanism

Extreme weather and climate events with ecological relevance: a review.

Science.gov (United States)

Ummenhofer, Caroline C; Meehl, Gerald A

2017-06-19

Robust evidence exists that certain extreme weather and climate events, especially daily temperature and precipitation extremes, have changed in regard to intensity and frequency over recent decades. These changes have been linked to human-induced climate change, while the degree to which climate change impacts an individual extreme climate event (ECE) is more difficult to quantify. Rapid progress in event attribution has recently been made through improved understanding of observed and simulated climate variability, methods for event attribution and advances in numerical modelling. Attribution for extreme temperature events is stronger compared with other event types, notably those related to the hydrological cycle. Recent advances in the understanding of ECEs, both in observations and their representation in state-of-the-art climate models, open new opportunities for assessing their effect on human and natural systems. Improved spatial resolution in global climate models and advances in statistical and dynamical downscaling now provide climatic information at appropriate spatial and temporal scales. Together with the continued development of Earth System Models that simulate biogeochemical cycles and interactions with the biosphere at increasing complexity, these make it possible to develop a mechanistic understanding of how ECEs affect biological processes, ecosystem functioning and adaptation capabilities. Limitations in the observational network, both for physical climate system parameters and even more so for long-term ecological monitoring, have hampered progress in understanding bio-physical interactions across a range of scales. New opportunities for assessing how ECEs modulate ecosystem structure and functioning arise from better scientific understanding of ECEs coupled with technological advances in observing systems and instrumentation.This article is part of the themed issue 'Behavioural, ecological and evolutionary responses to extreme climatic events

What is the right way to talk about extreme events?

Science.gov (United States)

Sobel, A. H.

2013-12-01

Extreme weather events draw the attention of the public. By demonstrating the vulnerability of human society to climate, extreme events can cause nonscientists -government leaders as well as the broader population - to take the danger posed by anthropogenic global warming more seriously than they otherwise might. An extreme event that draws media attention can become a 'teachable moment'. But extreme events are difficult to talk about in a way that honors both the strengths and weaknesses of the underlying science. No single event can be attributed to climate change, and some types of events are not even clearly influenced by it (or not in any ways our science can yet demonstrate). Strong, media-friendly statements that closely connect specific events to climate - designed to make best use of the moment's teachability - can easily overstate the case. This will raise the hackles of one's colleagues, at a minimum, and at worst, may damage the credibility of the field more broadly. Yet talking too much about the uncertainties runs the risk of understating the basic truth that global warming is real and dangerous, and may lend inadvertent support to anti-scientific denialism. I will discuss this tension in the context of my own experiences in the media after 'Superstorm' Sandy. I will address arguments I have heard, from social scientists and media consultants, to the effect that climate scientists should adopt communications strategies that lead to stronger, more media-friendly statements, and learn to suppress the tendency, bred into us during our scientific training, to emphasize the uncertainties.

Clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans

Energy Technology Data Exchange (ETDEWEB)

Moon, Il Bong; Dong, Kyung Rae [Dept. Radiological Technology, Gwangju Health University, Gwangju (Korea, Republic of); Goo, Eun Hoe [Dept. Radiological Science, Cheongju University, Cheongju (Korea, Republic of)

2016-11-15

The purpose of this study was to assess clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans. From January to July 2016, 30 patients (mean age, 68) were studied with lower extremity CTA and lower extremity perfusion CT. 128 channel multi-detector row CT scans were acquired with a CT scanner (SOMATOM Definition Flash, Siemens medical solution, Germany) of lower extremity perfusion CT and lower extremity CTA. Acquired images were reconstructed with 3D workstation (Leonardo, Siemens, Germany). Site of lower extremity arterial occlusive and stenosis lesions were detected superficial femoral artery 36.6%, popliteal artery 23.4%, external iliac artery 16.7%, common femoral artery 13.3%, peroneal artery 10%. The mean total DLP comparison of lower extremity perfusion CT and lower extremity CTA, 650 mGy-cm and 675 mGy-cm, respectively. Lower extremity perfusion CT and lower extremity CTA were realized that were never be two examination that were exactly the same legions. Future through the development of lower extremity perfusion CT soft ware programs suggest possible clinical applications.

Quantifying population exposure to airborne particulate matter during extreme events in California due to climate change

OpenAIRE

A. Mahmud; M. Hixson; M. J. Kleeman

2012-01-01

The effect of climate change on population-weighted concentrations of particulate matter (PM) during extreme events was studied using the Parallel Climate Model (PCM), the Weather Research and Forecasting (WRF) model and the UCD/CIT 3-D photochemical air quality model. A "business as usual" (B06.44) global emissions scenario was dynamically downscaled for the entire state of California between the years 2000–2006 and 2047–2053. Air quality simulations were carried out for ...

Thermodynamics of extremal rotating thin shells in an extremal BTZ spacetime and the extremal black hole entropy

Science.gov (United States)

Lemos, José P. S.; Minamitsuji, Masato; Zaslavskii, Oleg B.

2017-02-01

In a (2 +1 )-dimensional spacetime with a negative cosmological constant, the thermodynamics and the entropy of an extremal rotating thin shell, i.e., an extremal rotating ring, are investigated. The outer and inner regions with respect to the shell are taken to be the Bañados-Teitelbom-Zanelli (BTZ) spacetime and the vacuum ground state anti-de Sitter spacetime, respectively. By applying the first law of thermodynamics to the extremal thin shell, one shows that the entropy of the shell is an arbitrary well-behaved function of the gravitational area A+ alone, S =S (A+). When the thin shell approaches its own gravitational radius r+ and turns into an extremal rotating BTZ black hole, it is found that the entropy of the spacetime remains such a function of A+, both when the local temperature of the shell at the gravitational radius is zero and nonzero. It is thus vindicated by this analysis that extremal black holes, here extremal BTZ black holes, have different properties from the corresponding nonextremal black holes, which have a definite entropy, the Bekenstein-Hawking entropy S (A+)=A/+4G , where G is the gravitational constant. It is argued that for extremal black holes, in particular for extremal BTZ black holes, one should set 0 ≤S (A+)≤A/+4G;i.e., the extremal black hole entropy has values in between zero and the maximum Bekenstein-Hawking entropy A/+4 G . Thus, rather than having just two entropies for extremal black holes, as previous results have debated, namely, 0 and A/+4 G , it is shown here that extremal black holes, in particular extremal BTZ black holes, may have a continuous range of entropies, limited by precisely those two entropies. Surely, the entropy that a particular extremal black hole picks must depend on past processes, notably on how it was formed. A remarkable relation between the third law of thermodynamics and the impossibility for a massive body to reach the velocity of light is also found. In addition, in the procedure, it

Elastic modulus of Extreme Ultraviolet exposed single-layer graphene

NARCIS (Netherlands)

Mund, Baibhav Kumar; Gao, An; Sturm, Jacobus Marinus; Lee, Christopher James; Bijkerk, Frederik

2015-01-01

Highly transparent membranes are required for a number of applications, such as protective coatings for components in Extreme Ultraviolet (EUV) lithography, beam splitters (EUV pump-probe experiments), transmission gratings, and reticles. Graphene is an excellent candidate due to its high tensile

Profound hyper natremia due to central diabetes insipidus

International Nuclear Information System (INIS)

Vaqar, A.; Javaid, K.H.; Parveen, R.; Sadaf, R.

2012-01-01

Diabetes insipidus is a rare endocrine disorder in paediatric patients. Polyuria is a cardinal manifestation that is extremely difficult to recognize in diapered infants. Careful urine quantification is the key to diagnosis in appropriate clinical setting. We report a case of a 4 months old infant presenting with an acute life threatening event following an episode of vomiting and decreased oral intake. She had profound hyper natremia which persisted after stabilization. Polyuria unrecognized by the mother was revealed by 24-hour urine output measurement. A diagnosis of diabetes insipidus was made after appropriate laboratory investigations including serum and urine osmolality. The central nature of the disease was confirmed by neuroimaging which showed holoprosencephaly. (author)

Vertical structure of extreme currents in the Faroe-Bank Channel

Directory of Open Access Journals (Sweden)

C. Carollo

2005-09-01

Full Text Available Extreme currents are studied with the aim of understanding their vertical and spatial structures in the Faroe-Bank Channel. Acoustic Doppler Current Profiler time series recorded in 3 deployments in this channel were investigated. To understand the main features of extreme events, the measurements were separated into their components through filtering and tidal analysis before applying the extreme value theory to the surge component. The Generalized Extreme Value (GEV distribution and the Generalized Pareto Distribution (GPD were used to study the variation of surge extremes from near-surface to deep waters. It was found that this component alone is not able to explain the extremes measured in total currents, particularly below 500 m. Here the mean residual flow enhanced by tidal rectification was found to be the component feature dominating extremes. Therefore, it must be taken into consideration when applying the extreme value theory, not to underestimate the return level for total currents. Return value speeds up to 250 cm s^–1 for 50/250 years return period were found for deep waters, where the flow is constrained by the topography at bearings near 300/330° It is also found that the UK Meteorological Office FOAM model is unable to reproduce either the magnitude or the form for the extremes, perhaps due to its coarse vertical and horizontal resolution, and is thus not suitable to model extremes on a regional scale.

Keywords. Oceanography: Physical (Currents; General circulation; General or miscellaneous

Statistical uncertainty of extreme wind storms over Europe derived from a probabilistic clustering technique

Science.gov (United States)

Walz, Michael; Leckebusch, Gregor C.

2016-04-01

Extratropical wind storms pose one of the most dangerous and loss intensive natural hazards for Europe. However, due to only 50 years of high quality observational data, it is difficult to assess the statistical uncertainty of these sparse events just based on observations. Over the last decade seasonal ensemble forecasts have become indispensable in quantifying the uncertainty of weather prediction on seasonal timescales. In this study seasonal forecasts are used in a climatological context: By making use of the up to 51 ensemble members, a broad and physically consistent statistical base can be created. This base can then be used to assess the statistical uncertainty of extreme wind storm occurrence more accurately. In order to determine the statistical uncertainty of storms with different paths of progression, a probabilistic clustering approach using regression mixture models is used to objectively assign storm tracks (either based on core pressure or on extreme wind speeds) to different clusters. The advantage of this technique is that the entire lifetime of a storm is considered for the clustering algorithm. Quadratic curves are found to describe the storm tracks most accurately. Three main clusters (diagonal, horizontal or vertical progression of the storm track) can be identified, each of which have their own particulate features. Basic storm features like average velocity and duration are calculated and compared for each cluster. The main benefit of this clustering technique, however, is to evaluate if the clusters show different degrees of uncertainty, e.g. more (less) spread for tracks approaching Europe horizontally (diagonally). This statistical uncertainty is compared for different seasonal forecast products.

E.X.T.R.E.M.E. project. Launch

International Nuclear Information System (INIS)

Eyrolle, F.; Charmasson, S.; Masson, O.

2005-01-01

Due to the drastic decrease in artificial radioactivity levels from primary sources such as atmospheric fallout or industrial releases, radioactive storages constituted in the past within several environmental compartments act today as non negligible secondary sources. These delayed sources are particularly active during extreme weather or climatic events such as rainfalls or atmospheric deposits, floods, storms, etc...that may remove important mass, generate activity levels higher than the predicted ones from modeling based on mean transfer process, and produce in a couple of hours or days fluxes similar to those accrued over several month or years. Extreme aims at assessing the consequences on man and its environment of natural events that generate extreme radioactive stocks and/or fluxes within several environmental compartments (atmosphere, soils, rivers, coastal marine environment and deep sea areas). (authors)

Extreme pressure differences at 0900 NZST and winds across New Zealand

Science.gov (United States)

Salinger, M. James; Griffiths, Georgina M.; Gosai, Ashmita

2005-07-01

Trends in extremes in station daily sea-level pressure differences at 0900 NZST are examined, and extreme daily wind gusts, across New Zealand, since the 1960s. Annual time series were examined (with indices of magnitude and frequency over threshold percentiles) from the daily indices selected. These follow from earlier indices of normalized monthly mean sea-level pressure differences between station pairs, except the daily indices are not normalized. The frequency statistics quantify the number of extreme zonal (westerly and easterly), or extreme meridional (southerly or northerly), pressure gradient events. The frequency and magnitude of extreme westerly episodes has increased slightly over New Zealand, with a significant increase in the westerly extremes to the south of New Zealand. In contrast, the magnitude and frequency of easterly extremes has decreased over New Zealand, but increased to the south, with some trends weakly significant. The frequency and magnitude of daily southerly extremes has decreased significantly in the region.Extreme daily wind gust events at key climate stations in New Zealand and at Hobart, Australia, are highly likely to be associated with an extreme daily pressure difference. The converse was less likely to hold: extreme wind gusts were not always observed on days with extreme daily pressure difference, probably due to the strong influence that topography has on localized station winds. Significant correlations exist between the frequency indices and both annual-average mean sea-level pressures around the Australasian region and annual-average sea surface temperature (SST) anomalies in the Southern Hemisphere. These correlations are generally stronger for indices of extreme westerly or extreme southerly airflows. Annual-average pressures in the Tasman Sea or Southern Ocean are highly correlated to zonal indices (frequency of extreme westerlies). SST anomalies in the NINO3 region or on either side of the South Island are

Extreme value distributions

CERN Document Server

Ahsanullah, Mohammad

2016-01-01

The aim of the book is to give a through account of the basic theory of extreme value distributions. The book cover a wide range of materials available to date. The central ideas and results of extreme value distributions are presented. The book rwill be useful o applied statisticians as well statisticians interrested to work in the area of extreme value distributions.vmonograph presents the central ideas and results of extreme value distributions.The monograph gives self-contained of theory and applications of extreme value distributions.

The distribution of urate deposition within the extremities in gout: a review of 148 dual-energy CT cases

International Nuclear Information System (INIS)

Mallinson, Paul I.; Reagan, Adrian C.; Munk, Peter L.; Ouellette, Hugue; Nicolaou, Savvas; Coupal, Tyler

2014-01-01

Clinical detection of gout can be difficult due to co-existent and mimicking arthropathies and asymptomatic disease. Understanding of the distribution of urate within the body can aid clinical diagnosis and further understanding of the resulting pathology. Our aim was to determine this distribution of urate within the extremities in patients with gout. All patients who underwent a four-limb dual-energy computed tomography (DECT) scan for suspected gout over a 2-year period were identified (n = 148, 121 male, 27 female, age range, 16-92 years, mean = 61.3 years, median = 63 years). The reports of the positive cases were retrospectively analyzed and the locations of all urate deposition recorded and classified by anatomical location. A total of 241 cases met the inclusion criteria, of which 148 cases were positive. Of these, 101 (68.2 %) patients had gout in the foot, 81 (56.1 %) in the knee, 79 (53.4 %) in the ankle, 41 (27.7 %) in the elbow, 25 (16.9 %) in the hand, and 25 (16.9 %) in the wrist. The distribution was further subcategorized for each body part into specific bone and soft tissue structures. In this observational study, we provide for the first time a detailed analysis of extremity urate distribution in gout, which both supports and augments to the current understanding based on clinical and microscopic findings. (orig.)

The distribution of urate deposition within the extremities in gout: a review of 148 dual-energy CT cases

Energy Technology Data Exchange (ETDEWEB)

Mallinson, Paul I. [Vancouver General Hospital, Radiology Department, Vancouver (Canada); Vancouver General Hospital, Clinical Fellow in Musculoskeletal Radiology, Vancouver, BC (Canada); Reagan, Adrian C.; Munk, Peter L.; Ouellette, Hugue; Nicolaou, Savvas [Vancouver General Hospital, Radiology Department, Vancouver (Canada); Coupal, Tyler [McMaster University, De Groote School of Medicine, Hamilton, Ontario (Canada)

2014-03-15

Clinical detection of gout can be difficult due to co-existent and mimicking arthropathies and asymptomatic disease. Understanding of the distribution of urate within the body can aid clinical diagnosis and further understanding of the resulting pathology. Our aim was to determine this distribution of urate within the extremities in patients with gout. All patients who underwent a four-limb dual-energy computed tomography (DECT) scan for suspected gout over a 2-year period were identified (n = 148, 121 male, 27 female, age range, 16-92 years, mean = 61.3 years, median = 63 years). The reports of the positive cases were retrospectively analyzed and the locations of all urate deposition recorded and classified by anatomical location. A total of 241 cases met the inclusion criteria, of which 148 cases were positive. Of these, 101 (68.2 %) patients had gout in the foot, 81 (56.1 %) in the knee, 79 (53.4 %) in the ankle, 41 (27.7 %) in the elbow, 25 (16.9 %) in the hand, and 25 (16.9 %) in the wrist. The distribution was further subcategorized for each body part into specific bone and soft tissue structures. In this observational study, we provide for the first time a detailed analysis of extremity urate distribution in gout, which both supports and augments to the current understanding based on clinical and microscopic findings. (orig.)

Assessing extreme sea levels due to tropical cyclones in the Atlantic basin

Science.gov (United States)

Muis, Sanne; Lin, Ning; Verlaan, Martin; Winsemius, Hessel; Vatvani, Deepak; Ward, Philip; Aerts, Jeroen

2017-04-01

Tropical cyclones (TCs), including hurricanes and typhoons, are characterised by high wind speeds and low pressure and cause dangerous storm surges in coastal areas. Over the last 50 years, storm surge incidents in the Atlantic accounted for more than 1,000 deaths in the United Stated. Recent flooding disasters, such as Hurricane Katrina in New Orleans in 2005 and, Hurricane Sandy in New York in 2012, exemplify the significant TC surge risk in the United States. In this contribution, we build on Muis et al. (2016), and present a new modelling framework to simulate TC storm surges and estimate their probabilities for the Atlantic basin. In our framework we simulate the surge levels by forcing the Global Tide and Surge Model (GTSM) with wind and pressure fields from TC events. To test the method, we apply it to historical storms that occurred between 1988 and 2015 in the Atlantic Basin. We obtain high-resolution meteorological forcing by applying a parametric hurricane model (Holland 1980; Lin and Chavas 2012) to the TC extended track data set (Demuth et al. 2006; updated), which describes the position, intensity and size of the historical TCs. Preliminary results show that this framework is capable of accurately reproducing the main surge characteristics during past events, including Sandy and Katrina. While the resolution of GTSM is limited for local areas with a complex bathymetry, the overall performance of the model is satisfactory for the basin-scale application. For an accurate assessment of risk to coastal flooding in the Atlantic basin it is essential to provide reliable estimates of surge probabilities. However, the length of observed TC tracks is too short to accurately estimate the probabilities of extreme TC events. So next steps are to statistically extend the observed record to many thousands of years (e.g., Emanuel et al. 2006), in order to force GTSM with a large number of synthetic storms. Based on these synthetic simulations, we would be able to

An observational and modeling study of the August 2017 Florida climate extreme event.

Science.gov (United States)

Konduru, R.; Singh, V.; Routray, A.

2017-12-01

A special report on the climate extremes by the Intergovernmental Panel on Climate Change (IPCC) elucidates that the sole cause of disasters is due to the exposure and vulnerability of the human and natural system to the climate extremes. The cause of such a climate extreme could be anthropogenic or non-anthropogenic. Therefore, it is challenging to discern the critical factor of influence for a particular climate extreme. Such kind of perceptive study with reasonable confidence on climate extreme events is possible only if there exist any past case studies. A similar rarest climate extreme problem encountered in the case of Houston floods and extreme rainfall over Florida in August 2017. A continuum of hurricanes like Harvey and Irma targeted the Florida region and caused catastrophe. Due to the rarity of August 2017 Florida climate extreme event, it requires the in-depth study on this case. To understand the multi-faceted nature of the event, a study on the development of the Harvey hurricane and its progression and dynamics is significant. Current article focus on the observational and modeling study on the Harvey hurricane. A global model named as NCUM (The global UK Met office Unified Model (UM) operational at National Center for Medium Range Weather Forecasting, India, was utilized to simulate the Harvey hurricane. The simulated rainfall and wind fields were compared with the observational datasets like Tropical Rainfall Measuring Mission rainfall datasets and Era-Interim wind fields. The National Centre for Environmental Prediction (NCEP) automated tracking system was utilized to track the Harvey hurricane, and the tracks were analyzed statistically for different forecasts concerning the Harvey hurricane track of Joint Typhon Warning Centre. Further, the current study will be continued to investigate the atmospheric processes involved in the August 2017 Florida climate extreme event.

Quantifying population exposure to airborne particulate matter during extreme events in California due to climate change

OpenAIRE

A. Mahmud; M. Hixson; M. J. Kleeman

2012-01-01

The effect of climate change on population-weighted concentrations of particulate matter (PM) during extreme pollution events was studied using the Parallel Climate Model (PCM), the Weather Research and Forecasting (WRF) model and the UCD/CIT 3-D photochemical air quality model. A "business as usual" (B06.44) global emissions scenario was dynamically downscaled for the entire state of California between the years 2000–2006 and 2047–2053. Air quality simulations were carried out for 1008 days ...

Can Concentration - Discharge Relationships Diagnose Material Source During Extreme Events?

Science.gov (United States)

Karwan, D. L.; Godsey, S.; Rose, L.

2017-12-01

Floods can carry >90% of the basin material exported in a given year as well as alter flow pathways and material sources. In turn, sediment and solute fluxes can increase flood damages and negatively impact water quality and integrate physical and chemical weathering of landscapes and channels. Concentration-discharge (C-Q) relationships are used to both describe export patterns as well as compute them. Metrics for describing C-Q patterns and inferring their controls are vulnerable to infrequent sampling that affects how C-Q relationships are interpolated and interpreted. C-Q relationships are typically evaluated from multiple samples, but because hydrological extremes are rare, data are often unavailable for extreme events. Because solute and sediment C-Q relationships likely respond to changes in hydrologic extremes in different ways, there is a pressing need to define their behavior under extreme conditions, including how to properly sample to capture these patterns. In the absence of such knowledge, improving load estimates in extreme floods will likely remain difficult. Here we explore the use of C-Q relationships to determine when an event alters a watershed system such that it enters a new material source/transport regime. We focus on watersheds with sediment and discharge time series include low-frequency and/or extreme events. For example, we compare solute and sediment patterns in White Clay Creek in southeastern Pennsylvania across a range of flows inclusive of multiple hurricanes for which we have ample ancillary hydrochemical data. TSS is consistently mobilized during high flow events, even during extreme floods associated with hurricanes, and sediment fingerprinting indicates different sediment sources, including in-channel remobilization and landscape erosion, are active at different times. In other words, TSS mobilization in C-Q space is not sensitive to the source of material being mobilized. Unlike sediments, weathering solutes in this watershed

Exascale Co-design for Modeling Materials in Extreme Environments

Energy Technology Data Exchange (ETDEWEB)

Germann, Timothy C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2014-07-08

Computational materials science has provided great insight into the response of materials under extreme conditions that are difficult to probe experimentally. For example, shock-induced plasticity and phase transformation processes in single-crystal and nanocrystalline metals have been widely studied via large-scale molecular dynamics simulations, and many of these predictions are beginning to be tested at advanced 4th generation light sources such as the Advanced Photon Source (APS) and Linac Coherent Light Source (LCLS). I will describe our simulation predictions and their recent verification at LCLS, outstanding challenges in modeling the response of materials to extreme mechanical and radiation environments, and our efforts to tackle these as part of the multi-institutional, multi-disciplinary Exascale Co-design Center for Materials in Extreme Environments (ExMatEx). ExMatEx has initiated an early and deep collaboration between domain (computational materials) scientists, applied mathematicians, computer scientists, and hardware architects, in order to establish the relationships between algorithms, software stacks, and architectures needed to enable exascale-ready materials science application codes within the next decade. We anticipate that we will be able to exploit hierarchical, heterogeneous architectures to achieve more realistic large-scale simulations with adaptive physics refinement, and are using tractable application scale-bridging proxy application testbeds to assess new approaches and requirements. Such current scale-bridging strategies accumulate (or recompute) a distributed response database from fine-scale calculations, in a top-down rather than bottom-up multiscale approach.

A Unique Sample of Extreme-BCG Clusters at 0.2 < z < 0.5

Science.gov (United States)

Garmire, Gordon

2017-09-01

The recently-discovered Phoenix cluster harbors the most extreme BCG in the known universe. Despite the cluster's high mass and X-ray luminosity, it was consistently identified by surveys as an isolated AGN, due to the bright central point source and the compact cool core. Armed with hindsight, we have undertaken an all-sky survey based on archival X-ray, OIR, and radio data to identify other similarly-extreme systems that were likewise missed. A pilot study demonstrated that this strategy works, leading to the discovery of a new, massive cluster at z 0.2 which was missed by previous X-ray surveys due to the presence of a bright central QSO. We propose here to observe 6 new clusters from our complete northern-sky survey, which harbor some of the most extreme central galaxies known.

Large-solid-angle illuminators for extreme ultraviolet lithography with laser plasmas

International Nuclear Information System (INIS)

Kubiak, G.D.; Tichenor, D.A.; Sweatt, W.C.; Chow, W.W.

1995-06-01

Laser Plasma Sources (LPSS) of extreme ultraviolet radiation are an attractive alternative to synchrotron radiation sources for extreme ultraviolet lithography (EUVL) due to their modularity, brightness, and modest size and cost. To fully exploit the extreme ultraviolet power emitted by such sources, it is necessary to capture the largest possible fraction of the source emission half-sphere while simultaneously optimizing the illumination stationarity and uniformity on the object mask. In this LDRD project, laser plasma source illumination systems for EUVL have been designed and then theoretically and experimentally characterized. Ellipsoidal condensers have been found to be simple yet extremely efficient condensers for small-field EUVL imaging systems. The effects of aberrations in such condensers on extreme ultraviolet (EUV) imaging have been studied with physical optics modeling. Lastly, the design of an efficient large-solid-angle condenser has been completed. It collects 50% of the available laser plasma source power at 14 nm and delivers it properly to the object mask in a wide-arc-field camera

Multidisciplinary Difficult Airway Course: An Essential Educational Component of a Hospital-Wide Difficult Airway Response Program.

Science.gov (United States)

Leeper, W Robert; Haut, Elliott R; Pandian, Vinciya; Nakka, Sajan; Dodd-O, Jeffrey; Bhatti, Nasir; Hunt, Elizabeth A; Saheed, Mustapha; Dalesio, Nicholas; Schiavi, Adam; Miller, Christina; Kirsch, Thomas D; Berkow, Lauren

2018-04-05

A hospital-wide difficult airway response team was developed in 2008 at The Johns Hopkins Hospital with three central pillars: operations, safety monitoring, and education. The objective of this study was to assess the outcomes of the educational pillar of the difficult airway response team program, known as the multidisciplinary difficult airway course (MDAC). The comprehensive, full-day MDAC involves trainees and staff from all provider groups who participate in airway management. The MDAC occurs within the Johns Hopkins Medicine Simulation Center approximately four times per year and uses a combination of didactic lectures, hands-on sessions, and high-fidelity simulation training. Participation in MDAC is the main intervention being investigated in this study. Data were collected prospectively using course evaluation survey with quantitative and qualitative components, and prepost course knowledge assessment multiple choice questions (MCQ). Outcomes include course evaluation scores and themes derived from qualitative assessments, and prepost course knowledge assessment MCQ scores. Tertiary care academic hospital center PARTICIPANTS: Students, residents, fellows, and practicing physicians from the departments of Surgery, Otolaryngology Head and Neck Surgery, Anesthesiology/Critical Care Medicine, and Emergency Medicine; advanced practice providers (nurse practitioners and physician assistants), nurse anesthetists, nurses, and respiratory therapists. Totally, 23 MDACs have been conducted, including 499 participants. Course evaluations were uniformly positive with mean score of 86.9 of 95 points. Qualitative responses suggest major value from high-fidelity simulation, the hands-on skill stations, and teamwork practice. MCQ scores demonstrated significant improvement: median (interquartile range) pre: 69% (60%-81%) vs post: 81% (72%-89%), p < 0.001. Implementation of a MDAC successfully disseminated principles and protocols to all airway providers. Demonstrable

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…

Difficult incidents and tutor interventions in problem-based learning tutorials.

Science.gov (United States)

Kindler, Pawel; Grant, Christopher; Kulla, Steven; Poole, Gary; Godolphin, William

2009-09-01

Tutors report difficult incidents and distressing conflicts that adversely affect learning in their problem-based learning (PBL) groups. Faculty development (training) and peer support should help them to manage this. Yet our understanding of these problems and how to deal with them often seems inadequate to help tutors. The aim of this study was to categorise difficult incidents and the interventions that skilled tutors used in response, and to determine the effectiveness of those responses. Thirty experienced and highly rated tutors in our Year 1 and 2 medical curriculum took part in semi-structured interviews to: identify and describe difficult incidents; describe how they responded, and assess the success of each response. Recorded and transcribed data were analysed thematically to develop typologies of difficult incidents and interventions and compare reported success or failure. The 94 reported difficult incidents belonged to the broad categories 'individual student' or 'group dynamics'. Tutors described 142 interventions in response to these difficult incidents, categorised as: (i) tutor intervenes during tutorial; (ii) tutor gives feedback outside tutorial, or (iii) student or group intervenes. Incidents in the 'individual student' category were addressed relatively unsuccessfully (effective 75% of the time) by response (iii). None of the interventions worked well when used in response to problems related to 'group dynamics'. Overall, 59% of the difficult incidents were dealt with successfully. Dysfunctional PBL groups can be highly challenging, even for experienced and skilled tutors. Within-tutorial feedback, the treatment that tutors are most frequently advised to apply, was often not effective. Our study suggests that the collective responsibility of the group, rather than of the tutor, to deal with these difficulties should be emphasised.

Extremely Randomized Machine Learning Methods for Compound Activity Prediction

Directory of Open Access Journals (Sweden)

Wojciech M. Czarnecki

2015-11-01

Full Text Available Speed, a relatively low requirement for computational resources and high effectiveness of the evaluation of the bioactivity of compounds have caused a rapid growth of interest in the application of machine learning methods to virtual screening tasks. However, due to the growth of the amount of data also in cheminformatics and related fields, the aim of research has shifted not only towards the development of algorithms of high predictive power but also towards the simplification of previously existing methods to obtain results more quickly. In the study, we tested two approaches belonging to the group of so-called ‘extremely randomized methods’—Extreme Entropy Machine and Extremely Randomized Trees—for their ability to properly identify compounds that have activity towards particular protein targets. These methods were compared with their ‘non-extreme’ competitors, i.e., Support Vector Machine and Random Forest. The extreme approaches were not only found out to improve the efficiency of the classification of bioactive compounds, but they were also proved to be less computationally complex, requiring fewer steps to perform an optimization procedure.

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)

Extremely Preterm Birth

Science.gov (United States)

... Events Advocacy For Patients About ACOG Extremely Preterm Birth Home For Patients Search FAQs Extremely Preterm Birth ... Spanish FAQ173, June 2016 PDF Format Extremely Preterm Birth Pregnancy When is a baby considered “preterm” or “ ...

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

International Nuclear Information System (INIS)

Di Lucia, Lorenzo

2013-01-01

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

Quasinormal modes of the near extremal Schwarzschild-de Sitter black hole

International Nuclear Information System (INIS)

Cardoso, Vitor; Lemos, Jose P.S.

2003-01-01

We present an exact expression for the quasinormal modes of scalar, electromagnetic, and gravitational perturbations of a near extremal Schwarzschild-de Sitter black hole and we show that is why a previous approximation holds exactly in this near extremal regime. In particular, our results give the asymptotic behavior of the quasinormal frequencies for highly damped modes, which has recently attracted much attention due to the proposed identification of its real part with the Barbero-Immirzi parameter

Extreme fire severity patterns in topographic, convective and wind-driven historical wildfires of Mediterranean pine forests.

Directory of Open Access Journals (Sweden)

Judit Lecina-Diaz

Full Text Available Crown fires associated with extreme fire severity are extremely difficult to control. We have assessed fire severity using differenced Normalized Burn Ratio (dNBR from Landsat imagery in 15 historical wildfires of Pinus halepensis Mill. We have considered a wide range of innovative topographic, fuel and fire behavior variables with the purposes of (1 determining the variables that influence fire severity patterns among fires (considering the 15 wildfires together and (2 ascertaining whether different variables affect extreme fire severity within the three fire types (topographic, convective and wind-driven fires. The among-fires analysis showed that fires in less arid climates and with steeper slopes had more extreme severity. In less arid conditions there was more crown fuel accumulation and closer forest structures, promoting high vertical and horizontal fuel continuity and extreme fire severity. The analyses carried out for each fire separately (within fires showed more extreme fire severity in areas in northern aspects, with steeper slopes, with high crown biomass and in climates with more water availability. In northern aspects solar radiation was lower and fuels had less water limitation to growth which, combined with steeper slopes, produced more extreme severity. In topographic fires there was more extreme severity in northern aspects with steeper slopes and in areas with more water availability and high crown biomass; in convection-dominated fires there was also more extreme fire severity in northern aspects with high biomass; while in wind-driven fires there was only a slight interaction between biomass and water availability. This latter pattern could be related to the fact that wind-driven fires spread with high wind speed, which could have minimized the effect of other variables. In the future, and as a consequence of climate change, new zones with high crown biomass accumulated in non-common drought areas will be available to burn

Extreme fire severity patterns in topographic, convective and wind-driven historical wildfires of Mediterranean pine forests.

Science.gov (United States)

Lecina-Diaz, Judit; Alvarez, Albert; Retana, Javier

2014-01-01

Crown fires associated with extreme fire severity are extremely difficult to control. We have assessed fire severity using differenced Normalized Burn Ratio (dNBR) from Landsat imagery in 15 historical wildfires of Pinus halepensis Mill. We have considered a wide range of innovative topographic, fuel and fire behavior variables with the purposes of (1) determining the variables that influence fire severity patterns among fires (considering the 15 wildfires together) and (2) ascertaining whether different variables affect extreme fire severity within the three fire types (topographic, convective and wind-driven fires). The among-fires analysis showed that fires in less arid climates and with steeper slopes had more extreme severity. In less arid conditions there was more crown fuel accumulation and closer forest structures, promoting high vertical and horizontal fuel continuity and extreme fire severity. The analyses carried out for each fire separately (within fires) showed more extreme fire severity in areas in northern aspects, with steeper slopes, with high crown biomass and in climates with more water availability. In northern aspects solar radiation was lower and fuels had less water limitation to growth which, combined with steeper slopes, produced more extreme severity. In topographic fires there was more extreme severity in northern aspects with steeper slopes and in areas with more water availability and high crown biomass; in convection-dominated fires there was also more extreme fire severity in northern aspects with high biomass; while in wind-driven fires there was only a slight interaction between biomass and water availability. This latter pattern could be related to the fact that wind-driven fires spread with high wind speed, which could have minimized the effect of other variables. In the future, and as a consequence of climate change, new zones with high crown biomass accumulated in non-common drought areas will be available to burn as extreme

Unusual tumour ablations: report of difficult and interesting cases

OpenAIRE

Mauri, Giovanni; Nicosia, Luca; Varano, Gianluca Maria; Shyn, Paul; Sartori, Sergio; Tombesi, Paola; Di Vece, Francesca; Orsi, Franco; Solbiati, Luigi

2017-01-01

Image-guided ablations are nowadays applied in the treatment of a wide group of diseases and in different organs and regions, and every day interventional radiologists have to face more difficult and unusual cases of tumour ablation. In the present case review, we report four difficult and unusual cases, reporting some tips and tricks for a successful image-guided treatment.

Extreme environment electronics

CERN Document Server

Cressler, John D

2012-01-01

Unfriendly to conventional electronic devices, circuits, and systems, extreme environments represent a serious challenge to designers and mission architects. The first truly comprehensive guide to this specialized field, Extreme Environment Electronics explains the essential aspects of designing and using devices, circuits, and electronic systems intended to operate in extreme environments, including across wide temperature ranges and in radiation-intense scenarios such as space. The Definitive Guide to Extreme Environment Electronics Featuring contributions by some of the world's foremost exp

Adequacy of current systems for monitoring extremity exposures at nuclear power plants

International Nuclear Information System (INIS)

Reece, W.D.; Harty, R.

1985-01-01

In general, only a small portion of workers at commercial nuclear power plants are limited by extremity exposures, and these workers can be readily identified. There seems to be no need for increased badging among the radiation workers. However, those workers who are extremity limited may not be receiving adequate dosimetry. For workers handling compact sources, unless contrary information is available, the tip of the thumb of the dominant hand can be assumed to be the limiting site, and dose to the thumb tip averaged over one square centimeter at the basal layer of the skin should be measured or estimated. As discussed briefly in this paper, the assessment of dose in high gradient fields can be a difficult task. The particular dosimeter studied is a band-aid type composed of a thermoluminescent material embedded in a carbon matrix under 4 mils of plastic. Advantages and disadvantages of the technique are discussed

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

EVALUATION OF DISTAL UPPER EXTREMITY (DUE MUSCULOSKELETAL DISORDERS BY STRAIN INDEX (SI IN AN IRONWORK INDUSTRY

Directory of Open Access Journals (Sweden)

Seyed-Ali Moussavi-Najarkola

2008-04-01

Full Text Available Background and aims:Work-related musculoskeletal disorders (WMSDS is one of the mostimportant problems in working populations of Iranian industries; so, in order to evaluate theintegrated roles and effects of various ergonomic risk factors inducing such disorders, the StrainIndex (SI methods was used.Methods: This was a cross-sectional study conducted on 448 male subjects including 63controls working in administrative jobs and 385 cases working in lathing, welding, melting andfoundry jobs using integrated procedure which includes observations, interview, NordicMusculoskeletal Questionnaire (NMQ methods and SI model. All workers were questioned.Data were analyzed using SPSS software v. 11 and Excel package.Results: The most prevalent MSDs in upper limbs were found in melting lathing, foundry andwelding respectively. There was a significant relationship between age and job groups (c2=7.33;df=16; p<0.001. One-way analysis of variance showed a significant differences among means ofcalculated Strain Indices of administrative (1.06, lathing (6.52, welding (3.68, melting (7.79and foundry (6.33 jobs (F=5.92; df=16; p=0.005. Also it was revealed that melting job wasattributed as "hazardous job" (4 risk level, lathing and foundry jobs were referred to "moderaterisk level" (3 risk level, welding job was allocated as "uncertain risk level" (2 risk level, andadministrative job was attributed as "safe risk level" (1 risk level. Moreover, there was asignificant relationship between DUE and job groups (c2=11.92; df=12; p=0.004.The paired ttestshowed significant difference with direct and relatively complete correlation between meansof Strain Indices in right (6.53 and left (4.29 hands (r=0.69; t=3.15; p<0.001.Conclusion: The Strain Index (SI model can be referred as an efficient and applicable methodfor the assessment of ergonomics risk factors inducing upper extremity musculoskeletal disorders(UEMSDs, classifying jobs, correcting and modifying work situations

Regional decision-makers as potential users of Extreme Weather Event Attribution - Case studies from the German Baltic Sea coast and the Greater Paris area

Directory of Open Access Journals (Sweden)

Maria Schwab

2017-12-01

Full Text Available Extreme Event Attribution has raised increasing attention in climate science in the last years. It means to judge the extent to which certain weather-related extreme events have changed due to human influences on climate with probabilistic statements. Extreme Event Attribution is often anticipated to spur more than just scientific ambition. It is able to provide answers to a commonly asked questions after extreme events, namely, ‘can we blame it on climate change’ and is assumed to support decision-making of various actors engaged in climate change mitigation and adaptation. More in-depth research is widely lacking about who these actors are; in which context they can make use of it; and what requirements they have, to be able to actually apply Extreme Event Attribution. We have therefore addressed these questions with two empirical case studies looking at regional decision-makers who deal with storm surge risks in the German Baltic Sea region and heat waves in the Greater Paris area. Stakeholder interviews and workshops reveal that fields of application and requirements are diverse, difficult to explicitly identify, and often clearly associated with stakeholders' specific mandate, the hazard background, and the regional socio-economic setting. Among the considered stakeholders in the Baltic Sea region, Extreme Event Attribution is perceived to be most useful to awareness-raising, in particular for climate change mitigation. They emphasised the importance of receiving understandable information - and that, rather later, but with smaller uncertainties than faster, but with higher uncertainties. In the Paris case, we typically talked to people engaged in adaptation with expertise in terms of climate science, but narrowly defined mandates which is typical for the Paris-centred political system with highly specialised public experts. The interviewees claimed that Extreme Event Attribution is most useful to political leverage and public

Extrapolation of extreme response for different mooring line systems of floating wave energy converters

DEFF Research Database (Denmark)

Ambühl, Simon; Sterndorff, Martin; Sørensen, John Dalsgaard

2014-01-01

Mooring systems for floating wave energy converters (WECs) are a major cost driver. Failure of mooring systems often occurs due to extreme loads. This paper introduces an extrapolation method for extreme response which accounts for the control system of a WEC that controls the loads onto...... measurements from lab-scaled WEPTOS WEC are taken. Different catenary anchor leg mooring (CALM) systems as well as single anchor legmooring (SALM)mooring systemsare implemented for a dynamic simulation with different number of mooring lines. Extreme tension loads with a return period of 50 years are assessed...... for the hawser as well as at the different mooring lines. Furthermore, the extreme load impact given failure of one mooring line is assessed and compared with extreme loads given no system failure....

Predictability and possible earlier awareness of extreme precipitation across Europe

Science.gov (United States)

Lavers, David; Pappenberger, Florian; Richardson, David; Zsoter, Ervin

2017-04-01

Extreme hydrological events can cause large socioeconomic damages in Europe. In winter, a large proportion of these flood episodes are associated with atmospheric rivers, a region of intense water vapour transport within the warm sector of extratropical cyclones. When preparing for such extreme events, forecasts of precipitation from numerical weather prediction models or river discharge forecasts from hydrological models are generally used. Given the strong link between water vapour transport (integrated vapour transport IVT) and heavy precipitation, it is possible that IVT could be used to warn of extreme events. Furthermore, as IVT is located in extratropical cyclones, it is hypothesized to be a more predictable variable due to its link with synoptic-scale atmospheric dynamics. In this research, we firstly provide an overview of the predictability of IVT and precipitation forecasts, and secondly introduce and evaluate the ECMWF Extreme Forecast Index (EFI) for IVT. The EFI is a tool that has been developed to evaluate how ensemble forecasts differ from the model climate, thus revealing the extremeness of the forecast. The ability of the IVT EFI to capture extreme precipitation across Europe during winter 2013/14, 2014/15, and 2015/16 is presented. The results show that the IVT EFI is more capable than the precipitation EFI of identifying extreme precipitation in forecast week 2 during forecasts initialized in a positive North Atlantic Oscillation (NAO) phase. However, the precipitation EFI is superior during the negative NAO phase and at shorter lead times. An IVT EFI example is shown for storm Desmond in December 2015 highlighting its potential to identify upcoming hydrometeorological extremes.

Use of extremity insulation during whole body hyperthermia to reduce temperature nonuniformity

International Nuclear Information System (INIS)

Thrall, D.E.; Page, R.L.

1987-01-01

The author previously documented during whole body hyperthermia in dogs using a radiant heating device that temperature at superficial sites, including tibial bone marrow, falls below systemic arterial temperature during the plateau phase of heating. This may be due to direct heat loss to the environment. Sites where temperature is lower than systemic arterial temperature during the plateau phase may become sanctuary sites where tumor deposits are spared because they do not receive the prescribed thermal dose. In an attempt to decrease temperature nonuniformity and increase thermal dose delivered to such superficial sites, extremity insulation has been employed during whole body hyperthermia in dogs. The author measured temperature at cutaneous and subcutaneous sites and within tibial bone marrow in insulated and noninsulated extremities of dogs undergoing whole body hyperthermia in the radiant heating device. The author found that extremity insulation is effective in reducing extremity temperature nonuniformity. Specific results are presented. Extremity insulation may be necessary during whole body hyperthermia to assure that extremity tumor deposits receive a thermal dose similar to that prescribed for the entire body

Use of versapoint to refashion the cervical canal to overcome unusually difficult embryo transfers and improve in-vitro fertilization-embryo transfer outcome: A case series

Directory of Open Access Journals (Sweden)

Nalini Mahajan

2011-01-01

Full Text Available Background : Smooth atraumatic embryo transfer is paramount for the success of in-vitro fertilization (IVF. In difficult cases, cervical canal manipulation may be required. Aim : To see if surgical correction of the cervical canal or cervical canal refashioning could improve ease of embryo transfer. Setting : Private infertility and IVF hospital. Design : Prospective study. Materials and Methods : Patients: 11 women with failed 1-3 IVF cycles with history of extremely difficult embryo transfers (ETs despite undergoing cervical dilatation in the cycle prior to IVF. Interventions : Operative hysteroscopy using Versapoint for refashioning of the cervical canal. Main Outcome Measures : Ease of ET in the subsequent IVF cycle. Secondary outcome measure was to assess reproductive outcome. Results : Easy and atraumatic ET in the IVF cycle after procedure in 100% patients. PR was 46.5%. Conclusions : Use of Versapoint for refashioning the cervical canal can improve the quality of ET and PR.

Deformation mechanisms in a coal mine roadway in extremely swelling soft rock.

Science.gov (United States)

Li, Qinghai; Shi, Weiping; Yang, Renshu

2016-01-01

The problem of roadway support in swelling soft rock was one of the challenging problems during mining. For most geological conditions, combinations of two or more supporting approaches could meet the requirements of most roadways; however, in extremely swelling soft rock, combined approaches even could not control large deformations. The purpose of this work was to probe the roadway deformation mechanisms in extremely swelling soft rock. Based on the main return air-way in a coal mine, deformation monitoring and geomechanical analysis were conducted, as well as plastic zone mechanical model was analysed. Results indicated that this soft rock was potentially very swelling. When the ground stress acted alone, the support strength needed in situ was not too large and combined supporting approaches could meet this requirement; however, when this potential released, the roadway would undergo permanent deformation. When the loose zone reached 3 m within surrounding rock, remote stress p ∞ and supporting stress P presented a linear relationship. Namely, the greater the swelling stress, the more difficult it would be in roadway supporting. So in this extremely swelling soft rock, a better way to control roadway deformation was to control the releasing of surrounding rock's swelling potential.

Emotional distance to so-called difficult patients

DEFF Research Database (Denmark)

Michaelsen, Jette Joost

2012-01-01

Scand J Caring Sci; 2011 Emotional distance to so-called difficult patients Purpose: To explore nurses' relationships with patients they regard as being difficult. How do nurses feel about such patients and relate to them, and what are the consequences for nurse and patient? Design and methods....... Patients' case records were studied and four meetings with the staff were arranged to discuss the findings. Data collection lasted 18 months in all. Findings: Three strategies were identified: persuasion, avoidance (emotional distance), and compromise. Interestingly, in the relationship with a particular...... patient, the avoidance strategy did not necessarily represent the terminal stage, since a nurse could revert to the compromise strategy. Some of the nurses experienced painful emotions regarding these interactions. Conclusions: The avoidance strategy (emotional distance) resulted in important social...

Strain evolution in Si substrate due to implantation of MeV ion observed by extremely asymmetric x-ray diffraction

International Nuclear Information System (INIS)

Emoto, T.; Ghatak, J.; Satyam, P. V.; Akimoto, K.

2009-01-01

We studied the strain introduced in a Si(111) substrate due to MeV ion implantation using extremely asymmetric x-ray diffraction and measured the rocking curves of asymmetrical 113 diffraction for the Si substrates implanted with a 1.5 MeV Au 2+ ion at fluence values of 1x10 13 , 5x10 13 , and 1x10 14 /cm 2 . The measured curves consisted of a bulk peak and accompanying subpeak with an interference fringe. The positional relationship of the bulk peak to the subpeak and the intensity variation of those peaks with respect to the wavelengths of the x rays indicated that crystal lattices near the surface were strained; the lattice spacing of surface normal (111) planes near the surface was larger than that of the bulk. Detailed strain profiles along the depth direction were successfully estimated using a curve-fitting method based on Darwin's dynamical diffraction theory. Comparing the shapes of resultant strain profiles, we found that a strain evolution rapidly occurred within a depth of ∼300 nm at fluence values between 1x10 13 and 5x10 13 /cm 2 . This indicates that formation of the complex defects progressed near the surface when the fluence value went beyond a critical value between 1x10 13 and 5x10 13 /cm 2 and the defects brought a large strain to the substrate.

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

Science.gov (United States)

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

2015-01-01

Background and Objective Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients. Methods In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes. Results A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (Δ) = 4.4, 95% CI, 2.7 to 6.1, Ptracheostomy than those who were unsuccessfully weaned. Conclusions In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning. Trial Registration ClinicalTrials.gov NCT01312142 PMID:26379127

Observed increase in extreme daily rainfall in the French Mediterranean

Science.gov (United States)

Ribes, Aurélien; Thao, Soulivanh; Vautard, Robert; Dubuisson, Brigitte; Somot, Samuel; Colin, Jeanne; Planton, Serge; Soubeyroux, Jean-Michel

2018-04-01

We examine long-term trends in the historical record of extreme precipitation events occurring over the French Mediterranean area. Extreme events are considered in terms of their intensity, frequency, extent and precipitated volume. Changes in intensity are analysed via an original statistical approach where the annual maximum rainfall amounts observed at each measurement station are aggregated into a univariate time-series according to their dependence. The mean intensity increase is significant and estimated at + 22% (+ 7 to + 39% at the 90% confidence level) over the 1961-2015 period. Given the observed warming over the considered area, this increase is consistent with a rate of about one to three times that implied by the Clausius-Clapeyron relationship. Changes in frequency and other spatial features are investigated through a Generalised Linear Model. Changes in frequency for events exceeding high thresholds (about 200 mm in 1 day) are found to be significant, typically near a doubling of the frequency, but with large uncertainties in this change ratio. The area affected by severe events and the water volume precipitated during those events also exhibit significant trends, with an increase by a factor of about 4 for a 200 mm threshold, again with large uncertainties. All diagnoses consistently point toward an intensification of the most extreme events over the last decades. We argue that it is difficult to explain the diagnosed trends without invoking the human influence on climate.

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study.

Science.gov (United States)

Lee, Tae Hoon; Hwang, Soon Oh; Choi, Hyun Jong; Jung, Yunho; Cha, Sang Woo; Chung, Il-Kwun; Moon, Jong Ho; Cho, Young Deok; Park, Sang-Heum; Kim, Sun-Joo

2014-02-17

Numerous clinical trials to improve the success rate of biliary access in difficult biliary cannulation (DBC) during ERCP have been reported. However, standard guidelines or sequential protocol analysis according to different methods are limited in place. We planned to investigate a sequential protocol to facilitate selective biliary access for DBC during ERCP. This prospective clinical study enrolled 711 patients with naïve papillae at a tertiary referral center. If wire-guided cannulation was deemed to have failed due to the DBC criteria, then according to the cannulation algorithm early precut fistulotomy (EPF; cannulation time > 5 min, papillary contacts > 5 times, or hook-nose-shaped papilla), double-guidewire cannulation (DGC; unintentional pancreatic duct cannulation ≥ 3 times), and precut after placement of a pancreatic stent (PPS; if DGC was difficult or failed) were performed sequentially. The main outcome measurements were the technical success, procedure outcomes, and complications. Initially, a total of 140 (19.7%) patients with DBC underwent EPF (n = 71) and DGC (n = 69). Then, in DGC group 36 patients switched to PPS due to difficulty criteria. The successful biliary cannulation rate was 97.1% (136/140; 94.4% [67/71] with EPF, 47.8% [33/69] with DGC, and 100% [36/36] with PPS; P EPF, 314.8 (65.2) seconds in DGC, and 706.0 (469.4) seconds in PPS (P EPF, DGC, and PPS may be safe and feasible for DBC. The use of EPF in selected DBC criteria, DGC in unintentional pancreatic duct cannulations, and PPS in failed or difficult DGC may facilitate successful biliary cannulation.

[Correlation between obstructive apnea syndrome and difficult airway in ENT surgery].

Science.gov (United States)

Pera, Marcia Hiray; Tardelli, Maria Angela; Novo, Neil Ferreira; Juliano, Yara; Silva, Helga Cristina Almeida da

2017-12-21

ENT patients with obstructive sleep apnea syndrome have a tendency of collapsing the upper airways in addition to anatomical obstacles. Obstructive sleep apnea syndrome is related to the increased risk of difficult airway and also increased perioperative complications. In order to identify these patients in the preoperative period, the STOP Bang questionnaire has been highlighted because it is summarized and easy to apply. Evaluate through the STOP Bang questionnaire whether patients undergoing ENT surgery with a diagnosis of obstructive sleep apnea syndrome have a higher risk of complications, particularly the occurrence of difficult airway. Measurements of anatomical parameters for difficult airway and questionnaire application for clinical prediction of obstructive sleep apnea syndrome were performed in 48 patients with a previous polysomnographic study. The sample detected difficult airway in about 18.7% of patients, all of them with obstructive sleep apnea syndrome. This group had older age, cervical circumference > 40cm, ASA II and Cormack III/IV. Patients with obstructive sleep apnea syndrome had higher body mass index, cervical circumference, and frequent apnea. In subgroup analysis, the group with severe obstructive sleep apnea syndrome showed a significantly higher SB score compared to patients without this syndrome or with a mild/moderate obstructive sleep apnea syndrome. The STOP Bang questionnaire was not able to predict difficult airway and mild obstructive sleep apnea syndrome, but it identified marked obstructive sleep apnea syndrome. All patients with difficult airway had moderate and marked obstructive sleep apnea syndrome, although this syndrome did not involve difficult airway. The variables Cormack III/IV and BMI greater than 35 Kg.m -2 were able to predict difficult airway and obstructive sleep apnea syndrome, respectively. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Creating and Understanding Hybrid Interfaces of Multifunctional Composite Laminates for Extreme Environments

Data.gov (United States)

National Aeronautics and Space Administration — Due to increasing needs for lightweight and multifunctional structures and materials that can operate at and sustain the extreme environment such as high temperature...

Extreme cosmos

CERN Document Server

Gaensler, Bryan

2011-01-01

The universe is all about extremes. Space has a temperature 270°C below freezing. Stars die in catastrophic supernova explosions a billion times brighter than the Sun. A black hole can generate 10 million trillion volts of electricity. And hypergiants are stars 2 billion kilometres across, larger than the orbit of Jupiter. Extreme Cosmos provides a stunning new view of the way the Universe works, seen through the lens of extremes: the fastest, hottest, heaviest, brightest, oldest, densest and even the loudest. This is an astronomy book that not only offers amazing facts and figures but also re

Combustion-assisted laser cutting of a difficult-to-machine superalloy

International Nuclear Information System (INIS)

Molian, P.A.

1992-01-01

In laser cutting, the largest single application of lasers in manufacturing, the assist gas plays an important role in affecting the cutting performance. The assist gas is usually oxygen or an inert gas. In this paper acetylene and oxygen was employed to create combustion reactions during CO 2 laser cutting that enabled an improvement in the cutting speed, and cut quality of a difficult-to-machine superalloy. A comparison with laser cutting of a plain carbon steel under identical conditions was also made to determine the usefulness of combustion energy. Results indicate that both cutting speed and quality are enhanced by the reduction in the viscosity of slag formed during cutting (which assisted in ejection of the slag through the bottom of the kerf) due to the heat released by the acetylene burning inside the kerf. Correlations of experimental data with a theoretical model provided the influence of combustion power and gas-flow power on the cutting phenomena

Modeling spatial processes with unknown extremal dependence class

KAUST Repository

Huser, Raphaël G.

2017-03-17

Many environmental processes exhibit weakening spatial dependence as events become more extreme. Well-known limiting models, such as max-stable or generalized Pareto processes, cannot capture this, which can lead to a preference for models that exhibit a property known as asymptotic independence. However, weakening dependence does not automatically imply asymptotic independence, and whether the process is truly asymptotically (in)dependent is usually far from clear. The distinction is key as it can have a large impact upon extrapolation, i.e., the estimated probabilities of events more extreme than those observed. In this work, we present a single spatial model that is able to capture both dependence classes in a parsimonious manner, and with a smooth transition between the two cases. The model covers a wide range of possibilities from asymptotic independence through to complete dependence, and permits weakening dependence of extremes even under asymptotic dependence. Censored likelihood-based inference for the implied copula is feasible in moderate dimensions due to closed-form margins. The model is applied to oceanographic datasets with ambiguous true limiting dependence structure.

The long shadows of the difficult past?

DEFF Research Database (Denmark)

Wolnik, Kevin; Busse, Britta; Tholen, Jochen

2017-01-01

This paper focuses on the question of how young people today evaluate the Second World War today and how this ‘difficult past’ determines their political attitudes. Furthermore, the channels through which the current young generation in Europe is informed about the events dating back to the first...... 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...

(When and where) Do extreme climate events trigger extreme ecosystem responses? - Development and initial results of a holistic analysis framework

Science.gov (United States)

Hauber, Eva K.; Donner, Reik V.

2015-04-01

a seasonal cycle for each quantile of the distribution, which can be used for a fully data-adaptive definition of extremes as exceedances above this time-dependent quantile function. (2) Having thus identified the extreme events, their distribution is analyzed in both space and time. Following a procedure recently proposed by Lloyd-Hughes (2012) and further exploited by Zscheischler et al. (2013), extremes observed at neighboring points in space and time are considered to form connected sets. Investigating the size distribution of these sets provides novel insights into the development and dynamical characteristics of spatio-temporally extended climate and ecosystem extremes. (3) Finally, the timing of such spatio-temporally extended extremes in different climatic as well as ecological variables is tested pairwise to rule out that co-occurrences of extremes have emerged solely due to chance. For this purpose, the recently developed framework of coincidence analysis (Donges et al., 2011; Rammig et al. 2014) is applied. The corresponding analysis allows identifying potential causal linkages between climatic extremes and extreme ecosystem responses and, thus, to study their mechanisms and spatial as well as seasonal distribution in great detail. In this work, the described method is exemplified by using different climate data from the ERA-Interim reanalysis as well as remote sensing-based land surface temperature data. References: Donges et al., PNAS, 108, 20422, 2011 Lloyd-Hughes, Int. J. Climatol., 32, 406, 2012 Rammig et al., Biogeosc. Disc., 11, 2537, 2014 Zscheischler et al., Ecol. Inform., 15, 66, 2013

Further outlooks: extremely uncomfortable; Die weiteren Aussichten: extrem ungemuetlich

Energy Technology Data Exchange (ETDEWEB)

Resenhoeft, T.

2006-07-01

Climate is changing extremely in the last decades. Scientists dealing with extreme weather, should not only stare at computer simulations. They have also to turn towards psyche, seriously personal experiences, knowing statistics, relativise supposed sensational reports and last not least collecting more data. (GL)

VARIABILITY OF THE INFRARED EXCESS OF EXTREME DEBRIS DISKS

International Nuclear Information System (INIS)

Meng, Huan Y. A.; Rieke, George H.; Su, Kate Y. L.; Rujopakarn, Wiphu; Ivanov, Valentin D.; Vanzi, Leonardo

2012-01-01

Debris disks with extremely large infrared excesses (fractional luminosities >10 –2 ) are rare. Those with ages between 30 and 130 Myr are of interest because their evolution has progressed well beyond that of protoplanetary disks (which dissipate with a timescale of order 3 Myr), yet they represent a period when dynamical models suggest that terrestrial planet building may still be progressing through large, violent collisions that could yield large amounts of debris and large infrared excesses. For example, our Moon was formed through a violent collision of two large protoplanets during this age range. We report two disks around the solar-like stars ID8 and HD 23514 in this age range where the 24 μm infrared excesses vary on timescales of a few years, even though the stars are not variable in the optical. Variations this rapid are difficult to understand if the debris is produced by collisional cascades, as it is for most debris disks. It is possible that the debris in these two systems arises in part from condensates from silicate-rich vapor produced in a series of violent collisions among relatively large bodies. If their evolution is rapid, the rate of detection of extreme excesses would indicate that major collisions may be relatively common in this age range.

Intramuscular vascular malformations of an extremity: findings on MR imaging and pathologic correlation

International Nuclear Information System (INIS)

Kim, E.Y.; Ahn, J.M.; Yoon, H.K.; Do, Y.S.; Kim, S.H.; Choo, S.W.; Choo, I.W.; Suh, Y.L.; Kim, S.M.; Kang, H.S.

1999-01-01

Objective. To analyze the findings of intramuscular vascular malformations of an extremity on MR imaging and to correlate these findings with histopathologic examination.Design and patients. The findings on MR imaging and the medical records of 14 patients with an intramuscular vascular malformation of the extremity were retrospectively studied. All patients underwent surgical excision. Diagnoses were based on the results of pathologic examination. Findings on MR imaging were noted and correlated with the histopathologic findings.Results. Intramuscular vascular malformations of an extremity showed multi-septate, honeycomb, or mixed appearance on MR imaging. Multi-septate areas correlated with dilated and communicating vascular spaces with flattened endothelium. Honeycomb areas corresponded to vascular spaces with inconspicuous small lumina and thickened vascular walls. Areas of increased signal intensity on T2-weighted images were found in all intramuscular vascular malformations. Infiltrative margins were more commonly seen in intramuscular lymphaticovenous malformations. Adherence to neurovascular structures and orientation of the lesion along the long axis of the affected muscle were more commonly seen in intramuscular venous malformations.Conclusions. Intramuscular vascular malformations showed either a multi-septate, honeycomb, or mixed appearance, reflecting the size of the vascular spaces and the thickness of the smooth muscles of the vessel walls. Prediction of the subtype of an intramuscular vascular malformation of an extremity on MR imaging seems to be difficult, although there are associated findings that may be helpful in the differential diagnosis of each subtype. (orig.)

An influence of extremal edges on boundary extension.

Science.gov (United States)

Hale, Ralph G; Brown, James M; McDunn, Benjamin A; Siddiqui, Aisha P

2015-08-01

Studies have shown that people consistently remember seeing more of a studied scene than was physically present (e.g., Intraub & Richardson Journal of Experimental Psychology: Learning, Memory, and Cognition, 15, 179-187, 1989). This scene memory error, known as boundary extension, has been suggested to occur due to an observer's failure to differentiate between the contributing sources of information, including the sensory input, amodal continuation beyond the view boundaries, and contextual associations with the main objects and depicted scene locations (Intraub, 2010). Here, "scenes" made of abstract shapes on random-dot backgrounds, previously shown to elicit boundary extension (McDunn, Siddiqui, & Brown Psychonomic Bulletin & Review, 21, 370-375, 2014), were compared with versions made with extremal edges (Palmer & Ghose Psychological Science, 19, 77-84, 2008) added to their borders, in order to examine how boundary extension is influenced when amodal continuation at the borders' view boundaries is manipulated in this way. Extremal edges were expected to reduce boundary extension as compared to the same scenes without them, because extremal edge boundaries explicitly indicate an image's end (i.e., they do not continue past the view boundary). A large and a small difference (16 % and 40 %) between the close and wide-angle views shown during the experiment were tested to examine the effects of both boundary extension and normalization with and without extremal edges. Images without extremal edges elicited typical boundary extension for the 16 % size change condition, whereas the 40 % condition showed signs of normalization. With extremal edges, a reduced amount of boundary extension occurred for the 16 % condition, and only normalization was found for the 40 % condition. Our findings support and highlight the importance of amodal continuation at the view boundaries as a component of boundary extension.

Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures.

Science.gov (United States)

Heinrich, Sebastian; Birkholz, Torsten; Ihmsen, Harald; Irouschek, Andrea; Ackermann, Andreas; Schmidt, Joachim

2012-08-01

Difficult laryngoscopy in pediatric patients undergoing anesthesia. This retrospective analysis was conducted to investigate incidence and predictors of difficult laryngoscopy in a large cohort of pediatric patients receiving general anesthesia with endotracheal intubation. Young age and craniofacial dysmorphy are predictors for the difficult pediatric airway and difficult laryngoscopy. For difficult laryngoscopy, other general predictors are not yet described. Retrospectively, from a 5-year period, data from 11.219 general anesthesia procedures in pediatric patients with endotracheal intubation using age-adapted Macintosh blades in a single center (university hospital) were analyzed statistically. The overall incidence of difficult laryngoscopy [Cormack and Lehane (CML) grade III and IV] was 1.35%. In patients younger than 1 year, the incidence of CML III or IV was significantly higher than in the older patients (4.7% vs 0.7%). ASA Physical Status III and IV, a higher Mallampati Score (III and IV) and a low BMI were all associated (P pediatric anesthesia is lower than in adults. Our results show that the risk of difficult laryngoscopy is much higher in patients below 1 year of age, in underweight patients and in ASA III and IV patients. The underlying disease might also contribute to the risk. If the Mallampati score could be obtained, prediction of difficult laryngoscopy seems to be reliable. Our data support the existing recommendations for a specialized anesthesiological team to provide safe anesthesia for infants and neonates. © 2012 Blackwell Publishing Ltd.

The New HARSHAW Extremity Dosimeters for Gamma and Beta Ray Monitoring

International Nuclear Information System (INIS)

Fellinger, J.; Majewski, M.; Rotunda, J.; Tawi, R.

1997-01-01

Large personnel dosimetry services providing extremity monitoring with finger rings based on thermoluminescent detectors have long been looking for a practical method for automated reading including automated identification of the detectors.All existing methods are at least not very suitable for medical applications, particularly for surgery, due to the fact that cold sterilization is usually impossible.Bicron radiation Measurement Products developed in co-operation with the Austrian Research Centre Seibersdorf a new finger ring dosimeter DXT-RAD as a fast and economic solution for fully automated evaluation of extremity dosemeters. (authors)

Arterial trauma of the extremities. An Ivorian surgical experience ...

African Journals Online (AJOL)

... clinical and surgical experience of the arterial injuries of extremities for 23 years(1977 to ... Their case files have been reviewed and forms the subject of this study ... due to reperfusion injury (1 case) and biliary peritonitis(1 case). Conclusion Arterial injury is a true surgical emergencies and repair should be urgent to avoid ...

The analysis of dependence between extreme rainfall and storm surge in the coastal zone

Science.gov (United States)

Zheng, F.; Westra, S.

2012-12-01

Flooding in coastal catchments can be caused by runoff generated by an extreme rainfall event, elevated sea levels due to an extreme storm surge event, or the combination of both processes occurring simultaneously or in close succession. Dependence in extreme rainfall and storm surge arises because common meteorological forcings often drive both variables; for example, cyclonic systems may produce extreme rainfall, strong onshore winds and an inverse barometric effect simultaneously, which the former factor influencing catchment discharge and the latter two factors influencing storm surge. Nevertheless there is also the possibility that only one of the variables is extreme at any given time, so that the dependence between rainfall and storm surge is not perfect. Quantification of the strength of dependence between these processes is critical in evaluating the magnitude of flood risk in the coastal zone. This may become more important in the future as the majority of the coastal areas are threatened by the sea level rise due to the climate change. This research uses the most comprehensive record of rainfall and storm surge along the coastline of Australia collected to-date to investigate the strength of dependence between the extreme rainfall and storm surge along the Australia coastline. A bivariate logistic threshold-excess model was employed to this end to carry out the dependence analysis. The strength of the estimated dependence is then evaluated as a function of several factors including: the distance between the tidal gauge and the rain gauge; the lag between the extreme precipitation event and extreme surge event; and the duration of the maximum storm burst. The results show that the dependence between the extreme rainfall and storm surge along the Australia coastline is statistically significant, although some locations clearly exhibit stronger dependence than others. We hypothesize that this is due to a combination of large-scale meteorological effects as

Extreme Drought Events Revealed in Amazon Tree Ring Records

Science.gov (United States)

Jenkins, H. S.; Baker, P. A.; Guilderson, T. P.

2010-12-01

The Amazon basin is a center of deep atmospheric convection and thus acts as a major engine for global hydrologic circulation. Yet despite its significance, a full understanding of Amazon rainfall variability remains elusive due to a poor historical record of climate. Temperate tree rings have been used extensively to reconstruct climate over the last thousand years, however less attention has been given to the application of dendrochronology in tropical regions, in large part due to a lower frequency of tree species known to produce annual rings. Here we present a tree ring record of drought extremes from the Madre de Dios region of southeastern Peru over the last 190 years. We confirm that tree ring growth in species Cedrela odorata is annual and show it to be well correlated with wet season precipitation. This correlation is used to identify extreme dry (and wet) events that have occurred in the past. We focus on drought events identified in the record as drought frequency is expected to increase over the Amazon in a warming climate. The Cedrela chronology records historic Amazon droughts of the 20th century previously identified in the literature and extends the record of drought for this region to the year 1816. Our analysis shows that there has been an increase in the frequency of extreme drought (mean recurrence interval = 5-6 years) since the turn of the 20th century and both Atlantic and Pacific sea surface temperature (SST) forcing mechanisms are implicated.

Noninvasive carcinoma ex pleomorphic adenoma of the parotid gland: A difficult diagnosis on fine needle aspiration

Directory of Open Access Journals (Sweden)

Theresa Scognamiglio

2015-01-01

Full Text Available Carcinoma ex pleomorphic adenoma (CXPA is a rare epithelial malignancy that arises from a primary or recurrent pleomorphic adenoma (PA. It may be noninvasive (NI or invasive. NI CXPA is extremely rare. Preoperative diagnosis on fine needle aspiration (FNA of CXPA may be difficult and poses a diagnostic challenge to clinicians and pathologists. Herein, we describe the FNA findings of a case of NI-CXPA. A 69-year-old woman presented with rapid enlargement of a stable parotid mass of 25 years. Cytologically, malignant cells were focally associated with metachromatic fibromyxoid matrix that was homogeneous and dense with a vague fibrillary quality. There were cell groups, papillary-like clusters and single malignant cells. The nuclei were pleomorphic with irregularly dispersed chromatin, and the cytoplasm was ill-defined and granular. Nucleoli were small to inconspicuous. Mitoses and necrosis were not seen. Cytological features were not specific for any type of salivary gland carcinoma. The FNA diagnosis was primary high-grade adenocarcinoma of the parotid gland, not otherwise specified. Facial nerve-sparing total parotidectomy was performed, which histologically showed PA interspersed with ducts and nests composed of pleomorphic atypical nuclei surrounded by extensive hyalinization. Single cells were also noted. No capsular infiltration was seen in the entirely sampled tumor. Immunohistochemistry for Ki-67 showed a higher proliferation rate in the malignant ducts and p63 positive cells focally surrounded some of the malignant ducts. Histological diagnosis was NI-CXPA. Accurate diagnosis is important for proper surgical management; however, the preoperative diagnosis of NI-CXPA is difficult to make on FNA.

Noninvasive carcinoma ex pleomorphic adenoma of the parotid gland: A difficult diagnosis on fine needle aspiration

Science.gov (United States)

Scognamiglio, Theresa; Joshi, Rohan; Kuhel, William I.; Tabbara, Sana O.; Rezaei, M. Katayoon; Hoda, Rana S.

2015-01-01

Carcinoma ex pleomorphic adenoma (CXPA) is a rare epithelial malignancy that arises from a primary or recurrent pleomorphic adenoma (PA). It may be noninvasive (NI) or invasive. NI CXPA is extremely rare. Preoperative diagnosis on fine needle aspiration (FNA) of CXPA may be difficult and poses a diagnostic challenge to clinicians and pathologists. Herein, we describe the FNA findings of a case of NI-CXPA. A 69-year-old woman presented with rapid enlargement of a stable parotid mass of 25 years. Cytologically, malignant cells were focally associated with metachromatic fibromyxoid matrix that was homogeneous and dense with a vague fibrillary quality. There were cell groups, papillary-like clusters and single malignant cells. The nuclei were pleomorphic with irregularly dispersed chromatin, and the cytoplasm was ill-defined and granular. Nucleoli were small to inconspicuous. Mitoses and necrosis were not seen. Cytological features were not specific for any type of salivary gland carcinoma. The FNA diagnosis was primary high-grade adenocarcinoma of the parotid gland, not otherwise specified. Facial nerve-sparing total parotidectomy was performed, which histologically showed PA interspersed with ducts and nests composed of pleomorphic atypical nuclei surrounded by extensive hyalinization. Single cells were also noted. No capsular infiltration was seen in the entirely sampled tumor. Immunohistochemistry for Ki-67 showed a higher proliferation rate in the malignant ducts and p63 positive cells focally surrounded some of the malignant ducts. Histological diagnosis was NI-CXPA. Accurate diagnosis is important for proper surgical management; however, the preoperative diagnosis of NI-CXPA is difficult to make on FNA. PMID:25972908

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.

Trends in the number of extreme hot SST days along the Canary Upwelling System due to the influence of upwelling

Directory of Open Access Journals (Sweden)

Xurxo Costoya

2014-07-01

Full Text Available Trends in the number of extreme hot days (days with SST anomalies higher than the 95% percentile were analyzed along the Canary Upwelling Ecosystem (CUE over the period 1982- 2012 by means of SST data retrieved from NOAA OI1/4 Degree. The analysis will focus on the Atlantic Iberian sector and the Moroccan sub- region where upwelling is seasonal (spring and summer are permanent, respectively. Trends were analyzed both near coast and at the adjacent ocean where the increase in the number of extreme hot days is higher. Changes are clear at annual scale with an increment of 9.8±0.3 (9.7±0.1 days dec-1 near coast and 11.6±0.2 (13.5±0.1 days dec-1 at the ocean in the Atlantic Iberian sector (Moroccan sub-region. The differences between near shore and ocean trends are especially patent for the months under intense upwelling conditions. During that upwelling season the highest differences in the excess of extreme hot days between coastal and ocean locations (Δn(#days dec-1 occur at those regions where coastal upwelling increase is high. Actually, Δn and upwelling trends have shown to be significantly correlated in both areas, R=0.88 (p<0.01 at the Atlantic Iberian sector and R=0.67 (p<0.01 at the Moroccan sub-region.

Predicting extreme rainfall over eastern Asia by using complex networks

International Nuclear Information System (INIS)

He Su-Hong; Gong Yan-Chun; Huang Yan-Hua; Wu Cheng-Guo; Feng Tai-Chen; Gong Zhi-Qiang

2014-01-01

A climate network of extreme rainfall over eastern Asia is constructed for the period of 1971–2000, employing the tools of complex networks and a measure of nonlinear correlation called event synchronization (ES). Using this network, we predict the extreme rainfall for several cases without delay and with n-day delay (1 ≤ n ≤ 10). The prediction accuracy can reach 58% without delay, 21% with 1-day delay, and 12% with n-day delay (2 ≤ n ≤ 10). The results reveal that the prediction accuracy is low in years of a weak east Asia summer monsoon (EASM) or 1 year later and high in years of a strong EASM or 1 year later. Furthermore, the prediction accuracy is higher due to the many more links that represent correlations between different grid points and a higher extreme rainfall rate during strong EASM years. (geophysics, astronomy, and astrophysics)

[Chonic diarrhea and malabsorption due to common variable immunodeficiency, gastrectomy and giardiasis infection: a difficult nutritional management].

Science.gov (United States)

Domínguez-López, M E; González-molero, I; Ramírez-Plaza, C P; Soriguer, F; Olveira, G

2011-01-01

Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas.

Science.gov (United States)

Kivelevitch, Dario; Frieder, Jillian; Watson, Ian; Paek, So Yeon; Menter, M Alan

2018-04-01

Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. Areas covered: This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. Expert opinion: Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.

Probability assessment for the incidence of extreme events due to the climatic change. Focus Germany; Berechnung der Wahrscheinlichkeiten fuer das Eintreten von Extremereignissen durch Klimaaenderungen. Schwerpunkt Deutschland

Energy Technology Data Exchange (ETDEWEB)

Jonas, Martin; Staeger, Tim; Schoenwiese, Christian-Dietrich [Frankfurt Univ. (Germany). Inst. fuer Atmosphaere und Umwelt, Arbeitsgruppe Klimaforschung

2005-08-15

The study on the probability of occurrence of extreme weather events in Germany is based on compiled data covering ground-level temperature, precipitation and wind during the time period 1901 to 2000. The data processing approach is based on two methodologies: a time-gliding extreme value analysis and a structure-oriented time-series analysis. The results show a significant increase of very hot months and at the same time a decrease of extreme cold months within the 20th century. In the time period after 1951 the probability of very high daily maximum temperatures increased for all seasons. Concerning the precipitation the increase of extreme values and higher variabilities are observed for the winter period. The results concerning the wind are not so clear. Summarizing the extreme behavior of temperature and precipitation has shown strong variations during the last century.

Global patterns of NDVI-indicated vegetation extremes and their sensitivity to climate extremes

International Nuclear Information System (INIS)

Liu Guo; Liu Hongyan; Yin Yi

2013-01-01

Extremes in climate have significant impacts on ecosystems and are expected to increase under future climate change. Extremes in vegetation could capture such impacts and indicate the vulnerability of ecosystems, but currently have not received a global long-term assessment. In this study, a robust method has been developed to detect significant extremes (low values) in biweekly time series of global normalized difference vegetation index (NDVI) from 1982 to 2006 and thus to acquire a global pattern of vegetation extreme frequency. This pattern coincides with vegetation vulnerability patterns suggested by earlier studies using different methods over different time spans, indicating a consistent mechanism of regulation. Vegetation extremes were found to aggregate in Amazonia and in the semi-arid and semi-humid regions in low and middle latitudes, while they seldom occurred in high latitudes. Among the environmental variables studied, extreme low precipitation has the highest slope against extreme vegetation. For the eight biomes analyzed, these slopes are highest in temperate broadleaf forest and temperate grassland, suggesting a higher sensitivity in these environments. The results presented here contradict the hypothesis that vegetation in water-limited semi-arid and semi-humid regions might be adapted to drought and suggest that vegetation in these regions (especially temperate broadleaf forest and temperate grassland) is highly prone to vegetation extreme events under more severe precipitation extremes. It is also suggested here that more attention be paid to precipitation-induced vegetation changes than to temperature-induced events. (letter)

Under-reported dosimetry errors due to interplay effects during VMAT dose delivery in extreme hypofractionated stereotactic radiotherapy.

Science.gov (United States)

Gauer, Tobias; Sothmann, Thilo; Blanck, Oliver; Petersen, Cordula; Werner, René

2018-06-01

Radiotherapy of extracranial metastases changed from normofractioned 3D CRT to extreme hypofractionated stereotactic treatment using VMAT beam techniques. Random interaction between tumour motion and dynamically changing beam parameters might result in underdosage of the CTV even for an appropriately dimensioned ITV (interplay effect). This study presents a clinical scenario of extreme hypofractionated stereotactic treatment and analyses the impact of interplay effects on CTV dose coverage. For a thoracic/abdominal phantom with an integrated high-resolution detector array placed on a 4D motion platform, dual-arc treatment plans with homogenous target coverage were created using a common VMAT technique and delivered in a single fraction. CTV underdosage through interplay effects was investigated by comparing dose measurements with and without tumour motion during plan delivery. Our study agrees with previous works that pointed out insignificant interplay effects on target coverage for very regular tumour motion patterns like simple sinusoidal motion. However, we identified and illustrated scenarios that are likely to result in a clinically relevant CTV underdosage. For tumour motion with abnormal variability, target coverage quantified by the CTV area receiving more than 98% of the prescribed dose decreased to 78% compared to 100% at static dose measurement. This study is further proof of considerable influence of interplay effects on VMAT dose delivery in stereotactic radiotherapy. For selected conditions of an exemplary scenario, interplay effects and related motion-induced target underdosage primarily occurred in tumour motion pattern with increased motion variability and VMAT plan delivery using complex MLC dose modulation.

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.

Traumatic oesophageal perforation due to haematoma

DEFF Research Database (Denmark)

Grønhøj Larsen, Christian; Brandt, Bodil

2014-01-01

. Three explanations postulated to be the cause for late perforation which might be due to esophageal wall ischemia from pressure built up between the hematoma, azygos vein and the lower part of thoracic trachea; or could be an immediate rupture walled-off until the patient became symptomatic......; or the intramural hematoma gradually lysed and causing late perforation. CONCLUSION: Although extremely rare, an oesophageal haematoma and late complications must be considered in patients on anti-coagulant therapy following blunt thoracic trauma and complaining only of chest pain....

Early warnings of extreme winds using the ECMWF Extreme Forecast Index

OpenAIRE

Petroliagis, Thomas I.; Pinson, Pierre

2014-01-01

The European FP7 SafeWind Project aims at developing research towards a European vision of wind power forecasting, which requires advanced meteorological support concerning extreme wind events. This study is focused mainly on early warnings of extreme winds in the early medium-range. Three synoptic stations (airports) of North Germany (Bremen, Hamburg and Hannover) were considered for the construction of time series of daily maximum wind speeds. All daily wind extremes were found to be linked...

High levels of IGF-1 predict difficult intubation of patients with acromegaly.

Science.gov (United States)

Zhang, Yu; Guo, Xiaopeng; Pei, Lijian; Zhang, Zhuhua; Tan, Gang; Xing, Bing

2017-08-01

To investigate the characteristics of difficult intubation and identify novel efficient predictors in patients with acromegaly. Patients with either untreated acromegaly or non-functional pituitary adenomas were enrolled. Patients with acromegaly underwent hormone assays, upper airway computed tomography and magnetic resonance imaging examinations and preoperative overnight polysomnography. The modified Mallampati classification, mouth opening, neck circumference, and neck extension were assessed, and the Cormack-Lehane grades and the time of tracheal intubation were recorded. Patients with acromegaly had a higher incidence of difficult intubation (62.5%). The time of tracheal intubation was prolonged, the neck circumference was enlarged, and the neck extension was confined. In patients with acromegaly and difficult intubation, the insulin-like growth factor 1 levels and apnea/hypoxia index were significantly higher compared to patients without difficult intubation (1115.40 ± 253.73 vs. 791.67 ± 206.62 ng/ml, P = 0.020; 22.17 ± 23.25 vs. 2.47 ± 2.84, P = 0.026, respectively). The bilateral regression analysis revealed that high levels of insulin-like growth factor 1 were an independent risk factor for developing difficult intubation (p = 0.042, Exp B = 1.006). The modified Mallampati classification was positively correlated with apnea/hypoxia index and could be calculated using the following logarithmic equation: MMC = 0.2982 * ln (AHI) + 2.1836. In patients with acromegaly, neck movement is confined, the time of tracheal intubation is prolonged, and the neck circumference is enlarged, and these patients suffer from an increased incidence of difficult intubation (62.5%) during anesthesia induction. The apnea/hypoxia index and insulin-like growth factor 1 levels are both increased in acromegalic patients with difficult intubation, and elevated insulin-like growth factor 1 levels are an independent risk factor of difficult

Guillain-Barré Syndrome due to CMV Reactivation after Cardiac Transplantation

Directory of Open Access Journals (Sweden)

Christina Maria Steger

2012-01-01

Full Text Available A 40-year-old male patient suffered from end-stage heart failure due to ischemic cardiomyopathy and received orthotopiccardiac transplantation in June 2005. The instantaneous postoperative course was uneventful, but, seven months later, he suffered from paralysis in the lower extremities finally resulting in quadriplegia and was admitted to hospital. After laboratory testings the diagnosis of a Guillain-Barré syndrome due to cytomegalovirus reactivation was confirmed.

Extreme-Scale Bayesian Inference for Uncertainty Quantification of Complex Simulations

Energy Technology Data Exchange (ETDEWEB)

Biros, George [Univ. of Texas, Austin, TX (United States)

2018-01-12

Uncertainty quantification (UQ)—that is, quantifying uncertainties in complex mathematical models and their large-scale computational implementations—is widely viewed as one of the outstanding challenges facing the field of CS&E over the coming decade. The EUREKA project set to address the most difficult class of UQ problems: those for which both the underlying PDE model as well as the uncertain parameters are of extreme scale. In the project we worked on these extreme-scale challenges in the following four areas: 1. Scalable parallel algorithms for sampling and characterizing the posterior distribution that exploit the structure of the underlying PDEs and parameter-to-observable map. These include structure-exploiting versions of the randomized maximum likelihood method, which aims to overcome the intractability of employing conventional MCMC methods for solving extreme-scale Bayesian inversion problems by appealing to and adapting ideas from large-scale PDE-constrained optimization, which have been very successful at exploring high-dimensional spaces. 2. Scalable parallel algorithms for construction of prior and likelihood functions based on learning methods and non-parametric density estimation. Constructing problem-specific priors remains a critical challenge in Bayesian inference, and more so in high dimensions. Another challenge is construction of likelihood functions that capture unmodeled couplings between observations and parameters. We will create parallel algorithms for non-parametric density estimation using high dimensional N-body methods and combine them with supervised learning techniques for the construction of priors and likelihood functions. 3. Bayesian inadequacy models, which augment physics models with stochastic models that represent their imperfections. The success of the Bayesian inference framework depends on the ability to represent the uncertainty due to imperfections of the mathematical model of the phenomena of interest. This is a

Preoperative Ultrasonography as a Predictor of Difficult ...

African Journals Online (AJOL)

patient.[8]. On the basis of ultrasound findings, surgeons can select the cases appropriate for their skills aiming at reducing operative complications and minimizing the waste of operative time.[2]. Based on ... bed-more than 20 min. 4. Spillage of bile and ... gallbladder turned out to be difficult laparoscopically. The positive ...

Extreme value analysis of meterological parameters observed at Narora during the period 1989-2001

International Nuclear Information System (INIS)

Varakhedkar, V.K.; Dube, B.; Gurg, R.P.

2002-08-01

The design of engineering structures requires an understanding of extreme weather conditions that may occur at the site of interest, which is very essential, so that the structures can be designed to withstand weather stresses. In this report an analysis of extreme values of meteorological parameters observed at Narora for the period 1989- 2001 is described. The parameters considered are maximum and minimum air temperature, minimum relative humidity, maximum wind speed, maximum rainfall in a day and month, and annual rainfall. The extreme value analysis reveals that the variables such as annual maximum air temperature, minimum relative humidity and monthly maximum rainfall obey Fisher -Tippet Type -I extreme value distribution where as annual minimum air temperature, maximum hourly wind speed, daily maximum rainfall and maximum and minimum annual rainfall, obey Fisher -Tippet Type -2 extreme value distribution function. Various distribution function parameters for each variable are determined. Extreme values corresponding to return periods of 50 years and 100 years are worked out. These derived extreme values are particularly useful for arriving at suitable design values to ensure the safety of any civil structure in Narora area with respect to stresses due to weather conditions. (author)

Observation and nursing of complications due to high re-perfusion injury occurring after balloon angioplasty for diabetic vascular diseases of lower extremity

International Nuclear Information System (INIS)

Zhang Lingling; Zhu Yueqi; Mou Ling

2011-01-01

Objective: To evaluate the symptomatic nursing in treating the complications caused by high re-perfusion which develops after balloon angioplasty for the treatment of diabetic vascular diseases of lower extremity. Methods: Eighteen patients with lower limb ischemia caused by diabetes mellitus developed high re-perfusion injury complications after receiving balloon angioplasty. The patients were randomly and equally divided into study group and control group. The special nursing measures designed by the author's department, including raising the diseased lower limb, enforcing the flexion and extension movement of the leg, cold compress, wound exposure, etc. were carried out for patients of study group, while no special nursing measures were adopted for patients of control group. The clinical results, such as limb pain, swelling and subcutaneous petechia after re-perfusion injury, were evaluated and compared between two groups. Results: After the treatment, the limb pain, swelling and subcutaneous petechia due to high re-perfusion injury in study group were relieved more markedly than that in control group, the difference in evaluation score between two groups was statistically significant (P<0.01). Conclusion: The special symptomatic nursing measures are very effective in relieving the high re-perfusion injury after balloon angioplasty for the treatment of diabetic lower limb ischemia. (authors)

Extreme oceanographic forcing and coastal response due to the 2015-2016 El Niño.

Science.gov (United States)

Barnard, Patrick L; Hoover, Daniel; Hubbard, David M; Snyder, Alex; Ludka, Bonnie C; Allan, Jonathan; Kaminsky, George M; Ruggiero, Peter; Gallien, Timu W; Gabel, Laura; McCandless, Diana; Weiner, Heather M; Cohn, Nicholas; Anderson, Dylan L; Serafin, Katherine A

2017-02-14

The El Niño-Southern Oscillation is the dominant mode of interannual climate variability across the Pacific Ocean basin, with influence on the global climate. The two end members of the cycle, El Niño and La Niña, force anomalous oceanographic conditions and coastal response along the Pacific margin, exposing many heavily populated regions to increased coastal flooding and erosion hazards. However, a quantitative record of coastal impacts is spatially limited and temporally restricted to only the most recent events. Here we report on the oceanographic forcing and coastal response of the 2015-2016 El Niño, one of the strongest of the last 145 years. We show that winter wave energy equalled or exceeded measured historical maxima across the US West Coast, corresponding to anomalously large beach erosion across the region. Shorelines in many areas retreated beyond previously measured landward extremes, particularly along the sediment-starved California coast.

Data-based perfect-deficit approach to understanding climate extremes and forest carbon assimilation capacity

International Nuclear Information System (INIS)

Wei, Suhua; Yi, Chuixiang; Hendrey, George; Eaton, Timothy; Rustic, Gerald; Wang, Shaoqiang; Liu, Heping; Krakauer, Nir Y; Wang, Weiguo; Desai, Ankur R; Montagnani, Leonardo; Tha Paw U, Kyaw; Falk, Matthias; Black, Andrew; Bernhofer, Christian; Grünwald, Thomas; Laurila, Tuomas; Cescatti, Alessandro; Moors, Eddy

2014-01-01

Several lines of evidence suggest that the warming climate plays a vital role in driving certain types of extreme weather. The impact of warming and of extreme weather on forest carbon assimilation capacity is poorly known. Filling this knowledge gap is critical towards understanding the amount of carbon that forests can hold. Here, we used a perfect-deficit approach to identify forest canopy photosynthetic capacity (CPC) deficits and analyze how they correlate to climate extremes, based on observational data measured by the eddy covariance method at 27 forest sites over 146 site-years. We found that droughts severely affect the carbon assimilation capacities of evergreen broadleaf forest (EBF) and deciduous broadleaf forest. The carbon assimilation capacities of Mediterranean forests were highly sensitive to climate extremes, while marine forest climates tended to be insensitive to climate extremes. Our estimates suggest an average global reduction of forest CPC due to unfavorable climate extremes of 6.3 Pg C (∼5.2% of global gross primary production) per growing season over 2001–2010, with EBFs contributing 52% of the total reduction

Prevention of Dental Damage and Improvement of Difficult Intubation Using a Paraglossal Technique With a Straight Miller Blade

Directory of Open Access Journals (Sweden)

Yu-Feng Huang

2010-10-01

Full Text Available Patients with diseased teeth, or those who are difficult to intubate, have a higher risk of dental injury during laryngoscopy. We report 3 cases of smooth endotracheal intubation using a paraglossal technique with a straight Miller blade in patients with poor dentition. Three patients with poor dentition were scheduled to undergo surgery under general anesthesia. All patients presented with extremely loose upper central incisors and had lost the other right upper teeth, while micrognathia and prominent, loose upper incisors were noted in 1 case. We elected to use a straight Miller blade using a paraglossal approach. A nasopharyngeal airway was inserted after induction of general anesthesia to facilitate mask ventilation and prevent air leakage from the mask. The Miller blade was then inserted from the right corner of the mouth, avoiding contact with the vulnerable incisors, and advanced along the groove between the tongue and tonsil. The endotracheal tube was subsequently smoothly inserted after obtaining a grade 1 Cormack and Lehane view without dental trauma in all 3 cases. Direct laryngoscopy using the paraglossal straight blade technique avoids dental damage in patients with mobile upper incisors and no right maxillary molars. It is a practical alternative method that differs from the traditional Macintosh laryngoscope in patients with a high risk of dental injury during the procedure. This technique, which provides an improved view of the larynx, might also be helpful with patients in whom intubation is difficult.

Difficult Tracheal Intubation in Obese Gastric Bypass patients

DEFF Research Database (Denmark)

Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, J.

2016-01-01

Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess...... the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients...... was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass...

Seeking the best training model for difficult conversations in neonatology.

Science.gov (United States)

Lechner, Beatrice E; Shields, Robin; Tucker, Richard; Bender, G Jesse

2016-05-01

We hypothesize that a formal simulation curriculum prepares neonatology fellows for difficult conversations better than traditional didactics. Single-center neonatology fellowship graduates from 1999 to 2013 were sent a retrospective web-based survey. Some had been exposed to a Difficult Conversations curriculum (simulation group), others had not (no simulation group). The simulation group participated in one workshop annually, consisting of lecture, simulation, and debriefing. Scenarios were customized to year of training. Epoch comparisons were made between the simulation and no simulation groups. Self-rated baseline effectiveness at discussing difficult topics was not different. The simulation group reported more supervised family meetings and feedback after fellow-led meetings. Simulations were rated very positively. The simulation group reported increased comfort levels. Strategic pause and body positioning were specific communication skills more frequently acquired in the simulation group. In both groups, the highest ranked contributors to learning were mentor observation and clinical practice. In the simulation group, simulation and debriefing outranked didactics or other experiences. Simulation-based workshops improve communication skills in high stakes conversations. However, they do not substitute for mentor observation and experience. Establishing a structured simulation-based difficult conversations curriculum refines vital communication skills necessary for the high stakes conversations neonatologists direct in clinical practice.

Extreme meteorological conditions

International Nuclear Information System (INIS)

Altinger de Schwarzkopf, M.L.

1983-01-01

Different meteorological variables which may reach significant extreme values, such as the windspeed and, in particular, its occurrence through tornadoes and hurricanes that necesarily incide and wich must be taken into account at the time of nuclear power plants' installation, are analyzed. For this kind of study, it is necessary to determine the basic phenomenum of design. Two criteria are applied to define the basic values of design for extreme meteorological variables. The first one determines the expected extreme value: it is obtained from analyzing the recurence of the phenomenum in a convened period of time, wich may be generally of 50 years. The second one determines the extreme value of low probability, taking into account the nuclear power plant's operating life -f.ex. 25 years- and considering, during said lapse, the occurrence probabilities of extreme meteorological phenomena. The values may be determined either by the deterministic method, which is based on the acknowledgement of the fundamental physical characteristics of the phenomena or by the probabilistic method, that aims to the analysis of historical statistical data. Brief comments are made on the subject in relation to the Argentine Republic area. (R.J.S.) [es

Ileocolic intussusception due to a cecal endometriosis: Case report and review of literature

Directory of Open Access Journals (Sweden)

Emmanuel Rivkine

2012-06-01

Full Text Available Abstract Cecal endometriosis and ileocolic intussusception due to a cecal endometriosis is extremely rare. We report a case of a woman who presented an ileocecal intussusception due to a cecal endometriosis. The patient gave two months history of chronic periombilical pain requiring regular hospital admission and analgesia. The symptoms were not related to menses. A laparotomy was performed and revealed an ileocolic intussusception. The abdominal exploration did not find any endometriosis lesion. Ileocaecal resection was performed. Microscopic examination showed a cystic component, lined by a regular cylindric epithelium. Foci of endometrial tissu were oberved in the cecal subserosa and muscularis mucosal, with irregular endometrial glands lined by cylindric epithelium without atypia immunostained with CK7, and characteristic endometrial stroma immunostained with CD10. Cecal endometriosis and ileocolic intussusception due to a cecal endometriosis is extremely rare. Diagnose of etiology remains challenging due to the absence of clinical and radiological specific characteristics. Virtual slide The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2975867306869166

Extreme hypertriglyceridemia, pseudohyponatremia, and pseudoacidosis in a neonate with lipoprotein lipase deficiency due to segmental uniparental disomy.

Science.gov (United States)

Ashraf, Ambika P; Hurst, Anna C E; Garg, Abhimanyu

Extreme hypertriglyceridemia is rare in the neonatal period. We report a neonate with lipoprotein lipase (LPL) deficiency who presented with diagnostic and management conundrum. A full-term 36-day-old female was noted to have "Pepto-Bismol like" blood when repeating a newborn screening. The initial plasma triglyceride level was 24,318 mg/dL. The laboratory tests revealed serum bicarbonate level of severe anemia. There were no signs of acute distress. The point of care capillary blood testing, however, demonstrated normal serum pH (7.2), bicarbonate (25.4 mmol/L), and sodium (139 mmol/L). The patient had mild elevation of serum lactic acid and no ketonuria. A diagnosis of type I hyperlipoproteinemia was made. Oral feeding was stopped, and the infant received intravenous fluids for the next 7 days resulting in lowering of serum triglyceride levels to 1016 mg/dL. Oral feeding was initiated with an amino acid-rich formula to which medium chain triglycerides were slowly added, while maintaining the total fat content to A, p.(Gly215Glu) mutation. Subsequent analysis of the parental samples revealed that only the father, but not the mother, was a heterozygous carrier of the same mutation. Analysis of 18 informative microsatellite markers on chromosome 8 revealed paternal segmental uniparental disomy with partial absence of the maternal chromosome 8p, confirmed by single-nucleotide polymorphism microarray. We conclude that besides pseudohyponatremia, extreme hypertriglyceridemia can rarely present as pseudoacidosis and uniparental disomy can be an underlying mechanism for autosomal recessive diseases such as LPL deficiency. Published by Elsevier Inc.

Difficult intubation: are you prepared for it?

Science.gov (United States)

Balcom, C

1994-01-01

The endotracheal intubation of a patient for surgery requires an anaesthetist who is aided by a skilled and experienced helper. This paper explores reasons why some patients are difficult to intubate. Some are predictable on pre-operative assessment and others are not. Suggestions are given on how the helper is useful to the anaesthetist in this potentially critical situation.

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A ...

African Journals Online (AJOL)

Pujahari[2] [Table 1]. The scores were added up to get a total score and the patients were divided into categories of risks based on the total score [Table 2]. The following operative parameters ... The timing was noted from the first port site incision till the last ports closure. ..... Dhanke PS, Vgane SP. Factors predicting difficult ...

Early warnings of extreme winds using the ECMWF Extreme Forecast Index

DEFF Research Database (Denmark)

Petroliagis, Thomas I.; Pinson, Pierre

2014-01-01

The European FP7 SafeWind Project aims at developing research towards a European vision of wind power forecasting, which requires advanced meteorological support concerning extreme wind events. This study is focused mainly on early warnings of extreme winds in the early medium-range. Three synoptic...... regimes. Overall, it becomes clear that the first indications of an extreme wind event might come from the ECMWF deterministic and/or probabilistic components capturing very intense weather systems (possible windstorms) in the medium term. For early warnings, all available EPS Extreme Forecast Index (EFI......) formulations were used, by linking daily maximum wind speeds to EFI values for different forecast horizons. From all possible EFI schemes deployed for issuing early warnings, the highest skill was found for the Gust Factor formulation (EFI-10FGI). Using EFI-10FGI, the corresponding 99% threshold could provide...

Defining difficult laryngoscopy findings by using multiple parameters: A machine learning approach

Directory of Open Access Journals (Sweden)

Moustafa Abdelaziz Moustafa

2017-04-01

Conclusion: “Alex Difficult Laryngoscopy Software” (ADLS is a machine learning program for prediction of difficult laryngoscopy. New cases can be entered to the training set thus improving the accuracy of the software.

Difficult Sudoku Puzzles Created by Replica Exchange Monte Carlo Method

OpenAIRE

Watanabe, Hiroshi

2013-01-01

An algorithm to create difficult Sudoku puzzles is proposed. An Ising spin-glass like Hamiltonian describing difficulty of puzzles is defined, and difficult puzzles are created by minimizing the energy of the Hamiltonian. We adopt the replica exchange Monte Carlo method with simultaneous temperature adjustments to search lower energy states efficiently, and we succeed in creating a puzzle which is the world hardest ever created in our definition, to our best knowledge. (Added on Mar. 11, the ...

Optimization with Extremal Dynamics

International Nuclear Information System (INIS)

Boettcher, Stefan; Percus, Allon G.

2001-01-01

We explore a new general-purpose heuristic for finding high-quality solutions to hard discrete optimization problems. The method, called extremal optimization, is inspired by self-organized criticality, a concept introduced to describe emergent complexity in physical systems. Extremal optimization successively updates extremely undesirable variables of a single suboptimal solution, assigning them new, random values. Large fluctuations ensue, efficiently exploring many local optima. We use extremal optimization to elucidate the phase transition in the 3-coloring problem, and we provide independent confirmation of previously reported extrapolations for the ground-state energy of ±J spin glasses in d=3 and 4

Regional anesthesia in difficult airway: The quest for a solution continues.

Science.gov (United States)

Khetarpal, Ranjana; Chatrath, Veena; Dhawan, Akshay; Attri, Joginder Pal

2016-01-01

Difficult airway, a scenario with potentially life threatening outcome, is routinely encountered by an anesthesiologist leaving him with the dilemma of whether to use regional anesthesia (RA) or general anesthesia. Our study aims to look into this problem. The literature search was performed in the Google, PubMed, and Medscape using key words "regional anesthesia, difficult airway, pregnancy, ventilation, intubation, epidural anesthesia, nerve blocks." More than 38 free full articles and books published from the year 1987 to 2014 were retrieved and studied. At first sight, RA may appear to offer an ideal solution as it helps to avoid the problem of difficult airway. However, the possibility of a total spinal block, failed or incomplete RA, local anesthetic toxicity or unforeseen surgical complication may make it imperative that the airway is secured. The correct decision can only be made by the anesthetist when all the relevant clinical information is taken into account. It is also important to ensure that before considering RA in a patient of difficult airway, an anesthesiologist must have a preformulated strategy for intubation.

Performance of High Temperature Operational Amplifier, Type LM2904WH, under Extreme Temperatures

Science.gov (United States)

Patterson, Richard; Hammoud, Ahmad; Elbuluk, Malik

2008-01-01

Operation of electronic parts and circuits under extreme temperatures is anticipated in NASA space exploration missions as well as terrestrial applications. Exposure of electronics to extreme temperatures and wide-range thermal swings greatly affects their performance via induced changes in the semiconductor material properties, packaging and interconnects, or due to incompatibility issues between interfaces that result from thermal expansion/contraction mismatch. Electronics that are designed to withstand operation and perform efficiently in extreme temperatures would mitigate risks for failure due to thermal stresses and, therefore, improve system reliability. In addition, they contribute to reducing system size and weight, simplifying its design, and reducing development cost through the elimination of otherwise required thermal control elements for proper ambient operation. A large DC voltage gain (100 dB) operational amplifier with a maximum junction temperature of 150 C was recently introduced by STMicroelectronics [1]. This LM2904WH chip comes in a plastic package and is designed specifically for automotive and industrial control systems. It operates from a single power supply over a wide range of voltages, and it consists of two independent, high gain, internally frequency compensated operational amplifiers. Table I shows some of the device manufacturer s specifications.

The biomechanics of upper extremity kinematic and kinetic modeling: applications to rehabilitation engineering.

Science.gov (United States)

Slavens, Brooke A; Harris, Gerald F

2008-01-01

Human motion analysis has evolved from the lower extremity to the upper extremity. Rehabilitation engineering is reliant upon three-dimensional biome-chanical models for a thorough understanding of upper body motions and forces in order to improve treatment methods, rehabilitation strategies and to prevent injury. Due to the complex nature of upper body movements, a standard biomechanical model does not exist. This paper reviews several kinematic and kinetic rehabilitation engineering models from the literature. These models may capture a single joint; multijoints such as the shoulder, elbow and wrist; or a combination of joints and an ambulatory aid, which serves as the extension of the upper arm. With advances in software and hardware, new models continuously arise due to the clinical questions at hand. When designing a biomechanical upper extremity model, several key components must be determined. These include deciding on the anatomic segments of the model, the number of markers and placement on bony landmarks, the definition of joint coordinate systems, and the description of the joint motions. It is critical to apply the proper model to further our understanding of pathologic populations.

Understanding extreme sea levels for coastal impact and adaptation analysis

Science.gov (United States)

Wahl, T.; Haigh, I. D.; Nicholls, R. J.; Arns, A.; Hinkel, J.; Dangendorf, S.; Slangen, A.

2016-12-01

Coastal impact and adaptation assessments require detailed knowledge on extreme sea levels, because increasing damage due to extreme events, such as storm surges and tropical cyclones, is one of the major consequences of sea level rise and climate change. In fact, the IPCC has highlighted in its AR4 report that "societal impacts of sea level change primarily occur via the extreme levels rather than as a direct consequence of mean sea level changes". Over the last few decades, substantial research efforts have been directed towards improved understanding of past and future mean sea level; different scenarios were developed with process-based or semi-empirical models and used for coastal impact assessments at various spatial scales to guide coastal management and adaptation efforts. The uncertainties in future sea level rise are typically accounted for by analyzing the impacts associated with a range of scenarios leading to a vertical displacement of the distribution of extreme sea-levels. And indeed most regional and global studies find little or no evidence for changes in storminess with climate change, although there is still low confidence in the results. However, and much more importantly, there is still a limited understanding of present-day extreme sea-levels which is largely ignored in most impact and adaptation analyses. The two key uncertainties stem from: (1) numerical models that are used to generate long time series of extreme sea-levels. The bias of these models varies spatially and can reach values much larger than the expected sea level rise; but it can be accounted for in most regions making use of in-situ measurements; (2) Statistical models used for determining present-day extreme sea-level exceedance probabilities. There is no universally accepted approach to obtain such values for flood risk assessments and while substantial research has explored inter-model uncertainties for mean sea level, we explore here, for the first time, inter

Human due diligence.

Science.gov (United States)

Harding, David; Rouse, Ted

2007-04-01

Most companies do a thorough job of financial due diligence when they acquire other companies. But all too often, deal makers simply ignore or underestimate the significance of people issues in mergers and acquisitions. The consequences are severe. Most obviously, there's a high degree of talent loss after a deal's announcement. To make matters worse, differences in decision-making styles lead to infighting; integration stalls; and productivity declines. The good news is that human due diligence can help companies avoid these problems. Done early enough, it helps acquirers decide whether to embrace or kill a deal and determine the price they are willing to pay. It also lays the groundwork for smooth integration. When acquirers have done their homework, they can uncover capability gaps, points of friction, and differences in decision making. Even more important, they can make the critical "people" decisions-who stays, who goes, who runs the combined business, what to do with the rank and file-at the time the deal is announced or shortly thereafter. Making such decisions within the first 30 days is critical to the success of a deal. Hostile situations clearly make things more difficult, but companies can and must still do a certain amount of human due diligence to reduce the inevitable fallout from the acquisition process and smooth the integration. This article details the steps involved in conducting human due diligence. The approach is structured around answering five basic questions: Who is the cultural acquirer? What kind of organization do you want? Will the two cultures mesh? Who are the people you most want to retain? And how will rank-and-file employees react to the deal? Unless an acquiring company has answered these questions to its satisfaction, the acquisition it is making will be very likely to end badly.

Similarity and scaling laws for transient arcs in a strongly accelerating gas flow

International Nuclear Information System (INIS)

Blundell, R.E.; Fang, M.T.C.; Terrill, R.M.

1995-01-01

A high-power electric arc, such as that burning in the interrupter (usually a supersonic nozzle) of a gas-blast circuit-breaker, presents a challenging problem both to theoretical and experimental investigators. The complex non-linear nature of the governing equations and steep radial gradients of arc quantities make analytic and numerical solution of the equations extremely difficult. Experimental work is also difficult due to the extreme physical conditions encountered. It is therefore highly desirable to use similarity theory to extend the limited results available to as wide a variety of arcing conditions as possible

From Drought to Flood: Biological Responses of Large River Salmonids and Emergent Management Challenges Under California's Extreme Hydroclimatic Variability

Science.gov (United States)

Anderson, C.

2017-12-01

California's hydroclimatic regime is characterized by extreme interannual variability including periodic, multi-year droughts and winter flooding sequences. Statewide, water years 2012-2016 were characterized by extreme drought followed by likely one of the wettest years on record in water year 2017. Similar drought-flood patterns have occurred multiple times both in the contemporary empirical record and reconstructed climate records. Both the extreme magnitude and rapid succession of these hydroclimatic periods pose difficult challenges for water managers and regulatory agencies responsible for providing instream flows to protect and recover threatened and endangered fish species. Principal among these riverine fish species are federally listed winter-run and spring-run Chinook salmon (Oncorhynchus tshawytscha), Central Valley steelhead (Oncorhynchus mykiss), and the pelagic species Delta smelt (Hypomesus transpacificus). Poor instream conditions from 2012-2016 resulted in extremely low abundance estimates and poor overall fish health, and while fish monitoring results from water year 2017 are too preliminary to draw substantive conclusions, early indicators show continued downward population trends despite the historically wet conditions. This poster evaluates California's hydroclimatic conditions over the past decade and quantifies resultant impacts of the 2012-2016 drought and the extremely wet 2017 water year to both adult escapement and juvenile production estimates in California's major inland salmon rivers over that same time span. We will also examine local, state, and federal regulatory actions both in response to the extreme hydroclimatic variability and in preparation for future drought-flood sequences.

Control of extreme events in the bubbling onset of wave turbulence.

Science.gov (United States)

Galuzio, P P; Viana, R L; Lopes, S R

2014-04-01

We show the existence of an intermittent transition from temporal chaos to turbulence in a spatially extended dynamical system, namely, the forced and damped one-dimensional nonlinear Schrödinger equation. For some values of the forcing parameter, the system dynamics intermittently switches between ordered states and turbulent states, which may be seen as extreme events in some contexts. In a Fourier phase space, the intermittency takes place due to the loss of transversal stability of unstable periodic orbits embedded in a low-dimensional subspace. We mapped these transversely unstable regions and perturbed the system in order to significantly reduce the occurrence of extreme events of turbulence.

Extremity fractures associated with ATVs and dirt bikes: a 10-year national epidemiologic study.

Science.gov (United States)

Lombardo, D J; Jelsema, T; Gambone, A; Weisman, M; Petersen-Fitts, G; Whaley, J D; Sabesan, V J

2017-08-01

Morbidity and mortality of all-terrain vehicles and dirt bikes have been studied, as well as the association of helmet use and head injury. The purpose of this study is to compare and contrast the patterns of extremity fractures associated with ATVs and dirt bikes. We believe there will be unique and potentially preventable injury patterns associated with dirt bikes and three-wheeled ATVs due to the poor stability of these vehicles. Descriptive epidemiology study. The National Electronic Injury Surveillance System (NEISS) was used to acquire data for extremity fractures related to ATV (three wheels, four wheels, and number of wheels undefined) and dirt bike use from 2007 to 2012. Nationwide estimation of injury incidence was determined using NEISS weight calculations. The database yielded an estimate of 229,362 extremity fractures from 2007 to 2012. The incidence rates of extremity fractures associated with ATV and dirt bike use were 3.87 and 6.85 per 1000 participant-years. The largest proportion of all fractures occurred in the shoulder (27.2%), followed by the wrist and lower leg (13.8 and 12.4%, respectively). There were no differences in the distribution of the location of fractures among four-wheeled or unspecified ATVs. However, three-wheeled ATVs and dirt bikes had much larger proportion of lower leg, foot, and ankle fractures compared to the other vehicle types. While upper extremity fractures were the most commonly observed in this database, three-wheeled ATVs and dirt bikes showed increased proportions of lower extremity fractures. Several organizations have previously advocated for better regulation of the sale and use of these specific vehicles due to increased risks. These findings help illustrate some of the specific risks associated with these commonly used vehicles.

Endotypes of difficult-to-control asthma in inner-city African American children.

Directory of Open Access Journals (Sweden)

K R Brown

Full Text Available African Americans have higher rates of asthma prevalence, morbidity, and mortality in comparison with other racial groups. We sought to characterize endotypes of childhood asthma severity in African American patients in an inner-city pediatric asthma population. Baseline blood neutrophils, blood eosinophils, and 38 serum cytokine levels were measured in a sample of 235 asthmatic children (6-17 years enrolled in the NIAID (National Institute of Allergy and Infectious Diseases-sponsored Asthma Phenotypes in the Inner City (APIC study (ICAC (Inner City Asthma Consortium-19. Cytokines were quantified using a MILLIPLEX panel and analyzed on a Luminex analyzer. Patients were classified as Easy-to-Control or Difficult-to-Control based on the required dose of controller medications over one year of prospective management. A multivariate variable selection procedure was used to select cytokines associated with Difficult-to-Control versus Easy-to-Control asthma, adjusting for age, sex, blood eosinophils, and blood neutrophils. In inner-city African American children, 12 cytokines were significant predictors of Difficult-to-Control asthma (n = 235. CXCL-1, IL-5, IL-8, and IL-17A were positively associated with Difficult-to-Control asthma, while IL-4 and IL-13 were positively associated with Easy-to-Control asthma. Using likelihood ratio testing, it was observed that in addition to blood eosinophils and neutrophils, serum cytokines improved the fit of the model. In an inner-city pediatric population, serum cytokines significantly contributed to the definition of Difficult-to-Control asthma endotypes in African American children. Mixed responses characterized by TH2 (IL-5 and TH17-associated cytokines were associated with Difficult-to-Control asthma. Collectively, these data may contribute to risk stratification of Difficult-to-Control asthma in the African American population.

Long-term reactions of plants and macroinvertebrates to extreme floods in floodplain grasslands.

Science.gov (United States)

Ilg, Christiane; Dziock, Frank; Foeckler, Francis; Follner, Klaus; Gerisch, Michael; Glaeser, Judith; Rink, Anke; Schanowski, Arno; Scholz, Mathias; Deichner, Oskar; Henle, Klaus

2008-09-01

Extreme summertime flood events are expected to become more frequent in European rivers due to climate change. In temperate areas, where winter floods are common, extreme floods occurring in summer, a period of high physiological activity, may seriously impact floodplain ecosystems. Here we report on the effects of the 2002 extreme summer flood on flora and fauna of the riverine grasslands of the Middle Elbe (Germany), comparing pre- and post-flooding data collected by identical methods. Plants, mollusks, and carabid beetles differed considerably in their response in terms of abundance and diversity. Plants and mollusks, displaying morphological and behavioral adaptations to flooding, showed higher survival rates than the carabid beetles, the adaptation strategies of which were mainly linked to life history. Our results illustrate the complexity of responses of floodplain organisms to extreme flood events. They demonstrate that the efficiency of resistance and resilience strategies is widely dependent on the mode of adaptation.

Detecting impacts of extreme events with ecological in situ monitoring networks

Directory of Open Access Journals (Sweden)

M. D. Mahecha

2017-09-01

Full Text Available Extreme hydrometeorological conditions typically impact ecophysiological processes on land. Satellite-based observations of the terrestrial biosphere provide an important reference for detecting and describing the spatiotemporal development of such events. However, in-depth investigations of ecological processes during extreme events require additional in situ observations. The question is whether the density of existing ecological in situ networks is sufficient for analysing the impact of extreme events, and what are expected event detection rates of ecological in situ networks of a given size. To assess these issues, we build a baseline of extreme reductions in the fraction of absorbed photosynthetically active radiation (FAPAR, identified by a new event detection method tailored to identify extremes of regional relevance. We then investigate the event detection success rates of hypothetical networks of varying sizes. Our results show that large extremes can be reliably detected with relatively small networks, but also reveal a linear decay of detection probabilities towards smaller extreme events in log–log space. For instance, networks with  ≈  100 randomly placed sites in Europe yield a  ≥  90 % chance of detecting the eight largest (typically very large extreme events; but only a  ≥  50 % chance of capturing the 39 largest events. These findings are consistent with probability-theoretic considerations, but the slopes of the decay rates deviate due to temporal autocorrelation and the exact implementation of the extreme event detection algorithm. Using the examples of AmeriFlux and NEON, we then investigate to what degree ecological in situ networks can capture extreme events of a given size. Consistent with our theoretical considerations, we find that today's systematically designed networks (i.e. NEON reliably detect the largest extremes, but that the extreme event detection rates are not higher than would

Coastal Flooding Hazards due to storm surges and subsidence

DEFF Research Database (Denmark)

Sørensen, Carlo; Knudsen, Per; Andersen, Ole B.

Flooding hazard and risk mapping are major topics in low-lying coastal areas before even considering the adverse effects of sea level rise (SLR) due to climate change. While permanent inundation may be a prevalent issue, more often floods related to extreme events (storm surges) have the largest...... damage potential.Challenges are amplified in some areas due to subsidence from natural and/or anthropogenic causes. Subsidence of even a few mm/y may over time greatly impair the safety against flooding of coastal communities and must be accounted for in order to accomplish the economically most viable...

Ideologies and Discourses: Extreme Narratives in Extreme Metal Music

Directory of Open Access Journals (Sweden)

Bojana Radovanović

2016-10-01

Full Text Available Historically speaking, metal music has always been about provoking a strong reaction. Depending on the characteristics of different sub-genres, one can focus on the sound, technique, visual appearance, and furthermore, the ideologies and ideas that are the foundation for each of the sub-genres. Although the majority of the metal community rejects accusations of being racially intolerant, some ideologies of extreme sub-genres (such as black metal are in fact formed around the ideas of self-conscious elitism expressed through interest in pagan mythology, racism, Nazism and fascism. There has been much interest in the Nazi era within the extreme metal scene thus influencing other sub-genres and artists. The aim of this paper is to examine various appearances of extreme narratives such as Nazism and racism in  different sub-genres of metal, bearing in mind variations dependent on geographical, political, and other factors.

The spatial return level of aggregated hourly extreme rainfall in Peninsular Malaysia

Science.gov (United States)

Shaffie, Mardhiyyah; Eli, Annazirin; Wan Zin, Wan Zawiah; Jemain, Abdul Aziz

2015-07-01

This paper is intended to ascertain the spatial pattern of extreme rainfall distribution in Peninsular Malaysia at several short time intervals, i.e., on hourly basis. Motivation of this research is due to historical records of extreme rainfall in Peninsular Malaysia, whereby many hydrological disasters at this region occur within a short time period. The hourly periods considered are 1, 2, 3, 6, 12, and 24 h. Many previous hydrological studies dealt with daily rainfall data; thus, this study enables comparison to be made on the estimated performances between daily and hourly rainfall data analyses so as to identify the impact of extreme rainfall at a shorter time scale. Return levels based on the time aggregate considered are also computed. Parameter estimation using L-moment method for four probability distributions, namely, the generalized extreme value (GEV), generalized logistic (GLO), generalized Pareto (GPA), and Pearson type III (PE3) distributions were conducted. Aided with the L-moment diagram test and mean square error (MSE) test, GLO was found to be the most appropriate distribution to represent the extreme rainfall data. At most time intervals (10, 50, and 100 years), the spatial patterns revealed that the rainfall distribution across the peninsula differ for 1- and 24-h extreme rainfalls. The outcomes of this study would provide additional information regarding patterns of extreme rainfall in Malaysia which may not be detected when considering only a higher time scale such as daily; thus, appropriate measures for shorter time scales of extreme rainfall can be planned. The implementation of such measures would be beneficial to the authorities to reduce the impact of any disastrous natural event.

Extremal surface barriers

International Nuclear Information System (INIS)

Engelhardt, Netta; Wall, Aron C.

2014-01-01

We present a generic condition for Lorentzian manifolds to have a barrier that limits the reach of boundary-anchored extremal surfaces of arbitrary dimension. We show that any surface with nonpositive extrinsic curvature is a barrier, in the sense that extremal surfaces cannot be continuously deformed past it. Furthermore, the outermost barrier surface has nonnegative extrinsic curvature. Under certain conditions, we show that the existence of trapped surfaces implies a barrier, and conversely. In the context of AdS/CFT, these barriers imply that it is impossible to reconstruct the entire bulk using extremal surfaces. We comment on the implications for the firewall controversy

Difficult airway management of children in ambulatory anesthesia: challenges and solutions

Directory of Open Access Journals (Sweden)

Huang AS

2016-11-01

Full Text Available Andrea S Huang,1 Lindsey Rutland,2 John Hajduk,1 Narasimhan Jagannathan1,2 1Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children’s Hospital of Chicago, 2Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: As the field of pediatric ambulatory anesthesia expands, anesthesiologists can anticipate encountering an increasing number of patients with expected and unexpected difficult airways. This unique setting and patient population both present challenges in making a decision whether and how to safely proceed in the case of a child with a difficult airway. A host of patient, provider, procedure, and facility-specific factors should be considered. Providers should understand the differences between the pediatric and adult airway, recognize common features and syndromes associated with difficult airways, and be comfortable with different airway equipment and techniques available in the ambulatory setting. Early anticipation, a comprehensive patient assessment, and a clear decision-making algorithm with multiple airway management plans are all critical in safely and effectively managing these patients. These issues and recommendations will be discussed in this comprehensive narrative review. Keywords: difficult airway, pediatrics, ambulatory surgery, airway devices, children

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.

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

Science.gov (United States)

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

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. 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. 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. 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.

Braving Difficult Choices Alone: Children's and Adolescents' Medical Decision Making

Science.gov (United States)

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

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. PMID:25084274

Prototype Application of Portable Augmented Reality Technology for Enhancement of Space and Planetary Exploration

Data.gov (United States)

National Aeronautics and Space Administration — Due to a lack of atmosphere and lighting, ascertaining location and distance of features on the lunar surface is extremely difficult. Because of these issues,...

Characterization of General TCP Traffic under a Large Number of Flows Regime

National Research Council Canada - National Science Library

Tinnakornsrisuphap, Peerapol; La, Richard J; Makowski, Armand M

2002-01-01

.... Accurate traffic modeling of a large number of short-lived TCP flows is extremely difficult due to the interaction between session, transport, and network layers, and the explosion of the size...

Understanding extreme sea levels for broad-scale coastal impact and adaptation analysis

NARCIS (Netherlands)

Wahl, T.; Haigh, I.D.; Nicholls, R.J.; Arns, A.; Dangendorf, S.; Hinkel, J.; Slangen, A.B.A.

2017-01-01

One of the main consequences of mean sea level rise (SLR) on human settlements is an increase in flood risk due to an increase in the intensity and frequency of extreme sea levels (ESL). While substantial research efforts are directed towards quantifying projections and uncertainties of future

Implications of Age-Related Changes in Anatomy for Geriatric-Focused Difficult Airways

Directory of Open Access Journals (Sweden)

Shih-Yi Lee

2017-09-01

Full Text Available The structure and function surrounding the airway change by the age, which may ultimately result in having anatomic features of difficult airways in the elderly. Hence, we reviewed the literature focusing on the age-related anatomic changes and accordingly to compare the characteristics of difficult airways. With age, teeth wear and loss, protein and collagen synthesis reduction, and bone loss and muscle atrophy results in aged face (chin protrusion, cheek retraction and drooping, jaw restriction (temporo-madibular joint disc displacement and osteoarthritis, neck and back stiffness, and kyphotic deformities (degeneration of spinal articular cartilage, intervertebral discs, and spinal osteoporosis. These age-related changes in anatomy are compatible with the predictors of a difficult airway. We hope that these age-related anatomic approaches will prospectively allow a detailed understanding of the hallmarks resulting in geriatric-focused difficult airways in the future studies.

Revisiting the 1993 historical extreme precipitation and damaging flood event in Central Nepal

Science.gov (United States)

Marahatta, S.; Adhikari, L.; Pokharel, B.

2017-12-01

Nepal is ranked the fourth most climate-vulnerable country in the world and it is prone to different weather-related hazards including droughts, floods, and landslides [Wang et al., 2013; Gillies et al., 2013]. Although extremely vulnerable to extreme weather events, there are no extreme weather warning system established to inform public in Nepal. Nepal has witnessed frequent drought and flood events, however, the extreme precipitation that occurred on 19-20 July 1993 created a devastating flood and landslide making it the worst weather disaster in the history of Nepal. During the second week of July, Nepal and northern India experienced abnormal dry condition due to the shifting of the monsoon trough to central India. The dry weather changed to wet when monsoon trough moved northward towards foothills of the Himalayas. Around the same period, a low pressure center was located over the south-central Nepal. The surface low was supported by the mid-, upper-level shortwave and cyclonic vorticity. A meso-scale convective system created record breaking one day rainfall (540 mm) in the region. The torrential rain impacted the major hydropower reservoir, Bagmati barrage in Karmaiya and triggered many landslides and flash floods. The region had the largest hydropower (Kulekhani hydropower, 92 MW) of the country at that time and the storm event deposited extremely large amount of sediments that reduced one-fourth (4.8 million m3) of reservoir dead storage (12 million m3). The 1-in-1000 years flood damaged the newly constructed barrage and took more than 700 lives. Major highways were damaged cutting off supply of daily needed goods, including food and gas, in the capital city, Kathmandu, for more than a month. In this presentation, the meteorological conditions of the extreme event will be diagnosed and the impact of the sedimentation due to the flood on Kulekhani reservoir and hydropower generation will be discussed.

Das rechte Geschlecht. Geschlechterkonstruktionen in extrem rechten Medien und deren Relevanz für völkisches Denken

OpenAIRE

Wamper, Regina

2016-01-01

„The Right Gender“ For a long time, right-wing extremism - mainly due to its dimensions of violence - has been perceived as a mainly male phenomenon. It is only since the 1990s that scientific examinations have also considered gender sensitive perspectives. For a long time since then, research has mainly focused on right-wing women and their self-conceptions. With considerable delay, right-wing extremism researchers began to discuss the category of masculinity within the extreme right. A conc...

Extreme Mississippi River Floods in the Late Holocene: Reconstructions and Simulations

Science.gov (United States)

Munoz, S. E.; Giosan, L.; Donnelly, J. P.; Dee, S.

2016-12-01

Extreme flooding of the Mississippi River is costly in both economic and social terms. Despite ambitious engineering projects conceived in the early 20th century to mitigate damage from extreme floods, economic losses due to flooding have increased over recent years. Forecasting extreme flood occurrence over seasonal or longer time-scales remains a major challenge - especially in light of shifts in hydroclimatic conditions expected in response to continued greenhouse forcing. Here, we present findings from a series of paleoflood records that span the late Holocene derived from laminated sediments deposited in abandoned channels of the Mississippi River. These sedimentary archives record individual overbank floods as unique events beds with upward fining that we identify using grain-size analysis, bulk geochemistry, and radiography. We use sedimentological characteristics to reconstruct flood magnitude by calibrating our records against instrumental streamflow data from nearby gauging stations. We also use the Last Millennium Experiments of the Community Earth System Model (CESM-LME) and historical reanalysis data to examine the state of climate system around river discharge extremes. Our paleo-flood records exhibit strong non-stationarities in flood frequency and magnitude that are associated with fluctuations in the frequency of the El Niño-Southern Oscillation (ENSO), because the warm ENSO phase is associated with increased surface water storage of the lower Mississippi basin that leads to enhanced runoff delivery to the main channel. We also show that the early 20th century was a period of anomalously high flood frequency and magnitude due to the combined effects of river engineering and natural climate variability. Our findings imply that flood risk along the lower Mississippi River is tightly coupled to the frequency of ENSO, highlighting the need for robust projections of ENSO variability under greenhouse warming.

A rare case of urinary tract infection due to Trichosporonasahii in a ...

African Journals Online (AJOL)

Trichosporonasahii is a basidiomycete yeast responsible for white piedra and onychomycosis in the immunocompetent host. In the immunocompromised patients, invasive infections are reported; their diagnosis is difficult and they are associated with high mortality rate. Urinary infection due to Trichosporon Asahi is rare but ...

Stretch due to Penile Prosthesis Reservoir Migration

Directory of Open Access Journals (Sweden)

E. Baten

2016-03-01

Full Text Available A 43-year old patient presented to the emergency department with stretch, due to impossible deflation of the penile prosthesis, 4 years after successful implant. A CT-scan showed migration of the reservoir to the left rectus abdominis muscle. Refilling of the reservoir was inhibited by muscular compression, causing stretch. Removal and replacement of the reservoir was performed, after which the prosthesis was well-functioning again. Migration of the penile prosthesis reservoir is extremely rare but can cause several complications, such as stretch.

Extremity dosimetry in medical applications within Europe: an overview of doses and monitoring practices

International Nuclear Information System (INIS)

Donadille, Laurent; Carinou, E.; Ginjaume, M.; Jankowski, J.; Rimpler, A.; Sans Merce, M.; Vanhavere, F.

2008-01-01

Full text: Some activities of the EURADOS Working Group 9 (WG9) related to the radiation protection dosimetry of medical staff were funded by the European Commission in the framework of the CONRAD project, Work Package 7. The objective of WG9 was to promote and co-ordinate research activities for the assessment of occupational exposure to staff at workplaces in therapeutic and diagnostic radiology and nuclear medicine. At these workplaces, from the point of view of the individual monitoring for external radiation, the skin of the fingers is generally the limiting organ. Subgroup 1 of WG9 had as main objective the study of the use of extremity dosemeters in medical radiation fields. The wide variety of radiation field characteristics present in medicine together with the difficulties of measuring a local dose which should be representative for the maximum skin dose using one single detector, makes it difficult to perform extremity dosimetry with an accuracy similar to that of whole-body one. A recent intercomparison organised by WG9 showed that some types of dosemeters significantly underestimate or overestimate skin doses. Subgroup 1 carried out a thorough literature review on extremity dosimetry issues. It covered diagnostic and therapeutic nuclear medicine and PET, interventional radiology and cardiology, and brachytherapy. It has notably pointed out the consensus about the requirement of regular extremity dose monitoring for nuclear medicine and PET, and the great difficulty of measuring extremity doses for procedures in interventional radiology and cardiology, activities for which routine extremity dose monitoring has been found to be poor. Furthermore, information on the status of extremity dosimetry in medical applications and associated monitoring practices was gathered from 7 European countries: France, Germany, Greece, Ireland, Poland, Spain and Switzerland. Interpretation of the data was not easy because of the wide range of procedures involved and also

Brachial index does not reflect upper extremity functionality following surgery for vascular trauma

Directory of Open Access Journals (Sweden)

Erdal Simsek

2014-04-01

Full Text Available OBJECTIVES: Vascular injuries to the upper extremities requiring surgical repair are common after accidents. However, neither postoperative functionality nor hemodynamic status of the extremity are routinely described. We evaluated the postoperative functional and hemodynamic status of patients with vascular traumas in the upper extremities. METHODS: 26 patients who suffered penetrating vascular traumas in the upper extremities from November 2008 to December 2011 were retrospectively evaluated. Data on first approach, surgical technique employed and early postoperative outcomes were recorded. Further data on the post-discharge period, including clinical functional status of the arm, Doppler ultrasonography and brachial-brachial index were also evaluated. RESULTS: Average follow up was 33.5±10.8 months. Right (1.05±0.09 and left (1.04±0.08 brachial indexes were measured during follow up,. Doppler ultrasonography showed arterial occlusion in 4 patients (15%. Near-normal brachial-brachial indexes was observed in all four of these patients with occlusion of one of the upper extremity arteries, even though they exhibited limited arm function for daily work. CONCLUSIONS: Evaluation of the postoperative outcomes of this small series of patients with penetrating vascular traumas in the upper extremity revealed that 15% of them suffered occlusion of one artery of the upper extremity. Artery occlusion did not correlate with brachial-brachial Doppler index, probably due to rich collateral circulation, but occlusion was associated with an extremity that was dysfunctional for the purposes of daily work. The result of the brachial-brachial index does not therefore correlate with functionality.

Clinical applications of SPECT/CT in imaging the extremities

International Nuclear Information System (INIS)

Huellner, Martin W.; Strobel, Klaus

2014-01-01

Today, SPECT/CT is increasingly used and available in the majority of larger nuclear medicine departments. Several applications of SPECT/CT as a supplement to or replacement for traditional conventional bone scintigraphy have been established in recent years. SPECT/CT of the upper and lower extremities is valuable in many conditions with abnormal bone turnover due to trauma, inflammation, infection, degeneration or tumour. SPECT/CT is often used in patients if conventional radiographs are insufficient, if MR image quality is impaired due to metal implants or in patients with contraindications to MR. In complex joints such as those in the foot and wrist, SPECT/CT provides exact anatomical correlation of pathological uptake. In many cases SPECT increases the sensitivity and CT the specificity of the study, increasing confidence in the final diagnosis compared to planar images alone. The CT protocol should be adapted to the clinical question and may vary from very low-dose (e.g. attenuation correction only), to low-dose for anatomical correlation, to normal-dose protocols enabling precise anatomical resolution. The aim of this review is to give an overview of SPECT/CT imaging of the extremities with a focus on the hand and wrist, knee and foot, and for evaluation of patients after joint arthroplasty. (orig.)

Clinical applications of SPECT/CT in imaging the extremities

Energy Technology Data Exchange (ETDEWEB)

Huellner, Martin W. [University Hospital Zurich, Department of Medical Radiology, Division of Nuclear Medicine, Zurich (Switzerland); Strobel, Klaus [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland)

2014-05-15

Today, SPECT/CT is increasingly used and available in the majority of larger nuclear medicine departments. Several applications of SPECT/CT as a supplement to or replacement for traditional conventional bone scintigraphy have been established in recent years. SPECT/CT of the upper and lower extremities is valuable in many conditions with abnormal bone turnover due to trauma, inflammation, infection, degeneration or tumour. SPECT/CT is often used in patients if conventional radiographs are insufficient, if MR image quality is impaired due to metal implants or in patients with contraindications to MR. In complex joints such as those in the foot and wrist, SPECT/CT provides exact anatomical correlation of pathological uptake. In many cases SPECT increases the sensitivity and CT the specificity of the study, increasing confidence in the final diagnosis compared to planar images alone. The CT protocol should be adapted to the clinical question and may vary from very low-dose (e.g. attenuation correction only), to low-dose for anatomical correlation, to normal-dose protocols enabling precise anatomical resolution. The aim of this review is to give an overview of SPECT/CT imaging of the extremities with a focus on the hand and wrist, knee and foot, and for evaluation of patients after joint arthroplasty. (orig.)

Difficult physician-patient relationships.

Science.gov (United States)

Reifsteck, S W

1998-01-01

Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system.

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.

Interesting cases which were difficult to diagnose by CT

International Nuclear Information System (INIS)

Ueki, Koji; Okubo, Koichi; Shinohara, Shinji

1981-01-01

Computed tomography (CT) clinically provides us with much more useful diagnostic informations regarding the localization, size, shape, extent and inner structure of the lesions and then in some cases the specific diagnosis can be also obtained by CT alone. However, it is usually difficult to define the longitudinal extent of the lesions, their relation to adjacent tissues, the originated site in enormous lesion and histological type also. At CT examination, it is essential to recognize these drawback and limitation on CT. From these points of view, six interesting cases (i.e. pericardial diverticulum, hepatoma with retroperitoneal metastasis, cholangiohepatoma, afferent loop syndrome, invagination and retroperitoneal malignant schwannoma) which were difficult to diagnose by CT and proved ultimately with operation or autopsy were illustrated with some reviews. (author)

Imaging of neuro-cognitive performance in extreme Environments—A (p)review

Science.gov (United States)

Schneider, Stefan; Bubeev, Juri A.; Choukèr, Alexander; Morukov, Boris; Johannes, Bernd; Strüder, Heiko K.

2012-12-01

Living in extreme environments is accompanied by a number of stressors, which can be classified either as physiological stressors (e.g. microgravity, missing sunlight) or psychological stressors (e.g. confinement). From earth bound studies a negative impact of stress on mental health and cognitive performance is well known and both factors might impair mission success and mission safety during longer inhabitation of space. Accordingly there is the need to identify adequate countermeasures. Nevertheless causal research of neuro-cognitive impairments in space remains speculative due to missing possibilities of brain imaging. Furthermore the reliability of current psychological tests used to assess and monitor cognitive performance in extreme environments seems to be vulnerable due to a lack of compliance. With on-going plans of international space agencies to send people to moon and/or mars, this manuscript aims to summarize and review research attempts of the past two decades and to identify methodological shortcomings. Finally, following the guideline that research has no legacy for its own but must serve the self-concept and well-being of man, this manuscript presents a number of recommendations to enhance future neuro-cognitive research in extreme environments. A deeper insight into neuro-cognitive coherence is not only desirable to understand the effects of stress on mental health, which seems to be a major issue for our current society, and to develop adequate countermeasures but will also help to maintain and improve mission success and mission safety in manned space flight.

Projections of future extreme weather losses under changes in climate and exposure

NARCIS (Netherlands)

Bouwer, L.M.

2013-01-01

Many attempts are made to assess future changes in extreme weather events due to anthropogenic climate change, but few studies have estimated the potential change in economic losses from such events. Projecting losses is more complex as it requires insight into the change in the weather hazard but

Difficult management of posterior urethra gunshot wound combined ...

African Journals Online (AJOL)

Posterior urethra gunshot wounds are poorly described in the literature. They are often associated with pelvic vital lesions making difficult early repair of urethral injuries. They can be complicated by urethrorectal fistula, which makes their management more complicated. We report a new case of posterior urethra disruption ...

Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry.

Science.gov (United States)

Burjek, Nicholas E; Nishisaki, Akira; Fiadjoe, John E; Adams, H Daniel; Peeples, Kenneth N; Raman, Vidya T; Olomu, Patrick N; Kovatsis, Pete G; Jagannathan, Narasimhan; Hunyady, Agnes; Bosenberg, Adrian; Tham, See; Low, Daniel; Hopkins, Paul; Glover, Chris; Olutoye, Olutoyin; Szmuk, Peter; McCloskey, John; Dalesio, Nicholas; Koka, Rahul; Greenberg, Robert; Watkins, Scott; Patel, Vikram; Reynolds, Paul; Matuszczak, Maria; Jain, Ranu; Khalil, Samia; Polaner, David; Zieg, Jennifer; Szolnoki, Judit; Sathyamoorthy, Kumar; Taicher, Brad; Riveros Perez, N Ricardo; Bhattacharya, Solmaletha; Bhalla, Tarun; Stricker, Paul; Lockman, Justin; Galvez, Jorge; Rehman, Mohamed; Von Ungern-Sternberg, Britta; Sommerfield, David; Soneru, Codruta; Chiao, Franklin; Richtsfeld, Martina; Belani, Kumar; Sarmiento, Lina; Mireles, Sam; Bilen Rosas, Guelay; Park, Raymond; Peyton, James

2017-09-01

The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques. Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt. In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.

Difficult to control atopic dermatitis

Science.gov (United States)

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

VALIDATION OF HANFORD PERSONNEL AND EXTREMITY DOSIMETERS IN PLUTONIUM ENVIRONMENTS

Energy Technology Data Exchange (ETDEWEB)

Scherpelz, Robert I.; Fix, John J.; Rathbone, Bruce A.

2000-02-10

A study was performed in the Plutonium Finishing Plant to assess the performance of Hanford personnel neutron dosimetry. The study was assessed whole body dosimetry and extremity dosimetry performance. For both parts of the study, the TEPC was used as the principle instrument for characterizing workplace neutron fields. In the whole body study, 12.7-cm-diameter TEPCs were used in ten different locations in the facility. TLD and TED personnel dosimeters were exposed on a water-filled phantom to enable a comparison of TEPC and dosimeter response. In the extremity study, 1.27-cm-diameter TEPCs were exposed inside the fingers of a gloveboxe glove. Extremity dosimeters were wrapped around the TEPCs. The glove was then exposed to six different cans of plutonium, simulating the exposure that a worker's fingers would receive in a glovebox. The comparison of TEPC-measured neutron dose equivalent to TLD-measured gamma dose equivalent provided neutron-to-gamma ratios that can be used to estimate the neutron dose equivalent received by a worker's finger based on the gamma readings of an extremity dosimeter. The study also utilized a Snoopy and detectors based on bubble technology for assessing neutron exposures, providing a comparison of the effectiveness of these instruments for workplace monitoring. The study concludes that the TLD component of the HCND performs adequately overall, with a positive bias of 30%, but exhibits excessive variability in individual results due to instabilities in the algorithm. The TED response was less variable but only 20% of the TEPC reference dose on average because of the low neutron energies involved. The neutron response of the HSD was more variable than the TLD component of the HCND and biased high by a factor of 8 overall due to its calibration to unmoderated 252Cf. The study recommends further work to correct instabilities in the HCND algorithm and to explore the potential shown by the bubble-based dosimeters.

Projections of extreme water level events for atolls in the western Tropical Pacific

Science.gov (United States)

Merrifield, M. A.; Becker, J. M.; Ford, M.; Yao, Y.

2014-12-01

Conditions that lead to extreme water levels and coastal flooding are examined for atolls in the Republic of the Marshall Islands based on a recent field study of wave transformations over fringing reefs, tide gauge observations, and wave model hindcasts. Wave-driven water level extremes pose the largest threat to atoll shorelines, with coastal levels scaling as approximately one-third of the incident breaking wave height. The wave-driven coastal water level is partitioned into a mean setup, low frequency oscillations associated with cross-reef quasi-standing modes, and wind waves that reach the shore after undergoing high dissipation due to breaking and bottom friction. All three components depend on the water level over the reef; however, the sum of the components is independent of water level due to cancelling effects. Wave hindcasts suggest that wave-driven water level extremes capable of coastal flooding are infrequent events that require a peak wave event to coincide with mid- to high-tide conditions. Interannual and decadal variations in sea level do not change the frequency of these events appreciably. Future sea-level rise scenarios significantly increase the flooding threat associated with wave events, with a nearly exponential increase in flooding days per year as sea level exceeds 0.3 to 1.0 m above current levels.

Daily temperature and precipitation extremes in the Baltic Sea region derived from the BaltAn65+ reanalysis

Science.gov (United States)

Toll, Velle; Post, Piia

2018-04-01

Daily 2-m temperature and precipitation extremes in the Baltic Sea region for the time period of 1965-2005 is studied based on data from the BaltAn65 + high resolution atmospheric reanalysis. Moreover, the ability of regional reanalysis to capture extremes is analysed by comparing the reanalysis data to gridded observations. The shortcomings in the simulation of the minimum temperatures over the northern part of the region and in the simulation of the extreme precipitation over the Scandinavian mountains in the BaltAn65+ reanalysis data are detected and analysed. Temporal trends in the temperature and precipitation extremes in the Baltic Sea region, with the largest increases in temperature and precipitation in winter, are detected based on both gridded observations and the BaltAn65+ reanalysis data. However, the reanalysis is not able to capture all of the regional trends in the extremes in the observations due to the shortcomings in the simulation of the extremes.

Comparison of different tests to determine difficult intubation in pediatric patients

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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.

Temporal and spatial scaling impacts on extreme precipitation

Science.gov (United States)

Eggert, B.; Berg, P.; Haerter, J. O.; Jacob, D.; Moseley, C.

2015-01-01

Both in the current climate and in the light of climate change, understanding of the causes and risk of precipitation extremes is essential for protection of human life and adequate design of infrastructure. Precipitation extreme events depend qualitatively on the temporal and spatial scales at which they are measured, in part due to the distinct types of rain formation processes that dominate extremes at different scales. To capture these differences, we first filter large datasets of high-resolution radar measurements over Germany (5 min temporally and 1 km spatially) using synoptic cloud observations, to distinguish convective and stratiform rain events. In a second step, for each precipitation type, the observed data are aggregated over a sequence of time intervals and spatial areas. The resulting matrix allows a detailed investigation of the resolutions at which convective or stratiform events are expected to contribute most to the extremes. We analyze where the statistics of the two types differ and discuss at which resolutions transitions occur between dominance of either of the two precipitation types. We characterize the scales at which the convective or stratiform events will dominate the statistics. For both types, we further develop a mapping between pairs of spatially and temporally aggregated statistics. The resulting curve is relevant when deciding on data resolutions where statistical information in space and time is balanced. Our study may hence also serve as a practical guide for modelers, and for planning the space-time layout of measurement campaigns. We also describe a mapping between different pairs of resolutions, possibly relevant when working with mismatched model and observational resolutions, such as in statistical bias correction.

Satellite skill in detecting extreme episodes in near-surface air quality

Science.gov (United States)

Ruiz, D. J.; Prather, M. J.

2017-12-01

Ozone (O3) contributes to ambient air pollution, adversely affecting public health, agriculture, and ecosystems. Reliable, long-term, densely distributed surface networks are required to establish the scale, intensity and repeatability of major pollution events (designated here in a climatological sense as air quality extremes, AQX as defined in Schnell's work). Regrettably, such networks are only available for North America (NA) and Europe (EU), which does not include many populated regions where the deaths associated with air pollution exposure are alarmingly high. Directly measuring surface pollutants from space without lidar is extremely difficult. Mapping of daily pollution events requires cross-track nadir scanners and these have limited sensitivity to surface O3 levels. This work examines several years of coincident surface and OMI satellite measurements over NA-EU, in combination with a chemistry-transport model (CTM) hindcast of that period to understand how the large-scale AQX episodes may extend into the free troposphere and thus be more amenable to satellite mapping. We show how extreme NA-EU episodes are measured from OMI and then look for such patterns over other polluted regions of the globe. We gather individual high-quality O3 surface site measurements from these other regions, to check on our satellite detection. Our approach with global satellite detection would avoid issues associated with regional variations in seasonality, chemical regime, data product biases; and it does not require defining a separate absolute threshold for each data product (surface site and satellite). This also enables coherent linking of the extreme events into large-scale pollution episodes whose magnitude evolves over 100's of km for several days. Tools used here include the UC Irvine CTM, which shows that much of the O3 surface variability is lost at heights above 2 km, but AQX local events are readily seen in a 0-3 km column average. The OMI data are taken from X

Extreme weather: Subtropical floods and tropical cyclones

Science.gov (United States)

Shaevitz, Daniel A.

Extreme weather events have a large effect on society. As such, it is important to understand these events and to project how they may change in a future, warmer climate. The aim of this thesis is to develop a deeper understanding of two types of extreme weather events: subtropical floods and tropical cyclones (TCs). In the subtropics, the latitude is high enough that quasi-geostrophic dynamics are at least qualitatively relevant, while low enough that moisture may be abundant and convection strong. Extratropical extreme precipitation events are usually associated with large-scale flow disturbances, strong ascent, and large latent heat release. In the first part of this thesis, I examine the possible triggering of convection by the large-scale dynamics and investigate the coupling between the two. Specifically two examples of extreme precipitation events in the subtropics are analyzed, the 2010 and 2014 floods of India and Pakistan and the 2015 flood of Texas and Oklahoma. I invert the quasi-geostrophic omega equation to decompose the large-scale vertical motion profile to components due to synoptic forcing and diabatic heating. Additionally, I present model results from within the Column Quasi-Geostrophic framework. A single column model and cloud-revolving model are forced with the large-scale forcings (other than large-scale vertical motion) computed from the quasi-geostrophic omega equation with input data from a reanalysis data set, and the large-scale vertical motion is diagnosed interactively with the simulated convection. It is found that convection was triggered primarily by mechanically forced orographic ascent over the Himalayas during the India/Pakistan flood and by upper-level Potential Vorticity disturbances during the Texas/Oklahoma flood. Furthermore, a climate attribution analysis was conducted for the Texas/Oklahoma flood and it is found that anthropogenic climate change was responsible for a small amount of rainfall during the event but the

Statistics of Extremes

KAUST Repository

Davison, Anthony C.

2015-04-10

Statistics of extremes concerns inference for rare events. Often the events have never yet been observed, and their probabilities must therefore be estimated by extrapolation of tail models fitted to available data. Because data concerning the event of interest may be very limited, efficient methods of inference play an important role. This article reviews this domain, emphasizing current research topics. We first sketch the classical theory of extremes for maxima and threshold exceedances of stationary series. We then review multivariate theory, distinguishing asymptotic independence and dependence models, followed by a description of models for spatial and spatiotemporal extreme events. Finally, we discuss inference and describe two applications. Animations illustrate some of the main ideas. © 2015 by Annual Reviews. All rights reserved.

Students' perceptions of difficult concepts in biology in senior ...

African Journals Online (AJOL)

Students' perceptions of difficult concepts in biology in senior secondary schools in ... that students in Senior Secondary School Two (SSII) have difficulties in learning, the ... However, teaching strategies, students' attitude, inadequate learning ...

Extreme oceanographic forcing and coastal response due to the 2015–2016 El Niño

Science.gov (United States)

Barnard, Patrick; Hoover, Daniel J.; Hubbard, David M.; Snyder, Alexander; Ludka, Bonnie C.; Allan, Jonathan; Kaminsky, George M.; Ruggiero,; Gallien, Timu W.; Gabel, Laura; McCandless, Diana; Weiner, Heather M.; Cohn, Nicholas; Anderson, Dylan L.; Serafin, Katherine A.

2017-01-01

The El Niño-Southern Oscillation is the dominant mode of interannual climate variability across the Pacific Ocean basin, with influence on the global climate. The two end members of the cycle, El Niño and La Niña, force anomalous oceanographic conditions and coastal response along the Pacific margin, exposing many heavily populated regions to increased coastal flooding and erosion hazards. However, a quantitative record of coastal impacts is spatially limited and temporally restricted to only the most recent events. Here we report on the oceanographic forcing and coastal response of the 2015–2016 El Niño, one of the strongest of the last 145 years. We show that winter wave energy equalled or exceeded measured historical maxima across the US West Coast, corresponding to anomalously large beach erosion across the region. Shorelines in many areas retreated beyond previously measured landward extremes, particularly along the sediment-starved California coast.

Moving in extreme environments: what's extreme and who decides?

Science.gov (United States)

Cotter, James David; Tipton, Michael J

2014-01-01

Humans work, rest and play in immensely varied extreme environments. The term 'extreme' typically refers to insufficiency or excess of one or more stressors, such as thermal energy or gravity. Individuals' behavioural and physiological capacity to endure and enjoy such environments varies immensely. Adverse effects of acute exposure to these environments are readily identifiable (e.g. heat stroke or bone fracture), whereas adverse effects of chronic exposure (e.g. stress fractures or osteoporosis) may be as important but much less discernable. Modern societies have increasingly sought to protect people from such stressors and, in that way, minimise their adverse effects. Regulations are thus established, and advice is provided on what is 'acceptable' exposure. Examples include work/rest cycles in the heat, hydration regimes, rates of ascent to and duration of stay at altitude and diving depth. While usually valuable and well intentioned, it is important to realise the breadth and importance of limitations associated with such guidelines. Regulations and advisories leave less room for self-determination, learning and perhaps adaptation. Regulations based on stress (e.g. work/rest cycles relative to WBGT) are more practical but less direct than those based on strain (e.g. core temperature), but even the latter can be substantively limited (e.g. by lack of criterion validation and allowance for behavioural regulation in the research on which they are based). Extreme Physiology & Medicine is publishing a series of reviews aimed at critically examining the issues involved with self- versus regulation-controlled human movement acutely and chronically in extreme environments. These papers, arising from a research symposium in 2013, are about the impact of people engaging in such environments and the effect of rules and guidelines on their safety, enjoyment, autonomy and productivity. The reviews will cover occupational heat stress, sporting heat stress, hydration, diving

All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

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Venkateswaran Ramkumar

2016-01-01

Full Text Available The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus. Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA. Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H 2 O is acceptable. Partial or complete release of cricoid pressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO 2 should be maintained ≥95%. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreoptic-guided intubation via the SAD or wake up the patient depends on the urgency of surgery, foeto-maternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs.

Extreme Precipitation in Poland in the Years 1951-2010

Science.gov (United States)

Malinowska, Miroslawa

2017-12-01

The characteristics of extreme precipitation, including the dominant trends, were analysed for eight stations located in different parts of Poland for the period 1951-2010. Five indices enabling the assessment of the intensity and frequency of both extremely dry and wet conditions were applied. The indices included the number of days with precipitation ≥10mm·d-1 (R10), maximum number of consecutive dry days (CDD), maximum 5-day precipitation total (R5d), simple daily intensity index (SDII), and the fraction of annual total precipitation due to events exceeding the 95th percentile calculated for the period 1961-1990. Annual trends were calculated using standard linear regression method, while the fit of the model was assessed with the F-test at the 95% confidence level. The analysed changes in extreme precipitation showed mixed patterns. A significant positive trend in the number of days with precipitation ≥10mm·d-1 (R10) was observed in central Poland, while a significant negative one, in south-eastern Poland. Based on the analysis of maximum 5-day precipitation totals (R5d), statistically significant positive trends in north-western, western and eastern parts of the country were detected, while the negative trends were found in the central and northeastern parts. Daily precipitation, expressed as single daily intensity index (SDII), increased over time in northern and central Poland. In southern Poland, the variation of SDII index showed non-significant negative tendencies. Finally, the fraction of annual total precipitation due to the events exceeding the 1961-1990 95th percentile increased at one station only, namely, in Warsaw. The indicator which refers to dry conditions, i.e. maximum number of consecutive dry days (CDD) displayed negative trends throughout the surveyed area, with the exception of Szczecin that is a representative of north-western Poland.

A descriptive analysis of nontuberculous mycobacterial infections (NTM of the upper extremity

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M Al-Knawy

2015-01-01

Conclusion: Diagnosis of NTM infection of the upper extremity is often delayed due to its indolent presentation and lack of clinical suspicion. Healthcare professionals should be aware of the increasing incidence of soft tissue NTM infection after percutaneous injury, especially in immunosuppressed patients, to improve diagnostic promptness and treatment outcome.

Characteristics of autumn-winter extreme precipitation on the Norwegian west coast identified by cluster analysis

Energy Technology Data Exchange (ETDEWEB)

Heikkilae, U. [Bjerknes Centre for Climate Research, Uni Bjerknes Centre, Bergen (Norway); Australian Nuclear Science and Technology Organisation (ANSTO), Lucas Heights, NSW (Australia); Sorteberg, A. [University of Bergen, Geophysical Institute, Bergen (Norway); University of Bergen, Bjerknes Centre for Climate Research, Bergen (Norway)

2012-08-15

Extremely high autumn and winter precipitation events on the European west coast are often driven by low-pressure systems in the North Atlantic. Climate projections suggest the number and intensity of these events is likely to increase far more than the mean precipitation. In this study we investigate the autumn-winter extreme precipitation on the Norwegian west coast and the connection between its spatial distribution and sea level pressure (SLP) patterns using the k-means cluster analysis. We use three relatively high resolved downscalings of one global coupled model: the Arpege global atmospheric model (stretched grid with 35-km horizontal resolution over Norway) and the WRF-downscaled Arpege model (30 and 10-km) for the 30-year periods of 1961-1990 and 2021-2050. The cluster analysis finds three main SLP patterns responsible for extreme precipitation in different parts of the country. The SLP patterns found are similar to the NAO positive pattern known to strengthen the westerly flow towards European coast. We then apply the method to investigate future change in extreme precipitation. We find an increase in the number of days with extreme precipitation of 15, 39 and 35% in the two simulations (Arpege 35-km and WRF 30 and 10-km, respectively). We do not find evidence of a significant change in the frequency of weather patterns between the present and the future periods. Rather, it is the probability of a given weather pattern to cause extreme precipitation which is increased in the future, probably due to higher temperatures and an increased moisture content of the air. The WRF model predicts the increase in this probability caused by the most important SLP patterns to be >50%. The Arpege model does not predict such a significant change because the general increase in extreme precipitation predicted is smaller, probably due to its coarser resolution over ocean which leads to smoother representation of the low pressure systems. (orig.)

Future changes in Asian summer monsoon precipitation extremes as inferred from 20-km AGCM simulations

Science.gov (United States)

Lui, Yuk Sing; Tam, Chi-Yung; Lau, Ngar-Cheung

2018-04-01

This study examines the impacts of climate change on precipitation extremes in the Asian monsoon region during boreal summer, based on simulations from the 20-km Meteorological Research Institute atmospheric general circulation model. The model can capture the summertime monsoon rainfall, with characteristics similar to those from Tropical Rainfall Measuring Mission and Asian Precipitation-Highly-Resolved Observational Data Integration Towards Evaluation. By comparing the 2075-2099 with the present-day climate simulations, there is a robust increase of the mean rainfall in many locations due to a warmer climate. Over southeastern China, the Baiu rainband, Bay of Bengal and central India, extreme precipitation rates are also enhanced in the future, which can be inferred from increases of the 95th percentile of daily precipitation, the maximum accumulated precipitation in 5 consecutive days, the simple daily precipitation intensity index, and the scale parameter of the fitted gamma distribution. In these regions, with the exception of the Baiu rainband, most of these metrics give a fractional change of extreme rainfall per degree increase of the lower-tropospheric temperature of 5 to 8.5% K-1, roughly consistent with the Clausius-Clapeyron relation. However, over the Baiu area extreme precipitation change scales as 3.5% K-1 only. We have also stratified the rainfall data into those associated with tropical cyclones (TC) and those with other weather systems. The AGCM gives an increase of the accumulated TC rainfall over southeastern China, and a decrease in southern Japan in the future climate. The latter can be attributed to suppressed TC occurrence in southern Japan, whereas increased accumulated rainfall over southeastern China is due to more intense TC rain rate under global warming. Overall, non-TC weather systems are the main contributor to enhanced precipitation extremes in various locations. In the future, TC activities over southeastern China tend to further

Extreme heat in India and anthropogenic climate change

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G. J. van Oldenborgh

2018-01-01

Full Text Available On 19 May 2016 the afternoon temperature reached 51.0 °C in Phalodi in the northwest of India – a new record for the highest observed maximum temperature in India. The previous year, a widely reported very lethal heat wave occurred in the southeast, in Andhra Pradesh and Telangana, killing thousands of people. In both cases it was widely assumed that the probability and severity of heat waves in India are increasing due to global warming, as they do in other parts of the world. However, we do not find positive trends in the highest maximum temperature of the year in most of India since the 1970s (except spurious trends due to missing data. Decadal variability cannot explain this, but both increased air pollution with aerosols blocking sunlight and increased irrigation leading to evaporative cooling have counteracted the effect of greenhouse gases up to now. Current climate models do not represent these processes well and hence cannot be used to attribute heat waves in this area. The health effects of heat are often described better by a combination of temperature and humidity, such as a heat index or wet bulb temperature. Due to the increase in humidity from irrigation and higher sea surface temperatures (SSTs, these indices have increased over the last decades even when extreme temperatures have not. The extreme air pollution also exacerbates the health impacts of heat. From these factors it follows that, from a health impact point of view, the severity of heat waves has increased in India. For the next decades we expect the trend due to global warming to continue but the surface cooling effect of aerosols to diminish as air quality controls are implemented. The expansion of irrigation will likely continue, though at a slower pace, mitigating this trend somewhat. Humidity will probably continue to rise. The combination will result in a strong rise in the temperature of heat waves. The high humidity will make health effects worse

Extreme heat in India and anthropogenic climate change

Science.gov (United States)

van Oldenborgh, Geert Jan; Philip, Sjoukje; Kew, Sarah; van Weele, Michiel; Uhe, Peter; Otto, Friederike; Singh, Roop; Pai, Indrani; Cullen, Heidi; AchutaRao, Krishna

2018-01-01

On 19 May 2016 the afternoon temperature reached 51.0 °C in Phalodi in the northwest of India - a new record for the highest observed maximum temperature in India. The previous year, a widely reported very lethal heat wave occurred in the southeast, in Andhra Pradesh and Telangana, killing thousands of people. In both cases it was widely assumed that the probability and severity of heat waves in India are increasing due to global warming, as they do in other parts of the world. However, we do not find positive trends in the highest maximum temperature of the year in most of India since the 1970s (except spurious trends due to missing data). Decadal variability cannot explain this, but both increased air pollution with aerosols blocking sunlight and increased irrigation leading to evaporative cooling have counteracted the effect of greenhouse gases up to now. Current climate models do not represent these processes well and hence cannot be used to attribute heat waves in this area. The health effects of heat are often described better by a combination of temperature and humidity, such as a heat index or wet bulb temperature. Due to the increase in humidity from irrigation and higher sea surface temperatures (SSTs), these indices have increased over the last decades even when extreme temperatures have not. The extreme air pollution also exacerbates the health impacts of heat. From these factors it follows that, from a health impact point of view, the severity of heat waves has increased in India. For the next decades we expect the trend due to global warming to continue but the surface cooling effect of aerosols to diminish as air quality controls are implemented. The expansion of irrigation will likely continue, though at a slower pace, mitigating this trend somewhat. Humidity will probably continue to rise. The combination will result in a strong rise in the temperature of heat waves. The high humidity will make health effects worse, whereas decreased air pollution

Extreme concentration fluctuations due to local reversibility of mixing in turbulent flows

Science.gov (United States)

Xia, Hua; Francois, Nicolas; Punzmann, Horst; Szewc, Kamil; Shats, Michael

2018-05-01

Mixing of a passive scalar in a fluid (e.g. a radioactive spill in the ocean) is the irreversible process towards homogeneous distribution of a substance. In a moving fluid, due to the chaotic advection [H. Aref, J. Fluid Mech. 143 (1984) 1; J. M. Ottino, The Kinematics of Mixing: Stretching,Chaos and Transport (Cambridge University Press, Cambridge, 1989)] mixing is much faster than if driven by molecular diffusion only. Turbulence is known as the most efficient mixing flow [B. I. Shraiman and E. D. Siggia, Nature 405 (2000) 639]. We show that in contrast to spatially periodic flows, two-dimensional turbulence exhibits local reversibility in mixing, which leads to the generation of unpredictable strong fluctuations in the scalar concentration. These fluctuations can also be detected from the analysis of the fluid particle trajectories of the underlying flow.

Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

OpenAIRE

Casini, Alessandro; Tschanz, Elisabeth; Dietrich, Pierre-Yves; Nendaz, Mathieu

2011-01-01

Syncope is caused by a wide variety of disorders. Recurrent syncope as a complication of malignancy is uncommon and may be difficult to diagnose and to treat. Primary neck carcinoma or metastases spreading in parapharyngeal and carotid spaces can involve the internal carotid artery and cause neurally mediated syncope with a clinical presentation like carotid sinus syndrome. We report the case of a 76-year-old man who suffered from recurrent syncope due to invasion of the right carotid sinus b...

Analysis of farmers’ adaptation to weather extremes in West African Sudan Savanna

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David Boansi

2017-06-01

Full Text Available There have been recent incidences of weather extremes in the West African Sudan Savanna and farmers have responded through implementation of relevant adaptation strategies. For a deeper insight into farmers’ adaptation to climatic shocks, this study documents farmers’ perception of recent changes in the local climate, and identifies factors that influence the number and choice of strategies implemented. Interdependencies among strategies are explored and joint and marginal probabilities of adoption estimated. Upper East Ghana and Southwest Burkina Faso are used as the case study regions. These regions were selected due to extreme reliance of inhabitants on agriculture for sustenance, and their recent exposure to weather extremes. Through estimation of a Poisson regression and multivariate probit model to identify the major factors that influence the number and choice of strategies adopted, we discover that, limited access to credit, markets, and extension services, smaller cropland area, and low level of mechanization could impede effective adaptation to weather extremes. To enhance farmers’ adaptive capacity, policy makers and various stakeholders need to contribute towards improving farmers’ access to credit, markets, and extension services, and implement measures to promote mechanization.

Inter-comparison of statistical downscaling methods for projection of extreme precipitation in Europe

DEFF Research Database (Denmark)

Sunyer Pinya, Maria Antonia; Hundecha, Y.; Lawrence, D.

2015-01-01

Information on extreme precipitation for future climate is needed to assess the changes in the frequency and intensity of flooding. The primary source of information in climate change impact studies is climate model projections. However, due to the coarse resolution and biases of these models......), three are bias correction (BC) methods, and one is a perfect prognosis method. The eight methods are used to downscale precipitation output from 15 regional climate models (RCMs) from the ENSEMBLES project for 11 catchments in Europe. The overall results point to an increase in extreme precipitation...... that at least 30% and up to approximately half of the total variance is derived from the SDMs. This study illustrates the large variability in the expected changes in extreme precipitation and highlights the need for considering an ensemble of both SDMs and climate models. Recommendations are provided...

Prosthetic Hip Loosening Due to Brucellar Infection: Case Report and Literature Review

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Anis Tebourbi

2016-12-01

Full Text Available Context: Brucellosis is actually considered to be the commonest zoonotic infection worldwide; conversely prosthetic infection due to brucella is extremely rare. Although diagnostic is easily achieved, management of such situations is extremely challenging. Aims: To report the case of prosthetic hip loosening due to brucellar infection, discuss management manners and to summarize data about 19 cases reported in the literature. Methods: We report the case of a 73-year-old woman with brucellar prosthetic hip loosening treated with 2-stage exchange of the prosthesis and prolonged double antibiotherapy Results: At two years follow up the patient is pain free with total functional recovery and no clinical and radiographic signs of prosthetic loosening Conclusions: Brucella should be evocated as a cause of total joint arthroplasty infection especially in patients from endemic regions and with occupational exposure. Antibiotic treatment alone can be followed if there are no signs of implant loosening. Tow stage revision should be considered in other cases.

Difficult airway management patterns among anesthesiologists practicing in Cairo University Hospitals

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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.

Clinical and Ultrasonographic Evaluation of Lower-extremity Vein Thrombosis in Behcet Syndrome

Science.gov (United States)

Seyahi, Emire; Cakmak, Osman Serdal; Tutar, Burcin; Arslan, Caner; Dikici, Atilla Suleyman; Sut, Necdet; Kantarci, Fatih; Tuzun, Hasan; Melikoglu, Melike; Yazici, Hasan

2015-01-01

Abstract Vascular involvement can be seen in up to 40% of patients with Behcet syndrome (BS), the lower-extremity vein thrombosis (LEVT) being the most common type. The aim of the current study was to compare venous Doppler findings and clinical features between BS patients with LEVT and control patients diagnosed as having LEVT due to other causes. All consecutive 78 patients (71 men, 7 women; mean age 38.6 ± 10.3 years) with LEVT due to BS and 50 control patients (29 men, 21 women; mean age 42.0 ± 12.5 years) who had LEVT due to other causes, or idiopathic, were studied with the help of a Doppler ultrasonography after a detailed clinical examination. Patterns of venous disease were identified by cluster analyses. Clinical features of chronic venous disease were assessed using 2 classification systems. Venous claudication was also assessed. Patients with BS were more likely to be men, had significantly earlier age of onset of thrombosis, and were treated mainly with immunosuppressives and less frequently with anticoagulants. Furthermore, they had significantly more bilateral involvement, less complete recanalization, and more frequent collateral formation. While control patients had a disorganized pattern of venous involvement, BS patients had a contiguous and symmetric pattern, involving all deep and superficial veins of the lower extremities, with less affinity for crural veins. Clinical assessment, as measured by the 2 classification systems, also indicated a more severe disease among the BS patients. In line, 51% of the BS patients suffered from severe post-thrombotic syndrome (PTS) and 32% from venous claudication, whereas these were present in 8% and 12%, respectively, among the controls. Among BS patients, a longer duration of thrombosis, bilateral femoral vein involvement, and using no anticoagulation along with immunosuppressive treatment when first diagnosed were found to be associated independently with severe PTS. Lower-extremity vein

Maxillofacial trauma patient: coping with the difficult airway

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Barak Michal

2009-05-01

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

Overspinning a nearly extreme black hole and the weak cosmic censorship conjecture

International Nuclear Information System (INIS)

Richartz, Mauricio; Saa, Alberto

2008-01-01

We revisit here the recent proposal for overspinning a nearly extreme black hole by means of a quantum tunneling process. We show that electrically neutral massless fermions evade possible backreaction effects related to superradiance, confirming the view that it would be indeed possible to form a naked singularity due to quantum effects.

Effects of climate extremes on the terrestrial carbon cycle: concepts, processes and potential future impacts

Science.gov (United States)

Frank, Dorothea; Reichstein, Markus; Bahn, Michael; Thonicke, Kirsten; Frank, David; Mahecha, Miguel D; Smith, Pete; van der Velde, Marijn; Vicca, Sara; Babst, Flurin; Beer, Christian; Buchmann, Nina; Canadell, Josep G; Ciais, Philippe; Cramer, Wolfgang; Ibrom, Andreas; Miglietta, Franco; Poulter, Ben; Rammig, Anja; Seneviratne, Sonia I; Walz, Ariane; Wattenbach, Martin; Zavala, Miguel A; Zscheischler, Jakob

2015-01-01

Extreme droughts, heat waves, frosts, precipitation, wind storms and other climate extremes may impact the structure, composition and functioning of terrestrial ecosystems, and thus carbon cycling and its feedbacks to the climate system. Yet, the interconnected avenues through which climate extremes drive ecological and physiological processes and alter the carbon balance are poorly understood. Here, we review the literature on carbon cycle relevant responses of ecosystems to extreme climatic events. Given that impacts of climate extremes are considered disturbances, we assume the respective general disturbance-induced mechanisms and processes to also operate in an extreme context. The paucity of well-defined studies currently renders a quantitative meta-analysis impossible, but permits us to develop a deductive framework for identifying the main mechanisms (and coupling thereof) through which climate extremes may act on the carbon cycle. We find that ecosystem responses can exceed the duration of the climate impacts via lagged effects on the carbon cycle. The expected regional impacts of future climate extremes will depend on changes in the probability and severity of their occurrence, on the compound effects and timing of different climate extremes, and on the vulnerability of each land-cover type modulated by management. Although processes and sensitivities differ among biomes, based on expert opinion, we expect forests to exhibit the largest net effect of extremes due to their large carbon pools and fluxes, potentially large indirect and lagged impacts, and long recovery time to regain previous stocks. At the global scale, we presume that droughts have the strongest and most widespread effects on terrestrial carbon cycling. Comparing impacts of climate extremes identified via remote sensing vs. ground-based observational case studies reveals that many regions in the (sub-)tropics are understudied. Hence, regional investigations are needed to allow a global

Production processes at extremely high energies

CERN Document Server

Gastmans, R; Wu, Tai Tsun

2013-01-01

The production processes are identified that contribute to the rise of the total cross section in proton-proton scattering at extremely high energies, s->~. At such energies, the scattering can be described by a black disk (completely absorptive) with a radius expanding logarithmically with energy surrounded by a gray fringe (partially absorptive). For the leading term of (lns)^2 in the increasing total cross section, the gray fringe is neglected, and geometrical optics is generalized to production processes. It is known that half of the rise in the total cross section is due to elastic scattering. The other half is found to originate from the production of jets with relatively small momenta in the center-of-mass system.

Peculiarities of the propagation of multidimensional extremely short optical pulses in germanene

Energy Technology Data Exchange (ETDEWEB)

Zhukov, Alexander V., E-mail: alex_zhukov@sutd.edu.sg [Singapore University of Technology and Design, 8 Somapah Road, 487372 Singapore (Singapore); Bouffanais, Roland [Singapore University of Technology and Design, 8 Somapah Road, 487372 Singapore (Singapore); Konobeeva, Natalia N. [Volgograd State University, 400062 Volgograd (Russian Federation); Belonenko, Mikhail B. [Laboratory of Nanotechnology, Volgograd Institute of Business, 400048 Volgograd (Russian Federation); Volgograd State University, 400062 Volgograd (Russian Federation)

2016-09-07

Highlights: • Established dynamics of ultra-short pulses in germanene. • Studied balance between dispersive and nonlinear effects in germanene. • Spin–orbit interaction effect onto pulse propagation. - Abstract: In this Letter, we study the propagation characteristics of both two-dimensional and three-dimensional extremely short optical pulses in germanene. A distinguishing feature of germanene—in comparison with other graphene-like structures—is the presence of a significant spin–orbit interaction. The account of this interaction has a significant impact on the evolution of extremely short pulses in such systems. Specifically, extremely short optical pulses, consisting of two electric field oscillations, cause the appearance of a tail associated with the excitation of nonlinear waves. Due to the large spin–orbit interaction in germanene, this tail behind the main pulse is much smaller in germanene-based samples as compared to graphene-based ones, thereby making germanene a preferred material for the stable propagation of pulses along the sample.

Real-time prediction of extreme ambient carbon monoxide concentrations due to vehicular exhaust emissions using univariate linear stochastic models

International Nuclear Information System (INIS)

Sharma, P.; Khare, M.

2000-01-01

Historical data of the time-series of carbon monoxide (CO) concentration was analysed using Box-Jenkins modelling approach. Univariate Linear Stochastic Models (ULSMs) were developed to examine the degree of prediction possible for situations where only a limited data set, restricted only to the past record of pollutant data are available. The developed models can be used to provide short-term, real-time forecast of extreme CO concentrations for an Air Quality Control Region (AQCR), comprising a major traffic intersection in a Central Business District of Delhi City, India. (author)

Distractor dwelling, skipping, and revisiting determine target absent performance in difficult visual search

Directory of Open Access Journals (Sweden)

Gernot Horstmann

2016-08-01

Full Text Available Some targets in visual search are more difficult to find than others. In particular, a target that is similar to the distractors is more difficult to find than a target that is dissimilar to the distractors. Efficiency differences between easy and difficult searches are manifest not only in target-present trials but also in target-absent trials. In fact, even physically identical displays are searched through with different efficiency depending on the searched-for target. Here, we monitored eye movements in search for a target similar to the distractors (difficult search versus a target dissimilar to the distractors (easy search. We aimed to examine three hypotheses concerning the causes of differential search efficiencies in target-absent trials: (a distractor dwelling (b distractor skipping, and (c distractor revisiting. Reaction times increased with target similarity which is consistent with existing theories and replicates earlier results. Eye movement data indicated guidance in target trials, even though search was very slow. Dwelling, skipping, and revisiting contributed to low search efficiency in difficult search, with dwelling being the strongest factor. It is argued that differences in dwell time account for a large amount of total search time differences.

Distractor Dwelling, Skipping, and Revisiting Determine Target Absent Performance in Difficult Visual Search

Science.gov (United States)

Horstmann, Gernot; Herwig, Arvid; Becker, Stefanie I.

2016-01-01

Some targets in visual search are more difficult to find than others. In particular, a target that is similar to the distractors is more difficult to find than a target that is dissimilar to the distractors. Efficiency differences between easy and difficult searches are manifest not only in target-present trials but also in target-absent trials. In fact, even physically identical displays are searched through with different efficiency depending on the searched-for target. Here, we monitored eye movements in search for a target similar to the distractors (difficult search) versus a target dissimilar to the distractors (easy search). We aimed to examine three hypotheses concerning the causes of differential search efficiencies in target-absent trials: (a) distractor dwelling (b) distractor skipping, and (c) distractor revisiting. Reaction times increased with target similarity which is consistent with existing theories and replicates earlier results. Eye movement data indicated guidance in target trials, even though search was very slow. Dwelling, skipping, and revisiting contributed to low search efficiency in difficult search, with dwelling being the strongest factor. It is argued that differences in dwell time account for a large amount of total search time differences. PMID:27574510

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

Directory of Open Access Journals (Sweden)

Sirvinskiene Giedre

2012-04-01

Full Text Available Abstract Background Problems experienced within the first year of an infant's life can be precursors of later mental health conditions. The purpose of this study was to examine the frequency and continuity of difficult behaviors in infants at 3 and 6 months of age and the associations of these difficulties with biomedical and psychosocial factors. Methods This study was a part of an ongoing prospective birth-cohort study. Study participants were 189 uniparous mothers and their full-term newborns. The index of infant difficult behavior was constructed. This index was then associated with the following factors: delivery mode, newborn function after birth, maternal emotional well-being, risk behavior, subjective evaluation of the quality of the relationship of the couple, and attitudes toward infant-rearing. Results Common difficult behaviors, including crying, sleeping and eating problems, were characteristic for 30.2% of 3 month old and for 22.2% of 6 month old full-term infants. The expression of infant difficult behaviors at the age of 3 months increased the likelihood of the expression of these difficulties at 6 months by more than 5 times. Factors including younger maternal age, poor prenatal and postnatal emotional well-being, prenatal alcohol consumption, low satisfaction with the couple's relationship before pregnancy, and deficiency of infant-centered maternal attitudes towards infant-rearing increased the likelihood of difficult behaviors in infants at the age of 3 months. Low maternal satisfaction with the relationship of the couple before pregnancy, negative emotional reactions of both parents toward pregnancy (as reported by the mother and the deficiency of an infant-centered maternal attitude towards infant-rearing increased the likelihood of infant difficult behaviors continuing between the ages of 3 to 6 months. Perinatal biomedical conditions were not related to the difficult behaviors in infants. Conclusions Our study suggests

Footwear traction and lower extremity noncontact injury.

Science.gov (United States)

Wannop, John W; Luo, Geng; Stefanyshyn, Darren J

2013-11-01

Football is the most popular high school sport; however, it has the highest rate of injury. Speculation has been prevalent that foot fixation due to high footwear traction contributes to injury risk. Therefore, the purpose of the study was to determine whether a relationship exists between the athlete's specific footwear traction (measured with their own shoes on the field of play) and lower extremity noncontact injury in high school football. For 3 yr, 555 high school football athletes had their footwear traction measured on the actual field of play at the start of the season, and any injury the athletes suffered during a game was recorded. Lower extremity noncontact injury rates, grouped based on the athlete's specific footwear traction (both translational and rotational), were compared. For translational traction, injury rate reached a peak of 23.3 injuries/1000 game exposures within the midrange of translational traction, before decreasing to 5.0 injuries/1000 game exposures in the high range of traction. For rotational traction, there was a steady increase in injury rate as footwear traction increased, starting at 4.2 injuries/1000 game exposures at low traction and reaching 19.2 injuries/1000 game exposures at high traction. A relationship exists between footwear traction and noncontact lower extremity injury, with increases in rotational traction leading to a greater injury rate and increases in translational traction leading to a decrease in injury. It is recommended that athletes consider selecting footwear with the lowest rotational traction values for which no detriment in performance results.

Likelihood estimators for multivariate extremes

KAUST Repository

Huser, Raphaë l; Davison, Anthony C.; Genton, Marc G.

2015-01-01

The main approach to inference for multivariate extremes consists in approximating the joint upper tail of the observations by a parametric family arising in the limit for extreme events. The latter may be expressed in terms of componentwise maxima, high threshold exceedances or point processes, yielding different but related asymptotic characterizations and estimators. The present paper clarifies the connections between the main likelihood estimators, and assesses their practical performance. We investigate their ability to estimate the extremal dependence structure and to predict future extremes, using exact calculations and simulation, in the case of the logistic model.

Likelihood estimators for multivariate extremes

KAUST Repository

Huser, Raphaël

2015-11-17

The main approach to inference for multivariate extremes consists in approximating the joint upper tail of the observations by a parametric family arising in the limit for extreme events. The latter may be expressed in terms of componentwise maxima, high threshold exceedances or point processes, yielding different but related asymptotic characterizations and estimators. The present paper clarifies the connections between the main likelihood estimators, and assesses their practical performance. We investigate their ability to estimate the extremal dependence structure and to predict future extremes, using exact calculations and simulation, in the case of the logistic model.

Characteristics of Extreme Extratropical Cyclones in a High-Resolution Global Climate Model

Science.gov (United States)

Catalano, A. J.; Broccoli, A. J.; Kapnick, S. B.; Janoski, T. P.

2017-12-01

In the northeastern United States, many of the strongest impacts from extratropical cyclones (ETCs) are associated with storms that exhibit slow movement, unusual tracks, or exceptional intensity. Examples of extreme ETCs include the Appalachian storm of November 1950, the Perfect Storm of October 1991, and the Superstorm of March 1993. Owing to the rare nature of these events, it is difficult to quantify the associated risks (e.g. high winds, storm surge) given the limited duration of high-quality observational datasets. Furthermore, storms with even greater impacts than those observed may be possible, particularly in a warming climate. In the context of tropical cyclones, Lin and Emanuel (2016) have used the metaphor "grey swans" to refer to high-impact events that have not been observed but may be physically possible. One method for analyzing "grey swans" is to generate a larger sample of ETCs using a coupled climate model. Therefore, we use long simulations (over 1,000 years with atmospheric constituents fixed at 1990 levels) from a global climate model (GFDL FLOR) with 50km atmospheric resolution. FLOR has been shown to realistically simulate the spatial distribution and climatology of ETCs during the reanalysis era. We will discuss the climatological features of these extreme ETC events.

Classifying Returns as Extreme

DEFF Research Database (Denmark)

Christiansen, Charlotte

2014-01-01

I consider extreme returns for the stock and bond markets of 14 EU countries using two classification schemes: One, the univariate classification scheme from the previous literature that classifies extreme returns for each market separately, and two, a novel multivariate classification scheme tha...

The "difficult" patient reconceived: an expanded moral mandate for clinical ethics.

Science.gov (United States)

Fiester, Autumn

2012-01-01

Between 15 and 60% of patients are considered "difficult" by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed "difficult." But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as a response to problematic interactions related to health care delivery. If there are grounds to reconceive the "difficult" patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.

Future Projection of Summer Extreme Precipitation from High Resolution Multi-RCMs over East Asia

Science.gov (United States)

Kim, Gayoung; Park, Changyong; Cha, Dong-Hyun; Lee, Dong-Kyou; Suh, Myoung-Seok; Ahn, Joong-Bae; Min, Seung-Ki; Hong, Song-You; Kang, Hyun-Suk

2017-04-01

Recently, the frequency and intensity of natural hazards have been increasing due to human-induced climate change. Because most damages of natural hazards over East Asia have been related to extreme precipitation events, it is important to estimate future change in extreme precipitation characteristics caused by climate change. We investigate future changes in extremal values of summer precipitation simulated by five regional climate models participating in the CORDEX-East Asia project (i.e., HadGEM3-RA, RegCM4, MM5, WRF, and GRIMs) over East Asia. 100-year return value calculated from the generalized extreme value (GEV) parameters is analysed as an indicator of extreme intensity. In the future climate, the mean values as well as the extreme values of daily precipitation tend to increase over land region. The increase of 100-year return value can be significantly associated with the changes in the location (intensity) and scale (variability) GEV parameters for extreme precipitation. It is expected that the results of this study can be used as fruitful references when making the policy of disaster management. Acknowledgements The research was supported by the Ministry of Public Safety and Security of Korean government and Development program under grant MPSS-NH-2013-63 and the National Research Foundation of Korea Grant funded by the Ministry of Science, ICT and Future Planning of Korea (NRF-2016M3C4A7952637) for its support and assistant in completion of the study.

Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study.

Science.gov (United States)

Johnson, S; Hennessy, E; Smith, R; Trikic, R; Wolke, D; Marlow, N

2009-07-01

To assess academic attainment and special educational needs (SEN) in extremely preterm children in middle childhood. Of 307 extremely preterm (special school. In mainstream schools, 105 (57%) extremely preterm children had SEN (OR 10; 6 to 18) and 103 (55%) required SEN resource provision (OR 10; 6 to 18). Teachers rated 50% of extremely preterm children as having below average attainment compared with 5% of classmates (OR 18; 8 to 41). Extremely preterm children who entered compulsory education an academic year early due to preterm birth had similar academic attainment but required more SEN support (OR 2; 1.0 to 3.6). Extremely preterm survivors remain at high risk for learning impairments and poor academic attainment in middle childhood. A significant proportion require full-time specialist education and over half of those attending mainstream schools require additional health or educational resources to access the national curriculum. The prevalence and impact of SEN are likely to increase as these children approach the transition to secondary school.

Non-invasive neurosensory testing used to diagnose and confirm successful surgical management of lower extremity deep distal posterior compartment syndrome

Directory of Open Access Journals (Sweden)

Guyton Gregory P

2009-05-01

Full Text Available Abstract Background Chronic exertional compartment syndrome (CECS is characterized by elevated pressures within a closed space of an extremity muscular compartment, causing pain and/or disability by impairing the neuromuscular function of the involved compartment. The diagnosis of CECS is primarily made on careful history and physical exam. The gold standard test to confirm the diagnosis of CECS is invasive intra-compartmental pressure measurements. Sensory nerve function is often diminished during symptomatic periods of CECS. Sensory nerve function can be documented with the use of non-painful, non-invasive neurosensory testing. Methods Non-painful neurosensory testing of the myelinated large sensory nerve fibers of the lower extremity were obtained with the Pressure Specified Sensory Device™ in a 25 year old male with history and invasive compartment pressures consistent with CECS both before and after running on a tread mill. After the patient's first operation to release the deep distal posterior compartment, the patient failed to improve. Repeat sensory testing revealed continued change in his function with exercise. He was returned to the operating room where a repeat procedure revealed that the deep posterior compartment was not completely released due to an unusual anatomic variant, and therefore complete release was accomplished. Results The patient's symptoms numbness in the plantar foot and pain in the distal calf improved after this procedure and his repeat sensory testing performed before and after running on the treadmill documented this improvement. Conclusion This case report illustrates the principal that non-invasive neurosensory testing can detect reversible changes in sensory nerve function after a provocative test and may be a helpful non-invasive technique to managing difficult cases of persistent lower extremity symptoms after failed decompressive fasciotomies for CECS. It can easily be performed before and after

Water-borne diseases and extreme weather events in Cambodia: review of impacts and implications of climate change.

Science.gov (United States)

Davies, Grace I; McIver, Lachlan; Kim, Yoonhee; Hashizume, Masahiro; Iddings, Steven; Chan, Vibol

2014-12-23

Cambodia is prone to extreme weather events, especially floods, droughts and typhoons. Climate change is predicted to increase the frequency and intensity of such events. The Cambodian population is highly vulnerable to the impacts of these events due to poverty; malnutrition; agricultural dependence; settlements in flood-prone areas, and public health, governance and technological limitations. Yet little is known about the health impacts of extreme weather events in Cambodia. Given the extremely low adaptive capacity of the population, this is a crucial knowledge gap. A literature review of the health impacts of floods, droughts and typhoons in Cambodia was conducted, with regional and global information reviewed where Cambodia-specific literature was lacking. Water-borne diseases are of particular concern in Cambodia, in the face of extreme weather events and climate change, due to, inter alia, a high pre-existing burden of diseases such as diarrhoeal illness and a lack of improved sanitation infrastructure in rural areas. A time-series analysis under quasi-Poisson distribution was used to evaluate the association between floods and diarrhoeal disease incidence in Cambodian children between 2001 and 2012 in 16 Cambodian provinces. Floods were significantly associated with increased diarrhoeal disease in two provinces, while the analysis conducted suggested a possible protective effect from toilets and piped water. Addressing the specific, local pre-existing vulnerabilities is vital to promoting population health resilience and strengthening adaptive capacity to extreme weather events and climate change in Cambodia.

Water-Borne Diseases and Extreme Weather Events in Cambodia: Review of Impacts and Implications of Climate Change

Directory of Open Access Journals (Sweden)

Grace I. Davies

2014-12-01

Full Text Available Cambodia is prone to extreme weather events, especially floods, droughts and typhoons. Climate change is predicted to increase the frequency and intensity of such events. The Cambodian population is highly vulnerable to the impacts of these events due to poverty; malnutrition; agricultural dependence; settlements in flood-prone areas, and public health, governance and technological limitations. Yet little is known about the health impacts of extreme weather events in Cambodia. Given the extremely low adaptive capacity of the population, this is a crucial knowledge gap. A literature review of the health impacts of floods, droughts and typhoons in Cambodia was conducted, with regional and global information reviewed where Cambodia-specific literature was lacking. Water-borne diseases are of particular concern in Cambodia, in the face of extreme weather events and climate change, due to, inter alia, a high pre-existing burden of diseases such as diarrhoeal illness and a lack of improved sanitation infrastructure in rural areas. A time-series analysis under quasi-Poisson distribution was used to evaluate the association between floods and diarrhoeal disease incidence in Cambodian children between 2001 and 2012 in 16 Cambodian provinces. Floods were significantly associated with increased diarrhoeal disease in two provinces, while the analysis conducted suggested a possible protective effect from toilets and piped water. Addressing the specific, local pre-existing vulnerabilities is vital to promoting population health resilience and strengthening adaptive capacity to extreme weather events and climate change in Cambodia.

The Defining Characteristics of ENSO Extremes and the Strong 2015/2016 El Niño

Science.gov (United States)

Santoso, Agus; Mcphaden, Michael J.; Cai, Wenju

2017-12-01

The year 2015 was special for climate scientists, particularly for the El Niño Southern Oscillation (ENSO) research community, as a major El Niño finally materialized after a long pause since the 1997/1998 extreme El Niño. It was scientifically exciting since, due to the short observational record, our knowledge of an extreme El Niño has been based only on the 1982/1983 and 1997/1998 events. The 2015/2016 El Niño was marked by many environmental disasters that are consistent with what is expected for an extreme El Niño. Considering the dramatic impacts of extreme El Niño, and the risk of a potential increase in frequency of ENSO extremes under greenhouse warming, it is timely to evaluate how the recent event fits into our understanding of ENSO extremes. Here we provide a review of ENSO, its nature and dynamics, and through analysis of various observed key variables, we outline the processes that characterize its extremes. The 2015/2016 El Niño brings a useful perspective into the state of understanding of these events and highlights areas for future research. While the 2015/2016 El Niño is characteristically distinct from the 1982/1983 and 1997/1998 events, it still can be considered as the first extreme El Niño of the 21st century. Its extremity can be attributed in part to unusually warm condition in 2014 and to long-term background warming. In effect, this study provides a list of physically meaningful indices that are straightforward to compute for identifying and tracking extreme ENSO events in observations and climate models.

The Relationship between Spatial and Temporal Magnitude Estimation of Scientific Concepts at Extreme Scales

Science.gov (United States)

Price, Aaron; Lee, H.

2010-01-01

Many astronomical objects, processes, and events exist and occur at extreme scales of spatial and temporal magnitudes. Our research draws upon the psychological literature, replete with evidence of linguistic and metaphorical links between the spatial and temporal domains, to compare how students estimate spatial and temporal magnitudes associated with objects and processes typically taught in science class.. We administered spatial and temporal scale estimation tests, with many astronomical items, to 417 students enrolled in 12 undergraduate science courses. Results show that while the temporal test was more difficult, students’ overall performance patterns between the two tests were mostly similar. However, asymmetrical correlations between the two tests indicate that students think of the extreme ranges of spatial and temporal scales in different ways, which is likely influenced by their classroom experience. When making incorrect estimations, students tended to underestimate the difference between the everyday scale and the extreme scales on both tests. This suggests the use of a common logarithmic mental number line for both spatial and temporal magnitude estimation. However, there are differences between the two tests in the errors student make in the everyday range. Among the implications discussed is the use of spatio-temporal reference frames, instead of smooth bootstrapping, to help students maneuver between scales of magnitude and the use of logarithmic transformations between reference frames. Implications for astronomy range from learning about spectra to large scale galaxy structure.

Stationary and non-stationary extreme value modeling of extreme temperature in Malaysia

Science.gov (United States)

Hasan, Husna; Salleh, Nur Hanim Mohd; Kassim, Suraiya

2014-09-01

Extreme annual temperature of eighteen stations in Malaysia is fitted to the Generalized Extreme Value distribution. Stationary and non-stationary models with trend are considered for each station and the Likelihood Ratio test is used to determine the best-fitting model. Results show that three out of eighteen stations i.e. Bayan Lepas, Labuan and Subang favor a model which is linear in the location parameter. A hierarchical cluster analysis is employed to investigate the existence of similar behavior among the stations. Three distinct clusters are found in which one of them consists of the stations that favor the non-stationary model. T-year estimated return levels of the extreme temperature are provided based on the chosen models.

Radiofrequency ablation for hepatocellular carcinoma: assistant techniques for difficult cases.

Science.gov (United States)

Inoue, Tatsuo; Minami, Yasunori; Chung, Hobyung; Hayaishi, Sousuke; Ueda, Taisuke; Tatsumi, Chie; Takita, Masahiro; Kitai, Satoshi; Hatanaka, Kinuyo; Ishikawa, Emi; Yada, Norihisa; Hagiwara, Satoru; Ueshima, Kazuomi; Kudo, Masatoshi

2010-07-01

To confirm the safety and effectiveness of techniques to assist radiofrequency ablation (RFA) for difficult cases, we retrospectively evaluated successful treatment rates, early complications and local tumor progressions. Between June 1999 and April 2009, a total of 341 patients with 535 nodules were treated as difficult cases. Artificial pleural effusion assisted ablation was performed on 64 patients with 82 nodules. Artificial ascites-assisted ablation was performed on 11 patients with 13 nodules. Cooling by endoscopic nasobiliary drainage (ENBD) tube-assisted ablation was performed on 6 patients with 8 nodules. When the tumors were not well visualized with conventional B-mode ultrasonography (US), contrast-enhanced US-assisted ablation with Levovist or Sonazoid or virtual CT sonography-assisted ablation was performed. Contrast-enhanced US-assisted ablation was performed on 139 patients with 224 nodules and virtual CT sonography-assisted ablation was performed on 121 patients with 209 nodules. In total, complete ablation was achieved in 514 of 535 (96%) nodules in difficult cases. For RFA with artificial pleural effusion, artificial ascites and ENBD, complete response was confirmed in all cases. For contrast-enhanced US- and CT sonography-assisted ablation, complete response was 95%. Early complications were recognized in 24 cases (4.5%). All cases recovered with no invasive treatment. Local tumor recurrence was investigated in 377 nodules of 245 patients, and 69 (18%) nodules were positive. Tumor recurrences in each assisted technique were 14.7% in artificial pleural effusion cases, 7% in artificial ascites, 12.5% in ENBD tube cases, 31% in virtual CT sonography, and 8.5% in contrast-enhanced US. Although local tumor progression needs to be carefully monitored, assisted techniques of RFA for difficult cases are well tolerated and expand the indications of RFA. Copyright (c) 2010 S. Karger AG, Basel.

Thermal extremes mortality risk assessment in urban areas

Directory of Open Access Journals (Sweden)

Paulo Canário

2010-06-01

Full Text Available The impact of heat waves on mortality has been the subject of numerous studies and the focus of attention of various national and international governmental bodies. In the summer of 2003 alone, which was exceptionally hot, the number of deaths in 12 European countries increased by 70,000. The overall trend of warming will lead to an increase in frequency, duration and intensity of heat waves and to an increase in heat related mortality. The need to assess the risk of death due to extreme heat, at a detailed spatial scale, has determined the implementation of a research project based on a general model of risk for potentially destructive natural phenomena; the model uses the relationship between hazard and vulnerability and was designed primarily for urban areas. The major hazardous meteorological variables are those that determine the thermal complex (air temperature, radiative temperature, wind and humidity and the variables related to air quality (mainly ozone and Particulate matter. Vulnerability takes into account the population sensitivity (at various spatial scales and their exposure to thermal extremes.

Vulnerability assessment of Central-East Sardinia (Italy to extreme rainfall events

Directory of Open Access Journals (Sweden)

A. Bodini

2010-01-01

Full Text Available In Sardinia (Italy, the highest frequency of extreme events is recorded in the Central-East area (3–4 events per year. The presence of high and steep mountains near the sea on the central and south-eastern coast, causes an East-West precipitation gradient in autumn especially, due to hot and moist currents coming from Africa. Soil structure and utilization make this area highly vulnerable to flash flooding and landslides. The specific purpose of this work is to provide a description of the heavy rainfall phenomenon on a statistical basis. The analysis mainly focuses on i the existence of trends in heavy rainfall and ii the characterization of the distribution of extreme events. First, to study possible trends in extreme events a few indices have been analyzed by the linear regression test. The analysis has been carried out at annual and seasonal scales. Then, extreme values analysis has been carried out by fitting a Generalized Pareto Distribution (GPD to the data. As far as trends are concerned, different results are obtained at the two temporal scales: significant trends are obtained at the seasonal scale which are masked at the annual scale. By combining trend analysis and GPD analysis, the vulnerability of the study area to the occurrence of heavy rainfall has been characterized. Therefore, this work might support the improvement of land use planning and the application of suitable prevention systems. Future work will consider the extension of the analysis to all Sardinia and the application of statistical methods taking into account the spatial correlation of extreme events.

Adaptation to extreme climate events at a regional scale

OpenAIRE

Hoffmann, Christin

2017-01-01

A significant increase of the frequency, the intensity and the duration of extreme climate events in Switzerland induces the need to find a strategy to deal with the damages they cause. For more than two decades, mitigation has been the main objective of climate policy. However, due to already high atmospheric carbon concentrations and the inertia of the climate system, climate change is unavoidable to some degree, even if today’s emissions were almost completely cut back. Along with the high...

Janiceps conjoined twins with extreme asymmetry: case report with complete autopsy and histopathologic findings.

Science.gov (United States)

Kastenbaum, Hannah A; McPherson, Elizabeth W; Murdoch, Geoffrey H; Ozolek, John A

2009-01-01

Conjoined twinning is a rare form of twinning, in which 2 bodies are attached, and is classified according to the anatomic place of attachment. An extremely rare form of conjoined twinning is janiceps conjoined twinning, in which 2 faces are attached but oriented in opposite directions. In this report, we present an unusual and difficult-to-classify case of conjoined male twins with partial duplication of craniofacial, upper oropharyngeal, and cardiac organs. We believe this to be one of the few reported cases of janiceps asymmetrus. We describe in detail the gross and microscopic pathology and offer some insights into the possible embryogenesis and distinction from the other rare form of conjoined twinning with facial duplication, diprosopus.

Acute colonic obstruction due to benign prostatic hypertrophy.

LENUS (Irish Health Repository)

Mac Giobuin, S

2012-02-01

A seventy two year old man presented to the Emergency Department with clinical features of colonic obstruction. Subsequent radiological investigations confirmed this impression and revealed the aetiology to be compression of the sigmoid colon against the sacrum by a massively distended urinary bladder. Chronic urinary retention due to benign prostatic hypertrophy is an extremely unusual cause of large bowel obstruction. Little in this patient\\'s clinical findings suggested this aetiology. We reviewed the literature in this area and highlight the benefits of CT scanning over contrast studies.

Extreme Programming: Maestro Style

Science.gov (United States)

Norris, Jeffrey; Fox, Jason; Rabe, Kenneth; Shu, I-Hsiang; Powell, Mark

2009-01-01

"Extreme Programming: Maestro Style" is the name of a computer programming methodology that has evolved as a custom version of a methodology, called extreme programming that has been practiced in the software industry since the late 1990s. The name of this version reflects its origin in the work of the Maestro team at NASA's Jet Propulsion Laboratory that develops software for Mars exploration missions. Extreme programming is oriented toward agile development of software resting on values of simplicity, communication, testing, and aggressiveness. Extreme programming involves use of methods of rapidly building and disseminating institutional knowledge among members of a computer-programming team to give all the members a shared view that matches the view of the customers for whom the software system is to be developed. Extreme programming includes frequent planning by programmers in collaboration with customers, continually examining and rewriting code in striving for the simplest workable software designs, a system metaphor (basically, an abstraction of the system that provides easy-to-remember software-naming conventions and insight into the architecture of the system), programmers working in pairs, adherence to a set of coding standards, collaboration of customers and programmers, frequent verbal communication, frequent releases of software in small increments of development, repeated testing of the developmental software by both programmers and customers, and continuous interaction between the team and the customers. The environment in which the Maestro team works requires the team to quickly adapt to changing needs of its customers. In addition, the team cannot afford to accept unnecessary development risk. Extreme programming enables the Maestro team to remain agile and provide high-quality software and service to its customers. However, several factors in the Maestro environment have made it necessary to modify some of the conventional extreme

[Qualified and emergency specialized surgical care for those with wounds to the extremities].

Science.gov (United States)

Iurkevich, V V; Fidarov, E Z; Bauér, V A

1997-06-01

Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.

Game theory and extremal optimization for community detection in complex dynamic networks.

Science.gov (United States)

Lung, Rodica Ioana; Chira, Camelia; Andreica, Anca

2014-01-01

The detection of evolving communities in dynamic complex networks is a challenging problem that recently received attention from the research community. Dynamics clearly add another complexity dimension to the difficult task of community detection. Methods should be able to detect changes in the network structure and produce a set of community structures corresponding to different timestamps and reflecting the evolution in time of network data. We propose a novel approach based on game theory elements and extremal optimization to address dynamic communities detection. Thus, the problem is formulated as a mathematical game in which nodes take the role of players that seek to choose a community that maximizes their profit viewed as a fitness function. Numerical results obtained for both synthetic and real-world networks illustrate the competitive performance of this game theoretical approach.

Gross tumor volume and clinical target volume: soft-tissue sarcoma of the extremities

International Nuclear Information System (INIS)

Lartigau, E.; Kantor, G.; Lagarde, P.; Taieb, S.; Ceugnart, L.; Vilain, M.O.; Penel, N.; Depadt, G.

2001-01-01

Soft tissue sarcomas of the extremities are currently treated with more conservative and functional approaches, combining surgery, radiotherapy and chemotherapy. The role of external beam radiotherapy and brachytherapy has been defined through randomized studies performed in the 80's and 90's. However, the ubiquity of tumour location for these tumours makes difficult a systematic definition of local treatments. Tumour volume definition is based on pre and post surgical imaging (MRI) and on described pathological report. The clinical target volume will take into account quality of the resection and anatomical barriers and will be based on an anatomy and not only on safety margins around the tumour bed. General rules for this irradiation (doses, volumes) and principal results will be presented. (authors)

Dynamically-downscaled projections of changes in temperature extremes over China

Science.gov (United States)

Guo, Junhong; Huang, Guohe; Wang, Xiuquan; Li, Yongping; Lin, Qianguo

2018-02-01

In this study, likely changes in extreme temperatures (including 16 indices) over China in response to global warming throughout the twenty-first century are investigated through the PRECIS regional climate modeling system. The PRECIS experiment is conducted at a spatial resolution of 25 km and is driven by a perturbed-physics ensemble to reflect spatial variations and model uncertainties. Simulations of present climate (1961-1990) are compared with observations to validate the model performance in reproducing historical climate over China. Results indicate that the PRECIS demonstrates reasonable skills in reproducing the spatial patterns of observed extreme temperatures over the most regions of China, especially in the east. Nevertheless, the PRECIS shows a relatively poor performance in simulating the spatial patterns of extreme temperatures in the western mountainous regions, where its driving GCM exhibits more uncertainties due to lack of insufficient observations and results in more errors in climate downscaling. Future spatio-temporal changes of extreme temperature indices are then analyzed for three successive periods (i.e., 2020s, 2050s and 2080s). The projected changes in extreme temperatures by PRECIS are well consistent with the results of the major global climate models in both spatial and temporal patterns. Furthermore, the PRECIS demonstrates a distinct superiority in providing more detailed spatial information of extreme indices. In general, all extreme indices show similar changes in spatial pattern: large changes are projected in the north while small changes are projected in the south. In contrast, the temporal patterns for all indices vary differently over future periods: the warm indices, such as SU, TR, WSDI, TX90p, TN90p and GSL are likely to increase, while the cold indices, such as ID, FD, CSDI, TX10p and TN10p, are likely to decrease with time in response to global warming. Nevertheless, the magnitudes of changes in all indices tend to

Design and control of RUPERT: a device for robotic upper extremity repetitive therapy.

Science.gov (United States)

Sugar, Thomas G; He, Jiping; Koeneman, Edward J; Koeneman, James B; Herman, Richard; Huang, H; Schultz, Robert S; Herring, D E; Wanberg, J; Balasubramanian, Sivakumar; Swenson, Pete; Ward, Jeffrey A

2007-09-01

The structural design, control system, and integrated biofeedback for a wearable exoskeletal robot for upper extremity stroke rehabilitation are presented. Assisted with clinical evaluation, designers, engineers, and scientists have built a device for robotic assisted upper extremity repetitive therapy (RUPERT). Intense, repetitive physical rehabilitation has been shown to be beneficial overcoming upper extremity deficits, but the therapy is labor intensive and expensive and difficult to evaluate quantitatively and objectively. The RUPERT is developed to provide a low cost, safe and easy-to-use, robotic-device to assist the patient and therapist to achieve more systematic therapy at home or in the clinic. The RUPERT has four actuated degrees-of-freedom driven by compliant and safe pneumatic muscles (PMs) on the shoulder, elbow, and wrist. They are programmed to actuate the device to extend the arm and move the arm in 3-D space. It is very important to note that gravity is not compensated and the daily tasks are practiced in a natural setting. Because the device is wearable and lightweight to increase portability, it can be worn standing or sitting providing therapy tasks that better mimic activities of daily living. The sensors feed back position and force information for quantitative evaluation of task performance. The device can also provide real-time, objective assessment of functional improvement. We have tested the device on stroke survivors performing two critical activities of daily living (ADL): reaching out and self feeding. The future improvement of the device involves increased degrees-of-freedom and interactive control to adapt to a user's physical conditions.

Spatial dependence of extreme rainfall

Science.gov (United States)

Radi, Noor Fadhilah Ahmad; Zakaria, Roslinazairimah; Satari, Siti Zanariah; Azman, Muhammad Az-zuhri

2017-05-01

This study aims to model the spatial extreme daily rainfall process using the max-stable model. The max-stable model is used to capture the dependence structure of spatial properties of extreme rainfall. Three models from max-stable are considered namely Smith, Schlather and Brown-Resnick models. The methods are applied on 12 selected rainfall stations in Kelantan, Malaysia. Most of the extreme rainfall data occur during wet season from October to December of 1971 to 2012. This period is chosen to assure the available data is enough to satisfy the assumption of stationarity. The dependence parameters including the range and smoothness, are estimated using composite likelihood approach. Then, the bootstrap approach is applied to generate synthetic extreme rainfall data for all models using the estimated dependence parameters. The goodness of fit between the observed extreme rainfall and the synthetic data is assessed using the composite likelihood information criterion (CLIC). Results show that Schlather model is the best followed by Brown-Resnick and Smith models based on the smallest CLIC's value. Thus, the max-stable model is suitable to be used to model extreme rainfall in Kelantan. The study on spatial dependence in extreme rainfall modelling is important to reduce the uncertainties of the point estimates for the tail index. If the spatial dependency is estimated individually, the uncertainties will be large. Furthermore, in the case of joint return level is of interest, taking into accounts the spatial dependence properties will improve the estimation process.

Clinicians' recognition and management of emotions during difficult healthcare conversations.

Science.gov (United States)

Martin, Elliott B; Mazzola, Natalia M; Brandano, Jessica; Luff, Donna; Zurakowski, David; Meyer, Elaine C

2015-10-01

To examine the most commonly reported emotions encountered among healthcare practitioners when holding difficult conversations, including frequency and impact on care delivery. Interprofessional learners from a range of experience levels and specialties completed self-report questionnaires prior to simulation-based communication workshops. Clinicians were asked to describe up to three emotions they experienced when having difficult healthcare conversations; subsequent questions used Likert-scales to measure frequency of each emotion, and whether care was affected. 152 participants completed questionnaires, including physicians, nurses, and psychosocial professionals. Most commonly reported emotions were anxiety, sadness, empathy, frustration, and insecurity. There were significant differences in how clinicians perceived these different emotions affecting care. Empathy and anxiety were emotions perceived to influence care more than sadness, frustration, and insecurity. Most clinicians, regardless of clinical experience and discipline, find their emotional state influences the quality of their care delivery. Most clinicians rate themselves as somewhat to quite capable of recognizing and managing their emotions, acknowledging significant room to grow. Further education designed to increase clinicians' recognition of, reflection on, and management of emotion would likely prove helpful in improving their ability to navigate difficult healthcare conversations. Interventions aimed at anxiety management are particularly needed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A joint analysis of wave and surge conditions for past and present extrem events in the south-western Baltic Sea

Science.gov (United States)

Groll, Nikolaus; Gaslikova, Lidia

2017-04-01

Extreme marine events in the south-western Baltic Sea like the historic storm in 1872 are rare, but have large impacts on human safety and coastal infrastructure. The aforementioned extreme storm event of 1872 and has cost over 250 human lives, left severely damaged infrastructure and caused land loss due to coastal erosion. Recent extreme events also result in drastic impacts to coastal regions. Using results from numerical wave and hydrodynamic model simulations we will present a joint analysis of wave and water level conditions for selected extreme events. For the historic event the numerical models have been forced by reconstructed wind and pressure fields from pressure readings. Simulated atmospheric conditions from reanalysis have been used for the more recent events. The height of the water level due to the possible previous inflow of water masses in the Baltic Sea basin, as well as possible seiches and swell effects have been incorporated in the simulations. We will discuss similarities and differences between the historic and the more recent marine hazard events.

Spatiotemporal trends in extreme rainfall and temperature indices over Upper Tapi Basin, India

Science.gov (United States)

Sharma, Priyank J.; Loliyana, V. D.; S. R., Resmi; Timbadiya, P. V.; Patel, P. L.

2017-12-01

The flood risk across the globe is intensified due to global warming and subsequent increase in extreme temperature and precipitation. The long-term trends in extreme rainfall (1944-2013) and temperature (1969-2012) indices have been investigated at annual, seasonal, and monthly time scales using nonparametric Mann-Kendall (MK), modified Mann-Kendall (MMK), and Sen's slope estimator tests. The extreme rainfall and temperature indices, recommended by the Expert Team on Climate Change Detection Monitoring Indices (ETCCDMI), have been analyzed at finer spatial scales for trend detection. The results of trend analyses indicate decreasing trend in annual total rainfall, significant decreasing trend in rainy days, and increasing trend in rainfall intensity over the basin. The seasonal rainfall has been found to decrease for all the seasons except postmonsoon, which could affect the rain-fed agriculture in the basin. The 1- and 5-day annual maximum rainfalls exhibit mixed trends, wherein part of the basin experiences increasing trend, while other parts experience a decreasing trend. The increase in dry spells and concurrent decrease in wet spells are also observed over the basin. The extreme temperature indices revealed increasing trends in hottest and coldest days, while decreasing trends in coldest night are found over most parts of the basin. Further, the diurnal temperature range is also found to increase due to warming tendency in maximum temperature (T max) at a faster rate compared to the minimum temperature (T min). The increase in frequency and magnitude of extreme rainfall in the basin has been attributed to the increasing trend in maximum and minimum temperatures, reducing forest cover, rapid pace of urbanization, increase in human population, and thereby increase in the aerosol content in the atmosphere. The findings of the present study would significantly help in sustainable water resource planning, better decision-making for policy framework, and setting up

Global crop yield response to extreme heat stress under multiple climate change futures

Science.gov (United States)

Deryng, D.; Conway, D.; Ramankutty, N.; Price, J.; Warren, R.

2014-12-01

Extreme heat stress during the crop reproductive period can be critical for crop productivity. Projected changes in the frequency and severity of extreme climatic events are expected to negatively impact crop yields and global food production. This study applies the global crop model PEGASUS to quantify, for the first time at the global scale, impacts of extreme heat stress on maize, spring wheat and soybean yields resulting from 72 climate change scenarios for the 21st century. Our results project maize to face progressively worse impacts under a range of RCPs but spring wheat and soybean to improve globally through to the 2080s due to CO2 fertilization effects, even though parts of the tropic and sub-tropic regions could face substantial yield declines. We find extreme heat stress at anthesis (HSA) by the 2080s (relative to the 1980s) under RCP 8.5, taking into account CO2 fertilization effects, could double global losses of maize yield (dY = -12.8 ± 6.7% versus -7.0 ± 5.3% without HSA), reduce projected gains in spring wheat yield by half (dY = 34.3 ± 13.5% versus 72.0 ± 10.9% without HSA) and in soybean yield by a quarter (dY = 15.3 ± 26.5% versus 20.4 ± 22.1% without HSA). The range reflects uncertainty due to differences between climate model scenarios; soybean exhibits both positive and negative impacts, maize is generally negative and spring wheat generally positive. Furthermore, when assuming CO2 fertilization effects to be negligible, we observe drastic climate mitigation policy as in RCP 2.6 could avoid more than 80% of the global average yield losses otherwise expected by the 2080s under RCP 8.5. We show large disparities in climate impacts across regions and find extreme heat stress adversely affects major producing regions and lower income countries.

Global crop yield response to extreme heat stress under multiple climate change futures

International Nuclear Information System (INIS)

Deryng, Delphine; Warren, Rachel; Conway, Declan; Ramankutty, Navin; Price, Jeff

2014-01-01

Extreme heat stress during the crop reproductive period can be critical for crop productivity. Projected changes in the frequency and severity of extreme climatic events are expected to negatively impact crop yields and global food production. This study applies the global crop model PEGASUS to quantify, for the first time at the global scale, impacts of extreme heat stress on maize, spring wheat and soybean yields resulting from 72 climate change scenarios for the 21st century. Our results project maize to face progressively worse impacts under a range of RCPs but spring wheat and soybean to improve globally through to the 2080s due to CO 2 fertilization effects, even though parts of the tropic and sub-tropic regions could face substantial yield declines. We find extreme heat stress at anthesis (HSA) by the 2080s (relative to the 1980s) under RCP 8.5, taking into account CO 2 fertilization effects, could double global losses of maize yield (ΔY = −12.8 ± 6.7% versus − 7.0 ± 5.3% without HSA), reduce projected gains in spring wheat yield by half (ΔY = 34.3 ± 13.5% versus 72.0 ± 10.9% without HSA) and in soybean yield by a quarter (ΔY = 15.3 ± 26.5% versus 20.4 ± 22.1% without HSA). The range reflects uncertainty due to differences between climate model scenarios; soybean exhibits both positive and negative impacts, maize is generally negative and spring wheat generally positive. Furthermore, when assuming CO 2 fertilization effects to be negligible, we observe drastic climate mitigation policy as in RCP 2.6 could avoid more than 80% of the global average yield losses otherwise expected by the 2080s under RCP 8.5. We show large disparities in climate impacts across regions and find extreme heat stress adversely affects major producing regions and lower income countries. (paper)

Extremely deformable structures

CERN Document Server

2015-01-01

Recently, a new research stimulus has derived from the observation that soft structures, such as biological systems, but also rubber and gel, may work in a post critical regime, where elastic elements are subject to extreme deformations, though still exhibiting excellent mechanical performances. This is the realm of ‘extreme mechanics’, to which this book is addressed. The possibility of exploiting highly deformable structures opens new and unexpected technological possibilities. In particular, the challenge is the design of deformable and bi-stable mechanisms which can reach superior mechanical performances and can have a strong impact on several high-tech applications, including stretchable electronics, nanotube serpentines, deployable structures for aerospace engineering, cable deployment in the ocean, but also sensors and flexible actuators and vibration absorbers. Readers are introduced to a variety of interrelated topics involving the mechanics of extremely deformable structures, with emphasis on ...

Unexpected Impacts of Global warming on Extreme Warm Spells

Science.gov (United States)

Sardeshmukh, P. D.; Compo, G. P.; McColl, C.; Penland, C.

2017-12-01

It is generally presumed that the likelihood of extreme warm spells around the globe has increased, and will continue to increase, due to global warming. However, we find that this is generally not true in three very different types of global observational datasets and uncoupled atmospheric model simulations of the 1959 to 2012 period with prescribed observed global SSTs, sea ice, and radiative forcing changes. While extreme warm spells indeed became more common in many regions, in many other regions their likelihood remained almost the same or even decreased from the first half to the second half of this period. Such regions of unexpected changes covered nearly 40 percent of the globe in both winter and summer. The basic reason for this was a decrease of temperature variability in such regions that offset or even negated the effect of the mean temperature shift on extreme warm spell probabilities. The possibility of such an impact on extreme value probabilities was highlighted in a recent paper by Sardeshmukh, Compo, and Penland (Journal of Climate 2015). The consistency of the changes in extreme warm spell probabilities among the different observational datasets and model simulations examined suggests that they are robust regional aspects of global warming associated with atmospheric circulation changes. This highlights the need for climate models to represent not just the mean regional temperature signals but also the changes in subseasonal temperature variability associated with global warming. However, current climate models (both CMIP3 and CMIP5) generally underestimate the magnitude of the changes in the atmospheric circulation and associated temperature variability. A likely major cause of this is their continuing underestimation of the magnitude of the spatial variation of tropical SST trends. By generating an overly spatially bland tropical SST warming in response to changes in radiative forcing, the models spuriously mute tropically

Environmental policy-making in a difficult context: motorized two-wheeled vehicle emissions in India

International Nuclear Information System (INIS)

Badami, Madhav G.

2004-01-01

Motor vehicle activity is growing rapidly in India and other less-industrialized countries in Asia. This growth is contributing to serious health and welfare effects due to vehicle emissions, and energy insecurity, acidification and climate change. This paper applies the problem-structuring tools of 'value-focused thinking' to inform policy-making and implementation related to this complex problem in a difficult context, with specific reference to motorized two-wheeled vehicles, which play an important role in transport air pollution but also provide affordable mobility to millions with few other attractive options. The paper describes the process used to elicit and structure objectives and measures, based on interviews conducted by the author, and demonstrates how the objectives and measures can be used to more effectively characterize policy impacts, and create policy packages that have a better chance of long-term success

Fuzzy mathematics method for theoretical analysis of ground movements due to underground excavation

Energy Technology Data Exchange (ETDEWEB)

Li Wenxiu (Changsa Research Institute of Mining and Metallurgy, Changsa (China))

1991-07-01

The analysis of the rock mass movements due to excavation operations is one of the many important problems of rock mass mechanics. It is difficult to calculate the ground movements due to underground excavation accurately because of the complexity of the problem. In this paper, the application is described of the fuzzy probability measures to the analysis of ground movements. Based on the definition of the fuzzy probability measure, the theories for both the two-dimensional and three-dimensional problems are developed and are applied to the analysis of ground movements due to underground excavation. 31 refs., 5 figs.

Occupational performance, pain, and global quality of life in women with upper extremity fractures

DEFF Research Database (Denmark)

Dekkers, Merete Klindt; Nielsen, Tove Lise

2010-01-01

on the COPM and with the COPM satisfaction score, and it can be argued that a finding of a low DASH score in elderly women with upper extremity fractures should be followed up by a referral to occupational therapy. Future studies, preferably follow-up studies, are called for to further explore the multiple......To examine pain, occupational performance problems, and quality of life (QoL) and possible associations between these variables, 41 elderly women with acute pain due to a fracture of the upper extremity were assessed with COPM, DASH, validated questions on pain, and a global question on Qo...

Assessing Climate Variability using Extreme Rainfall and ...

African Journals Online (AJOL)

user1

extreme frequency); the average intensity of rainfall from extreme events ... frequency and extreme intensity indices, suggesting that extreme events are more frequent and intense during years with high rainfall. The proportion of total rainfall from ...

Infection in the ischemic lower extremity.

Science.gov (United States)

Fry, D E; Marek, J M; Langsfeld, M

1998-06-01

Infections in the lower extremity of the patient with ischemia can cover a broad spectrum of different diseases. An understanding of the particular pathophysiologic circumstances in the ischemic extremity can be of great value in understanding the natural history of the disease and the potential complications that may occur. Optimizing blood flow to the extremity by using revascularization techniques is important for any patient with an ischemic lower extremity complicated by infection or ulceration. Infections in the ischemic lower extremity require local débridement and systemic antibiotics. For severe infections, such as necrotizing fasciitis or the fetid foot, more extensive local débridement and even amputation may be required. Fundamentals of managing prosthetic graft infection require removing the infected prosthesis, local wound débridement, and systemic antibiotics while attempting to preserve viability of the lower extremity using autogenous graft reconstruction.

Climatic changes of extreme precipitation in Denmark from 1872 to 2100

DEFF Research Database (Denmark)

Arnbjerg-Nielsen, Karsten; Gregersen, Ida Bülow; Sunyer Pinya, Maria Antonia

of climate change impacts from anthropogenic effects can be established based on projections of daily precipitation. These estimates have then been further downscaled to enable urban pluvial inundation calculations using different statistical downscaling and extreme value analysis techniques. . From...... of precipitation extremes. The objective is to establish cities that are resilient to pluvial floods by means of a gradual upgrading of the drainage capacity in combination with a structured risk management approach. Using the regional climate model (RCM) data repositories from PRUDENCE and ENSEMBLES, estimates....... These results are important for the extrapolation to future events. Currently efforts are dedicated to constructing similar models based on outputs from climate models, but the models are complicated due to the fact that the correlation structure of high-resolution precipitation in the climate models deviates...

Brief communication: Post-event analysis of loss of life due to hurricane Harvey

OpenAIRE

Jonkman, Sebastiaan N.; Godfroy, Maartje; Sebastian, Antonia; Kolen, Bas

2018-01-01

An analysis was made of the loss of life directly caused by hurricane Harvey. Information was collected for 70 fatalities that occurred directly due to the event. Most of the fatalities occurred in the greater Houston area, which was most severely affected by extreme rainfall and heavy flooding. The majority of fatalities in this area were recovered outside the designated 100 and 500 year flood zones. Most fatalities occurred due to drowning (81 %), particularly in and around vehicles...

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?" and…

A Decade of Progress Using Virtual Reality for Poststroke Lower Extremity Rehabilitation: Systematic Review of the Intervention Methods

Directory of Open Access Journals (Sweden)

Carlos Luque-Moreno

2015-01-01

Full Text Available Objective. To develop a systematic review of the literature, to describe the different virtual reality (VR interventions and interactive videogames applied to the lower extremity (LE of stroke patients, and to analyse the results according to the most frequently used outcome measures. Material and Methods. An electronic search of randomized trials between January 2004 and January 2014 in different databases (Medline, Cinahl, Web of Science, PEDro, and Cochrane was carried out. Several terms (virtual reality, feedback, stroke, hemiplegia, brain injury, cerebrovascular accident, lower limb, leg, and gait were combined, and finally 11 articles were included according to the established inclusion and exclusion criteria. Results. The reviewed trials showed a high heterogeneity in terms of study design and assessment tools, which makes it difficult to compare and analyze the different types of interventions. However, most of them found a significant improvement on gait speed, balance and motor function, due to VR intervention. Conclusions. Although evidence is limited, it suggests that VR intervention (more than 10 sessions in stroke patients may have a positive impact on balance, and gait recovery. Better results were obtained when a multimodal approach, combining VR and conventional physiotherapy, was used. Flexible software seems to adapt better to patients’ requirements, allowing more specific and individual treatments.

Future Extreme Event Vulnerability in the Rural Northeastern United States

Science.gov (United States)

Winter, J.; Bowen, F. L.; Partridge, T.; Chipman, J. W.

2017-12-01

Future climate change impacts on humans will be determined by the convergence of evolving physical climate and socioeconomic systems. Of particular concern is the intersection of extreme events and vulnerable populations. Rural areas of the Northeastern United States have experienced increased temperature and precipitation extremes, especially over the past three decades, and face unique challenges due to their physical isolation, natural resources dependent economies, and high poverty rates. To explore the impacts of future extreme events on vulnerable, rural populations in the Northeast, we project extreme events and vulnerability indicators to identify where changes in extreme events and vulnerable populations coincide. Specifically, we analyze future (2046-2075) maximum annual daily temperature, minimum annual daily temperature, maximum annual daily precipitation, and maximum consecutive dry day length for Representative Concentration Pathways (RCP) 4.5 and 8.5 using four global climate models (GCM) and a gridded observational dataset. We then overlay those projections with estimates of county-level population and relative income for 2060 to calculate changes in person-events from historical (1976-2005), with a focus on Northeast counties that have less than 250,000 people and are in the bottom income quartile. We find that across the rural Northeast for RCP4.5, heat person-events per year increase tenfold, far exceeding decreases in cold person-events and relatively small changes in precipitation and drought person-events. Counties in the bottom income quartile have historically (1976-2005) experienced a disproportionate number of heat events, and counties in the bottom two income quartiles are projected to experience a greater heat event increase by 2046-2075 than counties in the top two income quartiles. We further explore the relative contributions of event frequency, population, and income changes to the total and geographic distribution of climate change

Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones

DEFF Research Database (Denmark)

Stage, J G; Moesgaard, F; Grønvall, S

1998-01-01

or ureteroscope in ten patients and by stone removal by basket in the remaining four patients. The procedure was carried out using local anesthesia in the last 11 patients. Except for two patients with transient cholangitis, no complications occurred. CONCLUSIONS: Difficult bile duct and intrahepatic stones can...

Extreme events in total ozone over Arosa – Part 1: Application of extreme value theory

Directory of Open Access Journals (Sweden)

H. E. Rieder

2010-10-01

Full Text Available In this study ideas from extreme value theory are for the first time applied in the field of stratospheric ozone research, because statistical analysis showed that previously used concepts assuming a Gaussian distribution (e.g. fixed deviations from mean values of total ozone data do not adequately address the structure of the extremes. We show that statistical extreme value methods are appropriate to identify ozone extremes and to describe the tails of the Arosa (Switzerland total ozone time series. In order to accommodate the seasonal cycle in total ozone, a daily moving threshold was determined and used, with tools from extreme value theory, to analyse the frequency of days with extreme low (termed ELOs and high (termed EHOs total ozone at Arosa. The analysis shows that the Generalized Pareto Distribution (GPD provides an appropriate model for the frequency distribution of total ozone above or below a mathematically well-defined threshold, thus providing a statistical description of ELOs and EHOs. The results show an increase in ELOs and a decrease in EHOs during the last decades. The fitted model represents the tails of the total ozone data set with high accuracy over the entire range (including absolute monthly minima and maxima, and enables a precise computation of the frequency distribution of ozone mini-holes (using constant thresholds. Analyzing the tails instead of a small fraction of days below constant thresholds provides deeper insight into the time series properties. Fingerprints of dynamical (e.g. ENSO, NAO and chemical features (e.g. strong polar vortex ozone loss, and major volcanic eruptions, can be identified in the observed frequency of extreme events throughout the time series. Overall the new approach to analysis of extremes provides more information on time series properties and variability than previous approaches that use only monthly averages and/or mini-holes and mini-highs.

I-Love-Q to the extreme

Science.gov (United States)

Silva, Hector O.; Yunes, Nicolás

2018-01-01

Certain bulk properties of neutron stars, in particular their moment of inertia, rotational quadrupole moment and tidal Love number, when properly normalized, are related to one another in a nearly equation of state independent way. The goal of this paper is to test these relations with extreme equations of state at supranuclear densities constrained to satisfy only a handful of generic, physically sensible conditions. By requiring that the equation of state be (i) barotropic and (ii) its associated speed of sound be real, we construct a piecewise function that matches a tabulated equation of state at low densities, while matching a stiff equation of state parametrized by its sound speed in the high-density region. We show that the I-Love-Q relations hold to 1 percent with this class of equations of state, even in the extreme case where the speed of sound becomes superluminal and independently of the transition density. We also find further support for the interpretation of the I-Love-Q relations as an emergent symmetry due to the nearly constant eccentricity of isodensity contours inside the star. These results reinforce the robustness of the I-Love-Q relations against our current incomplete picture of physics at supranuclear densities, while strengthening our confidence in the applicability of these relations in neutron star astrophysics.

Diagnosing causes of extreme aerosol optical depth events

Science.gov (United States)

Bernstein, D. N.; Sullivan, R.; Crippa, P.; Thota, A.; Pryor, S. C.

2017-12-01

Aerosol burdens and optical properties exhibit substantial spatiotemporal variability, and simulation of current and possible future aerosol burdens and characteristics exhibits relatively high uncertainty due to uncertainties in emission estimates and in chemical and physical processes associated with aerosol formation, dynamics and removal. We report research designed to improve understanding of the causes and characteristics of extreme aerosol optical depth (AOD) at the regional scale, and diagnose and attribute model skill in simulating these events. Extreme AOD events over the US Midwest are selected by identifying all dates on which AOD in a MERRA-2 reanalysis grid cell exceeds the local seasonally computed 90th percentile (p90) value during 2004-2016 and then finding the dates on which the highest number of grid cells exceed their local p90. MODIS AOD data are subsequently used to exclude events dominated by wildfires. MERRA-2 data are also analyzed within a synoptic classification to determine in what ways the extreme AOD events are atypical and to identify possible meteorological `finger-prints' that can be detected in regional climate model simulations of future climate states to project possible changes in the occurrence of extreme AOD. Then WRF-Chem v3.6 is applied at 12-km resolution and regridded to the MERRA-2 resolution over eastern North America to quantify model performance, and also evaluated using in situ measurements of columnar AOD (AERONET) and near-surface PM2.5 (US EPA). Finally the sensitivity to (i) spin-up time (including procedure used to spin-up the chemistry), (ii) modal versus sectional aerosol schemes, (iii) meteorological nudging, (iv) chemistry initial and boundary conditions, and (v) anthropogenic emissions is quantified. Despite recent declines in mean AOD, supraregional (> 1000 km) extreme AOD events continue to occur. During these events AOD exceeds 0.6 in many Midwestern grid cells for multiple consecutive days. In all

Journal of Agricultural Extension Vol.17 (2) December, 2013 ISSN ...

African Journals Online (AJOL)

ONIKOYI

The inefficiency of extension service in passing information to farmers is extremely difficult due to the ... It is hoped that information and communication technologies (ICTs) will provide both “new and unique ..... Revolution?”InfoDev Working ...

APPENDICULAR INVAGINATION DUE TO ENDOMETRIOSIS

Directory of Open Access Journals (Sweden)

Vasja Kruh

2003-12-01

Full Text Available Background. Invagination of the vermiform appendix is a very rare occurrence. We summarize epidemiologic and etiologic factors, types of classification, symtomatology, diagnostic features and treatment.Patients and treatment. The authors present 49-years old female with long-standing abdominal pains, who came in our hospital due to acute exacerbation with sever abdominal pain. Because of progressive symptoms and sensitivity in the right-lower abdominal quadrant a diagnostic laparoscopy was performed. An anomaly of cecum and the absence of appendix vermiformis have forced us to proceed with laparotomy in McBurnay point. After cecotomy an invaginated gangrenous appendix was found. The histological examination revealed endometriosis.Conclusions. By presenting this extremely rare pathology we also want to emphasize the important role of diagnostic laparoscopy in front of acute abdomen.

Customized toric intraocular lens implantation for correction of extreme corneal astigmatism due to corneal scarring

Directory of Open Access Journals (Sweden)

R Bassily

2010-03-01

Full Text Available R Bassily, J LuckOphthalmology Department, Royal United Hospital, Combe Park, Bath, UKAbstract: A 76-year-old woman presented with decreased visual function due to cataract formation. Twenty-five years prior she developed right sided corneal ulceration that left her with 10.8 diopters (D of irregular astigmatism at 71.8° (steep axis. Her uncorrected visual acuity was 6/24 and could only ever wear a balanced lens due to the high cylindrical error. Cataract surgery was planned with a custom designed toric intraocular lens (IOL with +16.0 D sphere inserted via a wound at the steep axis of corneal astigmatism. Postoperative refraction was -0.75/+1.50 × 177° with a visual acuity of 6/9 that has remained unchanged at six-week follow-up with no IOL rotation. This case demonstrates the value of high power toric IOLs for the correction of pathological corneal astigmatism.Keywords: intraocular lens, corneal ulceration, visual acuity, scarring

Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies

Science.gov (United States)

Mark, Lynette J.; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I.; Berkow, Lauren C.; Haut, Elliott R.; Hillel, Alexander T.; Miller, Christina R.; Feller-Kopman, David J.; Schiavi, Adam J.; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

2015-01-01

Background Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. Methods We developed a quality improvement program—the Difficult Airway Response Team (DART)—to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had three core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Results Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index > 40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous

Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies.

Science.gov (United States)

Mark, Lynette J; Herzer, Kurt R; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I; Berkow, Lauren C; Haut, Elliott R; Hillel, Alexander T; Miller, Christina R; Feller-Kopman, David J; Schiavi, Adam J; Xie, Yanjun J; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W; Mirski, Marek A

2015-07-01

Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty

[Algorithm for securing an unexpected difficult airway : User analysis on a simulator].

Science.gov (United States)

Ott, T; Truschinski, K; Kriege, M; Naß, M; Herrmann, S; Ott, V; Sellin, S

2018-01-01

Critical incidents in difficult airway management are still a main contributory factor for perioperative morbidity and mortality. Many national associations have developed algorithms for management of these time critical events. For implementation of these algorithms the provision of technical requirements and procedure-related training are essential. Severe airway incidents are rare events and clinical experience of the individual operators is limited; therefore, simulation is an adequate instrument for training and evaluating difficult airway algorithms. The aim of this observational study was to evaluate the application of the institutional difficult airway algorithm among anesthetists. After ethics committee approval, anesthetists were observed while treating a "cannot intubate" (CI) and a "cannot intubate, cannot ventilate" (CICV) situation in the institutional simulation center. As leader of a supportive team the participants had to deal with an unexpected difficult airway after induction of anesthesia in a patient simulator. The following data were recorded: sequence of the applied airway instruments, time to ventilation after establishing a secured airway using any instrument in the CI situation and time to ventilation via cricothyrotomy in the CICV situation. Conformity to the algorithm was defined by the sequence of the applied instruments. Analysis comprised conformity to the algorithm, non-parametric tests for time to ventilation and differences between junior and senior anesthetists. Out of 50 participants 45 were analyzed in the CI situation. In this situation 93% of the participants acted in conformity with the algorithm. In 62% the airway was secured by flexible intubation endoscopy, in 38% with another device. Data from 46 participants were analyzed in the CICV situation. In this situation 91% acted in conformity with the algorithm. The last device used prior to the decision for cricothyrotomy was flexible intubation endoscopy in 39%, a

Detecting and taking into account possible impacts of climate change on hydrological extremes

International Nuclear Information System (INIS)

Renard, B.

2008-01-01

Climate change is widely considered as a reality by scientists. Nevertheless, impacts on hydrological extremes are more difficult to observe and to forecast. The aim of this thesis is to answer the following questions: How to detect changes in hydro-climatic series? What are the observed changes for extreme discharges in France? How to take into account possible changes in frequency analysis? These objectives refer to both local and regional scales. This paper describes the developments related to the third question. In a first step, the concept of return period is revisited in a non-stationary context. Frequency analysis methods are then updated in order to account for evolutions in time. This is achieved by modelling trends affecting the distribution parameters. Parameter estimation uses the Bayesian formalism, which is a convenient tool for quantifying the uncertainty related to the stationarity hypothesis. This approach can be generalized at the regional scale, by means of non-stationary regional models. Such models are more general than the model underlying the index flood method. However, results of such a regional analysis are affected by the spatial dependence existing between studied sites. Impacts of this dependence on quantile estimates are highlighted, and a first approach is proposed in order to explicitly model spatial dependence. (author)

Effects of anthropogenic heat due to air-conditioning systems on an extreme high temperature event in Hong Kong

Science.gov (United States)

Wang, Y.; Li, Y.; Di Sabatino, S.; Martilli, A.; Chan, P. W.

2018-03-01

Anthropogenic heat flux is the heat generated by human activities in the urban canopy layer, which is considered the main contributor to the urban heat island (UHI). The UHI can in turn increase the use and energy consumption of air-conditioning systems. In this study, two effective methods for water-cooling air-conditioning systems in non-domestic areas, including the direct cooling system and central piped cooling towers (CPCTs), are physically based, parameterized, and implemented in a weather research and forecasting model at the city scale of Hong Kong. An extreme high temperature event (June 23-28, 2016) in the urban areas was examined, and we assessed the effects on the surface thermal environment, the interaction of sea-land breeze circulation and urban heat island circulation, boundary layer dynamics, and a possible reduction of energy consumption. The results showed that both water-cooled air-conditioning systems could reduce the 2 m air temperature by around 0.5 °C-0.8 °C during the daytime, and around 1.5 °C around 7:00-8:00 pm when the planetary boundary layer (PBL) height was confined to a few hundred meters. The CPCT contributed around 80%-90% latent heat flux and significantly increased the water vapor mixing ratio in the atmosphere by around 0.29 g kg-1 on average. The implementation of the two alternative air-conditioning systems could modify the heat and momentum of turbulence, which inhibited the evolution of the PBL height (a reduction of 100-150 m), reduced the vertical mixing, presented lower horizontal wind speed and buoyant production of turbulent kinetic energy, and reduced the strength of sea breeze and UHI circulation, which in turn affected the removal of air pollutants. Moreover, the two alternative air-conditioning systems could significantly reduce the energy consumption by around 30% during extreme high temperature events. The results of this study suggest potential UHI mitigation strategies and can be extended to

Regional Frequency and Uncertainty Analysis of Extreme Precipitation in Bangladesh

Science.gov (United States)

Mortuza, M. R.; Demissie, Y.; Li, H. Y.

2014-12-01

Increased frequency of extreme precipitations, especially those with multiday durations, are responsible for recent urban floods and associated significant losses of lives and infrastructures in Bangladesh. Reliable and routinely updated estimation of the frequency of occurrence of such extreme precipitation events are thus important for developing up-to-date hydraulic structures and stormwater drainage system that can effectively minimize future risk from similar events. In this study, we have updated the intensity-duration-frequency (IDF) curves for Bangladesh using daily precipitation data from 1961 to 2010 and quantified associated uncertainties. Regional frequency analysis based on L-moments is applied on 1-day, 2-day and 5-day annual maximum precipitation series due to its advantages over at-site estimation. The regional frequency approach pools the information from climatologically similar sites to make reliable estimates of quantiles given that the pooling group is homogeneous and of reasonable size. We have used Region of influence (ROI) approach along with homogeneity measure based on L-moments to identify the homogenous pooling groups for each site. Five 3-parameter distributions (i.e., Generalized Logistic, Generalized Extreme value, Generalized Normal, Pearson Type Three, and Generalized Pareto) are used for a thorough selection of appropriate models that fit the sample data. Uncertainties related to the selection of the distributions and historical data are quantified using the Bayesian Model Averaging and Balanced Bootstrap approaches respectively. The results from this study can be used to update the current design and management of hydraulic structures as well as in exploring spatio-temporal variations of extreme precipitation and associated risk.

Recipes for correcting the impact of effective mesoscale resolution on the estimation of extreme winds

DEFF Research Database (Denmark)

Larsén, Xiaoli Guo; Ott, Søren; Badger, Jake

2012-01-01

Extreme winds derived from simulations using mesoscale models are underestimated due to the effective spatial and temporal resolutions. This is reflected in the spectral domain as an energy deficit in the mesoscale range. The energy deficit implies smaller spectral moments and thus underestimatio...

Technology transfer and catch-up; Lessons from the commercial aircraft industry

NARCIS (Netherlands)

Steenhuis, H.J.; de Bruijn, E.J.; Heerkens, Johannes M.G.

2007-01-01

This paper analyses the technology development and technology transfer strategies in the aircraft manufacturing industry for four industrially developing countries. It is concluded from four case studies that technology catch-up is extremely difficult due to aircraft technology characteristics.

Environmental justice: Bridging the gap between experts and laymen

NARCIS (Netherlands)

Loyens, Kim

2008-01-01

Sustainable Development deals with highly technological issues (e.g. genetic manipulation, brain science, environmental protection, etc.). The decision making process therefore tends to be very complex. The task for policymakers is extremely difficult due to the involvement of different

Research Article Special Issue

African Journals Online (AJOL)

2017-09-10

Sep 10, 2017 ... behavior of the structure due to the load of intermediate rate domain, which is extremely difficult to ... t physical phenomena in the real world process into a low ..... concrete filled steel tubes under transverse impact loading.

Global predictability of temperature extremes

Science.gov (United States)

Coughlan de Perez, Erin; van Aalst, Maarten; Bischiniotis, Konstantinos; Mason, Simon; Nissan, Hannah; Pappenberger, Florian; Stephens, Elisabeth; Zsoter, Ervin; van den Hurk, Bart

2018-05-01

Extreme temperatures are one of the leading causes of death and disease in both developed and developing countries, and heat extremes are projected to rise in many regions. To reduce risk, heatwave plans and cold weather plans have been effectively implemented around the world. However, much of the world’s population is not yet protected by such systems, including many data-scarce but also highly vulnerable regions. In this study, we assess at a global level where such systems have the potential to be effective at reducing risk from temperature extremes, characterizing (1) long-term average occurrence of heatwaves and coldwaves, (2) seasonality of these extremes, and (3) short-term predictability of these extreme events three to ten days in advance. Using both the NOAA and ECMWF weather forecast models, we develop global maps indicating a first approximation of the locations that are likely to benefit from the development of seasonal preparedness plans and/or short-term early warning systems for extreme temperature. The extratropics generally show both short-term skill as well as strong seasonality; in the tropics, most locations do also demonstrate one or both. In fact, almost 5 billion people live in regions that have seasonality and predictability of heatwaves and/or coldwaves. Climate adaptation investments in these regions can take advantage of seasonality and predictability to reduce risks to vulnerable populations.

Understanding the Reach of Agricultural Impacts from Climate Extremes in the Agricultural Model Intercomparison and Improvement Project (AgMIP)

Science.gov (United States)

Ruane, A. C.

2016-12-01

resilience planning even as precise prediction of extremes remains difficult. Increased research is necessary to understand hazards, vulnerability, and exposure of populations to characterize the risk of shocks and mechanisms by which unexpected losses drive land-use transitions.

Extreme rainfall and snowfall alter responses of soil respiration to nitrogen fertilization: a 3-year field experiment.

Science.gov (United States)

Chen, Zengming; Xu, Yehong; Zhou, Xuhui; Tang, Jianwu; Kuzyakov, Yakov; Yu, Hongyan; Fan, Jianling; Ding, Weixin

2017-08-01

Extreme precipitation is predicted to be more frequent and intense accompanying global warming and may have profound impacts on soil respiration (Rs) and its components, that is, autotrophic (Ra) and heterotrophic (Rh) respiration. However, how natural extreme rainfall or snowfall events affect these fluxes are still lacking, especially under nitrogen (N) fertilization. In this study, extreme rainfall and snowfall events occurred during a 3-year field experiment, allowing us to examine their effects on the response of Rs, Rh, and Ra to N supply. In normal rainfall years of 2011/2012 and 2012/2013, N fertilization significantly stimulated Rs by 23.9% and 10.9%, respectively. This stimulation was mainly due to the increase of Ra because of N-induced increase in plant biomass. In the record wet year of 2013/2014, however, Rs was independent on N supply because of the inhibition effect of the extreme rainfall event. Compared with those in other years, Rh and Ra were reduced by 36.8% and 59.1%, respectively, which were likely related to the anoxic stress on soil microbes and decreased photosynthates supply. Although N supply did not affect annual Rh, the response ratio (RR) of Rh flux to N fertilization decreased firstly during growing season, increased in nongrowing season and peaked during spring thaw in each year. Nongrowing season Rs and Rh contributed 5.5-16.4% to their annual fluxes and were higher in 2012/2013 than other years due to the extreme snowfall inducing higher soil moisture during spring thaw. The RR of nongrowing season Rs and Rh decreased in years with extreme snowfall or rainfall compared to those in normal years. Overall, our results highlight the significant effects of extreme precipitation on responses of Rs and its components to N fertilization, which should be incorporated into models to improve the prediction of carbon-climate feedbacks. © 2017 John Wiley & Sons Ltd.

Extremal graph theory

CERN Document Server

Bollobas, Bela

2004-01-01

The ever-expanding field of extremal graph theory encompasses a diverse array of problem-solving methods, including applications to economics, computer science, and optimization theory. This volume, based on a series of lectures delivered to graduate students at the University of Cambridge, presents a concise yet comprehensive treatment of extremal graph theory.Unlike most graph theory treatises, this text features complete proofs for almost all of its results. Further insights into theory are provided by the numerous exercises of varying degrees of difficulty that accompany each chapter. A

Web Based Information System for Job Training Activities Using Personal Extreme Programming (PXP)

Science.gov (United States)

Asri, S. A.; Sunaya, I. G. A. M.; Rudiastari, E.; Setiawan, W.

2018-01-01

Job training is one of the subjects in university or polytechnic that involves many users and reporting activities. Time and distance became problems for users to reporting and to do obligations tasks during job training due to the location where the job training took place. This research tried to develop a web based information system of job training to overcome the problems. This system was developed using Personal Extreme Programming (PXP). PXP is one of the agile methods is combination of Extreme Programming (XP) and Personal Software Process (PSP). The information system that has developed and tested which are 24% of users are strongly agree, 74% are agree, 1% disagree and 0% strongly disagree about system functionality.

Drought assessment in the Duero basin (Central Spain) by means of multivariate extreme value statistics

Science.gov (United States)

Kallache, M.

2012-04-01

Droughts cause important losses. On the Iberian Peninsula, for example, non-irrigated agriculture and the tourism sector are affected in regular intervals. The goal of this study is the description of droughts and their dependence in the Duero basin in Central Spain. To do so, daily or monthly precipitation data is used. Here cumulative precipitation deficits below a threshold define meteorological droughts. This drought indicator is similar to the commonly used standard precipitation index. However, here the focus lies on the modeling of severe droughts, which is done by applying multivariate extreme value theory (MEVT) to model extreme drought events. Data from several stations are assessed jointly, thus the uncertainty of the results is reduced. Droughts are a complex phenomenon, their severity, spatial extension and duration has to be taken into account. Our approach captures severity and spatial extension. In general we find a high correlation between deficit volumes and drought duration, thus the duration is not explicitely modeled. We apply a MEVT model with asymmetric logistic dependence function, which is capable to model asymptotic dependence and independence (cf. Ramos and Ledford, 2009). To summarize the information on the dependence in the joint tail of the extreme drought events, we utilise the fragility index (Geluk et al., 2007). Results show that droughts also occur frequently in winter. Moreover, it is very common for one site to suffer dry conditions, whilst neighboring areas experience normal or even humid conditions. Interpolation is thus difficult. Bivariate extremal dependence is present in the data. However, most stations are at least asymptotically independent. The according fragility indices are important information for risk calculations. The emerging spatial patterns for bivariate dependence are mostly influenced by topography. When looking at the dependence between more than two stations, it shows that joint extremes can occur more

Injuries in an Extreme Conditioning Program

Science.gov (United States)

Aune, Kyle T.; Powers, Joseph M.

2016-01-01

injury incidence rate among athletes with <6 months of experience in the ECP was 2.5 times greater than that of more experienced athletes (≥6 months of experience). Of the 132 injuries, 23 (17%) required surgical intervention. Squat cleans, ring dips, overhead squats, and push presses were more likely to cause injury. Athletes reported that 35% of injuries were due to overexertion and 20% were due to improper technique. Conclusion: The estimated injury rate among athletes participating in this ECP was similar to the rate of injury in weightlifting and most other recreational activities. The shoulder or upper arm was the most commonly injured area, and previous shoulder injury predisposed to new shoulder injury. New athletes are at considerable risk of injury compared with more experienced athletes. Clinical Relevance: Extreme conditioning programs are growing in popularity, and there is disagreement between science and anecdotal reports from athletes, coaches, and physicians about their relative safety. This study estimates the incidence of injury in extreme conditioning programs, which appears to be similar to other weight-training programs. PMID:27760844

Statistical Model of Extreme Shear

DEFF Research Database (Denmark)

Larsen, Gunner Chr.; Hansen, Kurt Schaldemose

2004-01-01

In order to continue cost-optimisation of modern large wind turbines, it is important to continously increase the knowledge on wind field parameters relevant to design loads. This paper presents a general statistical model that offers site-specific prediction of the probability density function...... by a model that, on a statistically consistent basis, describe the most likely spatial shape of an extreme wind shear event. Predictions from the model have been compared with results from an extreme value data analysis, based on a large number of high-sampled full-scale time series measurements...... are consistent, given the inevitabel uncertainties associated with model as well as with the extreme value data analysis. Keywords: Statistical model, extreme wind conditions, statistical analysis, turbulence, wind loading, statistical analysis, turbulence, wind loading, wind shear, wind turbines....

Floridian heatwaves and extreme precipitation: future climate projections

Science.gov (United States)

Raghavendra, Ajay; Dai, Aiguo; Milrad, Shawn M.; Cloutier-Bisbee, Shealynn R.

2018-02-01

Observational analysis and climate modeling efforts concur that the frequency, intensity, and duration of heatwaves will increase as the Earth's mean climate shifts towards warmer temperatures. While the impacts and mechanisms of heatwaves have been well explored, extreme temperatures over Florida are generally understudied. This paper sheds light on Floridian heatwaves by exploring 13 years of daily data from surface observations and high-resolution WRF climate simulations for the same timeframe. The characteristics of the current and future heatwaves under the RCP8.5 high emissions scenario for 2070-2099 were then investigated. Results show a tripling in the frequency, and greater than a sixfold increase in the mean duration of heatwaves over Florida when the current standard of heatwaves was used. The intensity of heatwaves also increased by 4-6 °C due to the combined effects of rising mean temperatures and a 1-2 °C increase attributed to the flattening of the temperature distribution. Since Florida's atmospheric boundary layer is rich in moisture and heatwaves could further increase the moisture content in the lower troposphere, the relationship between heatwaves and extreme precipitation was also explored in both the current and future climate. As expected, rainfall during a heatwave event was anomalously low, but it quickly recovered to normal within 3 days after the passage of a heatwave. Finally, the late 21st-century climate could witness a slight decrease in the mean precipitation over Florida, accompanied by heavier heatwave-associated extreme precipitation events over central and southern Florida.

Neurodevelopmental problems and extremes in BMI

Directory of Open Access Journals (Sweden)

Nóra Kerekes

2015-07-01

Full Text Available Background. Over the last few decades, an increasing number of studies have suggested a connection between neurodevelopmental problems (NDPs and body mass index (BMI. Attention deficit/hyperactivity disorder (ADHD and autism spectrum disorders (ASD both seem to carry an increased risk for developing extreme BMI. However, the results are inconsistent, and there have been only a few studies of the general population of children.Aims. We had three aims with the present study: (1 to define the prevalence of extreme (low or high BMI in the group of children with ADHD and/or ASDs compared to the group of children without these NDPs; (2 to analyze whether extreme BMI is associated with the subdomains within the diagnostic categories of ADHD or ASD; and (3 to investigate the contribution of genetic and environmental factors to BMI in boys and girls at ages 9 and 12.Method. Parents of 9- or 12-year-old twins (n = 12,496 were interviewed using the Autism—Tics, ADHD and other Comorbidities (A-TAC inventory as part of the Child and Adolescent Twin Study in Sweden (CATSS. Univariate and multivariate generalized estimated equation models were used to analyze associations between extremes in BMI and NDPs.Results. ADHD screen-positive cases followed BMI distributions similar to those of children without ADHD or ASD. Significant association was found between ADHD and BMI only among 12-year-old girls, where the inattention subdomain of ADHD was significantly associated with the high extreme BMI. ASD scores were associated with both the low and the high extremes of BMI. Compared to children without ADHD or ASD, the prevalence of ASD screen-positive cases was three times greater in the high extreme BMI group and double as much in the low extreme BMI group. Stereotyped and repetitive behaviors were significantly associated with high extreme BMIs.Conclusion. Children with ASD, with or without coexisting ADHD, are more prone to have low or high extreme BMIs than

Middleware Challenges for Cyber-Physical Systems

DEFF Research Database (Denmark)

Mohamed, Nader; Al-Jaroodi, Jameela; Lazarova-Molnar, Sanja

2017-01-01

enhancements for improving physical processes, the development of such complex systems composed of many distributed and heterogeneous components is extremely difficult. This is due to the many communication, computing, and networking challenges. Using an appropriate middleware that provides a framework...

Evidences of Significant Nonstationarity in Precipitation Extremes over Urbanizing Areas in India

Science.gov (United States)

Singh, J.; H, V.; Karmakar, S.; Ghosh, S.

2014-12-01

The statistical assumption of stationarity in hydrologic extreme time/event series has been relied heavily in frequency analysis. However, due to the analytically perceivable impacts of climate change, urbanization and concomitant land use pattern, assumption of stationarity in hydrologic time series will draw erroneous results, which inturn effects the policy and decision-making. Past studies provided sufficient evidences on changes in the characteristics of Indian monsoon rainfall extremes and further it has been attributed to climate change and urbanization, which indicates the presence of significant nonstationary in the Indian monsoon extremes. Therefore, a comprehensive nonstationary frequency analysis must be conducted all over India to obtain realistic return periods. The present study aims to conduct a nonstationary frequency analysis of the precipitation extremes over India at 1o resolution for a period of 1901-2004, with the implementation of the Generalized Additive Model for Location, Scale and Shape (GAMLSS) parameters. A cluster of 74 GAMLSS models has been developed by considering nonstationary in different combinations of distribution parameters and regression techniques (families of parametric polynomials and nonparametric/smoothing cubic spline), which overcomes the limitations of the previous studies. Further, for identification of urban, urbanizing and rural grids, an population density data has been utilized. The results showed the significant differences in the stationary and nonstationary return periods for the urbanizing grids, when compared to urbanized and rural grids. The results give implications of presence of nonstationary in the precipitation extremes more prominently in urbanizing areas compare to urbanized and rural areas.

Chernobyl: Chronicle of difficult weeks [videorecording

Energy Technology Data Exchange (ETDEWEB)

Volodymyr, S

1987-07-01

1. Chernobyl : chronicle of difficult weeks. Shevchenko's film crew was the first in the disaster zone following the meltdown of the core of the Chernobyl nuclear power plant in 1986. They shot continuously for more than three months. Portions of the film are exposed with white blotches - a radiation leakage. The film demonstrates how authorities and volunteers dealt with the accident, shows the efforts to get the fire under control, to take care of patients with radiation injuries, and to evacuate about 100,000 inhabitants of the area. 2. The BAM zone : permanent residents. The Baikal-Amur Mainline (BAM) railroad in Siberia is called the longest monument to the stagnation of the Brezhnev years. The film shows the lives and fates of the people in contrast to the marches and songs praising the project.

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

Energy Technology Data Exchange (ETDEWEB)

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

1995-05-01

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

Current status and issues of external event PSA for extreme natural hazards after Fukushima accident

International Nuclear Information System (INIS)

Choi, In-Kil; Hahm, Daegi; Kim, Min Kyu

2014-01-01

Extreme external events is emerged as significant risk contributor to the nuclear power plants after Fukushima Daiichi accident due to the catastrophic earthquake followed by great tsunami greater than a design basis. This accident shows that the extreme external events have the potential to simultaneously affect redundant and diverse safety systems and thereby induce common cause failure or common cause initiators. The probabilistic risk assessment methodology has been used for the risk assessment and safety improvement against the extreme natural hazards. The earthquake and tsunami hazard is an important issue for the nuclear industry in Korea. In this paper, the role and application of probabilistic safety assessment for the post Fukushima action will be introduced. For the evaluation of the extreme natural hazard, probabilistic seismic and tsunami hazard analysis is being performed for the safety enhancement. The research activity on the external event PSA and its interim results will be introduced with the issues to be solved in the future for the reliability enhancement of the risk analysis results. (authors)

Bilateral Upper Extremity DVT in a 43-Year-Old Man: Is It Thoracic Outlet Syndrome?!

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Hadoun Jabri

2014-01-01

Full Text Available Recurrent deep venous thrombosis, involving bilateral upper extremities, is an extremely rare phenomenon. We are presenting a 43-year-old man who was diagnosed with left upper extremity deep vein thrombosis (UEDVT and was treated with anticoagulation and surgical decompression in 2004. 9 years later, he presented with right arm swelling and was diagnosed with right UEDVT using US venous Doppler. Venogram showed compression of the subclavian vein by the first rib, diagnosing thoracic outlet syndrome (TOS. He was treated with anticoagulation and local venolysis and later by surgical decompression of the subclavian vein. Bilateral UEDVT, as mentioned above, is an extremely rare condition that is uncommonly caused by TOS. To our knowledge, we are reporting the first case of bilateral UEDVT due to TOS. Diagnosis usually starts with US venous Doppler to detect the thrombosis, followed by the gold standard venogram to locate the area of obstruction and lyse the thrombus if needed. The ultimate treatment for TOS remains surgical decompression of the vascular bundle at the thoracic outlet.

HIGH PERFORMANCE TAPS FOR CUTTING THREADS IN DIFFICULT TO MACHINE MATERIALS

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M. R. Akhmedova

2016-01-01

Full Text Available Objectives. This article explores in detail questions of instrument operation function of tapping internal threads in hard materials. The existing relationship between vibration system amplitude and tool durability is indicated; on this basis, it is determined that the best course for improving the durability performance is increasing vibratory resistance. Based on a critical analysis of existing designs with consideration of their flaws, the development of new technological designs of taps is tasked with ensuring stable operation when handling hard materials. Methods. It is noteworthy that one of the main vibration resistance improvement methods of the tool is to reduce the contact area of the tool with the work piece in the cutting zone. Methods are proposed for improving the vibration resistance of taps, considering the correlation adjustment of tap teeth in order to completely eliminate friction at the sides of the thread cutting surface and uneven implementation flute cutting steps. Results. The idea of increasing vibration resistance has seen the new development of vibration-proof tap designs, heralded as innovations due to the accuracy of thread cutting and durability achieved by reducing the thread contact area with the work piece in the cutting zone. Increased vibration resistance is achieved in the modified taps through high correction by means of thread side downgrading of the coarse tap cone by an additional angle of 30º. In another design, the stylus provided with uneven angular spacing. Test results of designed taps machined in corrosion-resistant 1Kh18N9T steel. A manifold increase in tool durability was achieved due to its high vibration resistance. Conclusions. The redesigned taps have a number of advantages, characterised by a high resistance when processing difficult materials and an insignificant increase in the complexity of their manufacture compared with standard taps. Therefore they can be recommended for large

Diffusion-Weighted Magnetic Resonance Imaging in Rhombencephalitis due to Listeria monocytogenes

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Hatipoglu, H.G.; Onbasioglu Gurbuz, M.; Sakman, B.; Yuksel, E. [Dept. of Radiology, Ankara Numune Education and Research Hospital, Ankara (Turkey)

2007-04-15

We present diffusion-weighted imaging findings of a case of rhombencephalitis due to Listeria monocytogenes. It is a rare, life-threatening disorder. The diagnosis is difficult by clinical findings only. In this report, we aim to draw attention to the role of conventional and diffusion-weighted magnetic resonance imaging findings. To our knowledge, this is the first case report in the literature with apparent diffusion coefficient values of diseased brain parenchyma.

Difficult behaviors in the emergency department: a cohort study of housed, homeless and alcohol dependent individuals.

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Tomislav Svoboda

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

Mask Materials and Designs for Extreme Ultra Violet Lithography

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Kim, Jung Sik; Ahn, Jinho

2018-03-01

Extreme ultra violet lithography (EUVL) is no longer a future technology but is going to be inserted into mass production of semiconductor devices of 7 nm technology node in 2018. EUVL is an extension of optical lithography using extremely short wavelength (13.5 nm). This short wavelength requires major modifications in the optical systems due to the very strong absorption of EUV light by materials. Refractive optics can no longer be used, and reflective optics is the only solution to transfer image from mask to wafer. This is why we need the multilayer (ML) mirror-based mask as well as an oblique incident angle of light. This paper discusses the principal theory on the EUV mask design and its component materials including ML reflector and EUV absorber. Mask shadowing effect (or mask 3D effect) is explained and its technical solutions like phase shift mask is reviewed. Even though not all the technical issues on EUV mask are handled in this review paper, you will be able to understand the principles determining the performance of EUV masks.

Return period curves for extreme 5-min rainfall amounts at the Barcelona urban network

Science.gov (United States)

Lana, X.; Casas-Castillo, M. C.; Serra, C.; Rodríguez-Solà, R.; Redaño, A.; Burgueño, A.; Martínez, M. D.

2018-03-01

Heavy rainfall episodes are relatively common in the conurbation of Barcelona and neighbouring cities (NE Spain), usually due to storms generated by convective phenomena in summer and eastern and south-eastern advections in autumn. Prevention of local flood episodes and right design of urban drainage have to take into account the rainfall intensity spread instead of a simple evaluation of daily rainfall amounts. The database comes from 5-min rain amounts recorded by tipping buckets in the Barcelona urban network along the years 1994-2009. From these data, extreme 5-min rain amounts are selected applying the peaks-over-threshold method for thresholds derived from both 95% percentile and the mean excess plot. The return period curves are derived from their statistical distribution for every gauge, describing with detail expected extreme 5-min rain amounts across the urban network. These curves are compared with those derived from annual extreme time series. In this way, areas in Barcelona submitted to different levels of flood risk from the point of view of rainfall intensity are detected. Additionally, global time trends on extreme 5-min rain amounts are quantified for the whole network and found as not statistically significant.

Specific gas turbines for extreme peak-load

International Nuclear Information System (INIS)

Bellot, C.

1992-12-01

As with other European countries, in France peak consumption of electricity occurs during winter. Due to the increasing use of electricity for domestic heating, outside temperature greatly influences consumption (1 200 MW for a drop of 1 deg C). To meet requirements during cold spells, EDF has sought to determine which special facilities are best suited for extreme peak load conditions (i.e. offering short lifespan and minimum capital cost) and has studied the possibility of installing generation means in transformer substations (20 kV). This solution does not require extension of networks since these means are scattered near consumption areas. An experiment conducted on 3 Diesel generators of 800 kWe each at Senlis revealed some of the disadvantages of Diesel (maintenance requirements, polluting emissions and noise). EDF then examined, for this same application, the use of gas turbines, for which these drawbacks are significantly less. A study carried out under an EDF contract by the French manufacturer TURBOMECA showed that it is possible to design a small capacity gas turbine that can compete with Diesel generators, and that capital costs could be minimized by simplifying the machine, adapting its lifespan to extreme peak load needs, and taking advantage of lower cost provided by mass production. TURBOMECA defined the machine's characteristics (2 MW, 6 000 hours lifespan) and aerodynamic flow. It also estimated the cost of packaging. In terms of overall cost (including initial investment, maintenance and fuel) the gas turbine appears cheaper than Diesel generators for annual operation times of less than one hundred hours, which corresponds closely with extreme peak load use. The lower maintenance costs and the better availability counterbalance the higher capital cost (+6%) and the greater consumption (+50%). (author). 7 figs

Intraabdominal actinomycosis resulting in a difficult to diagnose intraperitoneal mass: A case report.

Science.gov (United States)

Tsujimura, Naoto; Takemoto, Hiroyoshi; Nakahara, Yujiro; Wakasugi, Masaki; Matsumoto, Takashi; Nishioka, Kiyonori; Takachi, Kou; Oshima, Satoshi; Yoshida, Kyotaro

2018-01-01

Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces israelii. Preoperative confirmed diagnosis is very difficult, so most cases are diagnosed preoperatively as malignant tumors. We report a case of intraabdominal actinomycosis which was difficult to diagnose preoperatively. A woman, 60 years old, experienced discomfort in her lower right abdomen. She complained of nausea and anorexia and visited our hospital. Laboratory blood tests, abdominal CT, and abdominal MRI led to a diagnosis of a uterine sarcoma or primary intestinal mass, and she underwent surgery. Her histopathological diagnosis was intraabdominal actinomycosis. Actinomycosis is a chronic purulent granulomatous inflammation caused by Actinomyces israelii. No clinical symptoms or laboratory findings are characteristic of abdominal actinomycosis, so this disorder is very difficult to diagnose preoperatively. Therefore, many cases are diagnosed as malignant tumors and undergo surgery. After surgery, long-term antibiotic treatment (penicillin) is usually administered. We reported a case of intraabdominal actinomycosis that resulted in a difficult to diagnose intraperitoneal mass. When a large intraperitoneal mass is found, actinomycosis needs to be included as one of differential diagnoses. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Asymmetrical Responses of Ecosystem Processes to Positive Versus Negative Precipitation Extremes: a Replicated Regression Experimental Approach

Science.gov (United States)

Felton, A. J.; Smith, M. D.

2016-12-01

Heightened climatic variability due to atmospheric warming is forecast to increase the frequency and severity of climate extremes. In particular, changes to interannual variability in precipitation, characterized by increases in extreme wet and dry years, are likely to impact virtually all terrestrial ecosystem processes. However, to date experimental approaches have yet to explicitly test how ecosystem processes respond to multiple levels of climatic extremity, limiting our understanding of how ecosystems will respond to forecast increases in the magnitude of climate extremes. Here we report the results of a replicated regression experimental approach, in which we imposed 9 and 11 levels of growing season precipitation amount and extremity in mesic grassland during 2015 and 2016, respectively. Each level corresponded to a specific percentile of the long-term record, which produced a large gradient of soil moisture conditions that ranged from extreme wet to extreme dry. In both 2015 and 2016, asymptotic responses to water availability were observed for soil respiration. This asymmetry was driven in part by transitions between soil moisture versus temperature constraints on respiration as conditions became increasingly dry versus increasingly wet. In 2015, aboveground net primary production (ANPP) exhibited asymmetric responses to precipitation that largely mirrored those of soil respiration. In total, our results suggest that in this mesic ecosystem, these two carbon cycle processes were more sensitive to extreme drought than to extreme wet years. Future work will assess ANPP responses for 2016, soil nutrient supply and physiological responses of the dominant plant species. Future efforts are needed to compare our findings across a diverse array of ecosystem types, and in particular how the timing and magnitude of precipitation events may modify the response of ecosystem processes to increasing magnitudes of precipitation extremes.

Extreme climate, not extreme weather: the summer of 1816 in Geneva, Switzerland

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R. Auchmann

2012-02-01

Full Text Available We analyze weather and climate during the "Year without Summer" 1816 using sub-daily data from Geneva, Switzerland, representing one of the climatically most severely affected regions. The record includes twice daily measurements and observations of air temperature, pressure, cloud cover, wind speed, and wind direction as well as daily measurements of precipitation. Comparing 1816 to a contemporary reference period (1799–1821 reveals that the coldness of the summer of 1816 was most prominent in the afternoon, with a shift of the entire distribution function of temperature anomalies by 3–4 °C. Early morning temperature anomalies show a smaller change for the mean, a significant decrease in the variability, and no changes in negative extremes. Analyzing cloudy and cloud-free conditions separately suggests that an increase in the number of cloudy days was to a significant extent responsible for these features. A daily weather type classification based on pressure, pressure tendency, and wind direction shows extremely anomalous frequencies in summer 1816, with only one day (compared to 20 in an average summer classified as high-pressure situation but a tripling of low-pressure situations. The afternoon temperature anomalies expected from only a change in weather types was much stronger negative in summer 1816 than in any other year. For precipitation, our analysis shows that the 80% increase in summer precipitation compared to the reference period can be explained by 80% increase in the frequency of precipitation, while no change could be found neither in the average intensity of precipitation nor in the frequency distribution of extreme precipitation. In all, the analysis shows that the regional circulation and local cloud cover played a dominant role. It also shows that the summer of 1816 was an example of extreme climate, not extreme weather.

Acute Cardiac Failure in a Pregnant Woman due to Thyrotoxic Crisis

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Nao Okuda

2012-01-01

Full Text Available Introduction. Cardiac failure during pregnancy is usually related to preeclampsia/eclampsia, rarely to hyperthyroidism. While hyperthyroidism can easily lead to hypertensive cardiac failure and may harm the fetus, it is sometimes difficult to distinguish hyperthyroidism from normal pregnancy. Case Presentation. We encountered a case of 41-year-old pregnant woman with hypertensive cardiac failure. Because we initially diagnosed as pre-eclampsia/eclampsia, Caesarian section was performed. However, her symptoms still persisted after delivery. After thyroid function test results taken on the day of admission were obtained on the fourth day, we could diagnose that her cardiac failure was caused by thyrotoxic crisis. Conclusions. Hypertensive cardiac failure due to hyperthyroidism during pregnancy is rare and difficult to diagnose because of similar presentation of normal pregnancy. However, physicians should be aware of the risks posed by hyperthyroidism during pregnancy.

Management of the mangled extremity

NARCIS (Netherlands)

Prasarn, Mark L.; Helfet, David L.; Kloen, Peter

2012-01-01

The management of a mangled extremity continues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a

Improving the Statistical Modeling of the TRMM Extreme Precipitation Monitoring System

Science.gov (United States)

Demirdjian, L.; Zhou, Y.; Huffman, G. J.

2016-12-01

This project improves upon an existing extreme precipitation monitoring system based on the Tropical Rainfall Measuring Mission (TRMM) daily product (3B42) using new statistical models. The proposed system utilizes a regional modeling approach, where data from similar grid locations are pooled to increase the quality and stability of the resulting model parameter estimates to compensate for the short data record. The regional frequency analysis is divided into two stages. In the first stage, the region defined by the TRMM measurements is partitioned into approximately 27,000 non-overlapping clusters using a recursive k-means clustering scheme. In the second stage, a statistical model is used to characterize the extreme precipitation events occurring in each cluster. Instead of utilizing the block-maxima approach used in the existing system, where annual maxima are fit to the Generalized Extreme Value (GEV) probability distribution at each cluster separately, the present work adopts the peak-over-threshold (POT) method of classifying points as extreme if they exceed a pre-specified threshold. Theoretical considerations motivate the use of the Generalized-Pareto (GP) distribution for fitting threshold exceedances. The fitted parameters can be used to construct simple and intuitive average recurrence interval (ARI) maps which reveal how rare a particular precipitation event is given its spatial location. The new methodology eliminates much of the random noise that was produced by the existing models due to a short data record, producing more reasonable ARI maps when compared with NOAA's long-term Climate Prediction Center (CPC) ground based observations. The resulting ARI maps can be useful for disaster preparation, warning, and management, as well as increased public awareness of the severity of precipitation events. Furthermore, the proposed methodology can be applied to various other extreme climate records.

Problems in psychiatric care of 'difficult patients': a Delphi-study

NARCIS (Netherlands)

Koekkoek, Bauke; van Meijel, Berno; Schene, Aart; Hutschemaekers, Giel

2009-01-01

'difficult patients' may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where

Problems in psychiatric care of 'difficult patients': a Delphi-study

NARCIS (Netherlands)

Koekkoek, B.W.; Meijel, B.K.G. van; Schene, A.H.; Hutschemaekers, G.J.M.

2009-01-01

Aims - 'difficult patients' may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where

Simulation of temperature extremes in the Tibetan Plateau from CMIP5 models and comparison with gridded observations

Science.gov (United States)

You, Qinglong; Jiang, Zhihong; Wang, Dai; Pepin, Nick; Kang, Shichang

2017-09-01

Understanding changes in temperature extremes in a warmer climate is of great importance for society and for ecosystem functioning due to potentially severe impacts of such extreme events. In this study, temperature extremes defined by the Expert Team on Climate Change Detection and Indices (ETCCDI) from CMIP5 models are evaluated by comparison with homogenized gridded observations at 0.5° resolution across the Tibetan Plateau (TP) for 1961-2005. Using statistical metrics, the models have been ranked in terms of their ability to reproduce similar patterns in extreme events to the observations. Four CMIP5 models have good performance (BNU-ESM, HadGEM2-ES, CCSM4, CanESM2) and are used to create an optimal model ensemble (OME). Most temperature extreme indices in the OME are closer to the observations than in an ensemble using all models. Best performance is given for threshold temperature indices and extreme/absolute value indices are slightly less well modelled. Thus the choice of model in the OME seems to have more influences on temperature extreme indices based on thresholds. There is no significant correlation between elevation and modelled bias of the extreme indices for both the optimal/all model ensembles. Furthermore, the minimum temperature (Tmin) is significanlty positive correlations with the longwave radiation and cloud variables, respectively, but the Tmax fails to find the correlation with the shortwave radiation and cloud variables. This suggests that the cloud-radiation differences influence the Tmin in each CMIP5 model to some extent, and result in the temperature extremes based on Tmin.

Two case of osteoarthropathy due to mediastinal tumor

Energy Technology Data Exchange (ETDEWEB)

Lee, S; Lee, C S; Shin, Y K; Kim, B S [Busan National University College of Medicine, Busan (Korea, Republic of)

1972-12-15

Authors experienced two cases of osteoarthropathy due to mediastinal tumor, which are reported with a review of the literature. A case was 59 years old man, who complained chest discomfortness, coughing, dyspnea and clubbing fingers. The other was 39 years old man, who complained arthralgia, clubbing of digits and pain in the left medial clavicular area. Their family histories were not contributory. The radiologic findings of the chest showed timorous mass in the mediastinum. Examination of the extremities showed periosteal reaction and subperiosteal proliferation along the long bones and digits. Distal phalanges revealed clubbing without bone changes.

The relative importance among anthropogenic forcings of land use/land cover change in affecting temperature extremes

Science.gov (United States)

Chen, Liang; Dirmeyer, Paul A.

2018-05-01

Land use/land cover change (LULCC) exerts significant influence on regional climate extremes, but its relative importance compared with other anthropogenic climate forcings has not been thoroughly investigated. This study compares land use forcing with other forcing agents in explaining the simulated historical temperature extreme changes since preindustrial times in the CESM-Last Millennium Ensemble (LME) project. CESM-LME suggests that the land use forcing has caused an overall cooling in both warm and cold extremes, and has significantly decreased diurnal temperature range (DTR). Due to the competing effects of the GHG and aerosol forcings, the spatial pattern of changes in 1850-2005 climatology of temperature extremes in CESM-LME can be largely explained by the land use forcing, especially for hot extremes and DTR. The dominance of land use forcing is particularly evident over Europe, eastern China, and the central and eastern US. Temporally, the land-use cooling is relatively stable throughout the historical period, while the warming of temperature extremes is mainly influenced by the enhanced GHG forcing, which has gradually dampened the local dominance of the land use effects. Results from the suite of CMIP5 experiments partially agree with the local dominance of the land use forcing in CESM-LME, but inter-model discrepancies exist in the distribution and sign of the LULCC-induced temperature changes. Our results underline the overall importance of LULCC in historical temperature extreme changes, implying land use forcing should be highlighted in future climate projections.

CRUX: A compliant robotic upper-extremity exosuit for lightweight, portable, multi-joint muscular augmentation.

Science.gov (United States)

Lessard, Steven; Pansodtee, Pattawong; Robbins, Ash; Baltaxe-Admony, Leya Breanna; Trombadore, James M; Teodorescu, Mircea; Agogino, Adrian; Kurniawan, Sri

2017-07-01

Wearable robots can potentially offer their users enhanced stability and strength. These augmentations are ideally designed to actuate harmoniously with the user's movements and provide extra force as needed. The creation of such robots, however, is particularly challenging due to the underlying complexity of the human body. In this paper, we present a compliant, robotic exosuit for upper extremities called CRUX. This exosuit, inspired by tensegrity models of the human arm, features a lightweight (1.3 kg), flexible multi-joint design for portable augmentation. We also illustrate how CRUX maintains the full range of motion of the upper-extremities for its users while providing multi-DoF strength amplification to the major muscles of the arm, as evident by tracking the heart rate of an individual exercising said arm. Exosuits such as CRUX may be useful in physical therapy and in extreme environments where users are expected to exert their bodies to the fullest extent.

n-Alcohol/Water Partition Coefficients for Decachlorobiphenyl (PCB 209)

Science.gov (United States)

Measurements of n-octanol/water partition coefficients (Kow) for highly hydrophobic chemicals are extremely difficult and are rarely made, in part due to the large volumes of water typically needed to quantify these compounds in the aqueous phase. An extrapolation approach using ...

An anatomy of countertransference: staff reactions to difficult psychiatric hospital patients.

Science.gov (United States)

Colson, D B; Allen, J G; Coyne, L; Dexter, N; Jehl, N; Mayer, C A; Spohn, H

1986-09-01

Countertransference among hospital staff was investigated as part of ongoing research on difficult-to-treat psychiatric hospital patients. Staff's ratings of their emotional reactions to 127 patients on long-term units were analyzed by factor analysis, and the resulting factors were correlated by discipline with patient problem behaviors. Among the conclusions were that different forms of psychopathology elicit characteristic patterns of emotional reaction from staff; that some dimensions of psychopathology, particularly suicidal-depressed behavior and violence-agitation, elicit different emotional reactions among different disciplines, thus laying the groundwork for division among staff; and that the more difficult the process of hospital treatment, the more likely staff will experience a variety of emotions.

Using Extreme Tropical Precipitation Statistics to Constrain Future Climate States

Science.gov (United States)

Igel, M.; Biello, J. A.

2017-12-01

Tropical precipitation is characterized by a rapid growth in mean intensity as the column humidity increases. This behavior is examined in both a cloud resolving model and with high-resolution observations of precipitation and column humidity from CloudSat and AIRS, respectively. The model and the observations exhibit remarkable consistency and suggest a new paradigm for extreme precipitation. We show that the total precipitation can be decomposed into a product of contributions from a mean intensity, a probability of precipitation, and a global PDF of column humidity values. We use the modeling and observational results to suggest simple, analytic forms for each of these functions. The analytic representations are then used to construct a simple expression for the global accumulated precipitation as a function of the parameters of each of the component functions. As the climate warms, extreme precipitation intensity and global precipitation are expected to increase, though at different rates. When these predictions are incorporated into the new analytic expression for total precipitation, predictions for changes due to global warming to the probability of precipitation and the PDF of column humidity can be made. We show that strong constraints can be imposed on the future shape of the PDF of column humidity but that only weak constraints can be set on the probability of precipitation. These are largely imposed by the intensification of extreme precipitation. This result suggests that understanding precisely how extreme precipitation responds to climate warming is critical to predicting other impactful properties of global hydrology. The new framework can also be used to confirm and discount existing theories for shifting precipitation.

The influence of wheelchair propulsion technique on upper extremity muscle demand: a simulation study.

Science.gov (United States)

Rankin, Jeffery W; Kwarciak, Andrew M; Richter, W Mark; Neptune, Richard R

2012-11-01

The majority of manual wheelchair users will experience upper extremity injuries or pain, in part due to the high force requirements, repetitive motion and extreme joint postures associated with wheelchair propulsion. Recent studies have identified cadence, contact angle and peak force as important factors for reducing upper extremity demand during propulsion. However, studies often make comparisons between populations (e.g., able-bodied vs. paraplegic) or do not investigate specific measures of upper extremity demand. The purpose of this study was to use a musculoskeletal model and forward dynamics simulations of wheelchair propulsion to investigate how altering cadence, peak force and contact angle influence individual muscle demand. Forward dynamics simulations of wheelchair propulsion were generated to emulate group-averaged experimental data during four conditions: 1) self-selected propulsion technique, and while 2) minimizing cadence, 3) maximizing contact angle, and 4) minimizing peak force using biofeedback. Simulations were used to determine individual muscle mechanical power and stress as measures of muscle demand. Minimizing peak force and cadence had the lowest muscle power requirements. However, minimizing peak force increased cadence and recovery power, while minimizing cadence increased average muscle stress. Maximizing contact angle increased muscle stress and had the highest muscle power requirements. Minimizing cadence appears to have the most potential for reducing muscle demand and fatigue, which could decrease upper extremity injuries and pain. However, altering any of these variables to extreme values appears to be less effective; instead small to moderate changes may better reduce overall muscle demand. Copyright © 2012 Elsevier Ltd. All rights reserved.

A decade of weather extremes

NARCIS (Netherlands)

Coumou, Dim; Rahmstorf, Stefan

The ostensibly large number of recent extreme weather events has triggered intensive discussions, both in- and outside the scientific community, on whether they are related to global warming. Here, we review the evidence and argue that for some types of extreme - notably heatwaves, but also

Attitude extremity, consensus and diagnosticity

NARCIS (Netherlands)

van der Pligt, J.; Ester, P.; van der Linden, J.

1983-01-01

Studied the effects of attitude extremity on perceived consensus and willingness to ascribe trait terms to others with either pro- or antinuclear attitudes. 611 Ss rated their attitudes toward nuclear energy on a 5-point scale. Results show that attitude extremity affected consensus estimates. Trait

Controlling extreme events on complex networks

Science.gov (United States)

Chen, Yu-Zhong; Huang, Zi-Gang; Lai, Ying-Cheng

2014-08-01

Extreme events, a type of collective behavior in complex networked dynamical systems, often can have catastrophic consequences. To develop effective strategies to control extreme events is of fundamental importance and practical interest. Utilizing transportation dynamics on complex networks as a prototypical setting, we find that making the network ``mobile'' can effectively suppress extreme events. A striking, resonance-like phenomenon is uncovered, where an optimal degree of mobility exists for which the probability of extreme events is minimized. We derive an analytic theory to understand the mechanism of control at a detailed and quantitative level, and validate the theory numerically. Implications of our finding to current areas such as cybersecurity are discussed.

Paraplegia due to extramedullary hematopoiesis in thalassemia treated successfully with radiation therapy.

Science.gov (United States)

Malik, Monica; Pillai, Lakshmi S; Gogia, Nidhi; Puri, Tarun; Mahapatra, M; Sharma, Daya Nand; Kumar, Rajat

2007-03-01

Spinal cord compression due to extramedullary hematopoiesis (EMH) is a rare complication of thalassemia and generally presents as paraparesis with sensory impairment. Complete paraplegia is extremely rare in EMH due to thalassemia although it is known to occur in polycythemia vera and sickle cell anemia. Treatment options mostly include surgery and/or radiotherapy. Whereas cases presenting with paraparesis have been treated with either surgery or radiotherapy with equal frequency and efficacy, almost all reported cases with paraplegia have been treated with surgery with or without radiation therapy. We hereby report a case of thalassemia intermedia with paraplegia treated successfully with radiotherapy.

What's 'difficult'? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms.

Science.gov (United States)

Maatz, Anke; Wainwright, Megan; Russell, Andrew J; Macnaughton, Jane; Yiannakou, Yan

2016-11-01

The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term 'difficult'. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored. Three NHS trust secondary care hospitals in North-East England. 17 senior clinicians from seven medical and two surgical specialities. Unsolicited use of the term 'difficult' was common. 'Difficult' was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used 'difficult' to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of 'difficult'. Participants also reported experiences that were rewarding and positive. This study shows that blanket statements such as 'difficult patients' mask the complexity of doctors' experiences in the context of MUS. Our nuanced analysis of the use of 'difficult' challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS. Copyright © 2016 Elsevier Inc. All rights reserved.

CRPS of the upper or lower extremity: surgical treatment outcomes

Directory of Open Access Journals (Sweden)

Rosson Gedge D

2009-02-01

Full Text Available Abstract The hypothesis is explored that CRPS I (the "new" RSD persists due to undiagnosed injured joint afferents, and/or cutaneous neuromas, and/or nerve compressions, and is, therefore, a misdiagnosed form of CRPS II (the "new" causalgia. An IRB-approved, retrospective chart review on a series of 100 consecutive patients with "RSD" identified 40 upper and 30 lower extremity patients for surgery based upon their history, physical examination, neurosensory testing, and nerve blocks. Based upon decreased pain medication usage and recovery of function, outcome in the upper extremity, at a mean of 27.9 months follow-up (range of 9 to 81 months, gave results that were excellent in 40% (16 of 40 patients, good in 40% (16 of 40 patients and failure 20% (8 of 40 patients. In the lower extremity, at a mean of 23.0 months follow-up (range of 9 to 69 months the results were excellent in 47% (14 of 30 patients, good in 33% (10 of 30 patients and failure 20% (6 of 30 patients. It is concluded that most patients referred with a diagnosis of CRPS I have continuing pain input from injured joint or cutaneous afferents, and/or nerve compressions, and, therefore, similar to a patient with CRPS II, they can be treated successfully with an appropriate peripheral nerve surgical strategy.

The measured contribution of whipping and springing on the fatigue and extreme loading of container vessels

Science.gov (United States)

Storhaug, Gaute

2014-12-01

Whipping/springing research started in the 50'ies. In the 60'ies inland water vessels design rules became stricter due to whipping/springing. The research during the 70-90'ies may be regarded as academic. In 2000 a large ore carrier was strengthened due to severe cracking from North Atlantic operation, and whipping/springing contributed to half of the fatigue damage. Measurement campaigns on blunt and slender vessels were initiated. A few blunt ships were designed to account for whipping/springing. Based on the measurements, the focus shifted from fatigue to extreme loading. In 2005 model tests of a 4,400 TEU container vessel included extreme whipping scenarios. In 2007 the 4400 TEU vessel MSC Napoli broke in two under similar conditions. In 2009 model tests of an 8,600 TEU container vessel container vessel included extreme whipping scenarios. In 2013 the 8,100 TEU vessel MOL COMFORT broke in two under similar conditions. Several classification societies have published voluntary guidelines, which have been used to include whipping/springing in the design of several container vessels. This paper covers results from model tests and full scale measurements used as background for the DNV Legacy guideline. Uncertainties are discussed and recommendations are given in order to obtain useful data. Whipping/springing is no longer academic.

Mitral stenosis due to pannus overgrowth after rigid ring annuloplasty.

Science.gov (United States)

Oda, Takeshi; Kato, Seiya; Tayama, Eiki; Fukunaga, Shuji; Akashi, Hidetoshi; Aoyagi, Shigeaki

2010-03-01

Although mitral stenosis (MS) due to pannus overgrowth after mitral valve repair for rheumatic mitral regurgitation (MR) is not uncommon, it is extremely rare in relation to non-rheumatic mitral regurgitation. Whilst it has been suggested that the rigid annuloplasty ring induces pannus overgrowth in the same manner as the flexible ring, to date only in cases using the flexible ring has pannus formation been confirmed by a pathological examination after redo surgery. The case is described of a woman who had undergone mitral valve repair using a 28 mm rigid ring three years previously because of non-rheumatic MR, and subsequently suffered from MS due to pannus formation over the annuloplasty ring. To the present authors' knowledge, this is the first report of MS due to pannus formation after mitral valve repair using a rigid annuloplasty ring to treat non-rheumatic MR documented at reoperation.

Climate change impacts on rainfall extremes and urban drainage: state-of-the-art review

Science.gov (United States)

Willems, Patrick; Olsson, Jonas; Arnbjerg-Nielsen, Karsten; Beecham, Simon; Pathirana, Assela; Bülow Gregersen, Ida; Madsen, Henrik; Nguyen, Van-Thanh-Van

2013-04-01

Under the umbrella of the IWA/IAHR Joint Committee on Urban Drainage, the International Working Group on Urban Rainfall (IGUR) has reviewed existing methodologies for the analysis of long-term historical and future trends in urban rainfall extremes and their effects on urban drainage systems, due to anthropogenic climate change. Current practises have several limitations and pitfalls, which are important to be considered by trend or climate change impact modellers and users of trend/impact results. The review considers the following aspects: Analysis of long-term historical trends due to anthropogenic climate change: influence of data limitation, instrumental or environmental changes, interannual variations and longer term climate oscillations on trend testing results. Analysis of long-term future trends due to anthropogenic climate change: by complementing empirical historical data with the results from physically-based climate models, dynamic downscaling to the urban scale by means of Limited Area Models (LAMs) including explicitly small-scale cloud processes; validation of RCM/GCM results for local conditions accounting for natural variability, limited length of the available time series, difference in spatial scales, and influence of climate oscillations; statistical downscaling methods combined with bias correction; uncertainties associated with the climate forcing scenarios, the climate models, the initial states and the statistical downscaling step; uncertainties in the impact models (e.g. runoff peak flows, flood or surcharge frequencies, and CSO frequencies and volumes), including the impacts of more extreme conditions than considered during impact model calibration and validation. Implications for urban drainage infrastructure design and management: upgrading of the urban drainage system as part of a program of routine and scheduled replacement and renewal of aging infrastructure; how to account for the uncertainties; flexible and sustainable solutions

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

DEFF Research Database (Denmark)

Lauridsen, Karen M.; Madsen, Henning

intercultural collaboration. The issues that arise seem to be grounded in linguistic, cultural and educational factors. This paper reports on and discusses a study of student responses to intercultural collaboration (in English) in two programmes at Aarhus University, Denmark. One conclusion...... is that the international students are more prepared to work in multicultural teams than their Danish peers. Another one 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......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...

An unusual cause of difficult weaning in a patient with newly diagnosed small cell lung cancer

Directory of Open Access Journals (Sweden)

G. Deslypere

2015-01-01

Full Text Available We describe a patient with acute respiratory insufficiency and difficult ventilator weaning in the ICU ward, leading to diagnosis of small cell lung cancer with superior vena cava superior syndrome. Bilateral vocal cord paralysis caused his respiratory distress and weaning difficulties. Thyroidectomy and neurological problems (such as Parkinson disease and Guillain Barré syndrome are more common causes of bilateral vocal cord paralysis. Lung cancer patients are also at risk due to mediastinal invasion. The left recurrent laryngeal nerve is more prone to paralysis because of the typical anatomy. In contrary, bilateral vocal cord paralysis is rare and doesn't result in speech problems but rather breathing difficulties. Tracheostomy is the classic therapy, but laser cordectomy and Botulinum toxin injection in the laryngeal muscles are alternatives.

A single pH fluorescent probe for biosensing and imaging of extreme acidity and extreme alkalinity.

Science.gov (United States)

Chao, Jian-Bin; Wang, Hui-Juan; Zhang, Yong-Bin; Li, Zhi-Qing; Liu, Yu-Hong; Huo, Fang-Jun; Yin, Cai-Xia; Shi, Ya-Wei; Wang, Juan-Juan

2017-07-04

A simple tailor-made pH fluorescent probe 2-benzothiazole (N-ethylcarbazole-3-yl) hydrazone (Probe) is facilely synthesized by the condensation reaction of 2-hydrazinobenzothiazole with N-ethylcarbazole-3-formaldehyde, which is a useful fluorescent probe for monitoring extremely acidic and alkaline pH, quantitatively. The pH titrations indicate that Probe displays a remarkable emission enhancement with a pK a of 2.73 and responds linearly to minor pH fluctuations within the extremely acidic range of 2.21-3.30. Interestingly, Probe also exhibits strong pH-dependent characteristics with pK a 11.28 and linear response to extreme-alkalinity range of 10.41-12.43. In addition, Probe shows a large Stokes shift of 84 nm under extremely acidic and alkaline conditions, high selectivity, excellent sensitivity, good water-solubility and fine stability, all of which are favorable for intracellular pH imaging. The probe is further successfully applied to image extremely acidic and alkaline pH values fluctuations in E. coli cells. Copyright © 2017 Elsevier B.V. All rights reserved.

Near-extreme system condition and near-extreme remaining useful time for a group of products

International Nuclear Information System (INIS)

Wang, Hai-Kun; Li, Yan-Feng; Huang, Hong-Zhong; Jin, Tongdan

2017-01-01

When a group of identical products is operating in field, the aggregation of failures is a catastrophe to engineers and customers who strive to develop reliable and safe products. In order to avoid a swarm of failures in a short time, it is essential to measure the degree of dispersion from different failure times in a group of products to the first failure time. This phenomenon is relevant to the crowding of system conditions near the worst one among a group of products. The group size in this paper represents a finite number of products, instead of infinite number or a single product. We evaluate the reliability of the product fleet from two aspects. First, we define near-extreme system condition and near-extreme failure time for offline solutions, which means no online observations. Second, we apply them to a continuous degradation system that breaks down when it reaches a soft failure threshold. By using particle filtering in the framework of prognostics and health management for a group of products, we aim to estimate near-extreme system condition and further predict the remaining useful life (RUL) using online solutions. Numerical examples are provided to demonstrate the effectiveness of the proposed method. - Highlights: • The aggregation of failures is measured for a group of identical products. • The crowding of failures is quantitated by the near-extreme evaluations. • Near-extreme system condition are given for offline solutions. • Near-extreme remaining useful time are provided for online solutions.

Ischial Pain and Sitting Disability Due to Ischiogluteal Bursitis: Visual Vignette.

Science.gov (United States)

Ekiz, Timur; Biçici, Vedat; Hatioglu, Cem; Yalçın, Süha; Cingöz, Kagan

2015-01-01

Ischial bursitis or ischiogluteal bursitis is the inflammation of the ischiogluteal bursa due to excessive or inappropriate physical exercise, prolonged sitting, running, repetitive jumping, and kicking. Since ischial bursitis is a rare, infrequently recognized pathology and is difficult to differentiate from the soft tissue disease and tumors (both malignant and benign), herein exemplified is a case with ischiogluteal bursitis whereby the role of magnetic resonance imaging (MRI) in the prompt diagnosis has been highlighted.

Ductility increase in difficult to work nickel alloys due to calcium microalloying

International Nuclear Information System (INIS)

Shevtsov, V.A.; Grigoryan, R.A.; Aleev, V.P.; Stepanov, V.P.; Bytskij, E.V.

1995-01-01

Impact of calcium microadditions on mechanical properties of heat-resisting alloys Kh66VMTYu and KhN33KV is studied. It is established that the calcium additions up to 0.01% essentially increase the alloy plastic characteristics of the alloy without changing its strength characteristics.5 refs., 3 figs

Book review: Extreme ocean waves

Science.gov (United States)

Geist, Eric L.

2011-01-01

‘‘Extreme Ocean Waves’’ is a collection of ten papers edited by Efim Pelinovsky and Christian Kharif that followed the April 2007 meeting of the General Assembly of the European Geosciences Union. A note on terminology: extreme waves in this volume broadly encompass different types of waves, includ- ing deep-water and shallow-water rogue waves (alternatively termed freak waves), storm surges from cyclones, and internal waves. Other types of waves such as tsunamis or rissaga (meteotsunamis) are not discussed in this volume. It is generally implied that ‘‘extreme’’ has a statistical connotation relative to the average or significant wave height specific to each type of wave. Throughout the book, in fact, the reader will find a combination of theoretical and statistical/ empirical treatment necessary for the complete examination of this subject. In the introduction, the editors underscore the importance of studying extreme waves, documenting several dramatic instances of damaging extreme waves that occurred in 2007. 

Doubling of coastal flooding frequency within decades due to sea-level rise

Science.gov (United States)

Vitousek, Sean; Barnard, Patrick L.; Fletcher, Charles H.; Frazer, Neil; Erikson, Li; Storlazzi, Curt D.

2017-01-01

Global climate change drives sea-level rise, increasing the frequency of coastal flooding. In most coastal regions, the amount of sea-level rise occurring over years to decades is significantly smaller than normal ocean-level fluctuations caused by tides, waves, and storm surge. However, even gradual sea-level rise can rapidly increase the frequency and severity of coastal flooding. So far, global-scale estimates of increased coastal flooding due to sea-level rise have not considered elevated water levels due to waves, and thus underestimate the potential impact. Here we use extreme value theory to combine sea-level projections with wave, tide, and storm surge models to estimate increases in coastal flooding on a continuous global scale. We find that regions with limited water-level variability, i.e., short-tailed flood-level distributions, located mainly in the Tropics, will experience the largest increases in flooding frequency. The 10 to 20 cm of sea-level rise expected no later than 2050 will more than double the frequency of extreme water-level events in the Tropics, impairing the developing economies of equatorial coastal cities and the habitability of low-lying Pacific island nations.

Doubling of coastal flooding frequency within decades due to sea-level rise.

Science.gov (United States)

Vitousek, Sean; Barnard, Patrick L; Fletcher, Charles H; Frazer, Neil; Erikson, Li; Storlazzi, Curt D

2017-05-18

Global climate change drives sea-level rise, increasing the frequency of coastal flooding. In most coastal regions, the amount of sea-level rise occurring over years to decades is significantly smaller than normal ocean-level fluctuations caused by tides, waves, and storm surge. However, even gradual sea-level rise can rapidly increase the frequency and severity of coastal flooding. So far, global-scale estimates of increased coastal flooding due to sea-level rise have not considered elevated water levels due to waves, and thus underestimate the potential impact. Here we use extreme value theory to combine sea-level projections with wave, tide, and storm surge models to estimate increases in coastal flooding on a continuous global scale. We find that regions with limited water-level variability, i.e., short-tailed flood-level distributions, located mainly in the Tropics, will experience the largest increases in flooding frequency. The 10 to 20 cm of sea-level rise expected no later than 2050 will more than double the frequency of extreme water-level events in the Tropics, impairing the developing economies of equatorial coastal cities and the habitability of low-lying Pacific island nations.

[Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones].

Science.gov (United States)

Cuendis-Velázquez, A; Rojano-Rodríguez, M E; Morales-Chávez, C E; González Angulo-Rocha, A; Fernández-Castro, E; Aguirre-Olmedo, I; Torres-Ruiz, M F; Orellana-Parra, J C; Cárdenas-Lailson, L E

2014-01-01

Choledocholithiasis presents in 5-10% of the patients with biliary lithiasis. Numerous treatment algorithms have been considered for this disease, however, up to 10% of these therapeutic procedures may fail. Intraoperative choledochoscopy has become a useful tool in the treatment of patients with difficult-to-manage choledocholithiasis. To determine the usefulness of intraoperative choledochoscopy in the laparoendoscopic treatment of difficult stones that was carried out in our service. A cross-sectional study was conducted. The case records were reviewed of the patients that underwent intraoperative choledochoscopy during biliary tree exploration plus laparoscopic choledochoduodenal anastomosis within the time frame of March 1, 2011 and May 31, 2012, at the Hospital General Dr. Manuel Gea González. Transabdominal choledochoscopies were performed with active stone extraction when necessary, followed by peroral choledochoscopies through the recently formed bilioenteric anastomosis. The data were analyzed with descriptive statistics and measures of central tendency. The mean age was 71 years, 57% of the patients were women, and the ASA III score predominated. Active extraction of stones with 7 to 35mm diameters was carried out in 4 of the cases and the absence of stones in the biliary tract was corroborated in all the patients. The mean surgery duration was 18 minutes (range: 4 to 45min). Choledochoscopy is a safe and effective minimally invasive procedure for the definitive treatment of difficult stones. Copyright © 2013 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

Mortality impact of extreme winter temperatures

Science.gov (United States)

Díaz, Julio; García, Ricardo; López, César; Linares, Cristina; Tobías, Aurelio; Prieto, Luis

2005-01-01

During the last few years great attention has been paid to the evaluation of the impact of extreme temperatures on human health. This paper examines the effect of extreme winter temperature on mortality in Madrid for people older than 65, using ARIMA and GAM models. Data correspond to 1,815 winter days over the period 1986 1997, during which time a total of 133,000 deaths occurred. The daily maximum temperature (Tmax) was shown to be the best thermal indicator of the impact of climate on mortality. When total mortality was considered, the maximum impact occured 7 8 days after a temperature extreme; for circulatory diseases the lag was between 7 and 14 days. When respiratory causes were considered, two mortality peaks were evident at 4 5 and 11 days. When the impact of winter extreme temperatures was compared with that associated with summer extremes, it was found to occur over a longer term, and appeared to be more indirect.

The personal dispositions of violent extremism

Directory of Open Access Journals (Sweden)

Davydov D.G.

2017-04-01

Full Text Available The paper presents the differences in the nature of extremism and radicalism, and the necessity of introducing the concept of "violent extremism." It is shown that the ideology is the explanation of extremist behavior, rather than its cause. The ideology of extremism often eclectic, contradictory and can easily be transformed by changing the object of hostility, depending on the situation. For the description of the psychological causes of extremism it is proposed to use the concept of personal disposition. Disposition is the preferred way to subjective interpretation of reality and reflects both the specific needs of a person as well the typical social situations where it realized and personal experience. Considered the following dispositions of violent extremism: the Cult of force and aggression, Intolerance, Out-group hostility Conventional coercion, Social pessimism and destructiveness, Mystical, Fighting and overcoming, Nihilism to law, Anti-subjectivism. It is proposed to use these dispositions as diagnostic criteria and for preventing and correcting.

Due diligence duties for an environmental liability

International Nuclear Information System (INIS)

Huebsch, M.

2000-04-01

Jurisdiction turned out well to create a basic ruling for due diligence duties. These due diligence duties are high standards for the law of torts (outside of contracts) within the Austrian civil law and represent a liability-extension for the holder of the source of danger. They establish an action for injunction in particular for preventing (further) damages. Therewith due diligence duties get a general sense in the range of a civil law for environmental liability. The responsible holder of a danger zone will therefore influence his way of acting to protect potential victims and the environment. The burden of proof is on the plaintiff (victims) under the Civil Code. Victims have specific sources of danger including high endangering special facilities in their argumentation with the so-called prima-facie-proof or first-appearance-proof. A turning back of the presentation of evidence to the polluter is wrong. The polluter himself has a continuing liability for dangerous activities and his clerks in the case of an extremely high danger of damage. All due diligence duties can be arranged in three areas: in information-, danger-avoidance- and danger-prevention-duties. The determination of range and essence of the duties has to be adjusted to each individual case. The range of the specific danger area is the essential link. The intensity of due diligence duties is increasing with the size of danger in the way of a movable system depending on the protected interest. Due diligence duties have to be kept within reasonable limits with two criterions: necessarity and demand. Proportionality of actions is a third criterion to avoid exaggeration of due diligence duties to obtain an effective protection for victims including the environment. (author)

Ontogeny of Foraging Competence in Capuchin Monkeys (Cebus capucinus for Easy versus Difficult to Acquire Fruits: A Test of the Needing to Learn Hypothesis.

Directory of Open Access Journals (Sweden)

Elizabeth Christine Eadie

Full Text Available Which factors select for long juvenile periods in some species is not well understood. One potential reason to delay the onset of reproduction is slow food acquisition rates, either due to competition (part of the ecological risk avoidance hypothesis, or due to a decreased foraging efficiency (a version of the needing to learn hypothesis. Capuchins provide a useful genus to test the needing to learn hypothesis because they are known for having long juvenile periods and a difficult-to-acquire diet. Generalized, linear, mixed models with data from 609 fruit forage focal follows on 49, habituated, wild Cebus capucinus were used to test two predictions from the needing-to-learn hypothesis as it applies to fruit foraging skills: 1 capuchin monkeys do not achieve adult foraging return rates for difficult-to-acquire fruits before late in the juvenile period; and 2 variance in return rates for these fruits is at least partially associated with differences in foraging skill. In support of the first prediction, adults, compared with all younger age classes, had significantly higher foraging return rates when foraging for fruits that were ranked as difficult-to-acquire (return rates relative to adults: 0.30-0.41, p-value range 0.008-0.016, indicating that the individuals in the group who have the most foraging experience also achieve the highest return rates. In contrast, and in support of the second prediction, there were no significant differences between age classes for fruits that were ranked as easy to acquire (return rates relative to adults: 0.97-1.42, p-value range 0.086-0.896, indicating that strength and/or skill are likely to affect return rates. In addition, fruits that were difficult to acquire were foraged at nearly identical rates by adult males and significantly smaller (and presumably weaker adult females (males relative to females: 1.01, p = 0.978, while subadult females had much lower foraging efficiency than the similarly-sized but more

Ontogeny of Foraging Competence in Capuchin Monkeys (Cebus capucinus) for Easy versus Difficult to Acquire Fruits: A Test of the Needing to Learn Hypothesis.

Science.gov (United States)

Eadie, Elizabeth Christine

2015-01-01

Which factors select for long juvenile periods in some species is not well understood. One potential reason to delay the onset of reproduction is slow food acquisition rates, either due to competition (part of the ecological risk avoidance hypothesis), or due to a decreased foraging efficiency (a version of the needing to learn hypothesis). Capuchins provide a useful genus to test the needing to learn hypothesis because they are known for having long juvenile periods and a difficult-to-acquire diet. Generalized, linear, mixed models with data from 609 fruit forage focal follows on 49, habituated, wild Cebus capucinus were used to test two predictions from the needing-to-learn hypothesis as it applies to fruit foraging skills: 1) capuchin monkeys do not achieve adult foraging return rates for difficult-to-acquire fruits before late in the juvenile period; and 2) variance in return rates for these fruits is at least partially associated with differences in foraging skill. In support of the first prediction, adults, compared with all younger age classes, had significantly higher foraging return rates when foraging for fruits that were ranked as difficult-to-acquire (return rates relative to adults: 0.30-0.41, p-value range 0.008-0.016), indicating that the individuals in the group who have the most foraging experience also achieve the highest return rates. In contrast, and in support of the second prediction, there were no significant differences between age classes for fruits that were ranked as easy to acquire (return rates relative to adults: 0.97-1.42, p-value range 0.086-0.896), indicating that strength and/or skill are likely to affect return rates. In addition, fruits that were difficult to acquire were foraged at nearly identical rates by adult males and significantly smaller (and presumably weaker) adult females (males relative to females: 1.01, p = 0.978), while subadult females had much lower foraging efficiency than the similarly-sized but more experienced

Why reference to the past is difficult for agrammatic speakers

NARCIS (Netherlands)

Bastiaanse, Roelien

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

Prevailing trends of climatic extremes across Indus-Delta of Sindh-Pakistan

Science.gov (United States)

Abbas, Farhat; Rehman, Iqra; Adrees, Muhammad; Ibrahim, Muhammad; Saleem, Farhan; Ali, Shafaqat; Rizwan, Muhammad; Salik, Muhammad Raza

2018-02-01

This study examines the variability and change in the patterns of climatic extremes experienced in Indus-Delta of Sindh province of Pakistan, comprising regions of Karachi, Badin, Mohenjodaro, and Rohri. The homogenized daily minimum and maximum temperature and precipitation data for a 36-year period were used to calculate 13 and 11 indices of temperature and precipitation extremes with the help of RClimDex, a program written in the statistical software package R. A non-parametric Mann-Kendall test and Sen's slope estimates were used to determine the statistical significance and magnitude of the calculated trend. Temperatures of summer days and tropical nights increased in the region with overall significant warming trends for monthly maximum temperature as well as for warm days and nights reflecting dry conditions in the study area. The warm extremes and nighttime temperature indices showed greater trends than cold extremes and daytime indices depicting an overall warming trends in the Delta. Historic decrease in the acreage of major crops and over 33% decrease in agriculture credit for Sindh are the indicators of adverse impacts of warmer and drier weather on Sindh agriculture. Trends reported for Karachi and Badin are expected to decrease rice cultivation, hatching of fisheries, and mangroves forest surrounding these cities. Increase in the prevailing temperature trends will lead to increasingly hotter and drier summers resulting to constraints on cotton, wheat, and rice yield in Rohri and Mohenjodaro areas due to increased crop water requirements that may be met with additional groundwater pumping; nonetheless, the depleted groundwater resources would have a direct impact on the region's economy.

Socio-economic project evaluation in practice

International Nuclear Information System (INIS)

Larsen, A.

1995-01-01

The theoretical basis for a socio-economic project evaluation can be doubtful and specific analyses can involve quite essential uncertainty. Among serious theoretical problems of the energy sector there should be named the price distortions, due to various taxes. The choice of the presumed calculation interest can be difficult, due to the extremely long-range energy-political planning. (EG) 10 refs

Statistics of extremes theory and applications

CERN Document Server

Beirlant, Jan; Segers, Johan; Teugels, Jozef; De Waal, Daniel; Ferro, Chris

2006-01-01

Research in the statistical analysis of extreme values has flourished over the past decade: new probability models, inference and data analysis techniques have been introduced; and new application areas have been explored. Statistics of Extremes comprehensively covers a wide range of models and application areas, including risk and insurance: a major area of interest and relevance to extreme value theory. Case studies are introduced providing a good balance of theory and application of each model discussed, incorporating many illustrated examples and plots of data. The last part of the book covers some interesting advanced topics, including  time series, regression, multivariate and Bayesian modelling of extremes, the use of which has huge potential.  

Extreme scenarios for nuclear waste repositories

Energy Technology Data Exchange (ETDEWEB)

Brown, M J [Harvard Univ., Cambridge, MA (USA). Div. of Applied Sciences; Crouch, E [Harvard Univ., Cambridge, MA (USA). Energy and Environmental Policy Center

1982-09-01

Two extreme scenarios for release of radioactive waste have been constructed. In the first, a volcanic eruption releases 1 km/sup 2/ of an underground nuclear waste repository, while in the second, waste enters the drinking water reservoir of a major city. With pessimistic assumptions, upper bounds on the number of cancers due to radiation are calculated. In the volcano scenario, the effects of the waste are smaller than the effects of natural radioactivity in the volcanic dust if the delay between emplacement and eruption exceeds 2000 yr. The consequences of the waste in drinking water depend on the survival time of the canisters and the rate of leaching of the nuclides from the waste matrix. For a canister life of 400 yr and a leach time of 6300 yr the cancer rate in the affected area would increase by 25%.

Extreme scenarios for nuclear waste repositories

Energy Technology Data Exchange (ETDEWEB)

Brown, M J; Crouch, E

1982-09-01

Two extreme scenarios for release of radioactive waste have been constructed. In the first, a volcanic eruption releases 1 km2 of an underground nuclear waste repository, while in the second, waste enters the drinking water reservoir of a major city. With pessimistic assumptions, upper bounds on the number of cancers due to radiation are calculated. In the volcano scenario, the effects of the water are smaller than the effects of natural radioactivity in the volcanic dust if the delay between emplacement and eruption exceeds 2000 yr. The consequences of the waste in drinking water depend on the survival time of the canisters and the rate of leaching of the nuclides from the waste matrix. For a canister life of 400 yr and a leach time of 6300 yr the cancer rate in the affected area would increase by 25%.

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

International Nuclear Information System (INIS)

Durante, S; Comoglio, M; Rostagno, M

2011-01-01

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

Modulation of extreme temperatures in Europe under extreme values of the North Atlantic Oscillation Index.

Science.gov (United States)

Beniston, Martin

2018-03-10

This paper reports on the influence that extreme values in the tails of the North Atlantic Oscillation (NAO) Index probability density function (PDF) can exert on temperatures in Europe. When the NAO Index enters into its lowest (10% quantile or less) and highest (90% quantile or higher) modes, European temperatures often exhibit large negative or positive departures from their mean values, respectively. Analyses of the joint quantiles of the Index and temperatures (i.e., the simultaneous exceedance of particular quantile thresholds by the two variables) show that temperatures enter into the upper or lower tails of their PDF when the NAO Index also enters into its extreme tails, more often that could be expected from random statistics. Studies of this nature help further our understanding of the manner by which mechanisms of decadal-scale climate variability can influence extremes of temperature-and thus perhaps improve the forecasting of extreme temperatures in weather and climate models. © 2018 New York Academy of Sciences.

Increasing impacts of climate extremes on critical infrastructures in Europe

Science.gov (United States)

Forzieri, Giovanni; Bianchi, Alessandra; Feyen, Luc; Silva, Filipe Batista e.; Marin, Mario; Lavalle, Carlo; Leblois, Antoine

2016-04-01

The projected increases in exposure to multiple climate hazards in many regions of Europe, emphasize the relevance of a multi-hazard risk assessment to comprehensively quantify potential impacts of climate change and develop suitable adaptation strategies. In this context, quantifying the future impacts of climatic extremes on critical infrastructures is crucial due to their key role for human wellbeing and their effects on the overall economy. Critical infrastructures describe the existing assets and systems that are essential for the maintenance of vital societal functions, health, safety, security, economic or social well-being of people, and the disruption or destruction of which would have a significant impact as a result of the failure to maintain those functions. We assess the direct damages of heat and cold waves, river and coastal flooding, droughts, wildfires and windstorms to energy, transport, industry and social infrastructures in Europe along the 21st century. The methodology integrates in a coherent framework climate hazard, exposure and vulnerability components. Overall damage is expected to rise up to 38 billion €/yr, ten time-folds the current climate damage, with drastic variations in risk scenarios. Exemplificative are drought and heat-related damages that could represent 70% of the overall climate damage in 2080s versus the current 12%. Many regions, prominently Southern Europe, will likely suffer multiple stresses and systematic infrastructure failures due to climate extremes if no suitable adaptation measures will be taken.

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

-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...... 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...... that registration of the SARI and predictors for difficult mask ventilation are mandatory for the intervention group but invisible to controls....

Climate change, climatic variation and extreme biological responses.

Science.gov (United States)

Palmer, Georgina; Platts, Philip J; Brereton, Tom; Chapman, Jason W; Dytham, Calvin; Fox, Richard; Pearce-Higgins, James W; Roy, David B; Hill, Jane K; Thomas, Chris D

2017-06-19

Extreme climatic events could be major drivers of biodiversity change, but it is unclear whether extreme biological changes are (i) individualistic (species- or group-specific), (ii) commonly associated with unusual climatic events and/or (iii) important determinants of long-term population trends. Using population time series for 238 widespread species (207 Lepidoptera and 31 birds) in England since 1968, we found that population 'crashes' (outliers in terms of species' year-to-year population changes) were 46% more frequent than population 'explosions'. (i) Every year, at least three species experienced extreme changes in population size, and in 41 of the 44 years considered, some species experienced population crashes while others simultaneously experienced population explosions. This suggests that, even within the same broad taxonomic groups, species are exhibiting individualistic dynamics, most probably driven by their responses to different, short-term events associated with climatic variability. (ii) Six out of 44 years showed a significant excess of species experiencing extreme population changes (5 years for Lepidoptera, 1 for birds). These 'consensus years' were associated with climatically extreme years, consistent with a link between extreme population responses and climatic variability, although not all climatically extreme years generated excess numbers of extreme population responses. (iii) Links between extreme population changes and long-term population trends were absent in Lepidoptera and modest (but significant) in birds. We conclude that extreme biological responses are individualistic, in the sense that the extreme population changes of most species are taking place in different years, and that long-term trends of widespread species have not, to date, been dominated by these extreme changes.This article is part of the themed issue 'Behavioural, ecological and evolutionary responses to extreme climatic events'. © 2017 The Authors.

On the Extreme Wave Height Analysis

DEFF Research Database (Denmark)

Burcharth, H. F.; Liu, Zhou

1994-01-01

The determination of the design wave height is usually based on the statistical analysis of long-term extreme wave height measurements. After an introduction to the procedure of the extreme wave height analysis, the paper presents new development concerning various aspects of the extreme wave...... height analysis. Finally, the paper gives a practical example based on a data set of the hindcasted wave heights for a deep water location in the Mediterranean Sea....

Impacts of extreme weather events on transport infrastructure in Norway

Science.gov (United States)

Frauenfelder, Regula; Solheim, Anders; Isaksen, Ketil; Romstad, Bård; Dyrrdal, Anita V.; Ekseth, Kristine H. H.; Gangstø Skaland, Reidun; Harbitz, Alf; Harbitz, Carl B.; Haugen, Jan E.; Hygen, Hans O.; Haakenstad, Hilde; Jaedicke, Christian; Jónsson, Árni; Klæboe, Ronny; Ludvigsen, Johanna; Meyer, Nele K.; Rauken, Trude; Sverdrup-Thygeson, Kjetil

2016-04-01

century. The increase, both in total precipitation, and in the frequency and intensity of extreme events, is greatest in the west and southwest, and in parts of northern Norway, areas with the highest present precipitation. - Snowfall will increase due to increased precipitation in cold areas inland and at high elevations. In lower lying parts of the country, and along the coast, more precipitation as rain will replace snowfall. - The frequency of near-zero events, with freeze-thaw cycles, which can trigger rock falls, will decrease due to the generally increased temperatures. - The greatest uncertainties in the weather trends are linked to uncertainties in climate and emission scenarios, and to the downscaling. - More than 30% of the total length of road and railroads in Norway is exposed to snow avalanche and rock fall/slide hazard. As an example, one of the most exposed railroads, Raumabanen, has an annual probability of 1/3 to be hit by snow avalanches. - Total costs of geohazard impact on the road infrastructure (major roads only) were estimated to be roughly 100 mill. NOK per year, of which the costs of road closures comprise 70%. The numbers are unevenly distributed throughout the country, reflecting the topographic and climatic variability in Norway.

Reviewing Hit Discovery Literature for Difficult Targets: Glutathione Transferase Omega-1 as an Example.

Science.gov (United States)

Xie, Yiyue; Dahlin, Jayme L; Oakley, Aaron J; Casarotto, Marco G; Board, Philip G; Baell, Jonathan B

2018-05-10

Early stage drug discovery reporting on relatively new or difficult targets is often associated with insufficient hit triage. Literature reviews of such targets seldom delve into the detail required to critically analyze the associated screening hits reported. Here we take the enzyme glutathione transferase omega-1 (GSTO1-1) as an example of a relatively difficult target and review the associated literature involving small-molecule inhibitors. As part of this process we deliberately pay closer-than-usual attention to assay interference and hit quality aspects. We believe this Perspective will be a useful guide for future development of GSTO1-1 inhibitors, as well serving as a template for future review formats of new or difficult targets.

Environmental risk evaluation of difficult substances in USES 2.0