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Sample records for extremely difficult due

  1. Unexpected difficult intubation due to subglottic ring

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    Abdulkadir Atım

    2010-03-01

    Full Text Available Airway damages encountered during endotracheal intubationor tracheostomy may cause some complicationssuch as severe dyspnea. Upper airway diagnostic endoscopywas planned to find the etiology of effort dyspnea ina 5 years old girl who had endotracheal intubation beenperformed during newborn period. Her ASA score was 1,and Mallampati score for preoperative airway evaluationwas 1. Physical examination revealed neither dyspneanor stridor while the patient was not exerting effort. Herchest radiograms were normal. She had no history of previoussurgical or anesthetical intervention. In this reportwe presented a difficult intubation during the endoscopicexamination of upper airway in a patient who had dyspneawhile exerting effort.

  2. Extreme situations due to gender violence

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    Stela Meneghel

    2012-11-01

    Full Text Available This paper presents a synthesis of the third Critical Paths Seminar, held in Porto Alegre/Brazil in 2011, whose focus was extreme situations of gender violence. The extreme situations are human rights violations that include femicide or murder motivated by the situation of gender; LGBT murders, human rights violations of ethnic and racial minorities, sexual exploitation, violence to women in vulnerable situations and other violence caused by gender. The meeting objective was given space to share experiences, reflect critically and build strategies for facing violence and extreme situations resulting from gender systems.

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

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    Kouhei Iwashita

    2014-07-01

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

  4. Esophageal perforation due to blunt chest trauma: Difficult diagnosis because of coexisting severe disturbance of consciousness.

    Science.gov (United States)

    Mezuki, Satomi; Shono, Yuji; Akahoshi, Tomohiko; Hisanaga, Kana; Saeki, Hiroshi; Nakashima, Yuichiro; Momii, Kenta; Maki, Jun; Tokuda, Kentaro; Maehara, Yoshihiko

    2017-08-19

    Esophageal perforation due to blunt trauma is a rare clinical condition, and the diagnosis is often difficult because patients have few specific symptoms. Delayed diagnosis may result in a fatal clinical course due to mediastinitis and subsequent sepsis. In this article, we describe a 26-year-old man with esophageal perforation due to blunt chest trauma resulting from a motor vehicle accident. Because a severe disturbance of consciousness masked the patient's trauma-induced thoracic symptoms, we required 11h to diagnose the esophageal perforation. Therefore, the patient developed septic shock due to mediastinitis. However, his subsequent clinical course was good because of prompt combined therapy involving surgical repair and medical treatment after the diagnosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Sugammadex use in difficult intubation due to ankylosing spondylitis and severe restrictive respiratory disease

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    Yakup Tomak

    2012-09-01

    Full Text Available We describe anesthesia management of a 50-year-old man scheduled for thoracic spinal reconstruction, presenting with severe restrictive respiratory disease and difficult airway due to ankylosing spondilitis. The patient was unable to extend his head, had difficulty in breathing and sleeping in supine position due to thoracal deformities. The patient was intubated using intubating laryngeal mask airway to overcome the difficulties of limited mouth opening and head extension. He was extubated following administration of sugammadex to obtain optimal conditions in terms of respiratory muscle function and to prevent hypersecretion and bronchospasm. J Clin Exp Invest 2012; 3 (3: 398-400Key words: Restrictive lung disease, airway management, laryngeal masks, sugammadex, ankylosing spondylitis

  6. Intramolecular vibrational dynamical barrier due to extremely irrational couplings

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The intramolecular vibrational dynamics due to extremely irrational couplings is demonstrated by contrast to the resonance couplings, for the three-mode case of H2O as an example. The extremely irrational couplings are shown to impose such strong hindrance to intramolecular vibrational relaxation (IVR) that they act as barriers. They restrict the direct action/energy transfer between the two stretching modes, though they allow the transfer between a stretching and a bending modes. In contrast, the resonance is more mediated by the bending mode and leads to chaotic IVR. It is also shown that there is a region in the dynamical space in which resonance and extremely irrational couplings coexist.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  8. Chronic endocarditis due to Legionella anisa: a first case difficult to diagnose

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    F. Compain

    2015-11-01

    Full Text Available Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist.

  9. Chronic endocarditis due to Legionella anisa: a first case difficult to diagnose

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    Compain, F.; Bruneval, P.; Jarraud, S.; Perrot, S.; Aubert, S.; Napoly, V.; Ramahefasolo, A.; Mainardi, J.-L.; Podglajen, I.

    2015-01-01

    Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist. PMID:26693025

  10. Extremely High Q-factor metamaterials due to Anapole Excitation

    CERN Document Server

    Basharin, Alexey A; Volsky, Nikita; Kafesaki, Maria; Economou, Eleftherios N

    2016-01-01

    We demonstrate that ideal anapole metamaterials have infinite Q-factor. We have designed and fabricated a metamaterial consisting of planar metamolecules which exhibit anapole behavior in the sense that the electric dipole radiation is almost cancelled by the toroidal dipole one, producing thus an extremely high Q-factor at the resonance frequency. The size of the system, at the mm range, and the parasitic magnetic quadrupole radiation are the factors limiting the size of the Q-factor. In spite of the very low radiation losses the local fields at the metamolecules are extremely high, of the order of higher than the external incoming field.

  11. Extremely high Q -factor metamaterials due to anapole excitation

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    Basharin, Alexey A.; Chuguevsky, Vitaly; Volsky, Nikita; Kafesaki, Maria; Economou, Eleftherios N.

    2017-01-01

    We have designed and fabricated a metamaterial consisting of planar metamolecules which exhibit unusual, almost perfect anapole behavior in the sense that the electric dipole radiation is almost canceled by the toroidal dipole one, producing thus an extremely high Q -factor at the resonance frequency. Thus we have demonstrated theoretically and experimentally that metamaterials approaching ideal anapole behavior have very high Q -factor. The size of the system, at the millimeter range, and the parasitic magnetic quadrupole radiation are the factors limiting the size of the Q -factor. In spite of the very low radiation losses the estimated local fields at the metamolecules are extremely high, of the order of 104 higher than the external incoming field.

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

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    Cai-neng Wu

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

  13. The Damage To The Armour Layer Due To Extreme Waves

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    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

  14. Automated assessment of upper extremity movement impairment due to stroke.

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    Erienne V Olesh

    Full Text Available Current diagnosis and treatment of movement impairment post-stroke is based on the subjective assessment of select movements by a trained clinical specialist. However, modern low-cost motion capture technology allows for the development of automated quantitative assessment of motor impairment. Such outcome measures are crucial for advancing post-stroke treatment methods. We sought to develop an automated method of measuring the quality of movement in clinically-relevant terms from low-cost motion capture. Unconstrained movements of upper extremity were performed by people with chronic hemiparesis and recorded by standard and low-cost motion capture systems. Quantitative scores derived from motion capture were compared to qualitative clinical scores produced by trained human raters. A strong linear relationship was found between qualitative scores and quantitative scores derived from both standard and low-cost motion capture. Performance of the automated scoring algorithm was matched by averaged qualitative scores of three human raters. We conclude that low-cost motion capture combined with an automated scoring algorithm is a feasible method to assess objectively upper-arm impairment post stroke. The application of this technology may not only reduce the cost of assessment of post-stroke movement impairment, but also promote the acceptance of objective impairment measures into routine medical practice.

  15. Automated assessment of upper extremity movement impairment due to stroke.

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    Olesh, Erienne V; Yakovenko, Sergiy; Gritsenko, Valeriya

    2014-01-01

    Current diagnosis and treatment of movement impairment post-stroke is based on the subjective assessment of select movements by a trained clinical specialist. However, modern low-cost motion capture technology allows for the development of automated quantitative assessment of motor impairment. Such outcome measures are crucial for advancing post-stroke treatment methods. We sought to develop an automated method of measuring the quality of movement in clinically-relevant terms from low-cost motion capture. Unconstrained movements of upper extremity were performed by people with chronic hemiparesis and recorded by standard and low-cost motion capture systems. Quantitative scores derived from motion capture were compared to qualitative clinical scores produced by trained human raters. A strong linear relationship was found between qualitative scores and quantitative scores derived from both standard and low-cost motion capture. Performance of the automated scoring algorithm was matched by averaged qualitative scores of three human raters. We conclude that low-cost motion capture combined with an automated scoring algorithm is a feasible method to assess objectively upper-arm impairment post stroke. The application of this technology may not only reduce the cost of assessment of post-stroke movement impairment, but also promote the acceptance of objective impairment measures into routine medical practice.

  16. Changes in weather extremes over East Asia due to global warming

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    Lee, Min-Hee; Ho, Chang-Hoi; Kim, Jinwon; Song, Chang-Geun

    2010-05-01

    The changes in weather extremes due to the global warming induced by the emissions of anthropogenic greenhouse gases have received growing attention in climate research community. In this study, the authors introduce new indices that assess changes in extreme vulnerability over East Asia for the periods of past 100 years and future 100 years. Observed temperatures and precipitation at 895 meteorological stations in Korea, China, and Japan have been analyzed for 1960s-2000s. In addition, we examined data from a global climate model simulation using the National Center for Atmospheric Research Community Climate System Model for 1900-2099. The observations show increasing trends in warm and dry extremes, and decreases in cold extremes, particularly in northern East Asia. A notable regional anomaly is the increase in wet extremes over the Korean Peninsula. The temperature extremes in the model simulations are similar to the observed features in the same region during the for the 20th and 21st century periods.

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

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    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.

  18. Difficult Asthma

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    Ahmet Uslu

    2003-03-01

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

  19. Difficult asthma

    OpenAIRE

    Ahmet Uslu; Tülay Özdemir

    1989-01-01

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

  20. Deterministic and Probabilistic Analysis of NPP Communication Bridge Resistance Due to Extreme Loads

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    Králik Juraj

    2014-12-01

    Full Text Available This paper presents the experiences from the deterministic and probability analysis of the reliability of communication bridge structure resistance due to extreme loads - wind and earthquake. On the example of the steel bridge between two NPP buildings is considered the efficiency of the bracing systems. The advantages and disadvantages of the deterministic and probabilistic analysis of the structure resistance are discussed. The advantages of the utilization the LHS method to analyze the safety and reliability of the structures is presented

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

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    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.

  2. Changes in extreme regional sea surface height due to an abrupt weakening of the Atlantic MOC

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    S.-E. Brunnabend

    2014-04-01

    Full Text Available 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 of ocean model resolution on these SSH changes: a high-resolution (HR strongly eddying version and a low-resolution (LR version in which the effect of eddies are parameterized. The weakening of the AMOC is induced in both model versions by applying strong freshwater perturbations around Greenland. A rapid decrease of the AMOC in the HR version induces much shorter return times of several specific regional and coastal extremes in North Atlantic SSH than in the LR version. This effect is caused by a change in main eddy pathways associated with a change in separation latitude of the Gulf Stream.

  3. Genuine effectively biaxial left-handed metamaterials due to extreme coupling.

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    Menzel, Christoph; Alaee, Rasoul; Pshenay-Severin, Ekaterina; Helgert, Christian; Chipouline, Arkadi; Rockstuhl, Carsten; Pertsch, Thomas; Lederer, Falk

    2012-02-15

    Most left-handed metamaterials cannot be described by local effective permittivity or permeability tensors in the visible or near-infrared due to the mesoscopic size of the respective unit cells and the related strong spatial dispersion. We lift this problem and propose a metamaterial exhibiting artificial magnetism that does not suffer from this restriction. The artificial magnetism arises from the extreme coupling between both metallic films forming the unit cell. We show that its electromagnetic response can be properly described by biaxial local constitutive relations. A genuine biaxial left-handed fishnet metamaterial is suggested, which can be realized by atomic layer deposition to fabricate the nanoscaled spacing layers required for extreme coupling.

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

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    A. Mahmud

    2012-02-01

    Full Text Available 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 1008 days in each of the present-day and future climate conditions using year-2000 emissions. Population-weighted concentrations of PM0.1, PM2.5, and PM10 total mass, components species, and primary source contributions were calculated for California and three air basins: the Sacramento Valley air basin (SV, the San Joaquin Valley air basin (SJV and the South Coast Air Basin (SoCAB. Results over annual-average periods were contrasted with extreme events.

    Climate change between 2000 vs. 2050 did not cause a statistically significant change in annual-average population-weighted PM2.5 mass concentrations within any major sub-region of California in the current study. Climate change did alter the annual-average composition of the airborne particles in the SoCAB, with notable reductions of elemental carbon (EC; −3% and organic carbon (OC; −3% due to increased annual-average wind speeds that diluted primary concentrations from gasoline combustion (−3% and food cooking (−4%. In contrast, climate change caused significant increases in population-weighted PM2.5 mass concentrations in central California during extreme events. The maximum 24-h average PM2.5 concentration experienced by an average person during a ten-year period in the SJV increased by 21% due to enhanced production of secondary particulate matter (manifested as NH4NO3. In general, climate change caused increased

  5. Scale orientated analysis of river width changes due to extreme flood hazards

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    G. Krapesch

    2011-08-01

    Full Text Available This paper analyses the morphological effects of extreme floods (recurrence interval >100 years and examines which parameters best describe the width changes due to erosion based on 5 affected alpine gravel bed rivers in Austria. The research was based on vertical aerial photos of the rivers before and after extreme floods, hydrodynamic numerical models and cross sectional measurements supported by LiDAR data of the rivers. Average width ratios (width after/before the flood were calculated and correlated with different hydraulic parameters (specific stream power, shear stress, flow area, specific discharge. Depending on the geomorphological boundary conditions of the different rivers, a mean width ratio between 1.12 (Lech River and 3.45 (Trisanna River was determined on the reach scale. The specific stream power (SSP best predicted the mean width ratios of the rivers especially on the reach scale and sub reach scale. On the local scale more parameters have to be considered to define the "minimum morphological spatial demand of rivers", which is a crucial parameter for addressing and managing flood hazards and should be used in hazard zone plans and spatial planning.

  6. Soil temperature regime and vulnerability due to extreme soil temperatures in Croatia

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    Sviličić, Petra; Vučetić, Višnja; Filić, Suzana; Smolić, Ante

    2016-10-01

    Soil temperature is an important factor within the climate system. Changes of trends in soil temperature and analysis of vulnerability due to heat stress can provide useful information on climate change. In this paper, the soil temperature regime was analyzed on seasonal and annual scales at depths of 2, 5, 10, 20, 30, and 50 cm at 26 sites in Croatia. Trends of maximal, mean, and minimal soil temperatures were analyzed in the periods 1961-2010 and 1981-2010. Duration of extreme soil temperatures and vulnerability due to high or low soil temperatures in the recent standard period 1981-2010 was compared with the reference climate period 1961-1990. The results show a general warming in all seasons and depths for maximal and mean temperatures in both observed periods, while only at some locations for minimal soil temperature. Warming is more pronounced in the eastern and coastal parts of Croatia in the surface layers, especially in the spring and summer season in the second period. Significant trends of maximal, minimal, and mean soil temperature in both observed periods range from 2.3 to 6.6 °C/decade, from -1.0 to 1.3 °C/decade, and from 0.1 to 2.5 °C/decade, respectively. The highest vulnerability due to heat stress at 35 °C is noted in the upper soil layers of the coastal area in both observed periods. The mountainous and northwestern parts of Croatia at surface soil layers are the most vulnerable due to low soil temperature below 0 °C. Vulnerability due to high or low soil temperature decreases with depth.

  7. Compounding Hazards Facing Nepalese Villages due to Glacial Lake Thulagi, Extreme Monsoons, and Landslides

    Science.gov (United States)

    Leonard, Gregory; Kargel, Jeffrey; Regmi, Dhananjay

    2014-05-01

    Thulagi Tsho is listed by ICIMOD as among the most hazardous glacial lakes in Nepal. The listing is warranted by the physiography and downstream vulnerabilities. Tal Village—along a major trekking route—and a hydroelectric dam and reservoir are notably at risk due to the potential for a glacier lake outburst flood (GLOF), an extreme summer monsoon, extreme spring snowmelt, landslides, and rockfalls. Tal is downstream from Thulagi Lake just a couple meters above river level, and ordinary monsoons already cause an approach toward flood conditions, according to residents. A high flood stage due to an extreme monsoon or unusually rapid springtime melting of a thick winter snowpack could be catastrophic. Two significant mass movements occurred recently in Tal, one having buried some structures in the village in June 2012. In a favorable note, satellite image analysis shows that Thulagi Lake has slowed its elongation in the last couple years. Furthermore, any tsunami or other flood surge would have to traverse and erode a wide end moraine in order to generate a GLOF. On the other hand, remote sensing and field observations show that wasting of Thulagi Glacier has debuttressed the northern lateral moraine, which is slipping toward the growing lake and the thinning/retreating glacier. The landslip itself is not necessarily a bad thing: it is causing a loss of gravitational potential energy of the lateral moraine, and if that process continues gradually, it will result in diminished instability. However, the debuttressing and moraine slip signifies that the moraines are unstable. Will a rapid mass movement dump into the lake? Triggers could include seismicity, extreme rainfall, or a small landslip. The risk of a serious GLOF exceeds that of Imja Lake due to Thulagi Lake's large hydrographic head and the shape of its downstream end, which could funnel and amplify a potential tsunami generated by a large mass movement into the lake. A moraine collapse into the lake would

  8. Extreme tsunami runup simulation at Babi Island due to 1992 Flores tsunami and Okushiri due to 1993 Hokkido tsunami

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    Chule Kim, Dong; Choi, Byung Ho; Kim, Kyeong Ok; Pelinovsky, Efim

    2014-05-01

    This study is based on a series of three dimensional numerical modeling experiments to understand the tsunami run-up and inundation process at the circular shape Babi Island in the Indonesia caused by 1992 Flores earthquake tsunami and at Monai valley in Okushiri Island, west part of East (Japan) Sea caused by the 1993 Hokkaido Nansei-Oki earthquake. The wave field in the coastal area is modeled within the framework of fully nonlinear dispersive Reynolds-averaged Navier-Stokes (RANS) equations solved using the FLOW3D code. Boundary conditions for this model were extracted from computed wave characteristics obtained from the 2D tsunami propagation model based on the shallow water equations. This model has shown it effectivity to explain extreme runup characteristics during the 2004 Indian Ocean tsunami and 2011 Japan tsunami (Kim et al, 2013). In case of the 1992 Flores Island tsunami the results of numerical simulation run-up results are compared with field measured run-up heights. It has good agreement with measurement and computational run-up heights. The particle velocity distribution is also computed. In the case of 1993 Okushiri tsunami the numerical simulation reproduces extreme run-up at the Monai valley (31.7 m).

  9. Groundwater Level Changes Due to Extreme Weather—An Evaluation Tool for Sustainable Water Management

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    Jadwiga R. Ziolkowska

    2017-02-01

    Full Text Available In the past decade, extreme and exceptional droughts have significantly impacted many economic sectors in the US, especially in California, Oklahoma, and Texas. The record drought of 2011–2014 affected almost 90% of Texas areas and 95% of Oklahoma state areas. In 2011 alone, around $1.6 billion in agricultural production were lost as a result of drought in Oklahoma, and $7.6 billion in Texas. The agricultural sectors in Oklahoma and Texas rely mainly on groundwater resources from the non-replenishable Ogallala Aquifer in Panhandle and other aquifers around the states. The exceptional droughts of 2011–2014 not only caused meteorologically induced water scarcity (due to low precipitation, but also prompted farmers to overuse groundwater to maintain the imperiled production. Comprehensive studies on groundwater levels, and thus the actual water availability/scarcity across all aquifers in Oklahoma and Texas are still limited. Existing studies are mainly focused on a small number of selected sites or aquifers over a short time span of well monitoring, which does not allow for a holistic geospatial and temporal evaluation of groundwater level variations. This paper aims at addressing those issues with the proposed geospatial groundwater visualization model to assess availability of groundwater resources for agricultural, industrial, and municipal uses both in Oklahoma and Texas in the time frame of 2003–2014. The model is an evaluation tool that can be used by decision-makers for designing sustainable water management practices and by teachers and researchers for educational purposes.

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

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    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).

  11. Extreme dissipation event due to plume collision in a turbulent convection cell

    CERN Document Server

    Schumacher, Joerg

    2016-01-01

    An extreme dissipation event in the bulk of a closed three-dimensional turbulent convection cell is found to be correlated with a strong reduction of the large-scale circulation flow in the system that happens at the same time as a plume emission event from the bottom plate. The reduction in the large-scale circulation opens the possibility for a nearly frontal collision of down- and upwelling plumes and the generation of a high-amplitude thermal dissipation layer in the bulk. This collision is locally connected to a subsequent high-amplitude energy dissipation event in the form of a strong shear layer. Our analysis illustrates the impact of transitions in the large-scale structures on extreme events at the smallest scales of the turbulence, a direct link that is observed in a flow with boundary layers. We also show that detection of extreme dissipation events which determine the far-tail statistics of the dissipation fields in the bulk requires long-time integrations of the equations of motion over at least ...

  12. Extreme dissipation event due to plume collision in a turbulent convection cell

    Science.gov (United States)

    Schumacher, Jörg; Scheel, Janet D.

    2016-10-01

    An extreme dissipation event in the bulk of a closed three-dimensional turbulent convection cell is found to be correlated with a strong reduction of the large-scale circulation flow in the system that happens at the same time as a plume emission event from the bottom plate. The reduction in the large-scale circulation opens the possibility for a nearly frontal collision of down- and upwelling plumes and the generation of a high-amplitude thermal dissipation layer in the bulk. This collision is locally connected to a subsequent high-amplitude energy dissipation event in the form of a strong shear layer. Our analysis illustrates the impact of transitions in the large-scale structures on extreme events at the smallest scales of the turbulence, a direct link that is observed in a flow with boundary layers. We also show that detection of extreme dissipation events which determine the far-tail statistics of the dissipation fields in the bulk requires long-time integrations of the equations of motion over at least a hundred convective time units.

  13. 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.

  14. Pregnant woman with an extremely small uterus due to pelvic irradiation in childhood.

    Science.gov (United States)

    Watanabe, Takashi; Matsubara, Shigeki; Saito, Yutaka; Usui, Rie; Mugishima, Hideo; Suzuki, Mitsuaki

    2012-03-01

    A female cancer survivor, having suffered malignant lymphoma during childhood and received radio- and chemotherapy, became pregnant. Her uterus was extremely small and in the 22nd week of gestation, acute uterine contractions occurred, leading to preterm delivery and resulting in the death of the infant. Pelvic irradiation in childhood was considered to have caused a small uterus and thus brought on preterm delivery. The younger the patient, the more vulnerable the uterus is to irradiation. The exposure dose to the uterus in pediatric cancer patients should therefore be reduced, especially in younger patients. The cooperation of pediatric cancer specialists and obstetricians is necessary to preserve the future fertility of female cancer survivors.

  15. A novel rescue technique for difficult intubation and difficult ventilation.

    Science.gov (United States)

    Zestos, Maria M; Daaboul, Dima; Ahmed, Zulfiqar; Durgham, Nasser; Kaddoum, Roland

    2011-01-17

    We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit. Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation. A 13 year old patient was taken to the operating room for incision and drainage of a neck abscess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

  16. Increased jump height with an external focus due to enhanced lower extremity joint kinetics.

    Science.gov (United States)

    Wulf, Gabriele; Dufek, Janet S

    2009-10-01

    Individuals jump higher when they adopt an external focus of attention, relative to an internal focus or no focus of attention (G. Wulf, T. Zachry, C. Granados, & J. S. Dufek, 2007). In the present study, the authors determined the underlying cause of this effect. Participants performed a vertical jump-and-reach task for (a) an external focus condition (i.e., participants focused on the rungs of a Vertec [Perform Better, Cranston, RI] measurement device that they touched) and (b) an internal focus condition (i.e., participants focused on the finger with which they touched the rungs). Participants' jump height, center-of-mass displacement, jump impulse, and lower extremity joint moments were greater with an external focus compared with an internal focus. These results suggest that participants jump higher by producing greater forces when they adopt an external focus. This finding adds to evidence that an external focus facilitates the production of effective and efficient movement patterns.

  17. [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.

  18. 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

  19. 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

  20. A extremely rare case of cervical intramedullary granuloma due to Brucella accompanied by Chiari Type-1 malformation.

    Science.gov (United States)

    Tufan, Kadir; Aydemir, Fatih; Sarica, Feyzi Birol; Kursun, Ebru; Kardes, Özgür; Cekinmez, Melih; Caner, Hakan

    2014-01-01

    Chiari Type-1 malformation is displacement of the cerebellar tonsils through the foramen magnum into the cervical spine and usually does not exceed the level of C2. It is 50-70% associated with syringomyelia. Nervous system involvement due to brucellosis is called neurobrucellosis, and neurological involvement rate has been reported an average of 3-5%, ranging between 3% and 25% at different series. Intramedullary abscess or granuloma due to Brucella is extremely rare. Hence far, six cases have been reported in the literature and only two of these cases were reported as intramedullary granuloma. This case is presented in order to remind the importance of the cervical cord granuloma which was presented once before in the literature and to emphasize the importance of evaluation of patient history, clinical and radiological findings together in the evaluation of a patient.

  1. 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.

  2. 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.

  3. Extreme Wave Simulation due to Typhoon Bolaven based on locally Enhanced Fine-Mesh Unstructured Grid Model

    Science.gov (United States)

    Kim, Kyeong Ok; Choi, Byung Ho; Jung, Kyung Tae

    2016-04-01

    The performance of an integrally coupled wave-tide-surge model using the unstructured mesh system has been tested for the typhoon Bolaven which is regarded as the most powerful storm to strike the Korean Peninsula in nearly a decade with wind gusts measured up to 50 m/s, causing serious damages with 19 victims. Use of the unstructured mesh in coastal sea regions of marginal scale allows all energy from deep to shallow waters to be seamlessly followed; the physics of wave-circulation interactions can be then correctly resolved. The model covers the whole Yellow and East China Seas with locally refined meshes near the regions of Gageo Island (offshore southwestern corner of the Korean Peninsula) and south of Jeju Island (Gangjeong and Seogwipo ports). The wind and pressure fields during the passage of typhoon Bolaven are generated by the blending method. Generally the numerical atmospheric model cannot satisfactorily reproduce the strength of typhoons due to dynamic and resolution restrictions. In this study we could achieve an improved conservation of the typhoon strength by blending the Holland typhoon model result by the empirical formula onto the ambient meteorological fields of NCEP dataset. The model results are compared with the observations and the model performance is then evaluated. The computed wave spectrums for one and two dimensions are compared with the observation in Ieodo station. Results show that the wind wave significantly enhances the current intensity and surge elevation, addressing that to incorporate the wave-current interaction effect in the wave-tide-surge coupled model is important for the accurate prediction of current and sea surface elevation as well as extreme waves in shallow coastal sea regions. The resulting modeling system can be used for hindcasting and forecasting the wave-tide-surges in marine environments with complex coastlines, shallow water depth and fine sediment.

  4. What Makes Physics Difficult?

    Science.gov (United States)

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

    2008-01-01

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

  5. How extreme are extremes?

    Science.gov (United States)

    Cucchi, Marco; Petitta, Marcello; Calmanti, Sandro

    2016-04-01

    High temperatures have an impact on the energy balance of any living organism and on the operational capabilities of critical infrastructures. Heat-wave indicators have been mainly developed with the aim of capturing the potential impacts on specific sectors (agriculture, health, wildfires, transport, power generation and distribution). However, the ability to capture the occurrence of extreme temperature events is an essential property of a multi-hazard extreme climate indicator. Aim of this study is to develop a standardized heat-wave indicator, that can be combined with other indices in order to describe multiple hazards in a single indicator. The proposed approach can be used in order to have a quantified indicator of the strenght of a certain extreme. As a matter of fact, extremes are usually distributed in exponential or exponential-exponential functions and it is difficult to quickly asses how strong was an extreme events considering only its magnitude. The proposed approach simplify the quantitative and qualitative communication of extreme magnitude

  6. 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)

  7. 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.

  8. 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

  9. WHAT MAKES CHEMISTRY DIFFICULT?

    African Journals Online (AJOL)

    IICBA01

    regarded as a difficult subject for students by many researchers, teachers and science educators. [7-8] because ... Learning difficulties are important for both teaching and learning. Both ..... Concept –Cartoons as a strategy in teaching, learning.

  10. 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

  11. 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.

  12. 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.

  13. 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.

    2017-02-01

    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.

  14. 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...

  15. Massive hemobilia due to hepatic arteriobiliary fistula during endoscopic retrograde cholangiopancretography: An extremely rare guidewir-related complication

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Jeong Gu; Seo, Young Woo; Hwang, Jae Cheol; Weon, Young Cheol; Kang, Byeong Seong; Bang, Sung Jo; Bang, Min Seo [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2015-05-15

    Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective modality for diagnosis and treatment of biliary and pancreatic diseases, the risk for procedure-related complications is high. Hemorrhage is one of major complications of ERCP. Most ERCP-associated bleeding is primarily a complication related to sphincterotomy rather than diagnostic ERCP. We are reporting a case of massive hemobilia due to hepatic arteriobiliary fistula caused by guidewire-associated injury during ERCP, which was successfully treated with transarterial embolization of the hepatic artery.

  16. Amputation trends for patients with lower extremity ulcers due to diabetes and peripheral artery disease using statewide data.

    Science.gov (United States)

    Humphries, Misty D; Brunson, Ann; Li, Chin-Shang; Melnikow, Joy; Romano, Patrick S

    2016-12-01

    This study reports all-payer amputation rates using state-based administrative claims data for high-risk patients with lower extremity (LE) ulcers and concomitant peripheral artery disease (PAD), diabetes mellitus (DM), or combination PAD/DM. In addition, we characterize patient factors that affect amputation-free survival. We also attempted to create a measure of a patient's ability to manage chronic diseases or to access appropriate outpatient care for ulcer management by accounting for hospital and emergency department (ED) visits in the preceding 60 days to determine how this also affects amputation-free survival. Patients admitted to nonfederal hospitals, seen in an ED, or treated in an eligible ambulatory surgery center within California from 2005 through 2013 with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a disease-specific LE ulcer were identified in the California Office of Statewide Health Planning and Development database. All subsequent hospital, ED, and ambulatory surgery center visits and procedures are captured to identify whether a patient underwent major amputation. Yearly amputation rates were determined to analyze trends. Amputation-free survival for the PAD, DM, and PAD/DM groups was determined. Cox modeling was used to evaluate the effect of patient characteristics. There were 219,547 patients identified with an incident LE ulcer throughout the state. Of these, 131,731 were DM associated, 36,193 were PAD associated, and 51,623 were associated with both PAD and DM. From 2005 to 2013, the number of patients with LE ulcers who required inpatient admission, presented to the ED, or had outpatient procedures was stable. However, there was a statistically significant increase in overall disease-associated amputation rates from 5.1 in 2005 to 13.5 in 2013 (P amputation rates from 10 per 100 patients with LE ulcers in 2005 to 28 per 100 patients in 2013 (P amputation-free survival. Within

  17. 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...

  18. A Difficult Diagnosis

    DEFF Research Database (Denmark)

    Primholdt, Nina; Primdahl, Jette; Hendricks, Oliver

    2017-01-01

    the onset of symptoms to diagnosis of 5.4 years. The analysis resulted in the following three themes: 'Daily living and psychological reactions', 'A difficult diagnosis' and 'Working life and identity'. CONCLUSIONS: It took a long time to make the correct diagnosis, and the period before diagnosis...... framework was grounded in critical psychology, and the analysis was based on Kvale and Brinkmann's meaning condensation. RESULTS: The five men interviewed were 21-37 years old. At the time of the interview, the participants had been diagnosed with AS for an average of 2.6 years, with an average time from...

  19. 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...

  20. Center of Pressure Displacement of Standing Posture during Rapid Movements Is Reorganised Due to Experimental Lower Extremity Muscle Pain.

    Directory of Open Access Journals (Sweden)

    Shinichiro Shiozawa

    Full Text Available Postural control during rapid movements may be impaired due to musculoskeletal pain. The purpose of this study was to investigate the effect of experimental knee-related muscle pain on the center of pressure (CoP displacement in a reaction time task condition.Nine healthy males performed two reaction time tasks (dominant side shoulder flexion and bilateral heel lift before, during, and after experimental pain induced in the dominant side vastus medialis or the tibialis anterior muscles by hypertonic saline injections. The CoP displacement was extracted from the ipsilateral and contralateral side by two force plates and the net CoP displacement was calculated.Compared with non-painful sessions, tibialis anterior muscle pain during the peak and peak-to-peak displacement for the CoP during anticipatory postural adjustments (APAs of the shoulder task reduced the peak-to-peak displacement of the net CoP in the medial-lateral direction (P<0.05. Tibialis anterior and vastus medialis muscle pain during shoulder flexion task reduced the anterior-posterior peak-to-peak displacement in the ipsilateral side (P<0.05.The central nervous system in healthy individuals was sufficiently robust in maintaining the APA characteristics during pain, although the displacement of net and ipsilateral CoP in the medial-lateral and anterior-posterior directions during unilateral fast shoulder movement was altered.

  1. Dealing with difficult pasts

    DEFF Research Database (Denmark)

    McAtackney, Laura

    2013-01-01

    with in the post-conflict context differs dramatically. Robben Island, in South Africa, closed in 1996 and was quickly transformed into a museum (1997) and then World Heritage site (1999), thus confirming its significance to both the national and international community as a symbolic cornerstone of the new...... ‘Rainbow’ nation. In comparison, the best known political prison in Northern Ireland – Long Kesh / Maze – closed in 2000 and despite three different proposals for its future ‘regeneration’ its remains are closed to the public whilst plans for a conflict transformation centre based at the site tentatively...... 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...

  2. 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

  3. A difficult beginning

    Directory of Open Access Journals (Sweden)

    Suneth Agampodi

    2013-10-01

    receives. But the manuscripts are submitted according to the quality of the journal (impact factor, indexation, circulation,. This is a vicious circle almost similar to what we and many others faced as start up researchers yesteryear. Without a grant, it is difficult to do research but to receive a grant you have to show research (publications. Journal impact factors should not be used to assess individual researcher’s contribution to science and for hiring, promotion, or funding decisions (2. Impact factors can be manipulated by journal editors and Thomson Scientific (the private company who creates impact factors is neither transparent about the process or have a clear policy (3.We are determined to elevate the quality of the journal. You will be the jury, but don’t be a silent assassin. Please let us know what you think at least by an E-mail. Otherwise, same fate that happened to our ancient kingdom of Rajarata will befall on the AMJ!

  4. Intramuscular triamcinolone for difficult asthma.

    Science.gov (United States)

    Panickar, Jayachandran R; Kenia, Priti; Silverman, Michael; Grigg, Jonathan

    2005-05-01

    We treated a selected group of children attending a difficult asthma clinic with intramuscular triamcinolone acetonide. This study retrospectively reviews markers of asthma severity in those who received one or more monthly doses for three periods: 1) 3 months preceding the first injection (pretreatment), 2) from the first injection to 1 month after the last injection (treatment period), and 3) 3 months after the treatment period (follow-up period). Severity markers during the treatment and follow-up periods were compared with the pretreatment period by paired t-test. Five children (5-13 years old) received a single dose, and 8 children (12-15 years old) received multiple doses. Multiple doses of triamcinolone (n = 3-5) were associated with a fall in the number of asthma exacerbations (P < 0.01) and hospital admissions (P < 0.01) in both the treatment and follow-up periods. A single dose reduced exacerbations (P < 0.05, treatment vs. pretreatment) but not hospital admissions. We conclude that intramuscular triamcinolone is a useful short-term therapy in difficult asthma. Whether its efficacy is due to improved compliance, or an improved anti-inflammatory profile compared with oral steroids, remains unclear. Copyright 2005 Wiley-Liss, Inc

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

    Science.gov (United States)

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

    2009-08-01

    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 Au2+ ion at fluence values of 1×1013, 5×1013, and 1×1014/cm2. 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 1×1013 and 5×1013/cm2. This indicates that formation of the complex defects progressed near the surface when the fluence value went beyond a critical value between 1×1013 and 5×1013/cm2 and the defects brought a large strain to the substrate.

  6. 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.

  7. INTERVENTIONS TO MANAGE RESIDUAL LIMB ULCERATION DUE TO PROSTHETIC USE IN INDIVIDUALS WITH LOWER EXTREMITY AMPUTATION: A SYSTEMATIC REVIEW OF THE LITERATURE.

    Science.gov (United States)

    Highsmith, M Jason; Kahle, Jason T; Klenow, Tyler D; Andrews, Casey R; Lewis, Katherine L; Bradley, Rachel C; Ward, Jessica M; Orriola, John J; Highsmith, James T

    2016-09-01

    Patients with lower extremity amputation (LEA) experience 65% more dermatologic issues than non-amputees, and skin problems are experienced by ≈75% of LEA patients who use prostheses. Continuously referring LEA patients to a dermatologist for every stump related skin condition may be impractical. Thus, physical rehabilitation professionals should be prepared to recognize and manage common non-emergent skin conditions in this population. The purpose of this study was to determine the quantity, quality, and strength of available evidence supporting treatment methods for prosthesis-related residual limb (RL) ulcers. Systematic literature review with evidence grading and synthesis of empirical evidence statements (EES) was employed. Three EESs were formulated describing ulcer etiology, conditions in which prosthetic continuance is practical, circumstances likely requiring prosthetic discontinuance, and the consideration of additional medical or surgical interventions. Continued prosthetic use is a viable option to manage minor or early-stage ulcerated residual limbs in compliant patients lacking multiple comorbidities. Prosthetic discontinuance is also a viable method of residual limb ulcer healing and may be favored in the presence of severe acute ulcerations, chronic heavy smoking, intractable pain, rapid volume and weight change, history of chronic ulceration, systemic infections, or advanced dysvascular etiology. Surgery or other interventions may also be necessary in such cases to achieve restored prosthetic ambulation. A short bout of prosthetic discontinuance with a staged re-introduction plan is another viable option that may be warranted in patients with ulceration due to poor RL volume management. High-quality prospective research with larger samples is needed to determine the most appropriate course of treatment when a person with LEA develops an RL ulcer that is associated with prosthetic use.

  8. Assessing and modeling sediment mobility in estuarine and coastal settings due to extreme climate events from natural short-lived isotope distribution

    Science.gov (United States)

    Ghaleb, Bassam; Hillaire-Marcel, Claude; Ruiz Fernandez, Ana-Carolina; Sanchez Cabeza, Joan-Albert

    2016-04-01

    provide simple models governing these processes under relatively high sedimentation rates, i.e., when Ra-diffusion from the sediment towards the water column may be neglected. In sites characterized by extreme sedimentologival events, 228Th/232Th profiles depict departures from this model, thus bearing information on the timing and processes involved. Examples from the Saguenay Fjord (Canada) illustrate the case of fast-deposited layers due to floods, whereas examples from estuaries and coastal areas of Sinaloa show evidence for re-suspension and/or erosion events linked notably to storminess and/or land use changes. In the first case, the fast accumulation of flood layers has sealed most of the early 20th-century contamination, whereas in the second case, erosion and re-suspension events led to either some removal of sediments contaminated by heavy metals, or their secondary release into the environment.

  9. 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

  10. 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

  11. Drastic Measures for Difficult Times

    Science.gov (United States)

    Galuszka, Peter

    2008-01-01

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

  12. [Successful outcome of a pregnancy with an extremely low fetal heart rate (34 bpm) due to isolated complete heart block--case report].

    Science.gov (United States)

    Hamela-Olkowska, Anita; Dangel, Joanna; Miszczak-Knecht, Maria

    2009-09-01

    Isolated complete congenital heart block (CHB) in the majority of cases is associated with the presence of autoantibodies to SSA (Ro) and SSB (La) antigens in the maternal serum. The prognosis is less favorable in fetuses with a ventricular rate bpm. We have reported a case of a fetus with an isolated non-autoimmune CHB with an extremely low ventricular rate (34bpm) in which the outcome was favorable. In the neonate the non-compaction of the myocardium was diagnosed.

  13. Feasibility and outcomes of a classical Pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with impairments due to a stroke.

    Science.gov (United States)

    Shea, Sarah; Moriello, Gabriele

    2014-07-01

    Pilates is a method that can potentially be used for stroke rehabilitation to address impairments in gait, balance, strength, and posture. The purpose of this case report was to document the feasibility of using Pilates and to describe outcomes of a 9-month program on lower extremity strength, balance, posture, gait, and quality of life in an individual with stroke. The participant was taught Pilates exercises up to two times per week for nine months in addition to traditional rehabilitation in the United States. Outcomes were assessed using the Berg Balance Scale (BBS), Stroke Impact Scale (SIS), GAITRite System(®), 5 repetition sit-to-stand test (STST), and flexicurve. Improvements were found in balance, lower extremity strength, and quality of life. Posture and gait speed remained the same. While these changes cannot be specifically attributed to the intervention, Pilates may have added to his overall rehabilitation program and with some modifications was feasible to use in someone with a stroke. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders.

    Science.gov (United States)

    Kwon, Jung Won; Son, Sung Min; Lee, Na Kyung

    2015-06-01

    [Purpose] This study investigated upper-extremity muscle activities in natural, ideal, and corrected head positions. [Subjects and Methods] Forty subjects with a forward head posture and rounded shoulder were recruited and randomly assigned to the natural head position group (n = 13), ideal head position group (n = 14), or corrected head position group (n = 13). Muscle activities were measured using a four-channel surface electromyography system at the sternocleidomastoideus, upper and lower trapezius, and serratus anterior muscles on the right side during an overhead reaching task. [Results] The muscle activities of the upper trapezius and serratus anterior differed significantly among head positions. Post hoc tests revealed significant differences between natural and ideal head positions, and natural and ideal head positions for both the upper trapezius and serratus anterior. [Conclusion] Recovery of normal upper trapezius and serratus anterior muscle functions plays an important role in correcting forward head posture and rounded shoulders.

  15. Several difficult problems in lubrication

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Whether in industry or in our human life, we will encounter many lubrication problems. A goodlubricant not only should have good performance, but also should meet the needs of the specific condi-tions. Here we give some examples about the difficult problems in lubrication and their solutions. Theseexamples are: (i) hydrolysis and emulsion of ZDTP; (ii) corrosion of chlorowax; (iii) coexistence of greencompressor oil and cryogen (R-134A); (iv) lubrication of cystoscope and catheter. On the same time,some achievements in lubrication field provided by Lubrication Chemistry Laboratory of Shanghai Uni-versity will be introduced in this paper.

  16. [Difficult to control severe asthma].

    Science.gov (United States)

    Magnan, Antoine; Pipet, Anaïs

    2011-03-01

    Difficult to control severe asthma is characterized by the persistence of inacceptable symptoms of asthma despite a continuous treatment with at least high doses of inhaled steroids and long acting bronchodilators. The diagnosis is done after a period of observation and some investigations that will allow confirm the diagnosis of asthma, eliminate alternative diagnosis and etiological forms that would be difficult to treat intrinsically (allergic broncho-pulmonary aspergillosis, Churg and Strauss disease, chronic eosinophilic pneumonia, occupational asthma). At the end of this period devoted to diagnosis a systematic approach is set up to take care of these patients. Therapeutic education includes action plans and measures for triggering factors avoidance in order to prevent exacerbations. Comorbidities such as rhinitis, nasal polyposis, gastro-oesophageal reflux and obesity are taken into account. Lastly, the treatment must be adapted according to the patient's preferences and aims, and to the asthma severity. Ultimately in steroid-dependent asthma, the lowest efficient dose is tracked continuously. For these patients, new molecules are needed.

  17. Extremely large non-saturating magnetoresistance and ultrahigh mobility due to topological surface states in metallic Bi2Te3 topological insulator

    OpenAIRE

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

    2017-01-01

    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 topolog...

  18. [Anaesthetic implications in a pregnant patient with an extreme thrombocytopenia due to a May-Hegglin anomaly: general o regional anaesthesia?].

    Science.gov (United States)

    García Vallejo, G; Cabellos, M; Kabiri, M; Fraile, J R; Cuesta, J

    2014-10-01

    The May-Hegglin anomaly is an inherited disorder, so uncommon that the incidence is still unknown. It is characterized by macro-thrombocytopenia with normal platelet function and cytoplasmic inclusion bodies in granulocytes. The case is reported of a 28-year-old primiparous patient who had an urgent caesarean section due to failed induction of labour. The patient had no history of abnormal bleeding. Other causes of thrombocytopenia or platelet dysfunction, such as preeclampsia, HELLP syndrome, or placental abruption, were ruled out. The platelet count prior to surgery was 20,900/mm(3) with normal platelet function. General anaesthesia was performed. No excessive bleeding occurred and a platelet transfusion was not needed. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  19. What do mentors find difficult?

    Science.gov (United States)

    Moseley, Laurence G; Davies, Moira

    2008-06-01

    (i) To assess whether mentors had a positive or negative attitude towards their role; and (ii) to discover what aspects of the role they found easy or difficult. The fact that mentorship is an important element in nurse training was recognized by Sir Leonard Peach, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting and the Nursing and Midwifery Council which has recently published new standards to support learning and assessment in practice, which include standards for the preparation of Mentors, to be implemented by September 2007. There are many anecdotal reports of the problems which face mentors, but little firm evidence. This paper reports a study of those problems. It used a Thurstone scale to assess role satisfaction among mentors (n = 86, response rate 89%) and two Likert scales to assess where problems, if any, lay. Unlike anecdotal reports, the Thurstone scale found that, overall, mentors regarded the role positively. In addition, a principal components analysis of responses to the Likert scales showed that there were two clearly delineated factors. The first (interpersonal/organisational factors) had been widely discussed in the literature. The second (cognitive/intellectual factors) has been rarely discussed and could with profit be more strongly stressed in mentor training. (i) Mentors had a positive attitude towards their role and enjoyed it. (ii) When looking at what caused mentors difficulty, in addition to the commonly discussed dimensions of organisational constraints (workload, skill mix) and interpersonal factors, there was clearly an additional cognitive one. Knowledge, not just personality, mattered. Mentors and those who train them could with profit pay more attention to cognitive components of the role, even if that meant laying a lesser stress on the interpersonal ones.

  20. Extreme low-frequency electric and magnetic fields due to the use of household appliances; Extreem-laagfrequente elektrische en magnetische velden van huishoudelijke apparatuur

    Energy Technology Data Exchange (ETDEWEB)

    Kelfkens, G.; Pruppers, M.J.M.

    2005-07-01

    Exposure to electric and magnetic fields due to the use of most household appliances does not exceed the exposure levels recommended by the European Union. No short-term health effects are to be expected for these appliances. All appliances connected to the power grid are surrounded by electric and magnetic fields to which the user can be exposed. Because some people worry about possible health effects caused by this exposure, it is important to study the electromagnetic fields in the vicinity of household appliances. This report evaluates the scientific investigations of health effects that may occur in using household appliances. The legislation for the use of these appliances in both the European Union and the Netherlands is also described. Finally, an overview is given of comparative measurements with respect to the magnetic fields and exposure in the neighbourhood of household appliances. Scientific literature, which is not always up to date, suggests that for some household appliances possibly still in use, the magnetic fields will exceed the exposure levels advised by the EU. As a result of both technological improvement and the current obligation that household appliances comply with a European standard, exceeding the levels advised by the EU for appliances that come onto the market is less likely. The exposure levels recommended by the EU are based on effects that occur during or shortly afterwards exposure. It cannot be ruled out that exposure below these levels may lead to long-term health effects. However, there is no scientific evidence for a relationship between cancer and the use of household appliances. [Dutch] De blootstelling aan elektrische en magnetische velden ligt voor de meeste huishoudelijke apparaten onder de niveaus die de Europese Unie aanbeveelt. Voor die apparaten zijn geen gezondheidseffecten op de korte termijn te verwachten. Elk apparaat dat op het elektriciteitsnet is aangesloten, heeft een elektrisch en magnetisch veld om zich heen

  1. 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.

  2. Cuffed oropharyngeal airway for difficult airway management.

    Science.gov (United States)

    Takaishi, Kazumi; Kawahito, Shinji; Tomioka, Shigemasa; Eguchi, Satoru; Kitahata, Hiroshi

    2014-01-01

    Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.

  3. Extreme Heat

    Science.gov (United States)

    ... Landslides & Debris Flow Nuclear Blast Nuclear Power Plants Power Outages Pandemic Radiological Dispersion Device Severe Weather Snowstorms & Extreme ... Landslides & Debris Flow Nuclear Blast Nuclear Power Plants Power Outages Pandemic Radiological Dispersion Device Severe Weather Snowstorms & Extreme ...

  4. 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

  5. Management of difficult airway patients and the use of a difficult airway registry at a tertiary care pediatric hospital.

    Science.gov (United States)

    Sheeran, Paul W; Walsh, Brian K; Finley, Andre M; Martin, Aleta K; Brenski, Amy C

    2014-08-01

    Appropriate recognition and management of the pediatric difficult airway is essential. Two patient deaths in a 2-year period involving children with a known difficult airway led to the formation of the institution's multidisciplinary Difficult Airway Committee. Patients with a suspected difficult airway or a known difficult airway are entered into a registry of difficult airway patients. A note describing the airway and any experiences at airway manipulation is entered as part of a difficult airway note in the patient's electronic medical record as soon as the patient is recognized as having a difficult airway. A call system has been developed to mobilize expert emergency airway assistance for these patients. Multiple additional methods are employed to ensure that all hospital personnel are aware that these patients are difficult to intubate. Since inception almost 6 years ago, 164 patients (mean age 9.2 years) have been enrolled in the difficult airway registry. Eighty-seven patients (53%) had one of 28 identified syndromes or diagnoses. The most common reasons for airway obstruction were mandibular hypoplasia/micrognathia, decreased neck extension, and limited temporomandibular joint mobility. One hundred sixty-one patients (98%) in the registry were predicted by history or physical to have a difficult airway. The mortality of registry patients was 9.8% (n = 16) and was most commonly due to co-existing diseases. During the time period reviewed, there was one in-hospital death of a known difficult airway patient, in which expert airway assistance was not obtained in a timely fashion. The institution's difficult airway registry identifies patients with a suspected or known difficult airway. The presence of a difficult airway in children can usually be predicted based on history and physical examination by anesthesiologists and otolaryngologists. Providers without advanced airway skills, however, may not appreciate that an airway is difficult to intubate until

  6. Atypical sinonasal Schwannomas: a difficult diagnostic challenge.

    Science.gov (United States)

    Jacopo, Galli; Micaela, Imperiali; Italo, Cantore; Luigi, Corina; Larocca, Luigi M; Gaetano, Paludetti

    2009-08-01

    Schwannomas are benign tumours arising from Schwann cells of the peripheral nerve sheath. They are relatively frequent in the head and neck region (25-45%) but rarely involve in the sinonasal tract (4%). The authors outline the diagnostic difficulties and the problems in choosing the best surgical approach in two atypical cases of sinonasal Schwannomas. In the first case reported clinical data, sex and age of the patient, nasal endoscopy and angio-MRI led us to suspect an angiofibroma; therefore, we approached the case without a biopsy performing a preoperative selective embolization followed by an endoscopic resection. In the second case, due to initial visual symptoms and to the ethmoid-orbital compartment involvement, we performed a sinonasal endoscopy and collected a biopsy which resulted to be fundamental in the diagnostic assessment. Tumour excision was then obtained throughout an intracranial/endonasal approach. The two presented cases revealed the presence of cystic Schwannomas. In the first case, diagnosis was made only post-operatively after histological examination. Patients underwent complete surgical excision by means of an endoscopic sinonasal approach, in the second case associated to a left frontal craniotomy. The patients showed no signs of recurrence at a 9 months follow-up. Nasal endoscopy was extremely important in making the diagnosis, allowing an accurate assessment of the tumour extension and a biopsy. The diagnosis of sinonasal Schwannomas remains challenging; sometimes, clinical behaviour and modern imaging may be misleading. The diagnostic and therapeutic importance of sinonasal endoscopy is emphasised in the two presented cases.

  7. Difficult asthma: assessment and management, Part 1.

    Science.gov (United States)

    Long, Aidan A; Fanta, Christopher H

    2012-01-01

    A minority of asthma patients have disease that proves difficult to control with usual medications and experience ongoing symptoms, poor quality of life, and limitations in activity and/or frequent asthma exacerbations. This group of patients accounts for much of the expense associated with asthma care and is the focus of national and international collaborative study groups. Distinguishing between "difficult-to-manage asthma" and truly "therapy-resistant asthma" is helpful and promotes a systematic consideration of contributory factors. Critical evaluation of factors contributing to difficult-to-manage asthma including adverse environment, comorbidities, nonadherence, and incorrect diagnosis is recommended in a systematic fashion in Part 1 of this contribution.

  8. 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

  9. 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

  10. Elbe flood 2002 in retrospect. Pollution of sediments due to the extreme flood situation around Dresden (Saxony, Germany); Elbehochwasser 2002 - Ein Rueckblick. Schadstoffbelastung von Schlamm- und Sedimentproben im Raum Dresden (Sachsen)

    Energy Technology Data Exchange (ETDEWEB)

    Gruenwald, K.; Unger, C. [Technische Univ. Dresden (Germany). Inst. fuer Geographie; Brauch, H.J.; Schmidt, W. [DVGW-Technologiezentrum Wasser, Karlsruhe (Germany). TZW, Aussenstelle Dresden

    2004-07-01

    Objective: Flood sediments were investigated due to the extreme flood situation around Dresden in August 2002. Methods: The samples have been analyzed by screening inorganic and organic pollutants. Results: It was observed that As, Pb, Cd, Zn, Cu, B and other heavy metals as well as DDT, PCB and Benzo[a]pyren were significantly enriched. Conclusion: Depending on geogenic and anthropogenic impacts the spatial distribution of these contaminants was different. Organic compounds were dislocated downstream from Czech Republic along the Elbe River. Because of the old ore mining, samples near the Mulde and Weisseritz Rivers showed high metal pollution. Perspective: More detailed and systematic investigations should be undertaken in the Elbe and Mulde river systems. (orig.) [German] Ziel/Hintergrund. Neben direkten Schadenswirkungen bei Hochwasserereignissen gibt es zahlreiche indirekte Schaeden, zu denen die Verbreitung von Schadstoffen gehoert. Durch die grossraeumigen Ueberschwemmungen infolge der Sturzfluten und Dammbrueche im August 2002 im Elbegebiet wurden Sedimente und Schlaemme abgelagert, deren Gefahrenpotenzial analysiert und bewertet werden muss. Methoden. Unmittelbar nach dem Hochwasser wurden repraesentative Flutsediment- und Schlammproben aus dem oberen Elbtal und ausgewaehlten Erzgebirgszufluessen auf ein breites Spektrum anorganischer und organischer Schadstoffe untersucht. Ergebnisse. Es wurden teilweise relativ hohe Konzentrationen fuer As, Pb, Cd, Zn, Cu, B sowie DDT, PCB und Benzo[a]pyren festgestellt. Schlussfolgerungen. Geogener Hintergrund und Nutzungscharakteristik der Einzugsgebiete bestimmen das regionale Muster der Belastung. An der Elbe wurden vor allem persistente Organika aus den tschechischen Belastungsraeumen flussabwaerts verlagert. Schwerpunkte der anorganischen Stoffbelastung resultieren aus den erzgebirgischen Bergbaugebieten. Ausblick. Es werden Detailuntersuchungen zur Ermittlung der Gefaehrdungspotenziale an Elbe und Mulde

  11. Difficult childhood asthma: management and future.

    Science.gov (United States)

    Tillie-Leblond, Isabelle; Deschildre, Antoine; Gosset, Philippe; de Blic, Jacques

    2012-09-01

    Diagnosis and management of severe asthma implies the definition of different entities, that is, difficult asthma and refractory severe asthma, but also the different phenotypes included in the term refractory severe asthma. A complete evaluation by a physician expert in asthma is necessary, adapted for each child. Identification of mechanisms involved in different phenotypes in refractory severe asthma may improve the therapeutic approach. The quality of care and monitoring of children with severe asthma is as important as the prescription drug, and is also crucial for differentiating between severe asthma and difficult asthma, whereby expertise is required.

  12. Extreme Thrombocytosis and Cardiovascular Surgery

    Science.gov (United States)

    Natelson, Ethan A.

    2012-01-01

    Extreme thrombocytosis is a major risk factor for excessive bleeding and for thrombosis, either of which can complicate cardiovascular surgical and interventional procedures. Extreme thrombocytosis can also cause an unusual syndrome, erythromelalgia, that results in a type of chronic microvascular occlusive arterial disease. We present the differential diagnosis of conditions that may lead to extreme thrombocytosis, 3 cases (each of which illustrates a different potential complication), and a review of the pertinent medical literature. Correcting excessive thrombocytosis is typically not difficult, whether electively or acutely, and effective therapy usually controls thrombosis and excessive hemorrhage postprocedurally. PMID:23304015

  13. The Human and Economic Burden of Difficult-to-Treat Gouty Arthritis.

    Science.gov (United States)

    Bardin, Thomas; Voshaar, Martijn A H Oude; van de Laar, Martinus A F J

    2015-10-01

    Gouty arthritis, one of the most painful and common forms of adult arthritis, is caused by monosodium urate crystal deposits in joints, most often in the lower extremities. Crystals trigger an inflammatory response leading to acute flares characterized by a rapid onset of pain, warmth, swelling, and redness in involved joints. Over time, continued monosodium urate crystal deposits and inflammation can lead to chronic tophaceous gout that result in bone erosion, progressing to joint destruction and significant disability. The goal of therapy in an acute gout flare is prompt and safe termination of pain and inflammation. Acute gouty arthritis is usually treated with nonsteroidal anti-inflammatory drugs, colchicine, or corticosteroids. However, for a growing number of patients, current standard treatments are ineffective or are contraindicated, largely due to the presence of comorbidities. Gouty arthritis can have a major negative impact of health-related quality of life, especially in patients with difficult-to-treat disease, as revealed by recent studies comparing health-related quality of life with that of the general population. Additionally, gouty arthritis also constitutes an important economic burden through absence from work and medical costs. This burden is even greater in patients with difficult-to-treat disease.

  14. Polishing Difficult-To-Reach Cavities

    Science.gov (United States)

    Malinzak, R. Michael; Booth, Gary N.

    1990-01-01

    Springy abrasive tool used to finish surfaces of narrow cavities made by electrical-discharge machining. Robot arm moves vibrator around perimeters of cavities, polishing walls of cavities as it does so. Tool needed because such cavities inaccessible or at least difficult to reach with most surface-finishing tools.

  15. Qualitative analysis of unanticipated difficult airway management

    DEFF Research Database (Denmark)

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

    2006-01-01

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

  16. The difficult encounter between inspector and farmer

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  17. Panel Conditioning in Difficult Attitudinal Questions

    NARCIS (Netherlands)

    Binswanger, J.; Schunk, D.; Toepoel, V.

    2013-01-01

    We investigate whether survey answers of trained respondents differ systematically from answers of novice respondents. Focusing on difficult attitudinal or preference questions, we find that novice respondents answer “don’t know” significantly more often. Importantly, however, there is no systematic

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

    Science.gov (United States)

    Goodwin, Alan

    2003-01-01

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

  19. Teaching Difficult Topics with Primary Sources

    Science.gov (United States)

    Potter, Lee Ann

    2011-01-01

    "Difficult" or "challenging" topics to teach include racism, violence, genocide, bullying, gangs, abuse (physical, emotional, and substance), slavery, suffering, hatred, terrorism, war, disease, loss, addiction, and more. But by confronting them with students, in the safety of a classroom through thoughtfully constructed lessons (ones that take…

  20. Qualitative analysis of unanticipated difficult airway management

    DEFF Research Database (Denmark)

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

    2006-01-01

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

  1. Engaging Men in Difficult Dialogues about Privilege

    Science.gov (United States)

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

    2007-01-01

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

  2. [Partnership around difficult teenagers in Brest].

    Science.gov (United States)

    Saint-André, Stéphane; Botbol, Michel

    2013-01-01

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

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

    Science.gov (United States)

    Goodwin, Alan

    2003-01-01

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

  4. What healthcare teams find ethically difficult.

    Science.gov (United States)

    Rasoal, Dara; Kihlgren, Annica; James, Inger; Svantesson, Mia

    2016-12-01

    Ethically difficult situations are frequently encountered by healthcare professionals. Moral case deliberation is one form of clinical ethics support, which has the goal to support staff to manage ethical difficulties. However, little is known which difficult situations healthcare teams need to discuss. To explore which kinds of ethically difficult situations interprofessional healthcare teams raise during moral case deliberation. A series of 70 moral case deliberation sessions were audio-recorded in 10 Swedish workplaces. A descriptive, qualitative approach was applied, using thematic content analysis. Ethical considerations: An advisory statement specifying no objections to the study was provided from an Ethical Review Board, and consent to be recorded was assumed by virtue of participation in the moral case deliberation. Three themes emerged: powerlessness over managing difficult interactions with patients and next-of-kin, unease over unsafe and unequal care, and uncertainty over who should have power over care decisions. The powerlessness comprised feelings of insufficiency, difficulties to respond or manage patient's/next-of-kin's emotional needs or emotional outbursts and discouragement over motivating patients not taking responsibility for themselves. They could be uncertain over the patient's autonomy, who should have power over life and death, disclosing the truth or how much power next-of-kin should have. The findings suggest that the nature of the ethically difficult situations brought to moral case deliberations contained more relational-oriented ethics than principle-based ethics, were permeated by emotions and the uncertainties were pervaded by power aspects between stakeholders. MCD can be useful in understanding the connection between ethical issues and emotions from a team perspective.

  5. Hydrological extremes and security

    Science.gov (United States)

    Kundzewicz, Z. W.; Matczak, P.

    2015-04-01

    Economic losses caused by hydrological extremes - floods and droughts - have been on the rise. Hydrological extremes jeopardize human security and impact on societal livelihood and welfare. Security can be generally understood as freedom from threat and the ability of societies to maintain their independent identity and their functional integrity against forces of change. Several dimensions of security are reviewed in the context of hydrological extremes. The traditional interpretation of security, focused on the state military capabilities, has been replaced by a wider understanding, including economic, societal and environmental aspects that get increasing attention. Floods and droughts pose a burden and serious challenges to the state that is responsible for sustaining economic development, and societal and environmental security. The latter can be regarded as the maintenance of ecosystem services, on which a society depends. An important part of it is water security, which can be defined as the availability of an adequate quantity and quality of water for health, livelihoods, ecosystems and production, coupled with an acceptable level of water-related risks to people, environments and economies. Security concerns arise because, over large areas, hydrological extremes - floods and droughts - are becoming more frequent and more severe. In terms of dealing with water-related risks, climate change can increase uncertainties, which makes the state's task to deliver security more difficult and more expensive. However, changes in population size and development, and level of protection, drive exposure to hydrological hazards.

  6. Difficult asthma in adults: recognition and approaches to management.

    Science.gov (United States)

    Harrison, B D W

    2005-09-01

    Difficult asthma must be distinguished from severe asthma. It is then important in patients with suspected difficult asthma to ensure that the diagnosis is correct, and that if the patient has asthma that the attributed symptoms are indeed all genuinely due to the asthma and not to coexisting physical or psychogenic respiratory conditions. It is also important to be alert when there is discordance between symptoms and objective lung function in order to recognize both poor perceivers and over-reactors. Difficult asthma can occur in patients with objectively mild, moderate or severe disease, but the consequences are most dramatic in patients with severe asthma. Asthma may be difficult for the patient, for the clinician or both because of disease factors, doctor or nurse therapist factors, and/or patient factors. Investigation requires access to the full range of respiratory, imaging and allergy tests. It also requires a multidisciplinary approach involving ear, nose and throat specialists and speech therapists, and access to psychiatric and psychological assessment and therapies. Poor compliance is associated with significantly poorer asthma and asthma-related health outcomes. Poor compliance can be recognized in two-thirds of such patients by their not attending scheduled appointments. Poor compliance is significantly associated with anxiety, social deprivation and adverse family circumstances, and these characteristics and adversities probably contribute to the poorly compliant behaviour. In difficult asthma it is important to identify and manage the condition causing the symptoms rather than prescribing more and more asthma therapy. Recognizing psychosocial adversity is essential. A structured approach is essential. There remains a small number of patients with genuine steroid-resistant asthma, some with predominately neutrophilic rather than eosinophilic airway inflammation, and others for whom the secondary gain of continuing symptoms is overwhelming. There is

  7. Arctic sea ice, Eurasia snow, and extreme winter haze in China

    Science.gov (United States)

    Zou, Yufei; Wang, Yuhang; Zhang, Yuzhong; Koo, Ja-Ho

    2017-01-01

    The East China Plains (ECP) region experienced the worst haze pollution on record for January in 2013. We show that the unprecedented haze event is due to the extremely poor ventilation conditions, which had not been seen in the preceding three decades. Statistical analysis suggests that the extremely poor ventilation conditions are linked to Arctic sea ice loss in the preceding autumn and extensive boreal snowfall in the earlier winter. We identify the regional circulation mode that leads to extremely poor ventilation over the ECP region. Climate model simulations indicate that boreal cryospheric forcing enhances the regional circulation mode of poor ventilation in the ECP region and provides conducive conditions for extreme haze such as that of 2013. Consequently, extreme haze events in winter will likely occur at a higher frequency in China as a result of the changing boreal cryosphere, posing difficult challenges for winter haze mitigation but providing a strong incentive for greenhouse gas emission reduction. PMID:28345056

  8. Arctic sea ice, Eurasia snow, and extreme winter haze in China.

    Science.gov (United States)

    Zou, Yufei; Wang, Yuhang; Zhang, Yuzhong; Koo, Ja-Ho

    2017-03-01

    The East China Plains (ECP) region experienced the worst haze pollution on record for January in 2013. We show that the unprecedented haze event is due to the extremely poor ventilation conditions, which had not been seen in the preceding three decades. Statistical analysis suggests that the extremely poor ventilation conditions are linked to Arctic sea ice loss in the preceding autumn and extensive boreal snowfall in the earlier winter. We identify the regional circulation mode that leads to extremely poor ventilation over the ECP region. Climate model simulations indicate that boreal cryospheric forcing enhances the regional circulation mode of poor ventilation in the ECP region and provides conducive conditions for extreme haze such as that of 2013. Consequently, extreme haze events in winter will likely occur at a higher frequency in China as a result of the changing boreal cryosphere, posing difficult challenges for winter haze mitigation but providing a strong incentive for greenhouse gas emission reduction.

  9. Slow and fast responses of mean and extreme precipitation to different forcing in CMIP5 simulations

    Science.gov (United States)

    Sillmann, Jana; Stjern, Camilla Weum; Myhre, Gunnar; Forster, Piers M.

    2017-06-01

    We are investigating the fast and slow responses of changes in mean and extreme precipitation to different climate forcing mechanisms, such as greenhouse gas and solar forcing, to understand whether rapid adjustments are important for extreme precipitation. To disentangle the effect of rapid adjustment to a given forcing on the overall change in extreme precipitation, we use a linear regression method that has been previously applied to mean precipitation. Equilibrium experiments with preindustrial CO2 concentrations and reduced solar constant were compared with a four times CO2 concentration experiment for 10 state-of-the-art climate models. We find that the two forcing mechanisms, greenhouse gases and solar, impose clearly different rapid adjustment signals in the mean precipitation, while such difference is difficult to discern for extreme precipitation due to large internal variability. In contrast to mean precipitation, changes in extreme precipitation scale with surface temperature trends and do not seem to depend on the forcing mechanism.

  10. Space Situational Awareness: Difficult, Expensive and Necessary

    Science.gov (United States)

    2014-12-01

    Senior Leader Perspective November–December 2014 Air & Space Power Journal | 6 Space Situational Awareness Difficult, Expensive—and Necessary Dr...authors thank Gen William Shelton for his thoughtful and insightful comments. Disclaimer: The views and opinions expressed or implied in the Journal ...permission. If it is reproduced, the Air and Space Power Journal requests a courtesy line. Report Documentation Page Form ApprovedOMB No. 0704-0188

  11. Difficult treatment decisions in autoimmune hepatitis

    Institute of Scientific and Technical Information of China (English)

    Albert; J; Czaja

    2010-01-01

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

  12. Difficult ("heartsink" patients and clinical communication difficulties

    Directory of Open Access Journals (Sweden)

    Faustino R Pérez-López

    2010-12-01

    Full Text Available Faustino R Pérez-LópezDepartment of Obstetrics and Gynecology, Hospital Clínico de Zaragoza, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, SpainAbstract: Managing the difficult patient requires a set of skills or strategies oriented at improving the physician–patient relationship and avoiding conflictive situations. There are different types of difficult patients who should be precisely identified for their management. These patients seek appropriate medical care which is not always provided. However, some may have unrecognized pathological illnesses, especially personality or psychiatry disorders. Clinical communications may be altered by professional and situational factors. In some circumstances, clinical symptoms are medically unexplainable or poorly defined as part of a disease or syndrome. Organic disease should be ruled out before patients are classified as having a somatoform disorder. Diagnosis may be delayed when symptoms are not properly evaluated therefore causing serious health consequences. Clinical competence, empathy, and high quality communication is required to succeed in difficult clinical encounters.Keywords: physician–patient communication, barriers to communication, expert patient

  13. Host-parasite interactions under extreme climatic conditions

    Institute of Scientific and Technical Information of China (English)

    J. MARTINEZ; S. MERINO

    2011-01-01

    The effect that climatic changes can exert on parasitic interactions represents a multifactor problem whose results are difficult to predict. The actual impact of changes will depend on their magnitude and the physiological tolerance of affected organisms. When the change is considered extreme (I.e. Unusual weather events that are at the extremes of the historical distribution for a given area), the probability of an alteration in an organisms' homeostasis increases dramatically. However, factors determining the altered dynamics of host-parasite interactions due to an extreme change are the same as those acting in response to changes of lower magnitude. Only a deep knowledge of these factors will help to produce more accurate predictive models for the effects of extreme changes on parasitic interactions. Extreme environmental conditions may affect pathogens directly when they include free-living stages in their life-cycles and indirectly through reduced resource availability for hosts and thus reduced ability to produce efficient anti-parasite defenses, or by effects on host density affecting transmission dynamics of diseases or the frequency of intraspecific contact. What are the consequences for host-parasite interactions? Here we summarize the present knowledge on three principal factors in determining host-parasite associations; biodiversity, population density and immunocompetence. In addition, we analyzed examples of the effects of environmental alteration of anthropogenic origin on parasitic systems because the effects are analogous to that exerted by an extreme climatic change.

  14. Diarrea crónica refractaria y malabsorción secundaria a hipogammaglobulinemia común variable, infestación crónica por giardia lamblia y gastrectomía total por adenocarcinoma gástrico: un manejo nutricional complejo Chonic diarrhea and malabsorption due to common variable immunodeficiency, gastrectomy and giardiasis infection: a difficult nutritional management

    Directory of Open Access Journals (Sweden)

    M. E. Domínguez-López

    2011-08-01

    Full Text Available El adenocarcinoma gástrico es una de las causas más frecuentes de mortalidad en el mundo, siendo la cirugía el único tratamiento potencialmente curativo, aunque los efectos adversos digestivos y nutricionales son frecuentes y abundantes. La hipogammaglobulinemia variable común es causa de frecuentes manifestaciones digestivas, derivándose las más importantes en diarrea crónica causada por giardiasis, hiperplasia nodular linfoide o atrofia vellosa, siendo frecuente la malabsorción y la desnutrición. Los déficits nutricionales secundarios a la malabsorción (postgastrectomía y asociada a la atrofia vellosa y la giardiasis por hipogammaglobulinemia variable común son asimismo frecuentes. Presentamos el caso de un paciente gastrectomizado por adenocarcinoma gástrico y con hipogammaglobulinemia variable común e infestación crónica por giardiasis que presenta una importante diarrea crónica refractaria a tratamiento y malabsorción.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.

  15. 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...... World War. The evidence highlights the different perceptions of history among youth and points to the absence of a common European understanding of what happened between 1939 and 1945. The empirical evidence comes from a research project (2011–2015) funded by the European Commission and covering 14...

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

    Science.gov (United States)

    Saint-Andrté, Stéphane; Botbola, Michel

    2013-01-01

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

  17. [Prisoners in units for difficult patients].

    Science.gov (United States)

    Bouchard, Jean-Pierre; Brulin-Solignac, Diane; Lodetti, Célia

    2016-01-01

    Prisoners, on remand or convicted, can be placed for a variable amount of time in a unit for difficult patients if their pathological mental state so requires. For the most part, their therapeutic care does not depend on their status as prisoner. The treatments provided are those indicated for their psychological pathologies and their potential or known dangerousness. However, some administrative measures make a distinction between their treatment and that of non-prisoner patients placed in these secure psychiatric units. Copyright © 2016. Published by Elsevier Masson SAS.

  18. Facilitating Endotracheal Intubation in Difficult Cases Using an External Magnet

    Directory of Open Access Journals (Sweden)

    Mahin Seyedhejazi

    2015-04-01

    Full Text Available Difficult airway is conventionally defined as a medical scenario in which a trained examiner faces difficulty in either facemask ventilation or tracheal intubation (1. Unlike difficult intubation, the incidence of difficult mask ventilation in adults is considerable (2, 3. Anesthesiologists and those who practice intubation should be familiar with the management of airway and be able to recognize and identify potentially difficult airways including congenital craniofacial deformities with micrognathia (e.g. Pier Robin, Treacher Collins, Goldenhar's, and Crouzon's syndromes and metabolic diseases causing the deposition of accumulated by-products (e.g., Hurler's, Morquio's, and Beckwith-Wiedemann syndromes. Cormack and Lehane grades 3 and 4 at laryngoscopy are an indication for advanced techniques for intubation. Laryngeal mask airway (LMA and fiberscope with a directable tip are useful and important modalities in handling difficult airway and intubation (5. Even normal pediatric airway could become critical due to the anatomical and physiological differences between pediatric and adult airway; this particularly becomes a concern in infants, i.e. children younger than one year old. This hazard is augmented in the presence of congenital or acquired difficulties affecting airway. Consequently, proper preoperative assessment is considered as the cornerstone of pediatric difficult airway management. Every anesthetic plan should be tailored according to patients considering the scenario and also the expertise of the practitioner. Opting for spontaneous respiration maintenance and intervening in a step-wise manner are strongly suggested (6. Multiple airway devices have been and are developed that all of which can be placed under direct vision or blindly; most of these devices consistently both provide and maintain safe oxygenation and ventilation. Furthermore, a wide range of ancillary devices have also been introduced to be of assistance in the

  19. Biomarkers in the Management of Difficult Asthma.

    Science.gov (United States)

    Schleich, Florence; Demarche, Sophie; Louis, Renaud

    2016-01-01

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

  20. Honey bees selectively avoid difficult choices.

    Science.gov (United States)

    Perry, Clint J; Barron, Andrew B

    2013-11-19

    Human decision-making strategies are strongly influenced by an awareness of certainty or uncertainty (a form of metacognition) to increase the chances of making a right choice. Humans seek more information and defer choosing when they realize they have insufficient information to make an accurate decision, but whether animals are aware of uncertainty is currently highly contentious. To explore this issue, we examined how honey bees (Apis mellifera) responded to a visual discrimination task that varied in difficulty between trials. Free-flying bees were rewarded for a correct choice, punished for an incorrect choice, or could avoid choosing by exiting the trial (opting out). Bees opted out more often on difficult trials, and opting out improved their proportion of successful trials. Bees could also transfer the concept of opting out to a novel task. Our data show that bees selectively avoid difficult tasks they lack the information to solve. This finding has been considered as evidence that nonhuman animals can assess the certainty of a predicted outcome, and bees' performance was comparable to that of primates in a similar paradigm. We discuss whether these behavioral results prove bees react to uncertainty or whether associative mechanisms can explain such findings. To better frame metacognition as an issue for neurobiological investigation, we propose a neurobiological hypothesis of uncertainty monitoring based on the known circuitry of the honey bee brain.

  1. Assessment of difficult airway predictors for predicting difficult laryngoscopy and intubation

    OpenAIRE

    S, Srinivasa; Oza, Vrinda; Kumar, Vasantha; Parmar, Vandana; Chhaya, V. A.

    2014-01-01

    Title: Assessment of difficult airway predictors for predicting difficult laryngoscopy and intubationObjectives: The aims and objectives of this study was to study and compare the sensitivity, specificity, positive predictive value, negative predictive value, odds ratio, relative risk, likelihood ratio and accuracy of the following parameters, modified Mallampati grading, interincisor gap, thyromental distance (TMD), ratio of height to thyromental distance (RHTMD), sternomental distance, neck...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    INTRODUCTION: The successful outcome of a major amputation depends on several factors, including stump wound healing. The purpose of this study was to examine the criteria upon which the index amputation was based and to identify factors associated with early amputation failure after major non...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    INTRODUCTION: The successful outcome of a major amputation depends on several factors, including stump wound healing. The purpose of this study was to examine the criteria upon which the index amputation was based and to identify factors associated with early amputation failure after major non-tr...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-11-01

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

  5. Effective Climate Communication with Difficult Audiences

    Science.gov (United States)

    Denning, S.

    2015-12-01

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

  6. Foreign body aspiration masquerading as difficult asthma

    Directory of Open Access Journals (Sweden)

    Rai S

    2007-01-01

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

  7. Crowd sourcing difficult problems in protein science().

    Science.gov (United States)

    Alexander, Nathan S; Palczewski, Krzysztof

    2017-08-01

    Dedicated computing resources are expensive to develop, maintain, and administrate. Frequently, research groups require bursts of computing power, during which progress is still limited by available computing resources. One way to alleviate this bottleneck would be to use additional computing resources. Today, many computing devices remain idle most of the time. Passive volunteer computing exploits this unemployed reserve of computing power by allowing device-owners to donate computing time on their own devices. Another complementary way to alleviate bottlenecks in computing resources is to use more efficient algorithms. Engaging volunteer computing employs human intuition to help solve challenging problems for which efficient algorithms are difficult to develop or unavailable. Designing engaging volunteer computing projects is challenging but can result in high-quality solutions. Here, we highlight four examples. © 2017 The Protein Society.

  8. Current Trends in the Management of Difficult Urinary Catheterizations

    Directory of Open Access Journals (Sweden)

    Paul A Willette

    2012-12-01

    Full Text Available Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with acute urinary retention, including attending emergency physicians who often are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm for the management of difficult urinary catheterizations that incorporates technology enabling direct visualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients.

  9. 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

  10. Two cases of tracheal disease misdiagnosed as difficult-to-treat asthma.

    Science.gov (United States)

    Alici, Ibrahim Onur; Kar Kurt, Ozlem; Dursun, Adile Berna; Yilmaz, Aydin; Erkekol, Ferda Oner

    2013-11-01

    Initial management of patients with difficult-to-treat asthma must begin with confirmation of the diagnosis. We present 2 cases of tracheal disease misdiagnosed as difficult-to-treat asthma. After systemic evaluation, tracheomalacia and tracheobronchial narrowing due to diffuse calcification of the cartilaginous rings were found as mimicking asthma.

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

    Directory of Open Access Journals (Sweden)

    Zarogoulidis P

    2012-06-01

    Full Text Available Paul Zarogoulidis,1 Theodoros Kontakiotis,1 Kosmas Tsakiridis,2 Michael Karanikas,3 Christos Simoglou,4 Konstantinos Porpodis,1 Alexandros Mitrakas,3 Agisilaos Esebidis, 3 Maria Konoglou,5 Nikolaos Katsikogiannis,6 Vasilis Zervas,1 Christina Aggelopoulou,7 Dimitrios Mikroulis,4 Konstantinos Zarogoulidis11Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Cardiothoracic Department, Saint Luke Private Hospital, Thessaloniki, Greece; 31st University Surgery Department, 4Cardiothoracic Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 51st Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 6Surgery Department (NHS, 7Neurology Department (NHS, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, GreeceAbstract: Management of a "difficult airway" remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a "difficult airway" and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and

  12. Difficult-to-treat asthma in childhood.

    Science.gov (United States)

    Adams, Alexandra; Saglani, Sejal

    2013-06-01

    Asthma continues to be one of the greatest burdens to healthcare resources throughout the developed world. In most cases, good symptom control can be achieved with low-dose inhaled corticosteroids, and can be cared for in the primary and secondary healthcare systems. However, there is a group in whom control is not achieved despite high-dose inhaled corticosteroids and maximal add-on therapies; these are children with problematic severe asthma that should be referred to a specialist team for further investigation and management. In this review we aimed to provide an evidence-based guide for pediatricians providing care for children with asthma in secondary healthcare settings. The review focuses on a proposed investigation and management strategy for children aged between 6 and 16 years with problematic severe asthma, and is supported as far as possible by evidence from the literature. We first address recent advances in nomenclature and then discuss our proposed course of investigation and management of these children. Distinction of children with true, severe, therapy-resistant asthma from those with asthma that is difficult to treat because of unaddressed underlying modifiable factors is critical and is discussed in detail.

  13. Control of roofs difficult to break down

    Energy Technology Data Exchange (ETDEWEB)

    Lukashov, V.G.; Suslyakov, V.P.; Korobov, A.N.

    1981-03-01

    This paper describes a method of advanced torpedoing a roof difficult to break down at the Polysaevskaya coal mine. It consists in placing explosive charges in the roof ahead of the coal face. Three schemes were tested: boreholes were drilled parallel to the face, perpendicular or inclined at an angle to the face. Boreholes were 112 mm in diameter and their length ranged from 30 to 100 m, distance between the boreholes amounted to 20 m. 6ZhV ammonite explosive, 90 mm in diameter and 500 mm long, were used. Torpedos were 2 m long, and separated by 3 to 4 m long air pockets. When a roof characterized by a high compressive strength coefficient (about 10 on the Protod'yakonov scale) was torpedoed, 250 kg of ammonite were used for a borehole 80 m long, and 160 kg for a borehole 50 m long. When borehole length was reduced to 40 m explosive consumption decreased to 117 kg. In the case of rocks with compressive strength coefficient of 6, explosive amount was two times lower. In a coal mine in which an OKP-70 face system was used applying advanced torpedoing increased labor productivity of the face by 30% and reduced cost of mining by 42%. Number of work accidents was reduced 13 times. (In Russian)

  14. Why behavior change is difficult to sustain.

    Science.gov (United States)

    Bouton, Mark E

    2014-11-01

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

  15. Navigating language barriers under difficult circumstances.

    Science.gov (United States)

    Schenker, Yael; Lo, Bernard; Ettinger, Katharine M; Fernandez, Alicia

    2008-08-19

    The proportion of the U.S. population with limited English proficiency is growing. Physicians often find themselves caring for patients with limited English proficiency in settings with limited language services. There has been little exploration of the decisions physicians face when providing care across language barriers. The authors offer a conceptual framework to aid physicians in thinking through difficult choices about language services and provide responses to common questions encountered in the care of patients with limited English proficiency. Specifically, they describe 4 factors that should inform the decision to call an interpreter (the clinical situation, degree of language gap, available resources, and patient preference), discuss who may be an appropriate interpreter, and offer strategies for when a professional interpreter is not available. The authors use a hypothetical case to illustrate how decisions about language services may evolve over the course of an interaction. This conceptual and practical approach can help clinicians to improve the quality of care provided to patients with limited English proficiency.

  16. Definitions of Complexity are Notoriously Difficult

    Science.gov (United States)

    Schuster, Peter

    Definitions of complexity are notoriously difficult if not impossible at all. A good working hypothesis might be: Everything is complex that is not simple. This is precisely the way in which we define nonlinear behavior. Things appear complex for different reasons: i) Complexity may result from lack of insight, ii) complexity may result from lack of methods, and (iii) complexity may be inherent to the system. The best known example for i) is celestial mechanics: The highly complex Pythagorean epicycles become obsolete by the introduction of Newton's law of universal gravitation. To give an example for ii), pattern formation and deterministic chaos became not really understandable before extensive computer simulations became possible. Cellular metabolism may serve as an example for iii) and is caused by the enormous complexity of biochemical reaction networks with up to one hundred individual reaction fluxes. Nevertheless, only few fluxes are dominant in the sense that using Pareto optimal values for them provides near optimal values for all the others...

  17. OCT in difficult diagnostic cases in gynecology

    Science.gov (United States)

    Panteleeva, Olga; Shakhova, Natalia; Gelikonov, Grigory; Yunusova, Ekaterina

    2011-06-01

    The study is aimed at developing new methods for diagnosing causes of impairment of female reproductive function. An increase of infertility and chronic pelvic pains syndrome, a growing level of latent diseases of this group, as well as a stably high percentage (up to 25% for infertility and up to 60% for the chronic pelvic pains syndrome) of undetermined origin make this research extremely important. As a complementary technique to laparoscopy we propose to use optical coherence tomography. We have acquired OCT images of different parts of fallopian tubes and pelvic peritoneum and analyzed OCT criteria of unaltered tissues. The OCT images of the isthmic part of fallopian tubes and peritoneum have been morphologically verified for pelvic inflammatory diseases (PID) and endometriosis. Changes in the optical properties of the studied organs typical of PID and endometriosis have been investigated. Based on comparative analysis of the OCT data and the results of histological studies OCT criteria of the considered diseases have been developed. Statistical analysis of diagnostic efficacy of OCT in the case of PID has been carried out. High (75-85%) diagnostic accuracy of OCT in PID is shown.

  18. 儿童双骨肢体单骨骨折对关节的影响%Influence on Joints Due to Fracture of Single Bone on Double Bone Extremities in Children

    Institute of Scientific and Technical Information of China (English)

    俞志涛; 王承武; 范源

    1997-01-01

    Objective:To observe the overgrowth after the fracture of a single bone in double bone extremities in children.Methods:179 cases of forearm fracture and 123 of lower leg fracture (excluding Monteggia fracture,Galeazzi fracture or physeal injuries)were reviewed.The time of follow-up was 5~8 years(mean 7.5 years).Comparative assessments of bilateral extremities on X-ray examination included length of ulna and radius,radioulnar angle,anteversion of the radius,radiocapitular line,position of the capitellium,length of the tibia and fibula,and anteroposteriorproject of the ankle.Ranges of motion of the wrist,elbow,forearm and ankle were examined.Results:Overgrowth of affected bones With 2~4 mm in length were found only in 4 cases of forearm fracture and in 7 cases of lower leg fracture.Conclusions:In most cases of fracture of singlebone on double bone extremities,overgrowth of affected bone has been rarely observed.%目的:为了观察儿童双骨肢体单骨骨折后的过度生长.方法:对前臂单骨骨折179例(不包括孟氏骨折、盖氏骨折及骨骺损伤),小腿单骨骨折123例(不包括骨骺损伤),进行了5~6年的随访,平均7.5年.对比测量了双侧X线片中的尺、桡骨长度、胫腓骨长度、桡尺角、桡骨内倾角、桡骨头线、肱骨小头的位置以及踝关节正位片,并对腕、肘关节、踝关节活动进行了对比.结果:前臂有4例,小腿有7例较对侧长2~4 mm.前臂、腕、肘关节及踝关节活动无异常.结论:前臂是双骨均衡支撑肢体,小腿虽以胫骨负重为主,但单骨骨折后另一骨同样可起支撑作用,因此均不会出现明显的过度生长.

  19. 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.

  20. Combined precut in difficult biliary cannulation

    Directory of Open Access Journals (Sweden)

    Jesús Espinel-Díez

    2013-06-01

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

  1. Pen Torch Transillumination: Difficult Venepuncture Made Easy.

    Science.gov (United States)

    Cai, Elijah Zhengyang; Sankaran, Kalarani; Tan, Monica; Chan, Yiong Huak; Lim, Thiam Chye

    2017-09-01

    Our novel technique of pen torch transillumination (PTI) uses a cheap and easily available instrument (Penlite-LP212(®), Energizer(®), Missouri, USA) to visualize superficial veins invisible to the naked eye. We evaluate the efficacy of PTI in improving venepuncture success rate (SR) for patients with poor venous access. This prospective randomized controlled trial looked at adult patients (n = 69) aged 21-90 with difficult venous access (history of ≥3 consecutive attempts required for successful cannulation during the current admission) requiring non-emergent venepuncture. Patients underwent venepuncture over the upper-limb using one of the following: conventional venepuncture (control); Veinlite(®) EMS (TransLite(®), Texas, USA), a commercial transillumination device; PTI. Outcome measures were: successful cannulation within 2 attempts and total duration of venepuncture. Fisher's exact and Kruskal-Wallis tests were performed. A significantly larger number of patients had successful venepuncture within 2 attempts using PTI (22/23, 95.7%) and Veinlite (23/23, 100%), compared to the controls (7/23, 30.4%) (p < 0.05). The total duration required for successful venepuncture was significantly shorter for Veinlite (mean 3.7 min, 1.0-5.3 min) and PTI (mean 8.5 min, range 1.08-27 min) compared to the controls (mean 23.2 min, range 1.88-46.5 min) (p < 0.05). PTI allows users to visualize veins invisible to the naked eye. Thrombosed/tortuous veins, branch points and valves, are easily identified and avoided. It has comparable efficacy to Veinlite(®) and is cheaper (Veinlite(®)-USD 227 vs. Penlite-LP212(®)-USD 7.00) and more easily available. PTI improves patient care, especially in developing regions where costs are a concern.

  2. 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.

  3. Situações limite decorrentes da violência de gênero Situações limite decorrentes da violência de gênero Extreme situations due to gender violence

    Directory of Open Access Journals (Sweden)

    Stela Meneghel

    2012-11-01

    Full Text Available

    Este texto apresenta uma síntese do Seminário Rotas Críticas III, realizado em Porto Alegre/Brasil, em 2011, cujo foco foi situações limite da violência de gênero. As situações limite são violações de direitos humanos que incluem os femicídios ou assassinatos motivados pela situação de gênero; assassinatos de pessoas LGBT, violações a direitos de minorias étnicas e raciais, exploração sexual, violências a mulheres em situação de vulnerabilidade e outras violências decorrentes de gênero. O objetivo do encontro foi oportunizar espaço para partilhar experiências, refletir criticamente e construir estratégias para o enfrentamento de violências e situações limite decorrentes de sistemas de gênero.

     

    Este texto apresenta uma síntese do Seminário Rotas Críticas III, realizado em Porto Alegre/Brasil, em 2011, cujo foco foi situações limite da violência de gênero. As situações limite são violações de direitos humanos que incluem os femicídios ou assassinatos motivados pela situação de gênero; assassinatos de pessoas LGBT, violações a direitos de minorias étnicas e raciais, exploração sexual, violências a mulheres em situação de vulnerabilidade e outras violências decorrentes de gênero. O objetivo do encontro foi oportunizar espaço para partilhar experiências, refletir criticamente e construir estratégias para o enfrentamento de violências e situações limite decorrentes de sistemas de gênero.

    This paper presents a synthesis of the third Critical Paths Seminar, held in Porto Alegre/Brazil in 2011, whose focus was extreme situations of gender violence. The extreme situations are human rights violations that include femicide or murder motivated by the situation of gender; LGBT murders, human rights violations of ethnic and racial minorities, sexual exploitation, violence to women in vulnerable situations

  4. Extremely fast increase in the organic loading rate during the co-digestion of rapeseed oil and sewage sludge in a CSTR--characterization of granules formed due to CaO addition to maintain process stability.

    Science.gov (United States)

    Kasina, M; Kleyböcker, A; Michalik, M; Würdemann, H

    2015-01-01

    In a co-digestion system running with rapeseed oil and sewage sludge, an extremely fast increase in the organic loading rate was studied to develop a procedure to allow for flexible and demand-driven energy production. The over-acidification of the digestate was successfully prevented by calcium oxide dosage, which resulted in granule formation. Mineralogical analyses revealed that the granules were composed of insoluble salts of long chain fatty acids and calcium and had a porous structure. Long chain fatty acids and calcium formed the outer cover of granules and offered interfaces on the inside thereby enhancing the growth of biofilms. With granule size and age, the pore size increased and indicated degradation of granular interfaces. A stable biogas production up to the organic loading rate of 10.4 kg volatile solids m(-3) d(-1) was achieved although the hydrogen concentration was not favorable for propionic acid degradation. However, at higher organic loading rates, unbalanced granule formation and degradation were observed. Obviously, the adaption time for biofilm growth was too short to maintain the balance, thereby resulting in a low methane yield.

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

    Science.gov (United States)

    Özkan, Ahmet Selim; Nasır, Serdar Nazif

    2015-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Barış Bulunmnaz

    2012-03-01

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

  7. Paradoxical pop-ups: Why are they difficult to catch?

    Science.gov (United States)

    McBeath, Michael K.; Nathan, Alan M.; Bahill, A. Terry; Baldwin, David G.

    2008-08-01

    Professional baseball players occasionally find it difficult to gracefully approach seemingly routine pop-ups. We describe a set of towering pop-ups with trajectories that exhibit cusps and loops near the apex. For a normal fly ball the horizontal velocity continuously decreases due to drag caused by air resistance. For pop-ups the Magnus force is larger than the drag force. In these cases the horizontal velocity initially decreases like a normal fly ball, but after the apex, the Magnus force accelerates the horizontal motion. We refer to this class of pop-ups as paradoxical because they appear to misinform the typically robust optical control strategies used by fielders and lead to systematic vacillation in running paths, especially when a trajectory terminates near the fielder. Former major league infielders confirm that our model agrees with their experiences.

  8. Characterization methodology for Difficult To Measure nuclides in the Type B rad waste from the ITER

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Youngyong; Hong, Kwonpyo; Oh, Wanho; Kang, Munja; Na, Byungchan [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2012-10-15

    In general, it is not possible to directly detect beta rays from the rad waste in the field measurement due to their extremely low penetration through the materials. Only lab-scale measurements with proper shield and detecting system are available for the nondestructive assay. However, the disposal sites in many countries require the determination of inventories of the difficult to-measure (DTM) nuclides in the waste before their acceptance for disposal. Many sites that generate rad wastes thus are adapting the indirect method to characterize the DTM nuclides in the rad waste to be disposed. The rad waste from the operation of an international thermonuclear experimental reactor (ITER) will be sent to the hot cell building (HCB) after packing it to the basket and they are then treated into the disposal form as well as characterized through the nondestructive assay. The rad waste properties from the ITER are that high density material such as a steel, a copper, and a tungsten accounts for the main substance and many nuclides due to the neutron irradiation including the DTM nuclides exists in that waste. Therefore, the ITER is also facing with the problem for the characterization of DTM nuclides. The scaling factor for the radiological relationship between the gamma and the beta nuclides is one of the indirect measurements to characterize the DTM nuclides in the waste. The methodology of the scaling factor to apply this method to the characterization the Type B rad waste from the ITER are presented in this paper. There are several types of the in-vessel components (IVCs) in a Tokamak which will be activated by neutron and they will be divided into different types of the rad waste such as the divertor cassette, blanket module, and port plugs. In this paper, the characterization of DTM nuclides will be focused on the rad waste from a blanket module out of IVCs.

  9. 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 “ ...

  10. Difficult airway in a patient with H1N1 pneumonia in intensive care unit

    Directory of Open Access Journals (Sweden)

    Meltem Türkay

    2014-12-01

    Full Text Available The difficult airway is a frequent problem among adult patients in intensive care unit. All critical patients should initially be evaluated as a potential difficult airway cases. Development of a serious desaturation should be considered since these patients have less physiological reserve compared to those with difficult airway due to elective surgery. Development of respiratory failure with H1N1 associated pneumonia is likely and support of intubation and mechanic ventilator shall be needed. The objective of this report is to present the management of a patient with H1N1 associated pneumonia who required intubation however could not be intubated due to difficult airway. J Clin Exp Invest 2014; 5 (4: 617-619

  11. [Difficult respiratory management in a patient with bilateral giant bullae].

    Science.gov (United States)

    Fujita, Ayaka; Hashiba, Eiji; Takahira, Yoko; Kitayama, Masatou; Tubo, Toshihito; Hirota, Kazuyoshi

    2009-10-01

    We report a case of bilateral giant bullae in a patient with multiple traumas. He had his arm amputated at the shoulder because of a machine accident and admitted to our hospital. Chest X-ray showed right-sided pneumothorax with bilateral giant bullae. Trimming of the stump was performed immediately after the placement of a right chest tube. He gradually developed hypoxia and hypercapnia with acidemia during the operation because of atelectasis due to sputum. Postoperatively, enlargement of right giant bulla led to frequent respiratory failure and he received a bilateral bullectomy through a median sternotomy 3 weeks after the accident. It was difficult to ventilate him due to air leak from the bilateral bulla and SpO2 dropped to below 70% with 100% oxygen. We continued the operation with standby extracorporeal membrane oxygenator (ECMO). Although the operation was finished without ECMO finally, ECMO had better been kept ready during anethesia with giant bullae when life threatening complication may occur at any point.

  12. Mangrove species' responses to winter air temperature extremes in China

    Science.gov (United States)

    Chen, Luzhen; Wang, Wenqing; Li, Qingshun Q.; Zhang, Yihui; Yang, Shengchang; Osland, Michael J.; Huang, Jinliang; Peng, Congjiao

    2017-01-01

    The global distribution and diversity of mangrove forests is greatly influenced by the frequency and intensity of winter air temperature extremes. However, our understanding of how different mangrove species respond to winter temperature extremes has been lacking because extreme freezing and chilling events are, by definition, relatively uncommon and also difficult to replicate experimentally. In this study, we investigated species-specific variation in mangrove responses to winter temperature extremes in China. In 10 sites that span a latitudinal gradient, we quantified species-specific damage and recovery following a chilling event, for mangrove species within and outside of their natural range (i.e., native and non-native species, respectively). To characterize plant stress, we measured tree defoliation and chlorophyll fluorescence approximately one month following the chilling event. To quantify recovery, we measured chlorophyll fluorescence approximately nine months after the chilling event. Our results show high variation in the geographic- and species-specific responses of mangroves to winter temperature extremes. While many species were sensitive to the chilling temperatures (e.g., Bruguiera sexangula and species in the Sonneratia and Rhizophora genera), the temperatures during this event were not cold enough to affect certain species (e.g., Kandelia obovata, Aegiceras corniculatum, Avicennia marina, and Bruguiera gymnorrhiza). As expected, non-native species were less tolerant of winter temperature extremes than native species. Interestingly, tidal inundation modulated the effects of chilling. In comparison with other temperature-controlled mangrove range limits across the world, the mangrove range limit in China is unique due to the combination of the following three factors: (1) Mangrove species diversity is comparatively high; (2) winter air temperature extremes, rather than means, are particularly intense and play an important ecological

  13. Applied extreme-value statistics

    Energy Technology Data Exchange (ETDEWEB)

    Kinnison, R.R.

    1983-05-01

    The statistical theory of extreme values is a well established part of theoretical statistics. Unfortunately, it is seldom part of applied statistics and is infrequently a part of statistical curricula except in advanced studies programs. This has resulted in the impression that it is difficult to understand and not of practical value. In recent environmental and pollution literature, several short articles have appeared with the purpose of documenting all that is necessary for the practical application of extreme value theory to field problems (for example, Roberts, 1979). These articles are so concise that only a statistician can recognise all the subtleties and assumptions necessary for the correct use of the material presented. The intent of this text is to expand upon several recent articles, and to provide the necessary statistical background so that the non-statistician scientist can recognize and extreme value problem when it occurs in his work, be confident in handling simple extreme value problems himself, and know when the problem is statistically beyond his capabilities and requires consultation.

  14. Multidimensional extremal dependence coefficients

    OpenAIRE

    2017-01-01

    Extreme values modeling has attracting the attention of researchers in diverse areas such as the environment, engineering, or finance. Multivariate extreme value distributions are particularly suitable to model the tails of multidimensional phenomena. The analysis of the dependence among multivariate maxima is useful to evaluate risk. Here we present new multivariate extreme value models, as well as, coefficients to assess multivariate extremal dependence.

  15. The European Extreme Right and Religious Extremism

    Directory of Open Access Journals (Sweden)

    Jean-Yves Camus

    2007-12-01

    Full Text Available The ideology of the Extreme Right in Western Europe is rooted in Catholic fundamentalism and Counter-Revolutionary ideas. However, the Extreme Right, like all other political families, has had to adjust to an increasingly secular society. The old link between religion and the Extreme Right has thus been broken and in fact already was when Fascism overtook Europe: Fascism was secular, sometimes even anti-religious, in its essence. Although Catholic fundamentalists still retain strong positions within the apparatus of several Extreme Right parties (Front National, the vote for the Extreme Right is generally weak among regular churchgoers and strong among non-believers. In several countries, the vote for the Extreme Right is stronger among Protestant voters than among Catholics, since while Catholics may support Christian-Democratic parties, there are very few political parties linked to Protestant churches. Presently, it also seems that Paganism is becoming the dominant religious creed within the Extreme Right. In a multicultural Europe, non-Christian forms of religious fundamentalism such as Islamism also exist with ideological similarities to the Extreme Right, but this is not sufficient to categorize Islamism as a form of Fascism. Some Islamist groups seek alliances with the Extreme Right on the basis of their common dislike for Israel and the West, globalization and individual freedom of thought.

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Smita Prakash

    2013-01-01

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

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

    Science.gov (United States)

    Prakash, Smita; Kumar, Amitabh; Bhandari, Shyam; Mullick, Parul; Singh, Rajvir; Gogia, Anoop Raj

    2013-11-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  20. Proposal of Enhanced Extreme Programming Model

    Directory of Open Access Journals (Sweden)

    M. Rizwan Jameel Qureshi

    2015-01-01

    Full Text Available Extreme programming is one of the commonly used agile methodologies in software development. It is very responsive to changing requirements even in the late phases of the project. However, quality activities in extreme programming phases are implemented sequentially along with the activities that work on the functional requirements. This reduces the agility to deliver increments continuously and makes an inverse relationship between quality and agility. Due to this relationship, extreme programming does not consume enough time on making extensive documentation and robust design. To overcome these issues, an enhanced extreme programming model is proposed. Enhanced extreme programming introduces parallelism in the activities' execution through putting quality activities into a separate execution line. In this way, the focus on delivering increments quickly is achieved without affecting the quality of the final output. In enhanced extreme programming, the quality concept is extended to include refinement of all phases of classical extreme programming and creating architectural design based on the refined design documents.

  1. Non-adherence in difficult asthma and advances in detection.

    Science.gov (United States)

    Lindsay, John T; Heaney, Liam G

    2013-12-01

    Non-adherence to anti-inflammatory therapies is common in patients referred for specialist assessment at difficult-to-treat asthma services. In the difficult asthma setting, non-adherence to treatment is associated with poor baseline asthma control, increased frequency of exacerbations and asthma-related hospitalizations, as well as increased risk of death. Here, we present a review of the current literature surrounding the prevalence and risks of non-adherence in difficult asthma and we report on current methods of measuring treatment adherence and advances in the detection of non-adherence. We will also explore methods by which non-adherence in difficult asthma can be addressed.

  2. Incidence and predictors of difficult mask ventilation and intubation

    Directory of Open Access Journals (Sweden)

    Prerana N Shah

    2012-01-01

    Conclusions: The predictive score may lead to a better anticipation of difficult airway management, potentially deceasing the morbidity and mortality resulting from hypoxia or anoxia with failed ventilation.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  4. Clinical Judgments of Easy vs. Difficult Clients by Counselor Trainees.

    Science.gov (United States)

    Berger, Allen; Morrison, Thomas L.

    1984-01-01

    Investigated responses of counselor trainees (N=31) to easy versus difficult clients in terms of clinical judgments. Results indicated that clients with a difficult interpersonal style were not regarded as more psychologically disturbed, but were rated as having less potential for change and less ego strength. (LLL)

  5. Can difficult intubation be easily and rapidly predicted?

    Science.gov (United States)

    Fritscherova, Sarka; Adamus, Milan; Dostalova, Katerina; Koutna, Jirina; Hrabalek, Lumir; Zapletalova, Jana; Uvizl, Radovan; Janout, Vladimir

    2011-06-01

    Failed endotracheal intubation and inadequate ventilation with subsequent insufficient oxygenation can result in serious complications potentially leading to permanent health damage. Difficult intubation may occur not only in patients with apparent pathologies in the orofacial region but also, unexpectedly, in those without abnormalities. This study aimed at finding anthropometric parameters that are easy to examine and that would aid in predicting difficult intubation. A case-control study was undertaken. Based on defined criteria, 15 parameters were examined in patients with unanticipated difficult intubation. The parameters included a previous history of difficult intubation, pathologies associated with difficult intubation, clinical symptoms of airway pathology, the Mallampati score, upper lip bite test, receding mandible, and cervical spine and temporomandibular joint movement. Thyromental, hyomental and sternomental distances and inter-incisor gap were measured. The methods were precisely defined and the measurements were carried out by a trained anesthesiologist. Statistical analysis was performed on data from 74 patients with difficult intubation and 74 control patients with easy intubation. Significant predictors of difficult intubation were inter-incisor gap (IIG), thyromental distance (TMD) and class 3 limited movement of the temporomandibular joint. The IIG and TMD cut-offs were set at 42 mm and 93 mm, respectively. The results will be used to confirm these predictors in an anesthesiology clinic along with the aid of the laryngoscopic findings to improve the prediction of unanticipated difficult intubation.

  6. Validated Questionnaires heighten detection of Difficult Asthma Comorbidities.

    Science.gov (United States)

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

    2016-10-07

    Objective 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. Methods 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. Results 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. Conclusions 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.

  7. Unusual tumour ablations: report of difficult and interesting cases

    Science.gov (United States)

    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. PMID:28487751

  8. 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...

  9. Legacy to the extreme

    NARCIS (Netherlands)

    A. van Deursen (Arie); T. Kuipers (Tobias); L.M.F. Moonen (Leon)

    2000-01-01

    textabstractWe explore the differences between developing a system using extreme programming techniques, and maintaining a legacy system. We investigate whether applying extreme programming techniques to legacy maintenance is useful and feasible.

  10. Legacy to the extreme

    NARCIS (Netherlands)

    Deursen, A. van; Kuipers, T.; Moonen, L.M.F.

    2000-01-01

    We explore the differences between developing a system using extreme programming techniques, and maintaining a legacy system. We investigate whether applying extreme programming techniques to legacy maintenance is useful and feasible.

  11. 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

  12. 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.

  13. Deficiently Extremal Gorenstein Algebras

    Indian Academy of Sciences (India)

    Pavinder Singh

    2011-08-01

    The aim of this article is to study the homological properties of deficiently extremal Gorenstein algebras. We prove that if / is an odd deficiently extremal Gorenstein algebra with pure minimal free resolution, then the codimension of / must be odd. As an application, the structure of pure minimal free resolution of a nearly extremal Gorenstein algebra is obtained.

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

    Science.gov (United States)

    Coin, Irene; Beyermann, Michael; Bienert, Michael

    2007-01-01

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

  15. New techniques and devices for difficult airway management.

    Science.gov (United States)

    Shirgoska, Biljana; Netkovski, Jane

    2012-09-01

    The purpose of this review is to compare old conventional techniques and devices for difficult airway management and new sophisticated techniques and devices. Recent techniques and devices are defined as the American Society of Anesthesiology (ASA) practice guidelines for the management of difficult airway, published in 1992, reviewed in 1993 and updated in 2003. According to ASA, the techniques for difficult airway management are divided into techniques for difficult intubation and techniques for difficult ventilation. Awake fiberoptic intubation is the technique of choice for difficult airway management prescribed by the World Health Organization document for patient safety in the operating theater. Conventional techniques for intubation used direct visualization. The new generation of devices does not require direct visualization of the vocal cords for endotracheal tube placement. They allow better glottis view and successful endotracheal placement of the tube with indirect laryngoscopy. New intubation devices such as video laryngoscopes facilitate endotracheal intubation by indirect visualization of glottis structures without aligning the oral, pharyngeal and laryngeal axes in patients with cervical spine abnormality. Video laryngoscopes such as V-Mac and C-Mac, Glide scope, McGrath, Airway Scope, Airtraq, Bonfils and Bullard laryngoscope are widely available at the market. Airway gadgets are lighted stylets and endotracheal tube guides. The principal conclusion of this review is that utilization of these devices can be easily learned. The technique of indirect laryngoscopy is currently used for managing difficult airway in the operating room as well as for securing the airway in daily anesthesia routine.

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

    CERN Document Server

    Stern, David

    2013-01-01

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

  17. Spatiotemporal variability of extreme temperature frequency and amplitude in China

    Science.gov (United States)

    Zhang, Yuanjie; Gao, Zhiqiu; Pan, Zaitao; Li, Dan; Huang, Xinhui

    2017-03-01

    Temperature extremes in China are examined based on daily maximum and minimum temperatures from station observations and multiple global climate models. The magnitude and frequency of extremes are expressed in terms of return values and periods, respectively, estimated by the fitted Generalized Extreme Value (GEV) distribution of annual extreme temperatures. The observations suggest that changes in temperature extremes considerably exceed changes in the respective climatological means during the past five decades, with greater amplitude of increases in cold extremes than in warm extremes. The frequency of warm (cold) extremes increases (decreases) over most areas, with an increasingly faster rate as the extremity level rises. Changes in warm extremes are more dependent on the varying shape of GEV distribution than the location shift, whereas changes in cold extremes are more closely associated with the location shift. The models simulate the overall pattern of temperature extremes during 1961-1981 reasonably well in China, but they show a smaller asymmetry between changes in warm and cold extremes primarily due to their underestimation of increases in cold extremes especially over southern China. Projections from a high emission scenario show the multi-model median change in warm and cold extremes by 2040 relative to 1971 will be 2.6 °C and 2.8 °C, respectively, with the strongest changes in cold extremes shifting southward. By 2040, warm extremes at the 1971 20-year return values would occur about every three years, while the 1971 cold extremes would occur once in > 500 years.

  18. 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.

  19. [Retrovesical pseudocyst : difficult diagnosis of one case and literature review].

    Science.gov (United States)

    Sarf, I; Dahami, Z; Dakir, M; Joual, A; Bennani, S; Elmrini, M; Benjelloun, S

    2002-03-01

    Retrovesical localization of a cystic mass is rare. The authors report one observation of hematic retrovesical pseudocystic formation having a difficult diagnosis. In the light of this observation, different diagnostic patterns of cystic and pseudocystic retrovesical formation are discussed.

  20. PREDICTORS OF DIFFICULT INTUBATION: STUDY IN KASHMIRI POPULATION

    Directory of Open Access Journals (Sweden)

    Gupta A K

    2009-12-01

    Full Text Available Airway assessment is the most important aspect of Anaesthesia practice as a difficult intubation may be unanticipated. A prospective study was done to compare the efficacy of airway parameters to predict difficult intubation viz; degree of head extension, thyromental distance, inter incisor gap, grading ofprognathism, obesity and modified mallampati test. Six hundred patients with ASA I& ASA II grade were enrolled in study. All patients were preoperatively assessed for airway parameters. Intra-operatively all patients were classified according to Cormack and Lehane laryngoscopic view. Clinical data of each test was collected, tabulated and analyzed to obtain the sensitivity, specificity, positive predictive value & negative predictive value. Results obtained showed incidence of difficult intubation in 3.3%. Head&neck movements had the highest sensitivity (86.36%; high arched palate had highest specificity (99.38%.Head & neck movements had highest sensitivity; high arched palate had highest specificity, however, head & neck movements strongly correlated for patients with difficult intubation.

  1. Clinicians' strategies for managing their emotions during difficult healthcare conversations.

    Science.gov (United States)

    Luff, Donna; Martin, Elliott B; Mills, Kelsey; Mazzola, Natalia M; Bell, Sigall K; Meyer, Elaine C

    2016-09-01

    To examine strategies employed by clinicians from different disciplines to manage their emotions during difficult healthcare conversations. Self-report questionnaires were collected prior to simulation-based Program to Enhance Relational and Communication Skills (PERCS) workshops for professionals representing a range of experience and specialties at a tertiary pediatric hospital. In response to an open-ended prompt, clinicians qualitatively described their own strategies for managing their emotions during difficult healthcare conversations. 126 respondents reported emotion management strategies. Respondents included physicians (42%), nurses (29%), medical interpreters (16%), psychosocial professionals (9%), and other (4%). Respondents identified 1-4 strategies. Five strategy categories were identified: Self-Care (51%), Preparatory and Relational Skills, (29%), Empathic Presence (28%), Team Approach (26%), and Professional Identity (20%). Across disciplines and experience levels, clinicians have developed strategies to manage their emotions when holding difficult healthcare conversations. These strategies support clinicians before, during and after difficult conversations. Understanding what strategies clinicians already employ to manage their emotions when holding difficult conversations has implications for educational planning and implementation. This study has potential to inform the development of education to support clinicians' awareness of their emotions and to enhance the range and effectiveness of emotion management during difficult healthcare conversations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

    Directory of Open Access Journals (Sweden)

    Gaurav Gupta

    2015-11-01

    Methods: In 50 consecutive patients who underwent LC during 2013 to 2014 patient's characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were prospectively analyzed to determine predictors of difficult LC. Results: Of 50 patients 3 (06% required conversion to open cholecystectomy. Significant predictors of conversion were obscured anatomy of Calot's due to adhesions, sessile gall bladder, male gender and gall bladder wall thickness >3 mm. Conclusions: With preoperative clinical and ultrasonographic parameters, proper patient selection can be made to help predict difficult LC and a likelihood of conversion to open cholecystectomy. [Int J Res Med Sci 2015; 3(11.000: 3342-3346

  3. 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.

  4. Maxillary tumor in a child: An expected case of difficult airway

    Science.gov (United States)

    Reena; Vikram, A

    2016-01-01

    Craniofacial abnormalities in pediatric population fall under the category of expected case of difficult airway. We present here a case of large maxillary tumor in a 9-year-old girl where the relative difficulty was further compounded due to her noncooperation which was again expected from a child. Local anesthetic topicalization of airway followed by slow inhalational induction with gradually increasing sevoflurane, while maintaining her spontaneous breathing, we secured her airway using fiber optic bronchoscopy. The surgery and the extubation went uneventful. In conclusion a planned airway management using fiber optic bronchoscope after airway topicalization and sevoflurane induction is the ideal technique in an expected case of difficult pediatric airway. PMID:27051379

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

    Science.gov (United States)

    Dolinaj, Vladimir; Milošev, Sanja; Janjević, Dušanka

    2016-03-01

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

  6. Extremal black holes in dynamical Chern-Simons gravity

    Science.gov (United States)

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

    2016-12-01

    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.

  7. Extremely secure identification documents

    Energy Technology Data Exchange (ETDEWEB)

    Tolk, K.M. [Sandia National Labs., Albuquerque, NM (United States); Bell, M. [Sandia National Labs., Livermore, CA (United States)

    1997-09-01

    The technology developed in this project uses biometric information printed on the document and public key cryptography to ensure that an adversary cannot issue identification documents to unauthorized individuals or alter existing documents to allow their use by unauthorized individuals. This process can be used to produce many types of identification documents with much higher security than any currently in use. The system is demonstrated using a security badge as an example. This project focused on the technologies requiring development in order to make the approach viable with existing badge printing and laminating technologies. By far the most difficult was the image processing required to verify that the picture on the badge had not been altered. Another area that required considerable work was the high density printed data storage required to get sufficient data on the badge for verification of the picture. The image processing process was successfully tested, and recommendations are included to refine the badge system to ensure high reliability. A two dimensional data array suitable for printing the required data on the badge was proposed, but testing of the readability of the array had to be abandoned due to reallocation of the budgeted funds by the LDRD office.

  8. Reach Envelope of Human Extremities

    Institute of Scientific and Technical Information of China (English)

    YANG Jingzhou(杨景周); ZHANG Yunqing(张云清); CHEN Liping(陈立平); ABDEL-MALEK Karim

    2004-01-01

    Significant attention in recent years has been given to obtain a better understanding of human joint ranges, measurement, and functionality, especially in conjunction with commands issued by the central nervous system. While researchers have studied motor commands needed to drive a limb to follow a path trajectory, various computer algorithms have been reported that provide adequate analysis of limb modeling and motion. This paper uses a rigorous mathematical formulation to model human limbs, understand their reach envelope, delineate barriers therein where a trajectory becomes difficult to control, and help visualize these barriers. Workspaces of a typical forearm with 9 degrees of freedom, a typical finger modeled as a 4- degree-of-freedom system, and a lower extremity with 4 degrees of freedom are discussed. The results show that using the proposed formulation, joint limits play an important role in distinguishing the barriers.

  9. Extreme Velocity Wind Sensor

    Science.gov (United States)

    Perotti, Jose; Voska, Ned (Technical Monitor)

    2002-01-01

    This presentation provides an overview of the development of new hurricane wind sensor (Extreme Velocity Wind Sensor) for the Kennedy Space Center (KSC) which is designed to withstand winds of up to three hundred miles an hour. The proposed Extreme Velocity Wind Sensor contains no moveable components that would be exposed to extreme wind conditions. Topics covered include: need for new hurricane wind sensor, conceptual design, software applications, computational fluid dynamic simulations of design concept, preliminary performance tests, and project status.

  10. Stacked Extreme Learning Machines.

    Science.gov (United States)

    Zhou, Hongming; Huang, Guang-Bin; Lin, Zhiping; Wang, Han; Soh, Yeng Chai

    2015-09-01

    Extreme learning machine (ELM) has recently attracted many researchers' interest due to its very fast learning speed, good generalization ability, and ease of implementation. It provides a unified solution that can be used directly to solve regression, binary, and multiclass classification problems. In this paper, we propose a stacked ELMs (S-ELMs) that is specially designed for solving large and complex data problems. The S-ELMs divides a single large ELM network into multiple stacked small ELMs which are serially connected. The S-ELMs can approximate a very large ELM network with small memory requirement. To further improve the testing accuracy on big data problems, the ELM autoencoder can be implemented during each iteration of the S-ELMs algorithm. The simulation results show that the S-ELMs even with random hidden nodes can achieve similar testing accuracy to support vector machine (SVM) while having low memory requirements. With the help of ELM autoencoder, the S-ELMs can achieve much better testing accuracy than SVM and slightly better accuracy than deep belief network (DBN) with much faster training speed.

  11. Detectors in Extreme Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Blaj, G. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Carini, G. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Carron, S. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Haller, G. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Hart, P. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Hasi, J. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Herrmann, S. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Kenney, C. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Segal, J. [SLAC National Accelerator Lab., Menlo Park, CA (United States); Tomada, A. [SLAC National Accelerator Lab., Menlo Park, CA (United States)

    2015-08-06

    Free Electron Lasers opened a new window on imaging the motion of atoms and molecules. At SLAC, FEL experiments are performed at LCLS using 120Hz pulses with 1012 - 1013 photons in 10 femtoseconds (billions of times brighter than the most powerful synchrotrons). This extreme detection environment raises unique challenges, from obvious to surprising. Radiation damage is a constant threat due to accidental exposure to insufficiently attenuated beam, focused beam and formation of ice crystals reflecting the beam onto the detector. Often high power optical lasers are also used (e.g., 25TW), increasing the risk of damage or impeding data acquisition through electromagnetic pulses (EMP). The sample can contaminate the detector surface or even produce shrapnel damage. Some experiments require ultra high vacuum (UHV) with strict design, surface contamination and cooling requirements - also for detectors. The setup is often changed between or during experiments with short turnaround times, risking mechanical and ESD damage, requiring work planning, training of operators and sometimes continuous participation of the LCLS Detector Group in the experiments. The detectors used most often at LCLS are CSPAD cameras for hard x-rays and pnCCDs for soft x-rays.

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

    Directory of Open Access Journals (Sweden)

    Erik Schloericke

    2012-01-01

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

  13. Difficult airway equipment: a survey of standards across metropolitan Perth.

    Science.gov (United States)

    Alakeson, N; Flett, T; Hunt, V; Ramgolam, A; Reynolds, W; Hartley, K; Hegarty, M; von Ungern-Sternberg, B S

    2014-09-01

    The importance of appropriate equipment to manage the difficult airway has been highlighted by the publication of the Australian and New Zealand College of Anaesthetists (ANZCA) guidelines in 2012. We set out to audit compliance with these guidelines in all public and private sites providing general anaesthesia in metropolitan Perth. Public and private health care websites identified 39 sites of which 37 were studied. Institutional and ethics approval was obtained. A tick-box design audit tool, based on the ANZCA guidelines, was used to collect information regarding the dedicated difficult airway container (DDAC) at each site. As recommended in the guidelines, only equipment within the DDAC was considered. Further data about each site, including the number of theatre suites, satellite anaesthetic areas, use of capnography and categories of patients treated (adult, obstetric and paediatric) were collected. An adult DDAC was found at 92% of all sites, but none of the sites had all the essential equipment listed in the ANZCA guidelines. There was limited provision of adult difficult airway equipment within private sites compared to public, and less provision of paediatric difficult airway equipment across all sites treating paediatric patients in metropolitan Perth. Capnography was available in 76% of post anaesthesia care units and used regularly in 27%. Adherence to the ANZCA guidelines regarding the DDAC could be improved. Standardised equipment across a metropolitan region would be of value in the management of the difficult airway.

  14. 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.

  15. 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.

  16. 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.

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

    Science.gov (United States)

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

    2015-10-01

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

  18. Incidence and predictors of difficult nasotracheal intubation with airway scope.

    Science.gov (United States)

    Ono, Koyu; Goto, Tomoko; Nakai, Daishi; Ueki, Shuhei; Takenaka, Seiichiro; Moriya, Tomomi

    2014-10-01

    The airway scope (AWS) improves views of the larynx during orotracheal intubation. However, the role of the AWS in routine nasotracheal intubation has not been studied adequately. One hundred and three patients undergoing dental and maxillofacial surgery that required general anesthesia and nasotracheal intubation were enrolled. The study was approved by our Institution Review Board, and written informed consent was obtained from all patients. We evaluated the success rate of AWS intubation and the incidence of difficult nasotracheal intubation using a modified intubation difficulty scale (IDS) to examine preoperative characteristics and intubation profiles. Categories were difficult intubation (IDS ≥5), mildly difficult (IDS = 1-4), and intubation without difficulty (IDS = 0). We also assessed the incidence of the use of Magill forceps or cuff inflation (the cuff of endotracheal tube is inflated with 10-15 ml air) to guide the endotracheal tube into the glottis. AWS nasotracheal intubation was 100% successful. The cuff inflation technique was used in 37 patients. Neither Magill forceps nor other devices were needed for any patient during AWS use. The incidence of difficult nasotracheal intubation was 10% (n = 10). Of the patients, 61% (n = 63) had mildly difficult intubation and 29% (n = 30) had no difficulty. Patients with difficult intubation were more likely to be male and to have a larger tongue and a higher Cormack grade than in the other two groups. Complications, involving minor soft tissue injury, were observed in only 1 patient (1%). The AWS achieves a high success rate for nasotracheal intubation with cuff inflation in patients undergoing dental and maxillofacial surgery.

  19. Failure to predict difficult tracheal intubation for emergency caesarean section.

    Science.gov (United States)

    Basaranoglu, Gokcen; Columb, Malachy; Lyons, Gordon

    2010-11-01

    Difficult tracheal intubation following induction of general anaesthesia for caesarean section is a cause of morbidity and mortality. Our aim was to evaluate five bedside predictors that might identify women with potential intubation difficulty immediately prior to emergency caesarean section. Women requiring emergency caesarean section with general anaesthesia and tracheal intubation who had been assessed by the same experienced anaesthesiologist preoperatively were included in this study. Mallampati score, sternomental distance, thyromental distance, interincisor gap and atlantooccipital extension were all measured. The same anaesthesiologist performed laryngoscopy and graded the laryngeal view according to Cormack and Lehane. Exact logistic regression was used to identify significant independent predictors for difficult intubation (Cormack and Lehane grades ≥ 3) with two-sided P value less than 0.05 considered as significant. In 3 years, 239 women were recruited. Cormack and Lehane grades of 2 or less (easy) were found in 225 and grade of at least 3 (difficult) in 14 women. Patients' characteristics (age, height, weight, BMI or weight gain) were not significantly associated with difficulty of intubation. The incidence of difficult intubation was 1/17 women [95% confidence interval (CI) from 1/31 to 1/10]. A positive result from any of the five predictors combined had a sensitivity of 0.21 (95%CI 0.05-0.51), a specificity of 0.92 (95%CI 0.88-0.96), a positive predictive value of 0.15 (95%CI 0.032-0.38) and a negative predictive value of 0.95 (95%CI 0.91-0.97) for a Cormack and Lehane grade of at least 3 at laryngoscopy. Airway assessment using these tests cannot be relied upon to predict a difficult intubation at emergency caesarean section as the low sensitivity means that 79% (95%CI 49-95) of difficult intubations will be missed.

  20. Non-attendance at a difficult-asthma clinic.

    Science.gov (United States)

    McDonough, Beverley; Mault, Susan

    Increasing demand for our weekly difficult-asthma clinic means routine appointments are at a premium. This led us to explore the reasons why patients failed to attend for appointments and whether contacting them by telephone within a week of their missed scheduled appointment increased attendance. Memory lapses were the most common reason for non-attendance. Telephoning non-attenders led to a two-fold increase in attendance at subsequent clinics. Non-attendance may be a reflection of poor concordance, which, in itself, may contribute to a patient's difficult asthma.

  1. Transmyometrial embryo transfer after difficult immediate mock transcervical transfer.

    Science.gov (United States)

    Sharif, K; Afnan, M; Lenton, W; Bilalis, D; Hunjan, M; Khalaf, Y

    1996-05-01

    To evaluate the place of ultrasound-directed transvaginal transmyometrial ET in a protocol using both the transcervical and transmyometrial routes in a step-wise fashion. A prospective descriptive clinical study. A university-based assisted conception unit. Thirteen patients who had difficult or impossible mock transcervical ET immediately before the real transfer. Ultrasound-directed transvaginal transmyometrial ET. Pregnancy and clinical pregnancy. Four patients became pregnant, including three with clinical pregnancies. In cases in which transcervical ET isd difficult or impossible, transvaginal transmyometrial ET is a viable option. The use of mock transcervical ET immediately before the real transfer would identify patients needing transmyometrial ET.

  2. Management of the difficult airway in children. A case report

    Directory of Open Access Journals (Sweden)

    Magaly Álvarez Bárzaga

    2011-03-01

    Full Text Available The anesthesiologist plays a unique role in the health care of all patients who will undergo a surgical procedure. In this sense, he is a key factor in the appropriate and timely management of the airway. There are special situations that condition a difficult airway and can have a profound impact on anesthetic morbidity and mortality. These risks increases in the case of children, that is why the case of a pediatric patient with a difficult airway caused by limitation of mouth opening, scheduled for elective surgery in order to treat this condition in the Pediatric University Hospital ¨Paquito González Cueto " in Cienfuegos, is presented.

  3. 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...

  4. Why Is Leading School Improvement Such a Difficult Process?

    Science.gov (United States)

    Lindahl, Ronald A.

    2007-01-01

    Leading meaningful school improvement and reform has proven to be a difficult process. This article looks at some of the interactive, contextual variables that lend to the complexity of this challenge. These include complexities inherent in schools, in change processes and in the leadership role itself.

  5. Caregiver Beliefs and Dysphoric Affect Directed to Difficult Children.

    Science.gov (United States)

    Bugental, Daphne Blunt; And Others

    1990-01-01

    When sibling pairs interacted with unrelated mothers, facial and vocal affect directed to the difficult child in the pair was more dysphoric than that directed to the other. This was particularly the case among women who attributed relatively high control to children and low control to adults. A similar relation between affect and attributions was…

  6. Optimising the management of patients with difficult asthma.

    Science.gov (United States)

    Palmer, Evelyn; Higgins, Bernard

    2015-11-01

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

  7. Why Reference to the Past Is Difficult for Agrammatic Speakers

    Science.gov (United States)

    Bastiaanse, Roelien

    2013-01-01

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

  8. 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.

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

    Science.gov (United States)

    Fazeli, Fatemeh; Shokrpour, Nasrin

    2012-01-01

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

  10. Wagging the Dog: Managing Museum Priorities in a Difficult Economy

    Science.gov (United States)

    Bradburne, James M.

    2010-01-01

    In these difficult financial times, it is more important than ever to manage money carefully. Educators who don't do so are vulnerable, for despite a thirty-year history of increasing authority and status within and without the museum, education departments are still more expendable than curatorial or collections departments in some museums. This…

  11. Developing Difficult Dialogues: An Evaluation of Classroom Implementation

    Science.gov (United States)

    Placier, Peggy; Kroner, Crystal; Burgoyne, Suzanne; Worthington, Roger

    2012-01-01

    The University of Missouri (MU) participated in the Ford Foundation's Difficult Dialogues Initiative (DDI) supporting faculty development projects at over 40 institutions of higher education from 2006-2010. This paper reports findings from an evaluation conducted with instructors who not only engaged in faculty development workshops but also…

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

    NARCIS (Netherlands)

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

    2001-01-01

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

  13. Disaffection and Inclusion: Merton's Mainstream Approach to Difficult Behaviour.

    Science.gov (United States)

    Barrow, Giles

    This booklet describes an inclusive approach to disaffection in Merton Education Authority, a school district southwest of London (England). Instead of concentrating on providing for students with emotional and behavior difficulties in an off-site behavior support center, Merton switched its main efforts to preventing difficult behavior through…

  14. Why is Danish so difficult to understand for fellow Scandinavians?

    NARCIS (Netherlands)

    Schüppert, Anja; Hilton, Nanna; Gooskens, Charlotte

    2016-01-01

    It has consistently been shown that among the three mainland Scandinavian languages, Danish is most difficult to understand for fellow Scandinavians. Recent research suggests that Danish is spoken significantly faster than Norwegian and Swedish. This finding might partly explain the asymmetric intel

  15. Task Analyses for Difficult-to-Assess Collective Tasks

    Science.gov (United States)

    2014-02-01

    Counterintelligence and Human Intelligence Analysis and Production (34-4-1305) • Conduct Counterintelligence and Human Intelligence Analysis (34-4...Research Product 2014-05 Task Analyses for Difficult-to-Assess Collective Tasks Jonathan J. Bryson Rachel D. Barney...Christina K. Curnow Trevor M. Conrad Arnold L. Leonard Heidi Keller-Glaze ICF International Jennifer S. Tucker Christopher L. Vowels

  16. Extremal Black Holes in Dynamical Chern-Simons Gravity

    CERN Document Server

    McNees, Robert; Yunes, Nicolás

    2015-01-01

    Rapidly rotating black hole solutions in theories beyond general relativity play a key role in experimental gravity, as they allow us to compute observables in extreme spacetimes that deviate from the predictions of general relativity (GR). Such solutions are often difficult to find in beyond-GR theories due to the inclusion of additional fields that couple to the metric non-linearly and non-minimally. In this paper, we consider rotating black hole solutions in one such theory, dynamical Chern-Simons 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 dynamical Chern-Simons gravity as an effective field theory and thus work in the decoupling limit, where corrections are treated as small perturbations from general relativity. We perturb about the maximally-rotating Kerr solution, the so-called extremal limit, and develop mathematical insight into the analysis techniques needed to construct sol...

  17. Derivation and Validation of The Prehospital Difficult Airway IdentificationTool (PreDAIT): A Predictive Model for Difficult Intubation.

    Science.gov (United States)

    Carlson, Jestin N; Hostler, David; Guyette, Francis X; Pinchalk, Mark; Martin-Gill, Christian

    2017-06-01

    Endotracheal intubation (ETI) in the prehospital setting poses unique challenges where multiple ETI attempts are associated with adverse patient outcomes. Early identification of difficult ETI cases will allow providers to tailor airway-management efforts to minimize complications associated with ETI. We sought to derive and validate a prehospital difficult airway identification tool based on predictors of difficult ETI in other settings. We prospectively collected patient and airway data on all airway attempts from 16 Advanced Life Support (ALS) ground emergency medical services (EMS) agencies from January 2011 to October 2014. Cases that required more than two ETI attempts and cases where an alternative airway strategy (e.g. supraglottic airway) was employed after one unsuccessful ETI attempt were categorized as "difficult." We used a random allocation sequence to split the data into derivation and validation subsets. Using backward elimination, factors with a p3 (2.15, 1.19-3.88), limited neck movement (2.24, 1.28-3.93), trismus/jaw clenched (2.24, 1.09-4.6), inability to palpate the landmarks of the neck (5.92, 2.77-12.66), and fluid in the airway such as blood or emesis (2.25, 1.51-3.36). This was the most parsimonious model and exhibited good fit (Hosmer-Lemeshow test p = 0.167) with an AUC of 0.68 (95% CI [0.64-0.73]). When applied to the validation set, the model had an AUC of 0.63 (0.58-0.68) with high specificity for identifying difficult ETI if ≥2 factors were present (87.7% (95% CI [84.1-90.8])). We have developed a simple tool using five factors that may aid prehospital providers in the identification of difficult ETI.

  18. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Mittalgodu Anantha Krishna Murthy Vivek

    2014-01-01

    Full Text Available Context: Laparoscopic cholecystectomy (LC is the gold standard cholecystectomy. LC is the most common difficult laparoscopic surgery performed by surgeons today. The factors leading to difficult laparoscopic cholecystectomy can be predicted. Aims: To develop a scoring method that predicts difficult laparoscopic cholecystectomy. Settings and Design: Bidirectional prospective study in a medical college setup. Materials and Methods: Following approval from the institutional ethical committee, cases from the three associated hospitals in a medical college setup, were collected using a detailed proforma stating the parameters of difficulty in laparoscopic cholecystectomy. Study period was between May 10 and June 12. Preoperative, sonographic and intraoperative criteria were considered. Statistical Analysis Used: Chi Square test and Receiver Operater Curve (ROC analysis. Results: Total 323 patients were included. On analysis, elderly patients, males, recurrent cholecystitis, obese patients, previous surgery, patients who needed preoperative Endoscopic retrograde cholangiopancreatography (ERCP, abnormal serum hepatic and pancreatic enzyme profiles, distended or contracted gall bladder, intra-peritoneal adhesions, structural anomalies or distortions and the presence of a cirrhotic liver on ultrasonography (USG were identified as predictors of difficult LC. A scoring system tested against the same sample proved to be effective. A ROC analysis was done with area under receiver operator curve of 0.956. A score above 9 was considered difficult with sensitivity of 85% and specificity of 97.8%. Conclusions: This study demonstrates that a scoring system predicting the difficulty in LC is feasible. There is scope for further refinement to make the same less cumbersome and easier to handle. Further studies are warranted in this direction.

  19. Mind wandering while reading easy and difficult texts.

    Science.gov (United States)

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

    2013-06-01

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

  20. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

    OpenAIRE

    Tolga Ege; Aytekin Unlu; Huseyin Tas; Dogan Bek; Selim Turkan; Aytac Cetinkaya

    2015-01-01

    Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the envi...

  1. Confusing cracks and difficult deformations: Interpreting structural damage in masonry

    NARCIS (Netherlands)

    De Vent, I.; Rots, J.G.; Van Hees, R.P.J.; Hobbelman, G.J.

    2012-01-01

    Cracks and deformatiçns in masonry are common phenomena in historical buildings. If they are interpreted correctly, they can be an extremely valuable source çf informatiçn on the load history of the premises. Nevertheless, this interpretation is not always as obvious as one may think. In the framewo

  2. Difficult nasoendotracheal intubation in a patient with severe maxillofacial trauma

    Directory of Open Access Journals (Sweden)

    Ali Hossein Mesgarzadeh

    2012-01-01

    Full Text Available Dental occlusion is key point for proper maxillofacial reconstruction. In this way nasal airway management is extremely important for both oral and maxillofacial surgeons and anesthesiologists. We report a challenging case with severe maxillofacial trauma and nasal obstruction that it managed with a novel anesthetic - surgical procedure.

  3. [Thymoma in children: a rare and difficult diagnosis].

    Science.gov (United States)

    Juricic, M; Labouret, G; Castex, M-P; Baunin, C; Galinier, P; Abbo, O

    2015-08-01

    Thymoma is extremely rare within the pediatric age range, which could lead to delayed diagnosis. Based on the clinical case of a mediastinal tumor in an 8-year-old patient, we detail the key points in the management of this disease highlighted by our recent experience.

  4. Extreme wind turbine response during operation

    DEFF Research Database (Denmark)

    Sørensen, John Dalsgaard; Nielsen, S.R.K.

    2007-01-01

    Estimation of extreme response values is very important for structural design of wind turbines. Due to the influence of control system and nonlinear structural behavior the extreme response is usually assessed based on simulation of turbulence time series. In this paper the problem of statistical...... provides a tool to obtain consistent estimates incl. the statistical uncertainty. An illustrative example indicates that the statistical uncertainty is important compared to the coefficient of variation of the extreme response when the number of 10 minutes simulations at each mean wind speed is limited...

  5. Evaluation of dynamically downscaled extreme temperature using a spatially-aggregated generalized extreme value (GEV) model

    Science.gov (United States)

    Wang, Jiali; Han, Yuefeng; Stein, Michael L.; Kotamarthi, Veerabhadra R.; Huang, Whitney K.

    2016-11-01

    The weather research and forecast (WRF) model downscaling skill in extreme maximum daily temperature is evaluated by using the generalized extreme value (GEV) distribution. While the GEV distribution has been used extensively in climatology and meteorology for estimating probabilities of extreme events, accurately estimating GEV parameters based on data from a single pixel can be difficult, even with fairly long data records. This work proposes a simple method assuming that the shape parameter, the most difficult of the three parameters to estimate, does not vary over a relatively large region. This approach is applied to evaluate 31-year WRF-downscaled extreme maximum temperature through comparison with North American regional reanalysis (NARR) data. Uncertainty in GEV parameter estimates and the statistical significance in the differences of estimates between WRF and NARR are accounted for by conducting a novel bootstrap procedure that makes no assumption of temporal or spatial independence within a year, which is especially important for climate data. Despite certain biases over parts of the United States, overall, WRF shows good agreement with NARR in the spatial pattern and magnitudes of GEV parameter estimates. Both WRF and NARR show a significant increase in extreme maximum temperature over the southern Great Plains and southeastern United States in January and over the western United States in July. The GEV model shows clear benefits from the regionally constant shape parameter assumption, for example, leading to estimates of the location and scale parameters of the model that show coherent spatial patterns.

  6. Climate extremes and the carbon cycle (Invited)

    Science.gov (United States)

    Reichstein, M.; Bahn, M.; Ciais, P.; Mahecha, M. D.; Seneviratne, S. I.; Zscheischler, J.

    2013-12-01

    The terrestrial biosphere is a key component of the global carbon cycle and its carbon balance is strongly influenced by climate. Ongoing environmental changes are thought to increase global terrestrial carbon uptake. But evidence is mounting that rare climate extremes can lead to a decrease in ecosystem carbon stocks and therefore have the potential to negate the expected increase in terrestrial carbon uptake. Here we explore the mechanisms and impacts of climate extremes on the terrestrial carbon cycle, and propose a pathway to improve our understanding of present and future impacts of climate extremes on the terrestrial carbon budget. In addition to direct impact on the carbon fluxes of photosynthesis and respiration via extreme temperature and (or) drought, effects of extreme events may also lead to lagged responses, such as wildfires triggered by heat waves and droughts, or pest and pathogen outbreaks following wind-throw caused by heavy storms, reduced plant health due to drought stress or due to less frequent cold extremes in presently cold regions. One extreme event can potentially override accumulated previous carbon sinks, as shown by the Western European 2003 heat wave.. Extreme events have the potential to affect the terrestrial ecosystem carbon balance through a single factor, or as a combination of factors. Climate extremes can cause carbon losses from accumulated stocks, as well as long-lasting impacts on (e.g. lagged effects) on plant growth and mortality, extending beyond the duration of the extreme event itself. The sensitivity of terrestrial ecosystems and their carbon balance to climate change and extreme events varies according to the type of extreme, the climatic region, the land cover, and the land management. Extreme event impacts are very relevant in forests due to the importance of lagged and memory effects on tree growth and mortality, the longevity of tree species, the large forest carbon stocks and their vulnerability, as well as the

  7. Moving in extreme environments

    DEFF Research Database (Denmark)

    Lucas, Samuel J E; Helge, Jørn W; Schütz, Uwe H W;

    2016-01-01

    This review addresses human capacity for movement in the context of extreme loading and with it the combined effects of metabolic, biomechanical and gravitational stress on the human body. This topic encompasses extreme duration, as occurs in ultra-endurance competitions (e.g. adventure racing...... and transcontinental races) and expeditions (e.g. polar crossings), to the more gravitationally limited load carriage (e.g. in the military context). Juxtaposed to these circumstances is the extreme metabolic and mechanical unloading associated with space travel, prolonged bedrest and sedentary lifestyle, which may...

  8. Extremal surface barriers

    Energy Technology Data Exchange (ETDEWEB)

    Engelhardt, Netta; Wall, Aron C. [Department of Physics, University of California,Santa Barbara, CA 93106 (United States)

    2014-03-13

    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.

  9. [The clinical usefulness of predicting difficult endotracheal intubation].

    Science.gov (United States)

    Suyama, H; Tsuno, S; Takeyoshi, S

    1999-01-01

    We conducted several tests for predicting the difficult intubation airway in 476 patients excluding those with neck disease and anatomical abnormalities. The evaluation was performed using four methods. 1. The size of the tongue in relation to the oral cavity (Mallampani test: M-T). 2. The hyomental distance (H-D). 3. The thyromental distance (T-D). 4. The atranto-occipital joint extension (AOJE). Of these four methods, M-T was the best predictor of a difficult airway. However, all of these four methods may be good predictors, employing modified criteria which include M-T = class 2, 3, 4, H-D = less than 3.0 cm, T-D = less than 6.0 cm, and AOJE = less than 35 degrees.

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

    Science.gov (United States)

    Pradhan, Debasis; Bhattacharyya, Prithwis

    2015-09-01

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

  11. Management of difficult airway during laryngectomy and thyroidectomy

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2014-01-01

    Full Text Available Laryngectomy is always a challenging surgery both from surgical and anaesthesiologist′s perspective. The situation can get worse when such patients present with advanced laryngeal cancerrequire a definite surgical intervention along with thyroid gland removal. Apart from anesthetic difficulties in managing the deranged anatomy and pathophysiology, management of difficult airway during peri-operative period can be a huge challenging task. We are reporting a case of laryngeal carcinoma that was posted for laryngectomy and thyroidectomy as the thyroid gland was also invaded to a small extent. A difficult airway situation was anticipated as during indirect laryngoscopy it was observed that the glottic covering was occluded to a large extent by a soft tissue growth.

  12. An unanticipated difficult airway in Lesch–Nyhan syndrome

    Science.gov (United States)

    Salhotra, Rashmi; Sharma, Chhavi; Tyagi, Asha; Kumar, Surendra; Sethi, AK; Bhatt, Shuchi

    2012-01-01

    An 11-year-old boy with Lesch–Nyhan syndrome presented to the emergency for fixation of a fractured femur. During induction of general anesthesia, unexpected difficult intubation was encountered with a 6.5-mm ID endotracheal tube and successively smaller tubes, also failing to pass 1 cm beyond the vocal cords. Intubation was finally achieved with a 4.5-mm ID tube. The surgery was completed uneventfully. A tracheal diverticulum was found in the computerized tomography (CT) scan performed postoperatively to account for this unexpected difficult intubation. This case highlights the anesthetic concerns in Lesch-Nyhan syndrome and also reports the rare occurrence of a tracheal diverticulum associated with it. PMID:22557752

  13. An unanticipated difficult airway in Lesch-Nyhan syndrome.

    Science.gov (United States)

    Salhotra, Rashmi; Sharma, Chhavi; Tyagi, Asha; Kumar, Surendra; Sethi, Ak; Bhatt, Shuchi

    2012-04-01

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

  14. An unanticipated difficult airway in Lesch-Nyhan syndrome

    Directory of Open Access Journals (Sweden)

    Rashmi Salhotra

    2012-01-01

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

  15. [Bipolar disorder in children and adolescents: a difficult diagnosis].

    Science.gov (United States)

    Geoffroy, Pierre Alexis; Jardri, Renaud; Etain, Bruno; Thomas, Pierre; Rolland, Benjamin

    2014-09-01

    Bipolar disorder (BD) is a severe mental condition with neurodevelopmental features that clinically results in pathological fluctuations of mood. Whereas it was classically or traditionally considered as an adult-onset disorder, recent findings suggest that BD may occur very early in the life course, thus, determining what is now called Juvenile bipolar disorder (JBD). One of the reasons for which JBD has been so difficult to identify is that JBD primary symptoms vary much from the typical adulthood BD clinical expression. Euphoric mood is rare in JBD, while irritability mood, aggressive temper, mixed manic state onset, rapid cycling, anger outbursts and chronic course of symptoms are much more frequent. This specific clinical presentation makes JBD difficult to differentiate from other diagnoses related to pathological externalizing behaviours, including conduct disorder, oppositional provocative disorder, and attention deficit-hyperactivity disorder. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Emotional distance to so-called difficult patients

    DEFF Research Database (Denmark)

    Michaelsen, Jette Joost

    2012-01-01

    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......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...

  17. Difficult intubation in a patient with carcinoma colon due to tracheobronchopathia osteochondroplastica: An incidental finding or otherwise

    Directory of Open Access Journals (Sweden)

    Ankur Sharma

    2015-04-01

    Conclusion: Awareness of this entity and its anticipation in patients with colorectal carcinoma may help anesthetists to manage similar cases appropriately in the future. Also it shall help in future research being directed to this condition.

  18. Analysis of extreme events

    CSIR Research Space (South Africa)

    Khuluse, S

    2009-04-01

    Full Text Available ) determination of the distribution of the damage and (iii) preparation of products that enable prediction of future risk events. The methodology provided by extreme value theory can also be a powerful tool in risk analysis...

  19. Extreme environments and exobiology.

    Science.gov (United States)

    Friedmann, E I

    1993-01-01

    Ecological research on extreme environments can be applied to exobiological problems such as the question of life on Mars. If life forms (fossil or extant) are found on Mars, their study will help to solve fundamental questions about the nature of life on Earth. Extreme environments that are beyond the range of adaptability of their inhabitants are defined as "absolute extreme". Such environments can serve as terrestrial models for the last stages of life in the history of Mars, when the surface cooled down and atmosphere and water disappeared. The cryptoendolithic microbial community in porous rocks of the Ross Desert in Antarctica and the microbial mats at the bottom of frozen Antarctic lakes are such examples. The microbial communities of Siberian permafrost show that, in frozen but stable communities, long-term survival is possible. In the context of terraforming Mars, selected microorganisms isolated from absolute extreme environments are considered for use in creation of a biological carbon cycle.

  20. Venous Ultrasound (Extremities)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Ultrasound - Venous (Extremities) Venous ultrasound uses sound waves to ... limitations of Venous Ultrasound Imaging? What is Venous Ultrasound Imaging? Ultrasound is safe and painless, and produces ...

  1. Statistics of extremes

    CERN Document Server

    Gumbel, E J

    2012-01-01

    This classic text covers order statistics and their exceedances; exact distribution of extremes; the 1st asymptotic distribution; uses of the 1st, 2nd, and 3rd asymptotes; more. 1958 edition. Includes 44 tables and 97 graphs.

  2. The road to the synthesis of "difficult peptides".

    Science.gov (United States)

    Paradís-Bas, Marta; Tulla-Puche, Judit; Albericio, Fernando

    2016-02-07

    The last decade has witnessed a renaissance of peptides as drugs. This progress, together with advances in the structural behavior of peptides, has attracted the interest of the pharmaceutical industry in these molecules as potential APIs. In the past, major peptide-based drugs were inspired by sequences extracted from natural structures of low molecular weight. In contrast, nowadays, the peptides being studied by academic and industrial groups comprise more sophisticated sequences. For instance, they consist of long amino acid chains and show a high tendency to form aggregates. Some researchers have claimed that preparing medium-sized proteins is now feasible with chemical ligation techniques, in contrast to medium-sized peptide syntheses. The complexity associated with the synthesis of certain peptides is exemplified by the so-called "difficult peptides", a concept introduced in the 80's. This refers to sequences that show inter- or intra-molecular β-sheet interactions significant enough to form aggregates during peptide synthesis. These structural associations are stabilized and mediated by non-covalent hydrogen bonds that arise on the backbone of the peptide and-depending on the sequence-are favored. The tendency of peptide chains to aggregate is translated into a list of common behavioral features attributed to "difficult peptides" which hinder their synthesis. In this regard, this manuscript summarizes the strategies used to overcome the inherent difficulties associated with the synthesis of known "difficult peptides". Here we evaluate several external factors, as well as methods to incorporate chemical modifications into sequences, in order to describe the strategies that are effective for the synthesis of "difficult peptides". These approaches have been classified and ordered to provide an extensive guide for achieving the synthesis of peptides with the aforementioned features.

  3. An improved method to spot-weld difficult junctions

    Science.gov (United States)

    Ferrenz, Elizabeth E.; Amare, Andinet; Arumainayagam, Christopher R.

    2001-12-01

    Recent advances in spot-welding technology such as high frequency direct current inverter welders provide an improved and reproducible method to spot-weld difficult junctions. The importance of removing the oxide layers on metal surfaces, accurately delivering the weld pulse profile, and controlling the force applied to the materials during the welding process are discussed in the context of resistance spot-welding a molybdenum crystal to a tantalum loop and attaching a tungsten-rhenium thermocouple to the crystal.

  4. Families: from difficult to exceptional--one team's journey.

    Science.gov (United States)

    Baker, Marilyn Kay; Miers, Anne; Sulla, Stephanie; Vines, Heilia

    2007-01-01

    Families of patients need support when the hospital stay becomes more difficult than anticipated. Healthcare providers also need assistance when caring for them. A continuous improvement team, Caring for Exceptional Families, was initiated to develop a system with tools and interventions for a proactive multidisciplinary approach to identifying families at risk for negative behavior during the hospital experience. The process and outcomes of this team are described.

  5. Acute urinary retention and the difficult catheterization: current emergency management.

    Science.gov (United States)

    Sliwinski, Ania; D'Arcy, Frank T; Sultana, Ron; Lawrentschuk, Nathan

    2016-04-01

    Acute urinary retention (AUR) is a common presentation to emergency departments. This article updates the reader on the appropriate management, investigations and guidelines for AUR. It looks at the mechanism of normal micturition and describes the theories of AUR. It outlines urethral catheterization techniques for difficult cases, reviews suprapubic catheterization procedures and describes the management of AUR in polytrauma. Although emergency management is by bladder drainage, key points in the history and examination may expose significant, latent pathologies.

  6. THE PREDICTION OF DIFFICULT INTUBATION WITH BEDSIDE SCORING SYSTEMS

    OpenAIRE

    Gerçek, Arzu; Lim, Sema; İşler, Banu; Eti, Zeynep; Göğüs, Yılmaz

    2016-01-01

    Objective: The aim of this study was to evaluate the correlation of sex, age, bedside scoring systems and body mass index with laryngoscopic view in patients with clinically difficult intubation.Methods: Five hundred patients, aged 20-70 years, were included in the study. The age, sex, weight and height of the patients were recorded preoperatively and body mass index was calculated. The patients were examined for Mallampati classification, thyromental distance, mouth opening, neck mobility an...

  7. Difficultly Extractable Fixed Ammonium in Some Soils of China

    Institute of Scientific and Technical Information of China (English)

    CHENBIYUN; CHENGLILI; 等

    1999-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Piepho Tim

    2009-07-01

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

  9. Hydro-dissection - A simple Solution in Difficult Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Lubna, H; Masoom, M R

    2015-07-01

    This Quasi-experimental study was done to assess the effectiveness of hydro-dissection in difficult laparoscopic cholecystectomies in Hamdard University Hospital, Karachi, Pakistan, from April 2012 to March 2014. All consecutive patients who presented with cholelithiasis and planned for laparoscopic cholecystectomy were enrolled in this study. Per-operatively the degree of difficulty of the operation was assessed by Cuschieri's scale after grading; Grade II, III and IV cholecystectomies were included in this study. Hydro dissection with saline jet through 5mm simple irrigation and suction probe was used, Operative findings and the total number of patients, in whom anatomy of calot's triangle was clearly displayed with hydro-dissection, was recorded. A total 55 patients were included in the study after assessing the degree of difficulty per operatively by Cuschieri Scale. Thirty one (31) patients were in Group II, 22 in Group III and 02 were included in group IV of Cuschieri scale in which hydro-dissection was used. This method cleared the obscure anatomy in all patients in Group II but in 3 patients of Group III, dense adhesions required sharp dissection to clear the operative field. Two patients, in whom conversion was required, were grouped in Cuschieri's scale IV. Methods of dissection in difficult cholecystectomies are of paramount importance to avoid iatrogenic injuries. Hydro-dissection using suction irrigation probe is a safe and effective technique to clear the difficult anatomy.

  10. 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.

  11. 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.)

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

    Science.gov (United States)

    Kalezić, Nevena; Lakićević, Mirko; Miličić, Biljana; Stojanović, Marina; Sabljak, Vera; Marković, Dejan

    2016-08-02

    The hyomental distance ratio (HMDR) is the ratio between the hyomental distance (HMD) (the distance between the hyoid bone and the tip of the chin) at the extreme of head extension (HMDe) and the one in the neutral position (HMDn). The objective of the study was to examine the predictive value, sensitivity, and specificity of HMDe, HMDn, and HMDR in predicting difficult endotracheal intubation (DI). A prospective study included 262 patients that underwent elective surgical operations. The following parameters were observed as possible predictors of DI: HMDR, HMDe, HMDn, Mallampati score, and body mass index (BMI). The cut-off points for the DI predictors were HMDe predictor of DI with a sensitivity of 95.6% and specificity of 69.2%. HMDR can be used in the everyday work of anesthesiologists because HMDR values ≤1.2 may reliably predict DI.

  13. 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.)

  14. Extremal limits and Ba\\~nados-Silk-West effect

    CERN Document Server

    Pradhan, Parthapratim

    2016-01-01

    A fascinating property of extremal Kerr black hole (BH) is that it could be act as a particle accelerator with infinite high center-of-mass (CM) energy \\cite{bsw}. In this note, we would like to discuss about such fascinating result and to point out that this infinite energy at the event horizon comes solely due \\emph{to the singular nature of the extremal limit}. We also show that a non-extremal Kerr BH can \\emph{not} transform into extremal Kerr BH by the Ba\\~{n}ados-Silk-West mechanism. Moreover, we discuss about three possible geometries (near extremal, purely extremal and near horizon of extremal Kerr) of this mechanism. We further prove that near extremal geometry and near horizon geometry, precisely extremal geometry of extremal Kerr BHs are qualitatively different. Near extremal geometry and near horizon geometry gives the CM energy is finite, whereas precisely extremal geometry gives the diverging energy. Thus, we can argue that extremal Kerr BH and non-extremal Kerr BH are quite distinct objects. Fi...

  15. Stroke due to Hematologic Aspects

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2004-01-01

    @@ Stroke due to ‘cerebral vein thrombosis' (CVT) is commonly used to refer to thrombosis of the cerebral venous system, including either dural venous sinuses, or deep and superficial (cortical) cerebral veins. CVT are frightening events due to the severity of their clinical manifestations and their high mortality rate (up to 30% in some casereports).The clinical signs and symptoms of CVT are relatively nonspecific: they include headache, papilledema, vomiting,seizures, focal neurological deficits (motor or sensory) and impaired consciousness. CVT has long been considered as rare and mostly infection-related event; moreover, due to its nonspecific clinical manifestations, the diagnosis has been difficult, delayed and could often be made only post mortem.

  16. 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

  17. [Perioperative management of a case of myasthenic crisis with unexpected difficult airway].

    Science.gov (United States)

    Uchida, Shinya; Nishikawa, Koichi; Mizukami, Tatsuji; Saito, Shigeru

    2009-07-01

    Myasthenia gravis (MG) is an autoimmune disorder characterized by loss of acetylcholine receptors (AChR) due primarily to the production of anti-AChR autoantibodies. We report here a case of anesthetic management of MG patient associated with difficult airway. A 58-year-old woman, 150 cm in height and 43 kg in weight, was scheduled for elective thymectomy. Preoperative evaluation using Mallampati classification, mouth opening, and thyromental distance did not predict airway difficulty. After anesthetic induction with propofol and sevoflurane, mask ventilation was performed easily. However, tracheal intubation using Macintosh type laryngoscope was unexpectedly difficult. This was largely due to transformation of the epiglottis and thereby Cormack classification was grade III. Tracheal intubation was eventually performed by blindly with a gum elastic bougie after some trials. Postoperative day two, she was diagnosed as postoperative myasthenic crisis and needed re-intubation. We used fiberscope intubation for her because it was difficult to intubate."Cannot intubate, cannot ventilate (CICV)" scenario is very rare, but it sometimes leads to serious morbidity and mortality. Therefore, we need to deal with this emergency situation by using a variety of equipments and techniques. Careful examination of the airway and a carefully considered plan for re-intubation are prerequisites for this type of surgery.

  18. Difficult Tracheal Intubation in Obese Gastric Bypass patients.

    Science.gov (United States)

    Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, Jannie; Rønholm, Ebbe; Larsen, Jens Fromholt

    2016-11-01

    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 undergoing gastric bypass. Tracheal intubation was done preoperatively together with scoring of Intubation Score (IS), Mallampati (MLP), and Cormack-Lehane classification (CLC) and registration of the quantities of anesthetics and total attempts on cannulation. The overall proportion of patients with DTI 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 index (BMI) 2, ASA scores >2, and male gender were risk factors of DTI. Males generally had higher CLC, MLP, and ASA scores compared to females, but no difference in BMI. There was no difference in quantities of anesthetics used between the two groups with or without DTI. Intra-venous and intra-arterial cannulation was succeeded in first attempt in 85 and 86 % of the patients, respectively, and there were no association between BMI and difficult vascular access. We found no association between increasing BMI and DTI.

  19. Contentious Conversations: Using Mediation Techniques in Difficult Clinical Ethics Consultations.

    Science.gov (United States)

    Fiester, Autumn

    2015-01-01

    Mediators utilize a wide range of skills in the process of facilitating dialogue and resolving conflicts. Among the most useful techniques for clinical ethics consultants (CECs)-and surely the least discussed-are those employed in acrimonious, hostile conversations between stakeholders. In the context of clinical ethics disputes or other bedside conflicts, good mediation skills can reverse the negative interactions that have prevented the creation of workable treatment plans or ethical consensus. This essay lays out the central framework mediators use in distinguishing positions from interests and describes a set of strategies for managing contentious ethics consultations or working with "difficult" patients, families, or patient-careprovider interactions.

  20. Cystic hygroma: A difficult airway and its anaesthetic implications

    Directory of Open Access Journals (Sweden)

    Gurulingappa

    2011-01-01

    Full Text Available A 2-month-old child presented with gross and huge swelling on the left side of the neck with difficulty in feeding. It was diagnosed to be cystic hygroma and a decision was made to excise the swelling to enable the child thrive better. Difficult intubation was anticipated and the child was intubated with inhalation induction. The intra-operative period was smooth and the tumour was excised completely. Post-operatively, it was decided to ventilate the child because of airway difficulties.

  1. Predictors of Difficult Intubation with the Bonfils Rigid Fiberscope.

    Science.gov (United States)

    Nowakowski, Michal; Williams, Stephan; Gallant, Jason; Ruel, Monique; Robitaille, Arnaud

    2016-06-01

    Endotracheal intubation is commonly performed via direct laryngoscopy (DL). However, in certain patients, DL may be difficult or impossible. The Bonfils Rigid Fiberscope® (BRF) is an alternative intubation device, the design of which raises the question of whether factors that predict difficult DL also predict difficult BRF. We undertook this study to determine which demographic, morphologic, and morphometric factors predict difficult intubation with the BRF. Four hundred adult patients scheduled for elective surgery were recruited. Patients were excluded if awake intubation, rapid sequence induction, or induction without neuromuscular blocking agents was planned. Data were recorded, including age, sex, weight, height, American Society of Anesthesiologist classification, history of snoring and sleep apnea, Mallampati class, upper lip bite test score, interincisor, thyromental and sternothyroid distances, manubriomental distances in flexion and extension, neck circumference, maximal neck flexion and extension, neck skinfold thickness at the cricoid cartilage, and Cormack and Lehane grade obtained via DL after paralysis was confirmed. Quality of glottic visualization (good or poor), as well as the number of intubation attempts and time to successful intubation with the BRF, was noted. Univariate analyses were performed to evaluate the association between patient characteristics and time required for intubation. Variables that exhibited a significant correlation were included in a multivariate analysis using a standard least squares model. A P 1 attempt; 4 patients could not be intubated by using the BRF alone. These 4 patients were intubated by using a combination of DL and BRF (2 patients), DL and a Frova bougie (1 patient), and DL and an endotracheal tube shaped with a semirigid stylet (1 patient). Mean time for successful intubation was 26 ± 13 seconds. Multivariate analysis showed that decreased mouth opening (P = 0.008), increased body mass index (P = 0

  2. Maxillary tumor in a child: An expected case of difficult airway

    Directory of Open Access Journals (Sweden)

    Reena

    2016-01-01

    Full Text Available Craniofacial abnormalities in pediatric population fall under the category of expected case of difficult airway. We present here a case of large maxillary tumor in a 9-year-old girl where the relative difficulty was further compounded due to her noncooperation which was again expected from a child. Local anesthetic topicalization of airway followed by slow inhalational induction with gradually increasing sevoflurane, while maintaining her spontaneous breathing, we secured her airway using fiber optic bronchoscopy. The surgery and the extubation went uneventful. In conclusion a planned airway management using fiber optic bronchoscope after airway topicalization and sevoflurane induction is the ideal technique in an expected case of difficult pediatric airway.

  3. 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.

  4. 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 ...

  5. Precursors of extreme increments

    CERN Document Server

    Hallerberg, S; Holstein, D; Kantz, H; Hallerberg, Sarah; Altmann, Eduardo G.; Holstein, Detlef; Kantz, Holger

    2006-01-01

    We investigate precursors and predictability of extreme events in time series, which consist in large increments within successive time steps. In order to understand the predictability of this class of extreme events, we study analytically the prediction of extreme increments in AR(1)-processes. The resulting strategies are then applied to predict sudden increases in wind speed recordings. In both cases we evaluate the success of predictions via creating receiver operator characteristics (ROC-plots). Surprisingly, we obtain better ROC-plots for completely uncorrelated Gaussian random numbers than for AR(1)-correlated data. Furthermore, we observe an increase of predictability with increasing event size. Both effects can be understood by using the likelihood ratio as a summary index for smooth ROC-curves.

  6. Analytic results for oscillatory systems with extremal dynamic properties

    Directory of Open Access Journals (Sweden)

    Górecki Henryk

    2014-12-01

    Full Text Available The maximal value of the error is the most important criterion in system design. It is also the most difficult one. For that reason there exist many other criteria. The extreme value of the error represents the attainable accuracy which can be obtained and the corresponding extreme time gives information about how fast the transients are. The extreme values of the error and the corresponding time are treated here as functions of the roots of the characteristic equation. The proposed analytical formulae allow designing systems with prescribed dynamic properties.

  7. 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

  8. Current thinking about acute compartment syndrome of the lower extremity

    Science.gov (United States)

    Shadgan, Babak; Menon, Matthew; Sanders, David; Berry, Gregg; Martin, Claude; Duffy, Paul; Stephen, David; O’Brien, Peter J.

    2010-01-01

    Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice. The pathophysiology of the disorder has been extensively described and is well known to physicians who care for patients with musculoskeletal injuries. The diagnosis, however, is often difficult to make. In this article, we review the clinical risk factors of acute compartment syndrome of the lower extremity, identify the current concepts of diagnosis and discuss appropriate treatment plans. We also describe the Canadian medicolegal environment in regard to compartment syndrome of the lower extremity. PMID:20858378

  9. Extreme thrombocytosis and cardiovascular surgery: risks and management.

    Science.gov (United States)

    Natelson, Ethan A

    2012-01-01

    Extreme thrombocytosis is a major risk factor for excessive bleeding and for thrombosis, either of which can complicate cardiovascular surgical and interventional procedures. Extreme thrombocytosis can also cause an unusual syndrome, erythromelalgia, that results in a type of chronic microvascular occlusive arterial disease. We present the differential diagnosis of conditions that may lead to extreme thrombocytosis, 3 cases (each of which illustrates a different potential complication), and a review of the pertinent medical literature. Correcting excessive thrombocytosis is typically not difficult, whether electively or acutely, and effective therapy usually controls thrombosis and excessive hemorrhage post-procedurally.

  10. Maxillofacial trauma patient: coping with the difficult airway

    Directory of Open Access Journals (Sweden)

    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.

  11. High Metal Removal Rate Process for Machining Difficult Materials

    Energy Technology Data Exchange (ETDEWEB)

    Bates, Robert; McConnell, Elizabeth

    2016-06-29

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

  12. Difficult mask ventilation in obese patients: analysis of predictive factors.

    Science.gov (United States)

    Leoni, A; Arlati, S; Ghisi, D; Verwej, M; Lugani, D; Ghisi, P; Cappelleri, G; Cedrati, V; El Tantawi Ali Alsheraei, A; Pocar, M; Ceriani, V; Aldegheri, G

    2014-02-01

    This study aimed to determine the accuracy of commonly used preoperative difficult airway indices as predictors of difficult mask ventilation (DMV) in obese patients (BMI >30 kg/m2). In 309 consecutive obese patients undergoing general surgery, the modified Mallampati test, patient's Height/Thyromental distance ratio, Inter-Incisor Distance, Protruding Mandible (PM), history of Obstructive Sleep Apnea and Neck Circumference (NC) were recorded preoperatively. DMV was defined as Grade 3 mask ventilation (MV) by the Han's scale (MV inadequate, unstable or requiring two practitioners). Data are shown as means±SD or number and proportions. Independent DMV predictors were identified by multivariate analysis. The discriminating capacity of the model (ROC curve area) and adjusted weights for the risk factors (odds ratios) were also determined. BMI averaged 42.5±8.3 kg/m2. DMV was reported in 27 out of 309 patients (8.8%; 95%CI 5.6-11.9%). The multivariate analysis retained NC (OR 1.17; P2 associated factors as the best discriminating point for DMV. Obese patients show increased incidence of DMV with respect to the undifferentiated surgical population. Limited PM, Mallampati test and NC are important DMV predictors.

  13. Weather and Climate Extremes.

    Science.gov (United States)

    1997-09-01

    Antarctica’s highest (New Zealand Antarctic Society, 1974). This extreme exceeded the record of 58°F (14.4°C) that occurred on 20 October 1956 at Esperanza ... Esperanza (also known as Bahia Esperanza , Hope Bay) was in operation from 1945 through the early 1960s. Meteorological/Climatological Factors: This extreme...cm) Location: Grand Ilet, La R’eunion Island [21°00’S, 55°30’E] Date: 26 January 1980 WORLD’S GREATEST 24-HOUR RAINFALL 72 in (182.5 cm

  14. Adventure and Extreme Sports.

    Science.gov (United States)

    Gomez, Andrew Thomas; Rao, Ashwin

    2016-03-01

    Adventure and extreme sports often involve unpredictable and inhospitable environments, high velocities, and stunts. These activities vary widely and include sports like BASE jumping, snowboarding, kayaking, and surfing. Increasing interest and participation in adventure and extreme sports warrants understanding by clinicians to facilitate prevention, identification, and treatment of injuries unique to each sport. This article covers alpine skiing and snowboarding, skateboarding, surfing, bungee jumping, BASE jumping, and whitewater sports with emphasis on epidemiology, demographics, general injury mechanisms, specific injuries, chronic injuries, fatality data, and prevention. Overall, most injuries are related to overuse, trauma, and environmental or microbial exposure.

  15. 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

  16. Exploring the causes of rare extreme precipitation events

    Science.gov (United States)

    Schroeer, Katharina; Kirchengast, Gottfried

    2015-04-01

    Whereas trends of precipitation changes in general are disparate, an increase of extreme intensities of short precipitation events (daily to sub-hourly scale) with increasing temperatures seems unambiguous (e.g. Trenberth et al., Clim. Res. 47, 123-138, 2011; Berg et al., Nat. Clim. Change 13, 181-185, 2013; Kendon et al., Nat. Clim. Change 4, 570-576, 2014). In probability density functions (PDFs) of observed precipitation intensities that are frequently used in science and practice, high magnitude ("extreme") low frequency ("rare") precipitation events naturally appear at the tails of PDFs. Due to the factual data scarcity, rare extreme events ("REEs") are difficult to come by with statistical analyses. Amongst studies of extreme precipitation, statistical work nevertheless makes a major contribution to the research field. Usually as a first step, a threshold is defined to classify extreme events out of a sample (statistical extreme events, "SEEs"), where methods are affected by the sample size. Such thresholds can be described user-defined or constructed. Subsequently, a PDF is sought, fit and applied (e.g. Yilmaz et al., Hydrol. Earth Syst. Sci. 18, 4065-4076, 2014;, Papalexiou et al., Hydrol. Earth Syst. Sci. 17, 851-862, 2013). While these studies respond to the needs of engeneering practice in e.g. infrastructure design, or trend analysis of precipitation in climate studies, they a) have to ignore REEs because of practical or statistical/data limitations (i.e. left out as "residual risk") and b) tell us little about the underlying processes of the climate and weather system causing REEs. We define REEs in contrast to SEEs as to be of such occurrence that they cannot be sufficiently described nor predicted by means of a regular or fat-tailed PDF. We introduce a working hypothesis assuming that REEs are conditioned and caused by a conjunction of specific circumstances on different scales. We differentiate spatio-temporal circumstances of large

  17. Living with the extreme demand

    Directory of Open Access Journals (Sweden)

    Teppo Eskelinen

    2013-05-01

    Full Text Available Most of the ethical literature on extreme poverty suggests, that some, if not most, of the incomes of the residents of rich countries ought to be donated to the global poor. Yet complying with this ethical demand becomes increasingly more difficult as the changes in lifestyle in the (postindustrial north demand ever more consumption in order to obtain the necessities for survival in such societies. In this article, I will discuss Peter Singer's famous arguments for the ethical duty to donate one's possessions, and elaborate the conception of needs prevalent in both Singer's theory and the theories of many of his critics. My argument is that we have to recognise a category of needs called 'social necessities' that are neither luxuries nor basic needs. This leads to two main conclusions: first, the space for ethical deliberation on whether to donate to life-saving purposes is socially conditioned; and second, ethical strategies of redistribution ought to be accompanied with institutional changes, which also concern the conditions in wealthy countries.http://dx.doi.org/10.5324/eip.v7i1.1791

  18. Extremity perfusion for sarcoma

    NARCIS (Netherlands)

    Hoekstra, Harald Joan

    2008-01-01

    For more than 50 years, the technique of extremity perfusion has been explored in the limb salvage treatment of local, recurrent, and multifocal sarcomas. The "discovery" of tumor necrosis factor-or. in combination with melphalan was a real breakthrough in the treatment of primarily irresectable ext

  19. Acute lower extremity ischaemia

    African Journals Online (AJOL)

    tend to impact at arterial bifurcations, the commonest site being the ... Other ominous signs of advanced ischaemia include bluish ... Recommended standards for lower extremity ischaemia*. Doppler signals ... of the embolectomy procedure. An ... in a cath-lab or angio-suite under local ... We serially measure the aPTT and.

  20. Extremity perfusion for sarcoma

    NARCIS (Netherlands)

    Hoekstra, Harald Joan

    2008-01-01

    For more than 50 years, the technique of extremity perfusion has been explored in the limb salvage treatment of local, recurrent, and multifocal sarcomas. The "discovery" of tumor necrosis factor-or. in combination with melphalan was a real breakthrough in the treatment of primarily irresectable

  1. Statistics of Local Extremes

    DEFF Research Database (Denmark)

    Larsen, Gunner Chr.; Bierbooms, W.; Hansen, Kurt Schaldemose

    2003-01-01

    . A theoretical expression for the probability density function associated with local extremes of a stochasticprocess is presented. The expression is basically based on the lower four statistical moments and a bandwidth parameter. The theoretical expression is subsequently verified by comparison with simulated...

  2. de Sitter Extremal Surfaces

    CERN Document Server

    Narayan, K

    2015-01-01

    We study extremal surfaces in de Sitter space in the Poincare slicing in the upper patch, anchored on spatial subregions at the future boundary ${\\cal I}^+$, restricted to constant boundary Euclidean time slices (focussing on strip subregions). We find real extremal surfaces of minimal area as the boundaries of past lightcone wedges of the subregions in question: these are null surfaces with vanishing area. We find also complex extremal surfaces as complex extrema of the area functional, and the area is not always real-valued. In $dS_4$ the area is real and has some structural resemblance with entanglement entropy in a dual $CFT_3$. There are parallels with analytic continuation from the Ryu-Takayanagi expressions for holographic entanglement entropy in $AdS$. We also discuss extremal surfaces in the $dS$ black brane and the de Sitter "bluewall" studied previously. The $dS_4$ black brane complex surfaces exhibit a real finite cutoff-independent extensive piece. In the bluewall geometry, there are real surface...

  3. Moving in extreme environments

    DEFF Research Database (Denmark)

    Lucas, Samuel J E; Helge, Jørn W; Schütz, Uwe H W

    2016-01-01

    and transcontinental races) and expeditions (e.g. polar crossings), to the more gravitationally limited load carriage (e.g. in the military context). Juxtaposed to these circumstances is the extreme metabolic and mechanical unloading associated with space travel, prolonged bedrest and sedentary lifestyle, which may...

  4. Implications of the KONVERGENCE Model for Difficult Cleanup Decisions

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-08-04

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

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

    DEFF Research Database (Denmark)

    Witt, Flemming; Nielsen, Jørn Flohr

    characteristics of public organizations, and the specific attitudes of physicians and politicians and their desire to control the hospital sector. At the same time, this paper also emphasizes that the empowerment concept is likely to appeal to hospital managers and nurses in the Danish public hospital sector......The employee empowerment literature promises better organizational performance as well as more motivated and satisfied employees. However, this literature often neglects the specific context of public services in general, or the health care sector, hospitals, and nursing in particular. Nurses...... in Danish public hospitals work in a unique situation that makes the uncritical transfer of empowerment interventions intended to redesign their work difficult or even unfeasible. Analysis from an institutional perspective of the ongoing power struggle between agens of change at several levels in the Danish...

  6. Management of difficult airway in intratracheal tumor surgery

    Directory of Open Access Journals (Sweden)

    Agarwal Surendra K

    2005-06-01

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

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

    Science.gov (United States)

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

    2014-05-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-07-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Viet Q. Tran

    2008-01-01

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

  11. Case Report: Modified Laparoscopic Subtotal Cholecystectomy: An Alternative Approach to the “Difficult Gallbladder”

    Science.gov (United States)

    Segal, Michael S.; Huynh, Richard H.; Wright, George O.

    2017-01-01

    Patient: Male, 56 Final Diagnosis: Acute cholecystitis Symptoms: Abdominal pain Medication:— Clinical Procedure: Laparoscopic subtotal cholecystectomy Specialty: Surgery Objective: Unusual clinical course Background: Laparoscopic cholecystectomy is a commonly performed surgical procedure. In certain situations visualization of the Callot triangle can become difficult due to inflammation, adhesions, and sclerosing of the anatomy. Without being able to obtain the “critical view of safety” (CVS), there is increased risk of damage to vital structures. An alternative approach to the conventional conversion to an open cholecystectomy (OC) would be a laparoscopic subtotal cholecystectomy (LSC). Case Report: We present a case of a 56-year-old male patient with acute cholecystitis with a “difficult gallbladder” managed with LSC. Due to poor visualization of the Callot triangle due to adhesions, safe dissection was not feasible. In an effort to avoid injury to the common bile duct (CBD), dissection began at the dome of the gallbladder allowing an alternative view while ensuring safety of critical structures. Conclusions: We discuss the potential benefits and risks of LSC versus conversion to OC. Our discussion incorporates the pathophysiology that allows LSC in this particular circumstance to be successful, and the considerations a surgeon faces in making a decision in management. PMID:28220035

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

    Science.gov (United States)

    Hopper, Darrel G.

    2000-08-01

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

  13. Extreme wave and wind response predictions

    DEFF Research Database (Denmark)

    Jensen, Jørgen Juncher; Olsen, Anders S.; Mansour, Alaa E.

    2011-01-01

    The aim of the paper is to advocate effective stochastic procedures, based on the First Order Reliability Method (FORM) and Monte Carlo simulations (MCS), for extreme value predictions related to wave and wind-induced loads.Due to the efficient optimization procedures implemented in standard FORM...

  14. 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...

  15. 依达拉奉对深低温冻存大鼠断肢再植后缺血再灌注损伤骨骼肌细胞膜及线粒体的保护效应%Protective influence of edaravone on cellular membrane and mitochondria of replanted rat extremities following ischemia/reperfusion injury due to cryopreservation and rewarming

    Institute of Scientific and Technical Information of China (English)

    段永壮; 钟世镇; 王增涛; 徐达传; 丁自海; 付庆林; 郝丽文; 何波

    2007-01-01

    肌缺血再灌注损伤,对骨骼肌细胞膜及线粒体有保护作用.其作用可能与依达拉奉直接抑制羟自由基、提高骨骼肌超氧化物歧化酶活性、减少丙二醛的产生,使细胞进行正常的氧化磷酸化有关.%BACKGROUND: A lot of important organs are worthless for clinical application because they are hard to store for a long time. In addition, tissues or organs which are dealt with cryopreservation also attack ischemia/reperfusion injury with the recovery of blood flow; especially, skeletal muscle is the most involved tissue.OBJECTIVE: To observe the protective influence of edaravone on cellular membrane and mitochondria of replanted rat extremities following ischemia/reperfusion injury due to cryopreservation and rewarming.DESIGN: Randomized contrast animal study.SETTING: Basic Medical College of Southern Medical University; Department of Hand and Foot Surgery, Shandong Provincial Hospital.MATERIALS: The experiment was carried out in the Cryopreservation Laboratory, Shandong Provincial Hospital from April to November 2006. A total of 36 healthy adult male Wistar rats were provided by Experimental Animal Center of Medical College of Shandong University. All rats were randomly divided into control group, cryopreservation group and edaravone group with 12 in each group.METHODS: Femoral artery and vein of rats in control group were exposured, but extremities were not blocked. Rats in other two groups were used to establish ischemia/reperfusion injury models of replanted extremities. Before cryopreservation, their right hindlimbs were cut off and maintained in liquid nitrogen container for 1 month. After the operation mentioned above, the broken limbs were rewarmed, perfused with routine eluant and replanted. Four hours later, blood supply of extremities was recirculated and the samples were selected. Eluant in edaravone group contained 0.5 mg/kg edaravone. Samples of skeletal muscle were selected at the same time point to

  16. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

    Directory of Open Access Journals (Sweden)

    Tolga Ege

    2015-01-01

    Full Text Available Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS. However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method, injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months. In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11 and 9.24 (range 6–11, respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7 and 5.19 (range 3–8, respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS

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

    Science.gov (United States)

    Banks, Craig E; Compton, Richard G

    2004-08-01

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

  18. [Tetany as a difficult diagnostic problem in the neurological outpatient department].

    Science.gov (United States)

    Toruńska, Katarzyna

    2003-01-01

    The paper presents a model of diagnostic and therapeutic management of tetany, with special attention paid the role of magnesium and to psychotherapy or psychiatric treatment. Two types of tetany are distinguished: manifest and latent (spasmophilia). The former, due to hypocalcemia, is relatively rare and usually postoperative (parathyroid tetany), while the mechanism of the much more common latent tetany or spasmophilia involves hyperventilation and magnesium deficiency. Latent tetany affects particularly young women. There are many signs of spasmophilia, but none is specific, so this pathology is difficult to diagnose.

  19. Non-extremal branes

    Directory of Open Access Journals (Sweden)

    Pablo Bueno

    2015-04-01

    Full Text Available We prove that for arbitrary black brane solutions of generic Supergravities there is an adapted system of variables in which the equations of motion are exactly invariant under electric–magnetic duality, i.e. the interchange of a given extended object by its electromagnetic dual. We obtain thus a procedure to automatically construct the electromagnetic dual of a given brane without needing to solve any further equation. We apply this procedure to construct the non-extremal (p,q-string of Type-IIB String Theory (new in the literature, explicitly showing how the dual (p,q-five-brane automatically arises in this construction. In addition, we prove that the system of variables used is suitable for a generic characterization of every double-extremal Supergravity brane solution, which we perform in full generality.

  20. Tibetans at extreme altitude.

    Science.gov (United States)

    Wu, Tianyi; Li, Shupin; Ward, Michal P

    2005-01-01

    Between 1960 and 2003, 13 Chinese expeditions successfully reached the summit of Chomolungma (Mt Everest or Sagarmatha). Forty-five of the 80 summiteers were Tibetan highlanders. During these and other high-altitude expeditions in Tibet, a series of medical and physiological investigations were carried out on the Tibetan mountaineers. The results suggest that these individuals are better adapted to high altitude and that, at altitude, they have a greater physical capacity than Han (ethnic Chinese) lowland newcomers. They have higher maximal oxygen uptake, greater ventilation, more brisk hypoxic ventilatory responses, larger lung volumes, greater diffusing capacities, and a better quality of sleep. Tibetans also have a lower incidence of acute mountain sickness and less body weight loss. These differences appear to represent genetic adaptations and are obviously significant for humans at extreme altitude. This paper reviews what is known about the physiologic responses of Tibetans at extreme altitudes.

  1. Extremal periodic wave profiles

    Directory of Open Access Journals (Sweden)

    E. van Groesen

    2007-01-01

    Full Text Available As a contribution to deterministic investigations into extreme fluid surface waves, in this paper wave profiles of prescribed period that have maximal crest height will be investigated. As constraints the values of the momentum and energy integrals are used in a simplified description with the KdV model. The result is that at the boundary of the feasible region in the momentum-energy plane, the only possible profiles are the well known cnoidal wave profiles. Inside the feasible region the extremal profiles of maximal crest height are "cornered" cnoidal profiles: cnoidal profiles of larger period, cut-off and periodically continued with the prescribed period so that at the maximal crest height a corner results.

  2. Extreme Photonics & Applications

    CERN Document Server

    Hall, Trevor J; Paredes, Sofia A

    2010-01-01

    "Extreme Photonics & Applications" arises from the 2008 NATO Advanced Study Institute in Laser Control & Monitoring in New Materials, Biomedicine, Environment, Security and Defense. Leading experts in the manipulation of light offered by recent advances in laser physics and nanoscience were invited to give lectures in their fields of expertise and participate in discussions on current research, applications and new directions. The sum of their contributions to this book is a primer for the state of scientific knowledge and the issues within the subject of photonics taken to the extreme frontiers: molding light at the ultra-finest scales, which represents the beginning of the end to limitations in optical science for the benefit of 21st Century technological societies. Laser light is an exquisite tool for physical and chemical research. Physicists have recently developed pulsed lasers with such short durations that one laser shot takes the time of one molecular vibration or one electron rotation in an ...

  3. Extremal Hairy Black Holes

    CERN Document Server

    Gonzalez, P A; Saavedra, Joel; Vasquez, Yerko

    2014-01-01

    We consider a gravitating system consisting of a scalar field minimally coupled to gravity with a self-interacting potential and an U(1) electromagnetic field. Solving the coupled Einstein-Maxwell-scalar system we find exact hairy charged black hole solutions with the scalar field regular everywhere. We go to the zero temperature limit and we study the effect of the scalar field on the near horizon geometry of an extremal black hole. We find that except a critical value of the charge of the black hole there is also a critical value of the charge of the scalar field beyond of which the extremal black hole is destabilized. We study the thermodynamics of these solutions and we find that if the space is flat then at low temperature the Reissner-Nordstr\\"om black hole is thermodynamically preferred, while if the space is AdS the hairy charged black hole is thermodynamically preferred at low temperature.

  4. Back to the Future -Precipitation Extremes, Climate Variability, Environmental Planning and Adaptation

    Science.gov (United States)

    Barros, A. P.

    2008-12-01

    --"The last major climatic oscillation peak was about 1856, or 74 years ago. Practically all of our important railroad and public highway work has been done since that time. Most of our parks systems driveways, and roads of all type for auto travel, in the various States, have been completed within the past 30 years, namely, beginning at the very lowest point of our climatic swing (1900-1910). There is every reason to believe, therefore, as the next 20 years comes on apace, we will witness considerable damage to work done during the past regime of weather."-- Schuman, 1931 At the beginning of the 21st century, as at the beginning of the 20th century, the fundamental question is whether the nation is more prepared for natural disasters today than it was eight decades ago. Indeed, the question is whether the best science, engineering and policy tools are in place to prepare for and respond to extreme events. Changes in the risk and magnitude of extreme precipitation events rank among the most studied impacts, and indicators (symptoms) of climatic variations. Extreme precipitation translates generally into extreme flooding, landslides, collapse of lifeline infrastructure, and the breakdown of public health services among others. In approaching the problem of quantifying the risk and magnitude of extreme precipitation events, there are two major challenges: 1) it is difficult to characterize "observed" (20th century) conditions due to the lack of long-term observations - i.e., short and incomplete historical records; and 2) it is difficult to characterize "predicted" (21st century) conditions due to the lack of skill of precipitation forecasts at spatial and temporal scales meaningful for impact studies, and the short-duration of climate model simulations themselves. The first challenge translates in estimating the probability of occurrence (rare) and magnitude (very large) of events that may have not happened yet. The second challenge is that of quantifying

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

    Science.gov (United States)

    Arulvelan, Appavoo; Soumya, Madhusudhan; Santhosh, Kannath

    2015-01-01

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

  6. Religious Extremism in Pakistan

    Science.gov (United States)

    2014-12-01

    Face (July 2008): 32. 21 Ahmed Rashid , Pakistan on the Brink: The Future of America, Pakistan, and Afghanistan (New York: Viking, 2012). 22 Brian J...promoting extremism. Commentators such as Jessica Stern, Alan Richards, Hussain Haqqani, Ahmed Rashid , and Ali Riaz are a few of the scholars who...www.jstor.org/stable/3183558; See also Ahmed Rashid , Descent Into Chaos: The United States and the Failure of Nation Building in Pakistan, Afghanistan, and

  7. USACE Extreme Sea levels

    Science.gov (United States)

    2014-03-14

    report summarising the results of the research, together with a set of recommendations arising from the research. This report describes progress to...Southampton University at HR Wallingford and subsequent teleconference with Heidi Moritz and Kate White. The notes summarising the findings of the...suggestion was made that we may want to begin talking about extreme water levels separate from storms. Ivan mentioned an analysis of storminess which

  8. Extreme geomagnetically induced currents

    Science.gov (United States)

    Kataoka, Ryuho; Ngwira, Chigomezyo

    2016-12-01

    We propose an emergency alert framework for geomagnetically induced currents (GICs), based on the empirically extreme values and theoretical upper limits of the solar wind parameters and of d B/d t, the time derivative of magnetic field variations at ground. We expect this framework to be useful for preparing against extreme events. Our analysis is based on a review of various papers, including those presented during Extreme Space Weather Workshops held in Japan in 2011, 2012, 2013, and 2014. Large-amplitude d B/d t values are the major cause of hazards associated with three different types of GICs: (1) slow d B/d t with ring current evolution (RC-type), (2) fast d B/d t associated with auroral electrojet activity (AE-type), and (3) transient d B/d t of sudden commencements (SC-type). We set "caution," "warning," and "emergency" alert levels during the main phase of superstorms with the peak Dst index of less than -300 nT (once per 10 years), -600 nT (once per 60 years), or -900 nT (once per 100 years), respectively. The extreme d B/d t values of the AE-type GICs are 2000, 4000, and 6000 nT/min at caution, warning, and emergency levels, respectively. For the SC-type GICs, a "transient alert" is also proposed for d B/d t values of 40 nT/s at low latitudes and 110 nT/s at high latitudes, especially when the solar energetic particle flux is unusually high.

  9. Extremes in nature

    CERN Document Server

    Salvadori, Gianfausto; Kottegoda, Nathabandu T

    2007-01-01

    This book is about the theoretical and practical aspects of the statistics of Extreme Events in Nature. Most importantly, this is the first text in which Copulas are introduced and used in Geophysics. Several topics are fully original, and show how standard models and calculations can be improved by exploiting the opportunities offered by Copulas. In addition, new quantities useful for design and risk assessment are introduced.

  10. The Extreme Climate Index: a novel and multi-hazard index for extreme weather events.

    Science.gov (United States)

    Cucchi, Marco; Petitta, Marcello; Calmanti, Sandro

    2017-04-01

    In this presentation we introduce the Extreme Climate Index (ECI): an objective, multi-hazard index capable of tracking changes in the frequency or magnitude of extreme weather events in African countries, thus indicating that a shift to a new climate regime is underway in a particular area. This index has been developed in the context of XCF (eXtreme Climate Facilities) project lead by ARC (African Risk Capacity, specialised agency of the African Union), and will be used in the payouts triggering mechanism of an insurance programme against risks related to the increase of frequency and magnitude of extreme weather events due to climate regimes' changes. The main hazards covered by ECI will be extreme dry, wet and heat events, with the possibility of adding region-specific risk events such as tropical cyclones for the most vulnerable areas. It will be based on data coming from consistent, sufficiently long, high quality historical records and will be standardized across broad geographical regions, so that extreme events occurring under different climatic regimes in Africa can be comparable. The first step to construct such an index is to define single hazard indicators. In this first study we focused on extreme dry/wet and heat events, using for their description respectively the well-known SPI (Standardized Precipitation Index) and an index developed by us, called SHI (Standardized Heat-waves Index). The second step consists in the development of a computational strategy to combine these, and possibly other indices, so that the ECI can describe, by means of a single indicator, different types of climatic extremes. According to the methodology proposed in this paper, the ECI is defined by two statistical components: the ECI intensity, which indicates whether an event is extreme or not; the angular component, which represent the contribution of each hazard to the overall intensity of the index. The ECI can thus be used to identify "extremes" after defining a

  11. Application of Kinesio Taping method for newborn swallowing difficultly

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Radwanek-Bąk, Barbara; Nieć, Marek

    2014-05-01

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

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

    Science.gov (United States)

    Bickel, Janet; Rosenthal, Susan L

    2011-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Le Annie V

    2006-09-01

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

  15. Pet dander and difficult-to-control asthma: Therapeutic options.

    Science.gov (United States)

    Ling, Morris; Long, Aidan A

    2010-01-01

    The prevalence of sensitization to cat and dog allergens is high in the general population and poses a challenge to the physician managing allergic asthma. Adequate allergen avoidance is difficult to achieve because of the physical characteristics of airborne animal allergens and patient noncompliance. Allergen-specific high-dose subcutaneous immunotherapy has shown benefit in cat-allergic patients with asthma and rhinoconjunctivitis, whereas the data for dog-allergic patients are not as convincing. Alternative immunotherapy approaches including the sublingual route or allergen-derived peptide-based immunotherapy remain experimental. Pharmacotherapy of pet-allergic asthmatic patients requires a stepwise approach following established asthma management guidelines. In addition to short-acting beta-agonists and inhaled corticosteroids, prophylactic antihistamines before anticipated pet exposure, the use of intranasal steroids, and the use of leukotriene antagonists may also be considered as adjunctive therapy in pet-allergic patients with asthma and/or allergic rhinitis. Omalizumab appears to have particular efficacy in pet allergen-induced asthma. Novel therapies such as Fcgamma-Fel d 1 chimeric proteins still have to be evaluated in the human setting.

  16. Bronchogenic cyst in a patient with difficult asthma.

    Science.gov (United States)

    Ben Razavi, Soheil; Bemanian, Mohammad Hassan; Taghipoor, Shokooh; Moghadam, Reza Nafisi; Behnamfar, Zahra

    2010-03-01

    Difficult to treat asthma is an asthma syndrome that brings in our mind other differentials. Mediastinal masses are not common findings, but are important variables. Bronchogenic cyst is a congenital anomaly of the foregut that is typically found in the mediastinum and diagnosed accidentally. We present a 4-year-old girl with allergic asthma that began at 8-months of age and finally a bronchogenic cyst was detected in this patient. The patient had history of asthma since she was eight months old. She had a history of several asthma attacks which had partly responded to asthma management. During the last episodes of asthma attacks, she was hospitalized in Pediatric Intensive Care Unit. Imaging studies showed a 4x3 cm mass in the posterior part of the thoracic cavity that had led to tracheal narrowing was found for which the patient underwent thoracotomy and in surgical exploration a cyst that had compressed the thoracic trachea. Pathological examination of the cyst revealed a bronchogenic cyst. Bronchogenic cyst is an uncommon developmental abnormality but in a patient with obstructive pattern of airways it should be considered in differential diagnosis of asthma, especially if the asthma management is not successful.

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

    Science.gov (United States)

    Baer, Linda; Weinstein, Elizabeth

    2013-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

    D.S. Rampton

    2000-01-01

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

  19. Bronchogenic Cyst in a Patient with Difficult Asthma

    Directory of Open Access Journals (Sweden)

    Soheil Ben Razavi

    2010-03-01

    Full Text Available Difficult to treat asthma is an asthma syndrome that brings in our mind other differentials. Mediastinal masses are not common findings, but are important variables. Bronchogenic cyst is a congenital anomaly of the foregut that is typically found in the mediastinum and diagnosed accidentally. We present a 4-year-old girl with allergic asthma that began at 8-months of age and finally a bronchogenic cyst was detected in this patient. The patient had history of asthma since she was eight months old. She had a history of several asthma attacks which had partly responded to asthma management. During the last episodes of asthma attacks, she was hospitalized in Pediatric Intensive Care Unit. Imaging studies showed a 4×3 cm mass in the posterior part of the thoracic cavity that had led to tracheal narrowing was found for which the patient underwent thoracotomy and in surgical exploration a cyst that had compressed the thoracic trachea. Pathological examination of the cyst revealed a bronchogenic cyst. Bronchogenic cyst is an uncommon developmental abnormality but in a patient with obstructive pattern of airways it should be considered in differential diagnosis of asthma, especially if the asthma management is not successful.

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

    Science.gov (United States)

    Gong, Han; Cosker, Darren

    2016-09-01

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

  1. Genetic evidence of multiple loci in dystocia - difficult labour

    Directory of Open Access Journals (Sweden)

    Westgren Magnus

    2010-06-01

    Full Text Available Abstract Background Dystocia, difficult labour, is a common but also complex problem during childbirth. It can be attributed to either weak contractions of the uterus, a large infant, reduced capacity of the pelvis or combinations of these. Previous studies have indicated that there is a genetic component in the susceptibility of experiencing dystocia. The purpose of this study was to identify susceptibility genes in dystocia. Methods A total of 104 women in 47 families were included where at least two sisters had undergone caesarean section at a gestational length of 286 days or more at their first delivery. Study of medical records and a telephone interview was performed to identify subjects with dystocia. Whole-genome scanning using Affymetrix genotyping-arrays and non-parametric linkage (NPL analysis was made in 39 women exhibiting the phenotype of dystocia from 19 families. In 68 women re-sequencing was performed of candidate genes showing suggestive linkage: oxytocin (OXT on chromosome 20 and oxytocin-receptor (OXTR on chromosome 3. Results We found a trend towards linkage with suggestive NPL-score (3.15 on chromosome 12p12. Suggestive linkage peaks were observed on chromosomes 3, 4, 6, 10, 20. Re-sequencing of OXT and OXTR did not reveal any causal variants. Conclusions Dystocia is likely to have a genetic component with variations in multiple genes affecting the patient outcome. We found 6 loci that could be re-evaluated in larger patient cohorts.

  2. Difficult Diagnoses in Hyperkinetic Disorders – A Focused Review

    Directory of Open Access Journals (Sweden)

    Francisco eCardoso

    2012-10-01

    Full Text Available ABSTRACTHyperkinesias are heterogeneous conditions that share the feature of production of involuntary, abnormal, excessive movements. Tremor, dystonia, and chorea are amongst the most common of these phenomena. In this focused review there is a discussion of difficult issues in hyperkinesias. The first one is the differential diagnosis between essential tremor and Parkinson’s disease. They are readily distinguishable in the majority of patients but in a few subjects essential tremor coexist with parkinsonian features whose underlying mechanism remains to be determined. The second topic of the review is dystonic tremor. Although increasingly diagnosed and reported as accounting for the majority of SWEDDs, its diagnostic criteria are ill defined and differentiation from Parkinson’s disease and essential tremor can be challenging. In the last section, there is a discussion of the differential diagnosis of Sydenham’s chorea, the most common cause of chorea in children. In a few patients, vascular disease, systemic lupus erythematosus and primary antiphospholipid antibody syndrome can mimic Sydenham’s chorea.

  3. Interactive removal and ground truth for difficult shadow scenes

    Science.gov (United States)

    Gong, Han; Cosker, Darren

    2016-09-01

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

  4. [Malnutrition and intensive care: discussion on a difficult case].

    Science.gov (United States)

    Berger, Mette M; Revelly, Jean-Pierre; Cayeux, Marie-Christine; Gersbach, Philippe; Chioléro, René L

    2003-06-01

    Hospital malnutrition is an insidious problem which is responsible for many complications. Critically ill patients are frequently hypermetabolic with increased nutritional requirements, and are exposed to the risk of underfeeding. The case report presents the case of a patient which stayed 22 days in the intensive care unit (ICU), and whose nutritional support failed: he ultimately died of surgical and infectious complications. An optimal support includes a early metabolic support provided as glucose-insulin-potassium infusion and antioxidant micronutrients, with an enteral nutrition initiated on days 3 or 4. It is frequently difficult to reach energy targets with exclusive enteral nutrition: if the latter is not reached after 5-6 days of enteral feeding, combination with parenteral nutrition enables worsening of the energy deficit. Transition to oral feeding is another critical event which may expose the patient to underfeeding: prescription of oral supplements and/or maintenance of overnight enteral feeding providing 50-75% of energy requirements helps overcome this period. The case illustrates the importance of monitoring daily and cumulated energy balance.

  5. Prediction is difficult, preparation is critical and possible

    DEFF Research Database (Denmark)

    Zilli, Romano; Dalton, Luke; Ooms, Wim

    Problem Statement: Animal disease challenges appear to be ever increasing with new and emerging conditions rapidly becoming global problems due to factors such as climate change and globalisation of trade. Avian Influenza, Ebola, African Swine Fever and Porcine Epidemic Diarrhoea are just a few...

  6. Peristomal skin complications are common, expensive, and difficult to manage

    DEFF Research Database (Denmark)

    Meisner, S.; Lehur, P.-A.; Moran, B.

    2012-01-01

    Background: Peristomal skin complications (PSCs) are the most common post-operative complications following creation of a stoma. Living with a stoma is a challenge, not only for the patient and their carers, but also for society as a whole. Due to methodological problems of PSC assessment...

  7. 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

  8. 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

  9. Sleep phenotyping in a mouse model of extreme trait anxiety.

    Directory of Open Access Journals (Sweden)

    Vladimira Jakubcakova

    Full Text Available BACKGROUND: There is accumulating evidence that anxiety impairs sleep. However, due to high sleep variability in anxiety disorders, it has been difficult to state particular changes in sleep parameters caused by anxiety. Sleep profiling in an animal model with extremely high vs. low levels of trait anxiety might serve to further define sleep patterns associated with this psychopathology. METHODOLOGY/PRINCIPAL FINDINGS: Sleep-wake behavior in mouse lines with high (HAB, low (LAB and normal (NAB anxiety-related behaviors was monitored for 24 h during baseline and recovery after 6 h sleep deprivation (SD. The amounts of each vigilance state, sleep architecture, and EEG spectral variations were compared between the mouse lines. In comparison to NAB mice, HAB mice slept more and exhibited consistently increased delta power during non-rapid eye movement (NREM sleep. Their sleep patterns were characterized by heavy fragmentation, reduced maintenance of wakefulness, and frequent intrusions of rapid eye movement (REM sleep. In contrast, LAB mice showed a robust sleep-wake rhythm with remarkably prolonged sleep latency and a long, persistent period of wakefulness. In addition, the accumulation of delta power after SD was impaired in the LAB line, as compared to HAB mice. CONCLUSIONS/SIGNIFICANCE: Sleep-wake patterns were significantly different between HAB and LAB mice, indicating that the genetic predisposition to extremes in trait anxiety leaves a biological scar on sleep quality. The enhanced sleep demand observed in HAB mice, with a strong drive toward REM sleep, may resemble a unique phenotype reflecting not only elevated anxiety but also a depression-like attribute.

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

    Directory of Open Access Journals (Sweden)

    Benjamin Stielow

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

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

    Directory of Open Access Journals (Sweden)

    Naim Jerliu

    2015-12-01

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

  12. Association Between Difficult Airway Predictors and Failed Prehosptial Endotracheal Intubation.

    Science.gov (United States)

    Gaither, Joshua B; Stolz, Uwe; Ennis, Joshua; Moiser, Jarrod; Sakles, John C

    2015-01-01

    Difficult airway predictors (DAPs) are associated with failure of endotracheal intubation (ETI) in the emergency department (ED). The purpose of this study was to determine if DAPs are associated with failure of prehospital ETI. This retrospective study compared the prevalence of DAPs in cases of failed prehospital ETI successfully intubated in the ED (FPH/SED) with cases with no prehospital attempt that were successfully intubated in the ED on the first attempt by a physician using direct laryngoscopy (NPH/SED). All cases were transported by ground or air to an academic, level-1 trauma center. A total of 1377 ED ETIs were performed; 161 FPH/SED and 530 NPH/SED were identified. The odds ratios with 95% confidence intervals (CIs) of finding DAPs in the FPH/SED group compared with the NPH/SED group was blood = 5.80 (95% CI, 3.89-8.63), vomit = 2.01 (95% CI, 1.25-3.21), short neck = 2.67 (95% CI, 1.39-5.03), neck immobility = 2.52 (95% CI, 1.72-3.67), airway edema = 10.52 (95% CI, 4.15-29.92), facial trauma = 4.64 (95% CI, 2.91-7.39), and large tongue = 3.08 (95% CI, 1.75-5.40). When grouped by the number of DAPs per case (0, 1, 2, 3, or ≥ 4), the odds of multiple DAPs in cases of FPH/SED compared with NPH/SED ranged from 2.89 (95% CI, 1.71-4.90) with 1 DAP to 24.55 (95% CI, 10.60-56.90) with ≥ 4 DAPs. Cases of FPH/SED have more DAPs than NPH/SEDs. Copyright © 2015 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Djordje Djordjevic

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Giovanni Barla

    2016-01-01

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

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

    Science.gov (United States)

    Faller, James

    2015-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Giovanni Barla

    2016-06-01

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

  18. Evaluation of Truview evo2 Laryngoscope In Anticipated Difficult Intubation - A Comparison To Macintosh Laryngoscope.

    Science.gov (United States)

    Singh, Ishwar; Khaund, Abhijit; Gupta, Abhishek

    2009-04-01

    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.

  19. Diagnosis of Zollinger-Ellison syndrome: Increasingly difficult

    Institute of Scientific and Technical Information of China (English)

    Tetsuhide Ito; Guillaume Cadiot; Robert T Jensen

    2012-01-01

    In the present paper the increasing difficulty of diagnosis of Zollinger-Ellison syndrome (ZES) due to issues raised in two recent papers is discussed.These issues involve the difficulty and need to withdraw patients suspected of ZES from treatment with Proton Pump Inhibitors (omeprazole,esomeprazole,lansoprazole,rabeprazole,pantoprazole) and the unreliability of many gastrin radioimmunoassays.The clinical context of each of these important issues is reviewed and the conclusions in these articles commented from the perspective of clinical management.

  20. 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.

  1. Flooding hazards from sea extremes and subsidence

    DEFF Research Database (Denmark)

    Sørensen, Carlo; Vognsen, Karsten; Broge, Niels

    2015-01-01

    If we do not understand the effects of climate change and sea level rise (SLR) we cannot live in low-lying coastal areas in the future. Permanent inundation may become a prevalent issue but more often floods related to extreme events have the largest damage potential, and the management of flooding...... hazards needs to integrate the water loading from various sources. Furthermore, local subsidence must be accounted for in order to evaluate current and future flooding hazards and management options. We present the methodology (Figure) and preliminary results from the research project “Coastal Flooding...... Hazards due to Storm Surges and Subsidence” (2014-2017) with the objective to develop and test a practice oriented methodology for combining extreme water level statistics and land movement in coastal flooding hazard mapping and in climate change adaptation schemes in Denmark. From extreme value analysis...

  2. Extreme Programming Pocket Guide

    CERN Document Server

    Chromatic

    2003-01-01

    Extreme Programming (XP) is a radical new approach to software development that has been accepted quickly because its core practices--the need for constant testing, programming in pairs, inviting customer input, and the communal ownership of code--resonate with developers everywhere. Although many developers feel that XP is rooted in commonsense, its vastly different approach can bring challenges, frustrations, and constant demands on your patience. Unless you've got unlimited time (and who does these days?), you can't always stop to thumb through hundreds of pages to find the piece of info

  3. Mycetoma of lower extremity

    Directory of Open Access Journals (Sweden)

    Sahariah S

    1978-01-01

    Full Text Available Ten cases of mycetoma of the lower extremity were seen and treated at the Postgraduate Institute of Medical Education & Research, Chandigarh, India, during the years 1973 to 1975. Six were treated by conservative method e.g. antibiotics, sulfonamides and immobilization of the part while remaining four were submitted t o surgery. Four out o f six from the first group had recurrence and has been put on second line of therapy. Recurrence occurred in only one case from the second group and he required an above knee amputation while the remaining three are free of disease and are well rehabilitated.

  4. Metagenomics of extreme environments.

    Science.gov (United States)

    Cowan, D A; Ramond, J-B; Makhalanyane, T P; De Maayer, P

    2015-06-01

    Whether they are exposed to extremes of heat or cold, or buried deep beneath the Earth's surface, microorganisms have an uncanny ability to survive under these conditions. This ability to survive has fascinated scientists for nearly a century, but the recent development of metagenomics and 'omics' tools has allowed us to make huge leaps in understanding the remarkable complexity and versatility of extremophile communities. Here, in the context of the recently developed metagenomic tools, we discuss recent research on the community composition, adaptive strategies and biological functions of extremophiles.

  5. Characterizing Extreme Ionospheric Storms

    Science.gov (United States)

    Sparks, L.; Komjathy, A.; Altshuler, E.

    2011-12-01

    Ionospheric storms consist of disturbances of the upper atmosphere that generate regions of enhanced electron density typically lasting several hours. Depending upon the storm magnitude, gradients in electron density can sometimes become large and highly localized. The existence of such localized, dense irregularities is a major source of positioning error for users of the Global Positioning System (GPS). Consequently, satellite-based augmentation systems have been implemented to improve the accuracy and to ensure the integrity of user position estimates derived from GPS measurements. Large-scale irregularities generally do not pose a serious threat to estimate integrity as they can be readily detected by such systems. Of greater concern, however, are highly localized irregularities that interfere with the propagation of a signal detected by a user measurement but are poorly sampled by the receivers in the system network. The most challenging conditions have been found to arise following disturbances of large magnitude that occur only rarely over the course of a solar cycle. These extremely disturbed conditions exhibit behavior distinct from moderately disturbed conditions and, hence, have been designated "extreme storms". In this paper we examine and compare the behavior of the extreme ionospheric storms of solar cycle 23 (or, more precisely, extreme storms occurring between January 1, 2000, and December 31, 2008), as represented in maps of vertical total electron content. To identify these storms, we present a robust means of quantifying the regional magnitude of an ionospheric storm. Ionospheric storms are observed frequently to occur in conjunction with magnetic storms, i.e., periods of geophysical activity as measured by magnetometers. While various geomagnetic indices, such as the disturbance storm time (Dst) and the planetary Kp index, have long been used to rank the magnitudes of distinct magnetic storms, no comparable, generally recognized index exists for

  6. Winter Storms and Extreme Cold

    Science.gov (United States)

    ... Landslides & Debris Flow Nuclear Blast Nuclear Power Plants Power Outages Pandemic Radiological Dispersion Device Severe Weather Snowstorms & Extreme ... Landslides & Debris Flow Nuclear Blast Nuclear Power Plants Power Outages Pandemic Radiological Dispersion Device Severe Weather Snowstorms & Extreme ...

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

    Science.gov (United States)

    Bastiaanse, Roelien

    2013-04-01

    Many studies have shown that verb inflections are difficult to produce for agrammatic aphasic speakers: they are frequently omitted and substituted. The present article gives an overview of our search to understanding why this is the case. The hypothesis is that grammatical morphology referring to the past is selectively impaired in agrammatic aphasia. That is, verb inflections for past tense and perfect aspect are hard to produce. Furthermore, verb clusters that refer to the past will be affected as well, even if the auxiliary is in present tense, as in he has been writing a letter. It will be argued that all these verb forms referring to the past require discourse linking [Zagona, K. (2003). Tense and anaphora: Is there a tense-specific theory of coreference. In A. Barrs (Ed.), Anaphora: A reference guide (pp. 140-171). Oxford: Blackwell Publishing] and discourse linking is affected in agrammatic aphasia [Avrutin, S. (2006). Weak syntax. In K. Amunts, & Y. Grodzinsky (Eds.), Broca's region (pp. 49-62). New York: Oxford Press]. This hypothesis has been coined the PAst DIscourse LInking Hypothesis (PADILIH) [Bastiaanse, R., Bamyaci, E., Hsu, C.-J., Lee, J., Yarbay Duman, T., & Thompson, C.K. (2011). Time reference in agrammatic aphasia: A cross-linguistic study. Journal of Neurolinguistics, 24, 652-673]. The PADILIH has been tested in several languages and populations that have hardly been studied before in aphasiology: languages such as Turkish, Swahili and Indonesian were included, as well as monolingual and bilingual populations. In all these populations, the same test has been used: the Test for Assessing Reference of Time [Bastiaanse, R., Jonkers, R., & Thompson, C.K. (2008). Test for assessing reference of time (TART). Groningen: University of Groningen] to enable reliable comparisons between the languages. The results show that the PADILIH predicts the performance of agrammatic speakers very well: discourse-linked grammatical morphemes expressing time

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

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

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

  9. Plating on some difficult-to-plate metals and alloys

    Energy Technology Data Exchange (ETDEWEB)

    Dini, J.W.; Johnson, H.R.

    1980-02-01

    Electrodeposition of coatings on metals such as beryllium, beryllium-copper, Kovar, lead, magnesium, thorium, titanium, tungsten, uranium, zirconium, and their alloys can be problematic. This is due in most cases to a natural oxide surface film that readily reforms after being removed. The procedures we recommend for plating on these metals rely on replacing the oxide film with a displacement coating, or etching to allow mechanical keying between the substrate and plated deposit. The effectiveness of the procedures is demonstrated by interface bond strengths found in ring-shear and conical-head tensile tests.

  10. Chicago, IL Adapts to Improve Extreme Heat Preparedness

    Science.gov (United States)

    Recognizing that heat waves are expected to increase in Chicago due to climate change,–supported by the Chicago Climate Impacts Report, the city adopted a comprehensive set of actions to reduce deaths from extreme heat events.

  11. Environmental health aspects of drinking water-borne outbreak due to karst flooding: case study.

    Science.gov (United States)

    Dura, Gyula; Pándics, Tamás; Kádár, Mihály; Krisztalovics, Katalin; Kiss, Zoltánné; Bodnár, Judit; Asztalos, Agnes; Papp, Erzsébet

    2010-09-01

    Climate change may increase the incidence of waterborne diseases due to extreme rainfall events, and consequent microbiological contamination of the water source and supply. As a result of the complexity of the pathways from the surface to the consumer, it is difficult to detect an association between rainfall and human disease. The water supply of a Hungarian city, Miskolc (174,000 inhabitant), is mainly based on karstic water, a vulnerable underground water body. A large amount of precipitation fell on the catchment area of the karstic water source, causing an unusually strong karstic water flow and flooding, and subsequent microbiological contamination. The presence of several potential sources of contamination in the protective zone of the karstic water source should be emphasized. The water supplier was unprepared to treat the risk of waterborne outbreak caused by an extreme weather event. Public health intervention and hygienic measures were taken in line with epidemiological actions, focusing on the protection of consumers by providing safe drinking water. The contamination was identified, and measures were taken for risk reduction and prevention. This case study underlines the increasing importance of preparedness for extreme water events in order to protect the karstic water sources and to avoid waterborne outbreaks.

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

    Directory of Open Access Journals (Sweden)

    Nevena Kalezić

    2016-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Andrea Pizzini

    2007-06-01

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

  14. [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.

  15. Acquired Upper Extremity Growth Arrest.

    Science.gov (United States)

    Gauger, Erich M; Casnovsky, Lauren L; Gauger, Erica J; Bohn, Deborah C; Van Heest, Ann E

    2017-01-01

    This study reviewed the clinical history and management of acquired growth arrest in the upper extremity in pediatric patients. The records of all patients presenting from 1996 to 2012 with radiographically proven acquired growth arrest were reviewed. Records were examined to determine the etiology and site of growth arrest, management, and complications. Patients with tumors or hereditary etiology were excluded. A total of 44 patients (24 boys and 20 girls) with 51 physeal arrests who presented at a mean age of 10.6 years (range, 0.8-18.2 years) were included in the study. The distal radius was the most common site (n=24), followed by the distal humerus (n=8), metacarpal (n=6), distal ulna (n=5), proximal humerus (n=4), radial head (n=3), and olecranon (n=1). Growth arrest was secondary to trauma (n=22), infection (n=11), idiopathy (n=6), inflammation (n=2), compartment syndrome (n=2), and avascular necrosis (n=1). Twenty-six patients (59%) underwent surgical intervention to address deformity caused by the physeal arrest. Operative procedures included ipsilateral unaffected bone epiphysiodesis (n=21), shortening osteotomy (n=10), lengthening osteotomy (n=8), excision of physeal bar or bone fragment (n=2), angular correction osteotomy (n=1), and creation of single bone forearm (n=1). Four complications occurred; 3 of these required additional procedures. Acquired upper extremity growth arrest usually is caused by trauma or infection, and the most frequent site is the distal radius. Growth disturbances due to premature arrest can be treated effectively with epiphysiodesis or osteotomy. In this series, the specific site of anatomic growth arrest was the primary factor in determining treatment. [Orthopedics. 2017; 40(1):e95-e103.]. Copyright 2016, SLACK Incorporated.

  16. [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.

  17. Precipitation extremes under climate change

    CERN Document Server

    O'Gorman, Paul A

    2015-01-01

    The response of precipitation extremes to climate change is considered using results from theory, modeling, and observations, with a focus on the physical factors that control the response. Observations and simulations with climate models show that precipitation extremes intensify in response to a warming climate. However, the sensitivity of precipitation extremes to warming remains uncertain when convection is important, and it may be higher in the tropics than the extratropics. Several physical contributions govern the response of precipitation extremes. The thermodynamic contribution is robust and well understood, but theoretical understanding of the microphysical and dynamical contributions is still being developed. Orographic precipitation extremes and snowfall extremes respond differently from other precipitation extremes and require particular attention. Outstanding research challenges include the influence of mesoscale convective organization, the dependence on the duration considered, and the need to...

  18. "Triangular" extremal dilatonic dyons

    CERN Document Server

    Gal'tsov, Dmitri; Orlov, Dmitri

    2014-01-01

    Explicit dyonic dilaton black holes of the four-dimensional Einstein-Maxwell-dilaton theory are known only for two particular values of the dilaton coupling constant $a =1,\\sqrt{3}$, while for other $a$ numerical evidence was presented earlier about existence of extremal dyons in theories with the discrete sequence of dilaton couplings $a=\\sqrt{n(n+1)/2}$ with integer $n$. Apart from the lower members $n=1,\\,2$, this family of theories does not have motivation from supersymmetry or higher dimensions, and so far the above quantization rule has not been derived analytically. We fill this gap showing that this rule follows from analyticity of the dilaton at the $AdS_2\\times S^2$ event horizon with $n$ being the leading dilaton power in the series expansion. We also present generalization for asymptotically anti-de Sitter dyonic black holes with spherical, plane and hyperbolic topology of the horizon.

  19. Extreme skin depth waveguides

    CERN Document Server

    Jahani, Saman

    2014-01-01

    Recently, we introduced a paradigm shift in light confinement strategy and introduced a class of extreme skin depth (e-skid) photonic structures (S. Jahani and Z. Jacob, "Transparent sub-diffraction optics: nanoscale light confinement without metal," Optica 1, 96-100 (2014)). Here, we analytically establish that figures of merit related to light confinement in dielectric waveguides are fundamentally tied to the skin depth of waves in the cladding. We contrast the propagation characteristics of the fundamental mode of e-skid waveguides and conventional waveguides to show that the decay constant in the cladding is dramatically larger in e-skid waveguides, which is the origin of sub-diffraction confinement. Finally, we propose an approach to verify the reduced skin depth in experiment using the decrease in the Goos-H\\"anchen phase shift.

  20. Pulsars and Extreme Physics

    Science.gov (United States)

    Bell-Burnell, Jocelyn

    2004-10-01

    Pulsars were discovered 35 years ago. What do we know about them now, and what have they taught us about the extremes of physics? With an average density comparable to that of the nucleus, magnetic fields around 108 T and speeds close to c these objects have stretched our understanding of the behaviour of matter. They serve as extrememly accurate clocks with which to carry out precision experiments in relativity. Created in cataclysmic explosions, pulsars are a (stellar) form of life after death. After half a billion revolutions most pulsars finally die, but amazingly some are born again to yet another, even weirder, afterlife. Pulsar research continues lively, delivering exciting, startling and almost unbelievable results!

  1. 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.

  2. 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

  3. Incidence of difficult airway situations during prehospital airway management by emergency physicians--a retrospective analysis of 692 consecutive patients.

    Science.gov (United States)

    Thoeni, Nils; Piegeler, Tobias; Brueesch, Martin; Sulser, Simon; Haas, Thorsten; Mueller, Stefan M; Seifert, Burkhardt; Spahn, Donat R; Ruetzler, Kurt

    2015-05-01

    In the prehospital setting, advanced airway management is challenging as it is frequently affected by facial trauma, pharyngeal obstruction or limited access to the patient and/or the patient's airway. Therefore, incidence of prehospital difficult airway management is likely to be higher compared to the in-hospital setting and success rates of advanced airway management range between 80 and 99%. 3961 patients treated by an emergency physician in Zurich, Switzerland were included in this retrospective analysis in order to determine the incidence of a difficult airway along with potential circumstantial risk factors like gender, necessity of CPR, NACA score, GCS, use and type of muscle relaxant and use of hypnotic drugs. 692 patients underwent advanced prehospital airway management. Seven patients were excluded due to incomplete or incongruent documentation, resulting in 685 patients included in the statistical analysis. Difficult intubation was recorded in 22 patients, representing an incidence of a difficult airway of 3.2%. Of these 22 patients, 15 patients were intubated successfully, whereas seven patients (1%) had to be ventilated with a bag valve mask during the whole procedure. In this physician-led service one out of five prehospital patients requires airway management. Incidence of advanced prehospital difficult airway management is 3.2% and eventual success rate is 99%, if performed by trained emergency physicians. A total of 1% of all prehospital intubation attempts failed and alternative airway device was necessary. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Difficult OptEase Filter Retrievals After Prolonged Indwelling Times

    Energy Technology Data Exchange (ETDEWEB)

    Van Ha, Thuong G., E-mail: tgvanha@radiology.bsd.uchicago.edu; Kang, Lisa; Lorenz, Jonathan; Zangan, Steven; Navuluri, Rakesh; Straus, Christopher; Funaki, Brian [University of Chicago, Section of Interventional Radiology, Department of Radiology (United States)

    2013-08-01

    PurposeThe OptEase vena cave filter (Cordis, Piscataway, NJ) is commercially available as a retrievable or permanent filter with short recommended indwelling time, presumably due to extensive contact of the filter side struts with the inferior vena cava wall and subsequent neointimal hyperplasia leading to incorporation. Our purpose was to evaluate OptEase filter retrievals with a long indwelling time period that required unconventional retrieval techniques.Materials and MethodsWe retrospectively reviewed patients who underwent OptEase filter retrieval with long undwelling times requiring additional maneuvers for retrieval. Techniques used included rigid endobronchial forceps dissection and wire-through-loop snare. Each patient underwent postretrieval venogram to evaluate for possible complications. In addition, patients had clinical follow-up 2 weeks after the retrieval procedure.ResultsThere were three patients (2 women, 1 man; average age 64 years) who underwent OptEase filter retrieval. The mean indwelling time was 6.4 months. The indwelling filters were successfully retrieved. There were no complications. Postprocedural follow-up showed no clinical pathology.ConclusionUnconventional techniques aided in the retrieval of OptEase filters with long indwelling times.

  5. [Physical education, health and physical activities: difficult relationships].

    Science.gov (United States)

    Cogérino, Geneviève

    2016-06-08

    Physical education (PE) is an appropriate subject to investigate the links between physical activity (PA) and health. The current training of PE teachers tends to emphasize the link between PA and physical fitness, to the detriment of other health components. The occupational, environmental, cultural dimensions of PA are frequently overlooked. This article lists four topics related to PA-health links, which could be more extensively included in initial PE teacher training, on the basis of abundant scientific literature: 1. the diversity of exercise motives, according to the subject’s age, gender, ability, competence, living conditions, etc.; 2. the role of body image on the desire or reluctance of teenagers to perform PA or certain physical activities; 3. the evolution of motivations towards PA throughout life; 4. the impact of the PE teachers’ masculinist conceptions, consubstantial of PE, due to its link with sport. These topics could contribute to a better analysis of what individuals seek through PA and the PA-health links they value. They could help teachers to adjust their teaching to contribute to the pupils’ health and not solely their physical fitness..

  6. [Urologic emergencies: our difficult experience with care services].

    Science.gov (United States)

    Belvis Esclapes, V M; Merenciano Cortina, F; Torrus Tendero, P; Mira Llinares, A

    1994-09-01

    Urological emergencies, except those occurring in children, seen in a General Hospital were studied for one year. The retrospective study, both descriptive and comparative, conducted has allowed to know that there had been 3,244 emergencies (4.2% of total cases) though the urologist acted only in 1,410 (43.4%). A predominance of males (76.10%) in their sixth and seventh decade (33% of total) was seen. Presentation increased slightly (2%) above average during the summer months. 80.9% came to the Emergency Ward of their own accord and 70% were discharged soon after assistance. Nephritic colic (19.08%), haematuria (14.04%) and U.T.I. (13.83%) were the most common causes for presentation. A total of 284 patients (20.14%) required hospitalization. 96.6% were given medical and/or instrumental treatment, versus 3.4% (49) who underwent surgery basically due to testicular disease (34.69%), sepsis (24.50%), traumatic injury of male genitalia (20.3%), etc. The most frequent conditions were analyzed by age, sex, and seasonal distribution. Also, an analysis was made on the concept of "Urological Emergency" to evaluate incidence and types in our environment.

  7. 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.

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

    Science.gov (United States)

    Matteucci, Elena; Giampietro, Ottavio

    2016-01-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

  10. Extreme heterogeneity in Sr isotope systematic in the Himalayan leucogranites: A possible mechanism of partial melting based on thermal modeling

    Indian Academy of Sciences (India)

    Dilip K Mukhopadhyay

    2001-06-01

    The small leucogranite plutons occurring in linear belts in the Higher Himalayas have formed due to post-collision partial melting within the Himalayan crust. Several studies have documented that the Sr isotopic ratios in the granite bodies show chaotic variation and meaningful Rb-Sr isochron ages are difficult, if not impossible, to obtain. In tectonically overthickened crust, the depth-temperature profile (geotherm) remains strongly transient for the first tens of millions of years. It is proposed here that the intersecting relations between the transient geotherms and activity-dependent solidus/melting curves may generate small pods of magma at di erent depths and at di erent times. Each of these pods will have its unique Sr isotopic ratios. Coalescence of these small pods of magma without any e ective homogenization due to deformation-induced fast segregation, ascent and emplacement may lead to pluton-wide extreme heterogeneity in Sr isotopic ratios.

  11. Scabies Vaccine is Required, but Difficult to be Made

    Directory of Open Access Journals (Sweden)

    Simson Tarigan

    2007-03-01

    Full Text Available Sarcoptes scabiei, the mite causing scabies, infests human and at least 40 species of animals. The losses associated with the disease as a public health burden and economic losses are enormous because its prevalence is very high. The current available control by treating individuals diagnosed to have the disease is both ineffective and unpractical. Besides, dissatisfaction with the pharmacological control is escalating due to the development of resistance in the mites and rejection by consumers for animals products contaminated with drug residues. Vaccination is considered to be most the attractive alternative control although the availability of vaccine is still a long way off. Control of scabies by vaccination is considered to be feasible since animals recovered from the disease posses protective immunity against mite reinfestation. In addition, despite the fact that the mites reside not deeper than the unvascularised stratum corneum and they are not blood sucking parasites, they do ingest their host immunoglobulin. Vaccine for scabies, as for other ectoparasitic diseases, includes subunit vaccine developed from mite protective antigen produced by recombinant technology. Identification of sarcoptic protective antigen which comprise the first step in the vaccine development impede by the lability and low abundance of the protective antigen, and the difficulty in obtaining sufficient amount of mites. Identification of sarcoptic protective antigen by conventional biochemical technique, although the technique has been successful for other parasites, has been unsatisfactory for S. scabiei. Identifying the protective antigen just among proteins having vital functions in the survival of mites and accessible by the effector arms of the host immune system seems to be a more feasible alternative. The allergens and membrane proteins lining the digestive tract of the mites seem to fulfil the criteria.

  12. Lower extremity EMG-driven modeling of walking with automated adjustment of musculoskeletal geometry.

    Science.gov (United States)

    Meyer, Andrew J; Patten, Carolynn; Fregly, Benjamin J

    2017-01-01

    Neuromusculoskeletal disorders affecting walking ability are often difficult to manage, in part due to limited understanding of how a patient's lower extremity muscle excitations contribute to the patient's lower extremity joint moments. To assist in the study of these disorders, researchers have developed electromyography (EMG) driven neuromusculoskeletal models utilizing scaled generic musculoskeletal geometry. While these models can predict individual muscle contributions to lower extremity joint moments during walking, the accuracy of the predictions can be hindered by errors in the scaled geometry. This study presents a novel EMG-driven modeling method that automatically adjusts surrogate representations of the patient's musculoskeletal geometry to improve prediction of lower extremity joint moments during walking. In addition to commonly adjusted neuromusculoskeletal model parameters, the proposed method adjusts model parameters defining muscle-tendon lengths, velocities, and moment arms. We evaluated our EMG-driven modeling method using data collected from a high-functioning hemiparetic subject walking on an instrumented treadmill at speeds ranging from 0.4 to 0.8 m/s. EMG-driven model parameter values were calibrated to match inverse dynamic moments for five degrees of freedom in each leg while keeping musculoskeletal geometry close to that of an initial scaled musculoskeletal model. We found that our EMG-driven modeling method incorporating automated adjustment of musculoskeletal geometry predicted net joint moments during walking more accurately than did the same method without geometric adjustments. Geometric adjustments improved moment prediction errors by 25% on average and up to 52%, with the largest improvements occurring at the hip. Predicted adjustments to musculoskeletal geometry were comparable to errors reported in the literature between scaled generic geometric models and measurements made from imaging data. Our results demonstrate that with

  13. Skin Abscess due to Serratia marcescens in an Immunocompetent Patient after Receiving a Tattoo

    Directory of Open Access Journals (Sweden)

    J. Diranzo García

    2015-01-01

    Full Text Available The incidence of skin infections caused by Serratia marcescens is extremely low and such infections are typically observed in immunocompromised patients. The clinical manifestations of these infections include cellulitis, abscesses, fluctuant nodules, or granulomatous lesions. Infections caused by S. marcescens are very difficult to treat due to their resistance to many antibiotics, which often leads to specific and prolonged treatment. Infections after receiving a tattoo are very rare and are caused by unhygienic conditions or the inexperience of the tattooist. In this paper we present the case of a 32-year-old male with no comorbidity, who presented an abscess caused by S. marcescens in a area that was tattooed one month earlier. The case was resolved with surgery and antimicrobial therapy that was based on the antibiogram. To our knowledge, this is the first reported case of a S. marcescens skin infection following a tattoo, in the absence of immunosuppression.

  14. Estimating changes in temperature extremes from millennial-scale climate simulations using generalized extreme value (GEV) distributions

    Science.gov (United States)

    Huang, Whitney K.; Stein, Michael L.; McInerney, David J.; Sun, Shanshan; Moyer, Elisabeth J.

    2016-07-01

    Changes in extreme weather may produce some of the largest societal impacts of anthropogenic climate change. However, it is intrinsically difficult to estimate changes in extreme events from the short observational record. In this work we use millennial runs from the Community Climate System Model version 3 (CCSM3) in equilibrated pre-industrial and possible future (700 and 1400 ppm CO2) conditions to examine both how extremes change in this model and how well these changes can be estimated as a function of run length. We estimate changes to distributions of future temperature extremes (annual minima and annual maxima) in the contiguous United States by fitting generalized extreme value (GEV) distributions. Using 1000-year pre-industrial and future time series, we show that warm extremes largely change in accordance with mean shifts in the distribution of summertime temperatures. Cold extremes warm more than mean shifts in the distribution of wintertime temperatures, but changes in GEV location parameters are generally well explained by the combination of mean shifts and reduced wintertime temperature variability. For cold extremes at inland locations, return levels at long recurrence intervals show additional effects related to changes in the spread and shape of GEV distributions. We then examine uncertainties that result from using shorter model runs. In theory, the GEV distribution can allow prediction of infrequent events using time series shorter than the recurrence interval of those events. To investigate how well this approach works in practice, we estimate 20-, 50-, and 100-year extreme events using segments of varying lengths. We find that even using GEV distributions, time series of comparable or shorter length than the return period of interest can lead to very poor estimates. These results suggest caution when attempting to use short observational time series or model runs to infer infrequent extremes.

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

    Science.gov (United States)

    Schlesinger, Naomi

    2011-07-30

    Gouty arthritis is the most common inflammatory arthritis in adults and is characterized by very painful flares. Gouty arthritis results from an elevated body uric acid pool, which leads to deposition of monosodium urate crystals, mainly in the joints. These crystals trigger the release of proinflammatory cytokines, in particular interleukin (IL)-1β, which stimulates inflammation. Gouty arthritis can progress to a chronic, deforming and physically disabling disease through the development of disfiguring tophi, joint destruction and persistent pain. Standard treatments are effective in most patients. Acutely, anti-inflammatory therapies provide rapid pain relief and resolution of flares. Chronically, urate-lowering therapies reduce serum urate levels and, in combination with anti-inflammatory prophylaxis, reduce the risk of flares. However, for a growing number of patients, current standard treatments are ineffective or are contraindicated, largely due to the presence of co-morbidities. Indeed, metabolic syndrome, hypertension, dyslipidaemia, cardiovascular disease, diabetes mellitus and renal impairment are all highly prevalent in individuals with gouty arthritis, and may lead to standard treatments being ineffective or inappropriate. Such patients with difficult-to-treat disease require alternative therapies. Gouty arthritis can have a major impact on health-related quality of life (HR-QOL), especially in patients with difficult-to-treat disease, as revealed by recent studies comparing HR-QOL for patients with gouty arthritis with that of the general population. All studies revealed clinically significant reductions in physical functioning for individuals with gouty arthritis compared with the general population. The difference was particularly marked for patients with difficult-to-treat disease. Gouty arthritis also constitutes an important economic burden through absence from work and medical costs. Again, the burden is greater in patients with difficult

  16. Women in extreme poverty.

    Science.gov (United States)

    1994-01-01

    Population is estimated to increase from 5.5 billion in 1990 to 10 billion by 2050; the poverty level is expected to increase from 1 billion to 2-3 billion people. Women in development has been promoted throughout the UN and development system, but women in poverty who perform work in the informal sector are still uncounted, and solutions are elusive. The issue of extreme poverty can not be approached as just another natural disaster with immediate emergency relief. Many people live in precarious economic circumstances throughout their lives. Recent research reveals a greater understanding of the underlying causes and the need for inclusion of poor women in sustainable development. Sanitation, water, housing, health facilities need to be improved. Women must have access to education, opportunities for trading, and loans on reasonable terms. UNESCO makes available a book on survival strategies for poor women in the informal sector. The profile shows common problems of illiteracy, broken marriages, and full time involvement in provision of subsistence level existence. Existence is a fragile balance. Jeanne Vickers' "Women and the World" offers simple, low cost interventions for aiding extremely poor women. The 1992 Commission on the Status of Women was held in Vienna. Excerpts from several speeches are provided. The emphasis is on some global responses and an analysis of solutions. The recommendation is for attention to the gender dimension of poverty. Women's dual role contributes to greater disadvantages. Women are affected differently by macroeconomic factors, and that there is intergenerational transfer of poverty. Social services should be viewed as investments and directed to easing the burdens on time and energy. Public programs must be equipped to deal with poverty and to bring about social and economic change. Programs must be aware of the different distribution of resources within households. Women must be recognized as principal economic providers within

  17. Extreme winds in Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Kristensen, L.; Rathmann, O.; Hansen, S.O.

    1999-02-01

    Wind-speed data from four sites in Denmark have been analyzed in order to obtain estimates of the basic wind velocity which is defined as the 50-year wind speed under standard conditions, i.e. ten-minute averages at the height 10 m over a uniform terrain with the roughness length 0.05 m. The sites are, from west, Skjern (15 years), Kegnaes (7 years), Sprogoe (20 years), and Tystofte (15 years). The data are ten minute averages of wind speed, wind direction, temperature and pressure. The last two quantities are used to determine the air density {rho}. The data are cleaned for terrain effects by means of a slightly modified WASP technique where the sector speed-up factors and roughness lengths are linearly smoothed with a direction resolution of one degree. Assuming geotropic balance, all the wind-velocity data are transformed to friction velocity u{sub *} and direction at standard conditions by means of the geotropic drag law for neutral stratification. The basic wind velocity in 30 deg. sectors are obtained through ranking of the largest values of the friction velocity pressure 1/2{rho}u{sub *}{sup 2} taken both one every two months and once every year. The main conclusion is that the basic wind velocity is significantly larger at Skjern, close to the west coast of Jutland, than at any of the other sites. Irrespective of direction, the present standard estimates of 50-year wind are 25 {+-} 1 m/s at Skern and 22 {+-} 1 m/s at the other three sites. These results are in agreement with those obtained by Jensen and Franck (1970) and Abild (1994) and supports the conclusion that the wind climate at the west coast of Jutland is more extreme than in any other part of the country. Simple procedures to translate in a particular direction sector the standard basic wind velocity to conditions with a different roughness length and height are presented. It is shown that a simple scheme makes it possible to calculate the total 50-year extreme load on a general structure without

  18. Extreme Rainfall Events Over Southern Africa: Assessment of a Climate Model to Reproduce Daily Extremes

    Science.gov (United States)

    Williams, C.; Kniveton, D.; Layberry, R.

    2007-12-01

    It is increasingly accepted that any possible climate change will not only have an influence on mean climate but may also significantly alter climatic variability. This issue is of particular importance for environmentally vulnerable regions such as southern Africa. The subcontinent is considered especially vulnerable extreme events, due to a number of factors including extensive poverty, disease and political instability. Rainfall variability and the identification of rainfall extremes is a function of scale, so high spatial and temporal resolution data are preferred to identify extreme events and accurately predict future variability. The majority of previous climate model verification studies have compared model output with observational data at monthly timescales. In this research, the assessment of a state-of-the-art climate model to simulate climate at daily timescales is carried out using satellite derived rainfall data from the Microwave Infra-Red Algorithm (MIRA). This dataset covers the period from 1993-2002 and the whole of southern Africa at a spatial resolution of 0.1 degree longitude/latitude. Once the model's ability to reproduce extremes has been assessed, idealised regions of SST anomalies are used to force the model, with the overall aim of investigating the ways in which SST anomalies influence rainfall extremes over southern Africa. In this paper, results from sensitivity testing of the UK Meteorological Office Hadley Centre's climate model's domain size are firstly presented. Then simulations of current climate from the model, operating in both regional and global mode, are compared to the MIRA dataset at daily timescales. Thirdly, the ability of the model to reproduce daily rainfall extremes will be assessed, again by a comparison with extremes from the MIRA dataset. Finally, the results from the idealised SST experiments are briefly presented, suggesting associations between rainfall extremes and both local and remote SST anomalies.

  19. EPE The Extreme Physics Explorer

    Science.gov (United States)

    Garcia, Michael; Elvis, Martin; Bookbinder, Jay; Brenneman, Laura; Bulbul, Esra; Nulsen, Paul; Patnaude, Dan; Smith, Randall; Bandler, Simon; Okajima, Takashi; Ptak, Andy; Figueroa-Feliciano, Enectali; Chakrabarty, Deepto; Danner, Rolf; Daily, Dean; Fraser, George; Willingale, Richard; Miller, Jon; Turner, T. J.; Risalti, Guido; Galeazzi, Massimiliano

    2012-01-01

    The Extreme Physics Explorer (EPE) is a mission concept that will address fundamental and timely questions in astrophysics which are primary science objectives of IXO. The reach of EPE to the areas outlined in NASA RFI NNH11ZDA018L is shown as a table. The dark green indicates areas in which EPE can do the basic IXO science, and the light green areas where EPE can contribute but will not reach the full IXO capability. To address these science questions, EPE will trace orbits close to the event horizon of black holes, measure black hole spin in active galactic nuclei (AGN), use spectroscopy to characterize outflows and the environment of AGN, map bulk motions and turbulence in galaxy clusters, and observe the process of cosmic feedback where black holes inject energy on galactic and intergalactic scales. EPE gives up the high resolution imaging of IXO in return for lightweight, high TRL foil mirrors which will provide >20 times the effective area of ASTRO-H and similar spatial resolution, with a beam sufficient to study point sources and nearby galaxies and clusters. Advances in micro-calorimeters allow improved performance at high rates with twice the energy resolution of ASTRO-H. A lower TRL option would provide 200 times the area of ASTRO-H using a micro-channel plate optic (MCPO) and a deployable optical bench. Both options are in the middle range of RFI missions at between $600M and $1000M. The EPE foil optic has direct heritage to ASTRO-H, allowing robust cost estimates. The spacecraft is entirely off the shelf and introduces no difficult requirements. The mission could be started and launched in this decade to an L2 orbit, with a three-year lifetime and consumables for 5 years. While ASTRO-H will give us the first taste of high-resolution, non-dispersive X-ray spectroscopy, it will be limited to small numbers of objects in many categories. EPE will give us the first statistically significant samples in each of these categories.

  20. Solar extreme events

    CERN Document Server

    Hudson, Hugh S

    2015-01-01

    Solar flares and CMEs have a broad range of magnitudes. This review discusses the possibility of "extreme events," defined as those with magnitudes greater than have been seen in the existing historical record. For most quantitative measures, this direct information does not extend more than a century and a half into the recent past. The magnitude distributions (occurrence frequencies) of solar events (flares/CMEs) typically decrease with the parameter measured or inferred (peak flux, mass, energy etc. Flare radiation fluxes tend to follow a power law slightly flatter than $S^{-2}$, where S represents a peak flux; solar particle events (SPEs) follow a still flatter power law up to a limiting magnitude, and then appear to roll over to a steeper distribution, which may take an exponential form or follow a broken power law. This inference comes from the terrestrial $^{14}$C record and from the depth dependence of various radioisotope proxies in the lunar regolith and in meteorites. Recently major new observation...

  1. Extremal almost-Kahler metrics

    CERN Document Server

    Lejmi, Mehdi

    2009-01-01

    We generalize the notion of the Futaki invariant and extremal vector field to the general almost-Kahler case and we prove the periodicity of the extremal vector field when the symplectic form represents an integral cohomology class modulo torsion. We give also an explicit formula of the hermitian scalar curvature which allows us to obtain examples of non-integrable extremal almost-Kahler metrics saturating LeBrun's estimates.

  2. Upper extremity amputations and prosthetics.

    Science.gov (United States)

    Ovadia, Steven A; Askari, Morad

    2015-02-01

    Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions.

  3. 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.

  4. Acute flaccid paralysis due to rabies

    Directory of Open Access Journals (Sweden)

    J B Ghosh

    2009-01-01

    Full Text Available Two clinical forms of rabies are recognize: i a furious form associated with classical signs of excitation or phobic symptoms, ii Dumb rabies (paralytic rabies characterized by progressive paralysis without an initial furious phase wherein distinction from Guillain-Barrι Syndrome may be difficult. Paralytic rabies is more common in persons who have received postexposure vaccination. We report here the diagnostic dilemma of two cases of acute flaccid paralysis due to rabies.

  5. Mesenteric tumor due to chronic anisakiasis

    Directory of Open Access Journals (Sweden)

    Pablo Menéndez

    2015-09-01

    Full Text Available Intestinal anisakiasis is a rare parasitic disease and difficult to diagnose due to symptoms are not specific, so it is considered an underdiagnosed disease. The clinical suspicion with a correct diagnosis of anisakiasis allows the establishment of a correct treatment; in most cases, the resolution is possible with conservative treatment, avoiding unnecessary surgery to the preoperative differential diagnosis of acute abdomen. We report the case of a patient who required urgent surgery secondary to an exacerbation of chronic anisakiasis.

  6. Diplopia due to Dacryops

    OpenAIRE

    Rahmi Duman; Reşat Duman; Mehmet Balcı

    2013-01-01

    Dacryops is a lacrimal ductal cyst. It is known that it can cause globe displacement, motility restriction, and proptosis because of the mass effect. Diplopia due to dacryops has not been reported previously. Here, we present a 57-year-old man with binocular horizontal diplopia that occurred during left direction gaze due to dacryops.

  7. Diplopia due to Dacryops

    Directory of Open Access Journals (Sweden)

    Rahmi Duman

    2013-01-01

    Full Text Available Dacryops is a lacrimal ductal cyst. It is known that it can cause globe displacement, motility restriction, and proptosis because of the mass effect. Diplopia due to dacryops has not been reported previously. Here, we present a 57-year-old man with binocular horizontal diplopia that occurred during left direction gaze due to dacryops.

  8. Prediction of difficult laryngoscopy: Extended mallampati score versus the MMT, ULBT and RHTMD

    Directory of Open Access Journals (Sweden)

    Mohammadreza Safavi

    2014-01-01

    Conclusion: EMS predicted difficult laryngoscopy better than MMT while both ULBT and RHTMD had more power than EMS and MMT in this regard. ULBT and RHTMD had similar predictive value for prediction of difficult laryngoscopy in general population.

  9. Extreme Convective Weather in Future Decades

    Science.gov (United States)

    Gadian, Alan; Burton, Ralph; Groves, James; Blyth, Alan; Warner, James; Holland, Greg; Bruyere, Cindy; Done, James; Thielen, Jutta

    2016-04-01

    WISER (Weather Climate Change Impact Study at Extreme Resolution) is a project designed to analyse changes in extreme weather events in a future climate, using a weather model (WRF) which is able to resolve small scale processes. Use of a weather model is specifically designed to look at convection which is of a scale which cannot be resolved by climate models. The regional meso-scale precipitation events, which are critical in understanding climate change impacts will be analysed. A channel domain outer model, with a resolution of ~ 20km in the outer domain drives an inner domain of ~ 3 km resolution. Results from 1989-1994 and 2020-2024 and 2030-2034 will be presented to show the effects of extreme convective events over Western Europe. This presentation will provide details of the project. It will present data from the 1989-1994 ERA-interim and CCSM driven simulations, with analysis of the future years as defined above. The representation of pdfs of extreme precipitation, Outgoing Longwave Radiation and wind speeds, with preliminary comparison with observations will be discussed. It is also planned to use the output to drive the EFAS (European Flood model) to examine the predicted changes in quantity and frequency of severe and hazardous convective rainfall events and leading to the frequency of flash flooding due to heavy convective precipitation.

  10. 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…

  11. 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…

  12. E.X.T.R.E.M.E. project. Launch; Projet EXTREME. Rapport de lancement

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-07-01

    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)

  13. Improving Predictions and Management of Hydrological Extremes

    Science.gov (United States)

    Wijngaard, Janet; Liggins, Felicity; Hurk, Bart vd; Lavers, David; Magnusson, Linus; Bouwer, Laurens; Weerts, Albrecht; Kjellström, Erik; Mañez, Maria; Ramos, Maria-Helena; Hananel, Cedric; Ercin, Ertug; Hunink, Johannes; Klein, Bastian; Pouget, Laurent; de Moel, Hans

    2017-04-01

    The EU Roadmap on Climate Services can be seen as a result of convergence between society's call for "actionable research" and the climate research community's provision of tailored data, information and knowledge. Although weather and climate have distinct definitions, a strong link between weather and climate services does exist but, to date, this link has not been explored extensively. Stakeholders being interviewed in the context of the Roadmap consider changes in our climate as distant, long-term impacts that are difficult to consider in present-day decision making, a process usually dominated by their daily experience with handling adverse weather and extreme events. However, it could be argued that this experience is a rich source of inspiration to increase society's resilience to an unknown future. The European research project, IMPREX, is built on the notion that "experience in managing present day weather extremes can help us anticipate the consequences of future climate variability and change". This presentation illustrates how IMPREX is building the link between the providers and users of information and services addressing both the weather and climate timescales. For different stakeholders in key economic sectors the needs and vulnerabilities in their daily practice are discussed, followed by an analysis of how weather and climate (W&C) services could contribute to the demands that arise from this. Examples of case studies showing the relevance of the tailored W&C information in users' operations will be included.

  14. 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

  15. Gender, Education, Extremism and Security

    Science.gov (United States)

    Davies, Lynn

    2008-01-01

    This paper examines the complex relationships between gender, education, extremism and security. After defining extremism and fundamentalism, it looks first at the relationship of gender to violence generally, before looking specifically at how this plays out in more extremist violence and terrorism. Religious fundamentalism is also shown to have…

  16. Grassland responses to precipitation extremes

    Science.gov (United States)

    Grassland ecosystems are naturally subjected to periods of prolonged drought and sequences of wet years. Climate change is expected to enhance the magnitude and frequency of extreme events at the intraannual and multiyear scales. Are grassland responses to extreme precipitation simply a response to ...

  17. Modeling extreme risks in ecology.

    Science.gov (United States)

    Burgman, Mark; Franklin, James; Hayes, Keith R; Hosack, Geoffrey R; Peters, Gareth W; Sisson, Scott A

    2012-11-01

    Extreme risks in ecology are typified by circumstances in which data are sporadic or unavailable, understanding is poor, and decisions are urgently needed. Expert judgments are pervasive and disagreements among experts are commonplace. We outline approaches to evaluating extreme risks in ecology that rely on stochastic simulation, with a particular focus on methods to evaluate the likelihood of extinction and quasi-extinction of threatened species, and the likelihood of establishment and spread of invasive pests. We evaluate the importance of assumptions in these assessments and the potential of some new approaches to account for these uncertainties, including hierarchical estimation procedures and generalized extreme value distributions. We conclude by examining the treatment of consequences in extreme risk analysis in ecology and how expert judgment may better be harnessed to evaluate extreme risks.

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

    Science.gov (United States)

    Yeh, Pin-Hung; Hsu, Po-Kai

    2016-04-01

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

  19. Patients with Haemoglobinopathies and Chronic Hepatitis C: A Real Difficult to Treat Population in 2016?

    Science.gov (United States)

    Zachou, Kalliopi; Arvaniti, Pinelopi; Gatselis, Nikolaos K; Azariadis, Kalliopi; Papadamou, Georgia; Rigopoulou, Eirini; Dalekos, George N

    2017-01-01

    In the past, patients with haemoglobinopathies were at high risk of acquiring hepatitis C virus (HCV) due to multiple transfusions before HCV screening. In these patients, the coexistence of haemochromatosis and chronic hepatitis C (CHC) often leads to more severe liver disease. We assessed the HCV prevalence, clinical characteristics and outcome in this setting with particular attention to the response to treatment including therapies with the new direct acting antivirals (DAAs). The medical records of 81 consecutive patients followed the last 15 years were reviewed retrospectively. 43/81 (53%) patients were anti-HCV positive including 31/43 (72.1%) with CHC (HCV-RNA positive; age 25±7 years; 45.2% with genotype 1b; 19.4% cirrhotics; baseline ferritin 887 ng/ml; range: 81-10.820). Thirty patients received IFN-based therapy with or without ribavirin with sustained virological response (SVR) in 14/30 (46.7%). Eleven patients (9 non-responders to IFN-based therapies, one in relapse and one naïve) received treatment with DAAs (SVR: 100%). 3/11 patients increased their transfusion needs while 1/11 reported mild arthralgias. No drug-drug interactions between DAAs and chelation agents were observed as attested by the stability of ferritin levels during treatment. More than 1/3 of patients with haemoglobinopathies suffered from CHC. Response rates to IFN-based treatment seem to be similar to other patients with CHC, while most importantly, treatment with DAAs was excellent and safe even in difficult to treat patients (most null responders with severe fibrosis) suggesting that this group of HCV patients should no longer be regarded as a difficult to treat.

  20. PATIENTS WITH HAEMOGLOBINOPATHIES AND CHRONIC HEPATITIS C: A REALLY DIFFICULT TO TREAT POPULATION IN 2016?

    Directory of Open Access Journals (Sweden)

    Kalliopi Zachou

    2017-01-01

    Full Text Available Background & objectives: In the past, patients with haemoglobinopathies were at high risk for acquiring hepatitis C virus (HCV due to multiple transfusions before HCV screening. In these patients the coexistence of haemochromatosis and chronic hepatitis C (CHC often leads to more severe liver disease. We assessed the HCV prevalence, clinical characteristics and outcome in this setting with particular attention to the response to treatment including therapies with the new direct acting antivirals (DAAs. Methods: The medical records of 81 consecutive patients followed the last 15 years were reviewed retrospectively. Results: 43/81 (53% patients were anti-HCV positive including 31/43 (72.1% with CHC (HCV-RNA positive; age 25±7 years; 45.2% with genotype 1b; 19.4% cirrhotics; baseline ferritin 887 ng/ml; range: 81-10.820.  Thirty patients received IFN-based therapy with or without ribavirin with sustained virological response (SVR in 14/30 (46.7%.   Eleven patients (9 non-responders to IFN-based therapies, 1 relapser and 1 naïve received treatment with DAAs (SVR: 100%. 3/11 patients increased their transfusion needs while 1/11 reported mild arthralgias. No drug-drug interactions between DAAs and chelation agents were observed as attested by the stability of ferritin levels during treatment.  Conclusions: More than 1/3 of patients with haemoglobinopathies suffered from CHC. Response rates to antiviral treatment seem to be similar to other patients with CHC, while treatment with DAAs was very effective and safe even in difficult to treat patients (most null responders with severe fibrosis suggesting that this group of HCV patients should no longer be regarded as a difficult to treat.

  1. Synchronous papillary urothelial carcinoma of urinary bladder and adenocarcinoma of stomach in a middle-aged man: An extremely rare association with therapeutic dilemma

    Directory of Open Access Journals (Sweden)

    Dodul Mondal

    2013-01-01

    Full Text Available Synchronous occurrence of urinary bladder carcinoma and gastric carcinoma is very rare. A middle-aged Asian man presented with complaints of hematuria which was diagnosed due to muscle invasive papillary urothelial carcinoma of urinary bladder. Metastatic work-up revealed simultaneous presence of locally advanced gastric adenocarcinoma. He was treated with TURBT for the bladder cancer and was planned for radical gastric resection followed by radiation to urinary bladder and stomach with concurrent chemotherapy. However, due to very advanced nature of the gastric tumor patient was treated only with palliative gastric resection followed by palliative radiation to both urinary bladder and stomach due to his poor performance status. Lack of published English literature and evidence related to such clinical entity made this an extremely rare clinical entity and treatment decision difficult.

  2. Microhabitats reduce animal's exposure to climate extremes.

    Science.gov (United States)

    Scheffers, Brett R; Edwards, David P; Diesmos, Arvin; Williams, Stephen E; Evans, Theodore A

    2014-02-01

    Extreme weather events, such as unusually hot or dry conditions, can cause death by exceeding physiological limits, and so cause loss of population. Survival will depend on whether or not susceptible organisms can find refuges that buffer extreme conditions. Microhabitats offer different microclimates to those found within the wider ecosystem, but do these microhabitats effectively buffer extreme climate events relative to the physiological requirements of the animals that frequent them? We collected temperature data from four common microhabitats (soil, tree holes, epiphytes, and vegetation) located from the ground to canopy in primary rainforests in the Philippines. Ambient temperatures were monitored from outside of each microhabitat and from the upper forest canopy, which represent our macrohabitat controls. We measured the critical thermal maxima (CTmax ) of frog and lizard species, which are thermally sensitive and inhabit our microhabitats. Microhabitats reduced mean temperature by 1-2 °C and reduced the duration of extreme temperature exposure by 14-31 times. Microhabitat temperatures were below the CTmax of inhabitant frogs and lizards, whereas macrohabitats consistently contained lethal temperatures. Microhabitat temperatures increased by 0.11-0.66 °C for every 1 °C increase in macrohabitat temperature, and this nonuniformity in temperature change influenced our forecasts of vulnerability for animal communities under climate change. Assuming uniform increases of 6 °C, microhabitats decreased the vulnerability of communities by up to 32-fold, whereas under nonuniform increases of 0.66 to 3.96 °C, microhabitats decreased the vulnerability of communities by up to 108-fold. Microhabitats have extraordinary potential to buffer climate and likely reduce mortality during extreme climate events. These results suggest that predicted changes in distribution due to mortality and habitat shifts that are derived from macroclimatic samples and that assume

  3. 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

  4. Difficult Children

    DEFF Research Database (Denmark)

    Christensen, Else

    The purpose of this paper is to put focus on families and children who have had contact to the social service department because of problems related children’s well-being, health or development. Problems that are recognized by the families themselves and by the authorities as problems that put...... the family in a poor position regarding the children’s well-being, health and development, but not so severe that the child is to be placed out of home. The paper concentrates attention on differences between families with and without contact to the social service department for reasons related to the child....... Especially on children and their development in social relations to children at the same age, on how the mothers experience their child and on the parent’s resources concerning health, education and job situation. The paper presents results from the first two data collections (1996 and 1999) in a prospective...

  5. Difficult Children

    DEFF Research Database (Denmark)

    Christensen, Else

    The purpose of this paper is to put focus on families and children who have had contact to the social service department because of problems related children’s well-being, health or development. Problems that are recognized by the families themselves and by the authorities as problems that put...... the family in a poor position regarding the children’s well-being, health and development, but not so severe that the child is to be placed out of home. The paper concentrates attention on differences between families with and without contact to the social service department for reasons related to the child....... Especially on children and their development in social relations to children at the same age, on how the mothers experience their child and on the parent’s resources concerning health, education and job situation. The paper presents results from the first two data collections (1996 and 1999) in a prospective...

  6. A modified technique for Gore Excluder limb deployment in difficult iliac anatomy during endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Vourliotakis, George; Katsargyris, Αthanasios; Tielliu, Ignace F J; Zeebregts, Clark J; Verhoeven, Eric L G

    2015-02-01

    Complex iliac anatomy including extreme tortuosity constitutes a relative contraindication for endovascular abdominal aortic aneurysm repair with additional risk of limb-graft occlusion. The Gore Excluder limb-graft is a flexible stent-graft, which adapts easily to iliac tortuosity. Nevertheless, the presence of the stiff guide wire does not always allow for an ideal apposition of the stent graft to the angulated common iliac artery vessel wall. We describe herein a modified technique for Gore Excluder limb-graft deployment with partial removal of the stiff wire in cases with difficult tortuous or narrow iliac arteries during endovascular abdominal aortic aneurysm repair. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  7. Due process traditionalism.

    Science.gov (United States)

    Sunstein, Cass R

    2008-06-01

    In important cases, the Supreme Court has limited the scope of "substantive due process" by reference to tradition, but it has yet to explain why it has done so. Due process traditionalism might be defended in several distinctive ways. The most ambitious defense draws on a set of ideas associated with Edmund Burke and Friedrich Hayek, who suggested that traditions have special credentials by virtue of their acceptance by many minds. But this defense runs into three problems. Those who have participated in a tradition may not have accepted any relevant proposition; they might suffer from a systematic bias; and they might have joined a cascade. An alternative defense sees due process traditionalism as a second-best substitute for two preferable alternatives: a purely procedural approach to the Due Process Clause, and an approach that gives legislatures the benefit of every reasonable doubt. But it is not clear that in these domains, the first-best approaches are especially attractive; and even if they are, the second-best may be an unacceptably crude substitute. The most plausible defense of due process traditionalism operates on rule-consequentialist grounds, with the suggestion that even if traditions are not great, they are often good, and judges do best if they defer to traditions rather than attempting to specify the content of "liberty" on their own. But the rule-consequentialist defense depends on controversial and probably false assumptions about the likely goodness of traditions and the institutional incapacities of judges.

  8. 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.

  9. Kidney Failure Due to Abdominal Compartment Syndrome Following Snakebite.

    Science.gov (United States)

    Jalalzadeh, Mojgan; Ghadiani, Mohammad Hassan

    2017-01-01

    Treatment of snakebite complications is challenging, as it is difficult to distinguish what kind of antivenins should be used. Kidney failure as a result of rhabdomyolysis or hemolysis may happen due to accumulated fluids that increase the pressure in the abdomen. This case report describes acute kidney failure probably due to intra-abdominal hypertension following an unknown bite.

  10. 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.

  11. Onycholysis due to trauma

    Directory of Open Access Journals (Sweden)

    Patricia Chang

    2014-04-01

    Full Text Available Female patient, 35 years old who came to the private office due to discoloration of her left thumbnail and little pain since 1 month ago. Clinical examination shows nail disease on her left thumbnail with onycholysis and dyschromia, dermatoscopy showed white-yellowish discoloration (Fig. 1A, B. The rest of the clinical examination was normal. Patient use to using acrylic nails since 2 years ago and denied some trauma at the nail. The diagnosis of onycholysis due to trauma was done and recommended her not to use acrylic nail, maintain the nail short and avoid wetness.

  12. Technical Due Diligence

    DEFF Research Database (Denmark)

    Jensen, Per Anker; Varano, Mattia

    2011-01-01

    Technical Due Diligence (TDD) as an evaluation of the performance of constructed facilities has become an important new field of practice for consultants. Before the financial crisis started in autumn 2008 it represented the fastest growing activity in some consulting companies. TDD is mostly car...

  13. [Case of abdominal wall malignant peripheral nerve sheath tumor which is difficult to distinguish from a urachal disease].

    Science.gov (United States)

    Tatenuma, Tomoyuki; Sakata, Ryoko; Sugiura, Shinpei; Tajiri, Takehiro; Gondo, Toshikazu; Kitami, Kazuo

    2013-09-01

    Malignant peripheral nerve sheath tumors (MPNST) are highly malignant soft tissue sarcomas. It is very rare for MPNST to arise in the abdominal wall. We report a case of abdominal wall MPNST that was difficult to distinguish from a urachal disease. A 72-year-old woman found a mass of the umbilicus in October 2011. She visited a digestive surgery department in November because it gradually enlarged. Diagnostic imaging suggested a urachal tumor. She was then referred to our clinic. Contrast enhanced CT showed that the 5-cm cystic tumor extended from the umbilicus to abdominal wall. The tumor showed low uptake value in PET-CT. We diagnosed her with a urachal cyst, but could not deny urachal carcinoma. Therefore, we performed surgical resection in January 2012. The pathological diagnosis was MPNST. She has not experienced recurrence for 9 months. MPNST mostly occur in the retroperitoneum close to the spine, extremities, head, and neck. It is very rare for them to occur in the abdominal wall. This is the sixth case including overseas reports. In addition, this is the first case in which it was difficult to distinguish from a urachal disease.

  14. 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.

  15. 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)

  16. Traumatic extremity arterial injury in children: Epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score

    OpenAIRE

    Lange Nadine; Khaladj Nawid; Frink Michael; Hildebrand Frank; Zeckey Christian; Mommsen Philipp; Krettek Christian; Probst Christian

    2010-01-01

    Abstract Background Traumatic paediatric arterial injuries are a great challenge due to low incidence and specific characteristics of paediatric anatomy and physiology. The aim of the present study was to investigate their epidemiology, diagnostic and therapeutic options and complications. Furthermore, the prognostic value of the Mangled Extremity Severity Score (MESS) was evaluated. Methods In a retrospective clinical study 44 children aged 9.0 ± 3.2 years treated for traumatic extremity art...

  17. Extreme hypertriglyceridemia managed with insulin.

    Science.gov (United States)

    Thuzar, Moe; Shenoy, Vasant V; Malabu, Usman H; Schrale, Ryan; Sangla, Kunwarjit S

    2014-01-01

    Extreme hypertriglyceridemia can lead to acute pancreatitis and rapid lowering of serum triglycerides (TG) is necessary for preventing such life-threatening complications. However, there is no established consensus on the acute management of extreme hypertriglyceridemia. We retrospectively reviewed 10 cases of extreme hypertriglyceridemia with mean serum TG on presentation of 101.5 ± 23.4 mmol/L (8982 ± 2070 mg/dL) managed with insulin. Serum TG decreased by 87 ± 4% in 24 hours in those patients managed with intravenous insulin and fasting and 40 ± 8.4% in those managed with intravenous insulin alone (P = .0003). The clinical course was uncomplicated in all except 1 patient who subsequently developed a pancreatic pseudocyst. Thus, combination of intravenous insulin with fasting appears to be an effective, simple, and safe treatment strategy in immediate management of extreme hypertriglyceridemia. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  18. Moment methods in extremal geometry

    NARCIS (Netherlands)

    De Laat, D.

    2016-01-01

    In this thesis we develop techniques for solving problems in extremal geometry. We give an infinite dimensional generalization of moment techniques from polynomial optimization. We use this to construct semidefinite programming hierarchies for approximating optimal packing densities and ground state

  19. Moment methods in extremal geometry

    NARCIS (Netherlands)

    De Laat, D.

    2016-01-01

    In this thesis we develop techniques for solving problems in extremal geometry. We give an infinite dimensional generalization of moment techniques from polynomial optimization. We use this to construct semidefinite programming hierarchies for approximating optimal packing densities and ground state

  20. 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....

  1. Managing Difficult Patients: Roles of Psychologists in the Age of Interdisciplinary Care.

    Science.gov (United States)

    Robiner, William N; Petrik, Megan L

    2017-03-01

    Various problems can occur during encounters between health providers and patients. In some instances, clinicians attribute these problems to patients being "difficult." However, clinicians' perception of difficulties in the clinical encounter are also influenced by: clinicians' own attitudes, thoughts, and behavior; the specific setting in which patient and clinician interact; and properties of the healthcare organization in which they are embedded. This article explores how psychologists in medical settings can serve as a resource that: improves patient care for difficult patients; supports provider wellness; provides relevant education to clinical providers; and reduces the stress that difficult patients place on the healthcare system. The definition, scope, and impact of difficult patients in healthcare settings are reviewed, including an examination of patient, clinician, and systems factors that contribute to the etiology of difficult clinical encounters. Strategies are discussed that may prevent or limit the adverse impact of difficult patients in healthcare, with special emphasis on the roles of psychologists in interprofessional healthcare teams.

  2. 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...

  3. Deformations of extremal toric manifolds

    CERN Document Server

    Rollin, Yann

    2012-01-01

    Let $X$ be a compact toric extremal K\\"ahler manifold. Using the work of Sz\\'ekelyhidi, we provide a simple criterion on the fan describing $X$ to ensure the existence of complex deformations of $X$ that carry extremal metrics. As an example, we find new CSC metrics on 4-points blow-ups of $\\C\\P^1\\times\\C\\P^1$.

  4. Large Extremity Peripheral Nerve Repair

    Science.gov (United States)

    2015-10-01

    IL, Kochevar IE, Redmond RW. Large extremity peripheral nerve repair. Military Health System Research Symposium (MHSRS) Fort Lauderdale, FL. August...some notable discoveries that may impact military health care in the near future. There is a clear need in military medicine to improve outcomes in...membranes or “caul” intact was considered extremely lucky. Children were gifted with life-long happiness , the ability to see spirits, and protection

  5. Observed Statistics of Extreme Waves

    Science.gov (United States)

    2006-12-01

    9 Figure 5. An energy stealing wave as a solution to the NLS equation . (From: Dysthe and...shown that nonlinear interaction between four colliding waves can produce extreme wave behavior. He utilized the NLS equation in his numerical ...2000) demonstrated the formation of extreme waves using the Korteweg de Vries ( KdV ) equation , which is valid in shallow water. It was shown in the

  6. Weather Extremes Around the World

    Science.gov (United States)

    1974-04-01

    or ever has occurred. According to M. A. Arkin, "... record extremes must be taken with a grain of salt .... Ř He explains that news of an extreme...the edge of the Danakil Depression, a salt desert. By averaging the annual mean daily maximum temperature of 106°F36 atid the annual mean daily...increased by orographic lifting.1" Asa result of these monsoon disturbances, which are still not fully understood, the eastern Himalayan 105 106

  7. Using participatory agent-based models to measure flood managers' decision thresholds in extreme event response

    Science.gov (United States)

    Metzger, A.; Douglass, E.; Gray, S. G.

    2016-12-01

    Extreme flooding impacts to coastal cities are not only a function of storm characteristics, but are heavily influenced by decision-making and preparedness in event-level response. While recent advances in climate and hydrological modeling make it possible to predict the influence of climate change on storm and flooding patterns, flood managers still face a great deal of uncertainty related to adapting organizational responses and decision thresholds to these changing conditions. Some decision thresholds related to mitigation of extreme flood impacts are well-understood and defined by organizational protocol, but others are difficult to quantify due to reliance on contextual expert knowledge, experience, and complexity of information necessary to make certain decisions. Our research attempts to address this issue by demonstrating participatory modeling methods designed to help flood managers (1) better understand and parameterize local decision thresholds in extreme flood management situations, (2) collectively learn about scaling management decision thresholds to future local flooding scenarios and (3) identify effective strategies for adaptating flood mitigation actions and organizational response to climate change-intensified flooding. Our agent-based system dynamic models rely on expert knowledge from local flood managers and sophisticated, climate change-informed hydrological models to simulate current and future flood scenarios. Local flood managers from interact with these models by receiving dynamic information and making management decisions as a flood scenario progresses, allowing parametrization of decision thresholds under different scenarios. Flooding impacts are calculated in each iteration as a means of discussing effectiveness of responses and prioritizing response alternatives. We discuss the findings of this participatory modeling and educational process from a case study of Boston, MA, and discuss transferability of these methods to other types

  8. Use of simple clinical predictors on preoperative diagnosis of difficult endotracheal intubation in obese patients.

    Science.gov (United States)

    Magalhães, Edno; Oliveira Marques, Felipe; Sousa Govêia, Cátia; Araújo Ladeira, Luis Cláudio; Lagares, Jader

    2013-01-01

    Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Alternatives for the diagnosis and prediction of difficult intubation in the preoperative period may help reduce anesthetic complications in obese patients. The aim of this study was to identify predictors for the diagnosis of difficult airway in obese patients, correlating with the clinical methods of pre-anesthetic evaluation and polysomnography. We also compared the incidence of difficult facemask ventilation and difficult laryngoscopy between obese and non-obese patients, identifying the most prevalent predictors. Observational, prospective and comparative study, with 88 adult patients undergoing general anesthesia. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome (OSAS) and anatomical parameters. During anesthesia, we evaluated difficult facemask ventilation and laryngoscopy. Descriptive statistics and correlation test were used for analysis. Patients were allocated into two groups: obese group (n=43) and non-obese group (n=45). Physical status, prevalence of snoring, hypertension, diabetes mellitus, neck circumference, and Mallampati index were higher in the obese group. Obese patients had a higher incidence of difficult facemask ventilation and laryngoscopy. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups. In obese patients, the diagnosis of OSAS showed strong correlation with difficult laryngoscopy. The clinical and polysomnographic diagnosis of OSA proved useful in the preoperative diagnosis of difficult laryngoscopy. Obese patients are more prone to difficult facemask ventilation and laryngoscopy. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  9. In-Situ Micromechanical Testing in Extreme Environments

    Science.gov (United States)

    Lupinacci, Amanda Sofia

    In order to design engineering applications that can withstand extreme environments, we must first understand the underlying deformation mechanisms that can hinder material performance. It is not enough to characterize the mechanical properties alone, we must also characterize the microstructural changes as well so that we can understand the origin of material degradation. This dissertation focuses on two different extreme environments. The first environment is the cryogenic environment, where we focus on the deformation behavior of solder below the ductile to brittle transition temperature (DBTT). The second environment is the irradiated environment, where we focus on the effects that ion beam irradiation has on both the mechanical properties and microstructure of 304 stainless steel. Both classes of materials and testing environments utilize novel in situ micromechanical testing techniques inside a scanning electron microscope which enhances our ability to link the observed deformation behavior with its associated mechanical response. Characterizing plasticity mechanisms below the DBTT is traditionally difficult to accomplish in a systematic fashion. Here, we use a new experimental setup to perform in situ cryogenic mechanical testing of pure Sn micropillars at room temperature and at -142 °C. Subsequent electron microscopy characterization of the micropillars shows a clear difference in the deformation mechanisms at room temperature and at cryogenic temperatures. At room temperature, the Sn micropillars deformed through dislocation plasticity while at -142 °C they exhibited both higher strength and deformation twinning. Two different orientations were tested, a symmetric (100) orientation and a non-symmetric (45¯1) orientation. The deformation mechanisms were found to be the same for both orientations. This approach was also extended to a more complex solder alloy that is commonly used in industry, Sn96. In the case of the solder alloy more complex geometries

  10. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).

    Science.gov (United States)

    Mills, Joseph L; Conte, Michael S; Armstrong, David G; Pomposelli, Frank B; Schanzer, Andres; Sidawy, Anton N; Andros, George

    2014-01-01

    Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population.

  11. Irrigation mitigates against heat extremes

    Science.gov (United States)

    Thiery, Wim; Fischer, Erich; Visser, Auke; Hirsch, Annette L.; Davin, Edouard L.; Lawrence, Dave; Hauser, Mathias; Seneviratne, Sonia I.

    2017-04-01

    Irrigation is an essential practice for sustaining global food production and many regional economies. Emerging scientific evidence indicates that irrigation substantially affects mean climate conditions in different regions of the world. Yet how this practice influences climate extremes is currently unknown. Here we use gridded observations and ensemble simulations with the Community Earth System Model to assess the impacts of irrigation on climate extremes. While the influence of irrigation on annual mean temperatures is limited, we find a large impact on temperature extremes, with a particularly strong cooling during the hottest day of the year (-0.78 K averaged over irrigated land). The strong influence on hot extremes stems from the timing of irrigation and its influence on land-atmosphere coupling strength. Together these effects result in asymmetric temperature responses, with a more pronounced cooling during hot and/or dry periods. The influence of irrigation is even more pronounced when considering subgrid-scale model output, suggesting that local effects of land management are far more important than previously thought. Finally we find that present-day irrigation is partly masking GHG-induced warming of extreme temperatures, with particularly strong effects in South Asia. Our results overall underline that irrigation substantially reduces our exposure to hot temperature extremes and highlight the need to account for irrigation in future climate projections.

  12. Complications of extremity vascular injuries in conflict.

    Science.gov (United States)

    Brown, Kate V; Ramasamy, Arul; Tai, Nigel; MacLeod, Judith; Midwinter, Mark; Clasper, Jon C

    2009-04-01

    The extremities remain the most common sites of wounding in conflict, are associated with a significant incidence of vascular trauma, and have a high complication rate (infection, secondary amputation, and graft thrombosis). The purpose of this study was to study the complication rate after extremity vascular injury. In particular, the aim was to analyze whether this was influenced by the presence or absence of a bony injury. A prospectively maintained trauma registry was retrospectively reviewed for all UK military casualties with extremity injuries (Abbreviated Injury Score >1) December 8, 2003 to May 12, 2008. Demographics and the details of their vascular injuries, management, and outcome were documented using the trauma audit and medical notes. Thirty-four patients (34%)--37 limbs (30%)--had sustained a total of 38 vascular injuries. Twenty-eight limbs (22.6%) had an associated fracture, 9 (7.3%) did not. Twenty-nine limbs (23.4%) required immediate revascularization to preserve their limb: 16 limbs (13%) underwent an initial Damage Control procedure, and 13 limbs (10.5%) underwent Definitive Surgery. Overall, there were 25 limbs (20.2%) with complications. Twenty-two were in the 28 limbs with open fractures, 3 were in the 9 limbs without a fracture (p vascular trauma if there is an associated fracture, probably due to higher energy transfer and greater tissue damage.

  13. Overview of extremity arterial trauma in Jordan.

    Science.gov (United States)

    Heis, H A; Bani-Hani, K E; Elheis, M A

    2008-12-01

    The objectives of this study were to review etiologies of trauma, associated injuries, diagnosis, management, and outcomes of patients with vascular injuries in the extremities and relate factors in their treatment to the outcome of the injured extremity. Data were collected retrospectively on 73 patients diagnosed to have upper and lower limbs arterial injuries at King Abdullah University Hospital, Jordan, between 2001 and 2006. Factors evaluated included demographic data, location of vessels injured, mechanism of injury, associated injuries, treatment, and outcome. Patients were predominantly males (54 patients). Isolated vascular trauma was present in 36 patients, while in the remaining 37 patients vascular trauma was aggravated by concomitant injuries. The most common etiology of vascular injuries in the upper and lower extremities was a penetrating injury found in 38 patients (52%). The vessels most commonly involved were the femoral and brachial arteries. Various associated injuries were identified mainly orthopedic in 21 patients (29%) and nerve injuries in 18 patients (25%). Autogenous vein graft interposition was mostly performed in 32 patients (44%). Permanent disability was seen in 8 patients (11%), limb amputation was performed in 5 patients (7%). Five patients died due to associated intraabdominal, thoracic, and head injuries giving a mortality rate of 7%. Delay in surgery, blunt trauma and extensive soft tissue defect in combined orthopedic and vascular injuries were associated with increased risk of amputation, while associated nerve injuries and bone injuries with extensive soft tissue damage are risk factors of poor quality outcome.

  14. Converter-controlled belt conveyor systems under the difficult conditions; Umrichtergesteuerte Bandanlagen unter schwierigen Bedingungen

    Energy Technology Data Exchange (ETDEWEB)

    Horz, Michael-Josef [RAG Deutsche Steinkohle, Herne (Germany). Abt. Elektrotechnik unter Tage; Mueller, Uwe [RAG Deutsche Steinkohle, Herne (Germany). Servicebereich Technik- und Logistikdienste

    2010-05-15

    Panel 572 is located at a depth of 1,200 m in the Girondelle seam at the West mine. The panel has a mean thickness of 2.5 m and is designed as a shearer loader face with a length of 460 m. Coal is conveyed to the shaft by six belts with a total length of about 6 km and a total lifting height of 396 m. The main conveyor belt 1 with an installed power of 3 MW links the panel to a bunker. Conveyor belts 2 to 4 each with 500 kW drive power have operated in a stable manner since the start of working of the panel. Due to in-seam drivage with a selective-cut machine of type AM 85 an area with a marked trough was produced in the coal conveyor road. This area is traversed by belt 5. The planning and control of the conveyor belt in this difficult geological environment impose high demands on drive and control technology. To ensure stable operation under different loads a raft of measures was resolved and implemented. The contribution examines the problem and describes the implemented measures in detail. (orig.)

  15. HIGH PERFORMANCE TAPS FOR CUTTING THREADS IN DIFFICULT TO MACHINE MATERIALS

    Directory of Open Access Journals (Sweden)

    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

  16. Nonstationary modeling of extreme precipitation in China

    Science.gov (United States)

    Gao, Meng; Mo, Dingyuan; Wu, Xiaoqing

    2016-12-01

    The statistical methods based on extreme value theory have been traditionally used in meteorology and hydrology for a long time. Due to climate change and variability, the hypothesis of stationarity in meteorological or hydrological time series was usually not satisfied. In this paper, a nonstationary extreme value analysis was conducted for annual maximum daily precipitation (AMP) at 631 meteorological stations over China for the period 1951-2013. Stationarity of all 631 AMP time series was firstly tested using KPSS test method, and only 48 AMP time series showed non-stationarity at 5% significance level. The trends of these 48 nonstationary AMP time series were further tested using M-K test method. There were 25 nonstationary AMP time series mainly distributed in southern and western China showing significant positive trend at 5% level. Another 5 nonstationary AMP time series with significant negative trends were near northern urban agglomeration, Sichuan Basin, and central China. For these nonstationary AMP time series with significant positive or negative trends, the location parameter in generalized extreme value (GEV) distribution was assumed to be time-varying, and the trends were successfully characterized by the nonstationary GEV models. For the remaining 18 nonstationary AMP time series mainly in the eastern portion of China, no significant trend was detected. The correlation analysis showed that only 5 nonstationary AMP time series were significantly correlated with one or two of the four climate indices EASMI, WPI, SOI, and PDO. Then, the location and scale parameters in the GEV distribution were modeled as functions of the significantly correlated climate indices. The modeling results in this study showed that the nonstationary GEV distributions performed better than their stationary equivalents. Finally, 20-year and 50-year return levels of precipitation extremes at all 631 stations were estimated using the best fitting distribution for the year 1961

  17. A comparative assessment of statistical methods for extreme weather analysis

    Science.gov (United States)

    Schlögl, Matthias; Laaha, Gregor

    2017-04-01

    Extreme weather exposure assessment is of major importance for scientists and practitioners alike. We compare different extreme value approaches and fitting methods with respect to their value for assessing extreme precipitation and temperature impacts. Based on an Austrian data set from 25 meteorological stations representing diverse meteorological conditions, we assess the added value of partial duration series over the standardly used annual maxima series in order to give recommendations for performing extreme value statistics of meteorological hazards. Results show the merits of the robust L-moment estimation, which yielded better results than maximum likelihood estimation in 62 % of all cases. At the same time, results question the general assumption of the threshold excess approach (employing partial duration series, PDS) being superior to the block maxima approach (employing annual maxima series, AMS) due to information gain. For low return periods (non-extreme events) the PDS approach tends to overestimate return levels as compared to the AMS approach, whereas an opposite behavior was found for high return levels (extreme events). In extreme cases, an inappropriate threshold was shown to lead to considerable biases that may outperform the possible gain of information from including additional extreme events by far. This effect was neither visible from the square-root criterion, nor from standardly used graphical diagnosis (mean residual life plot), but from a direct comparison of AMS and PDS in synoptic quantile plots. We therefore recommend performing AMS and PDS approaches simultaneously in order to select the best suited approach. This will make the analyses more robust, in cases where threshold selection and dependency introduces biases to the PDS approach, but also in cases where the AMS contains non-extreme events that may introduce similar biases. For assessing the performance of extreme events we recommend conditional performance measures that focus

  18. 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

  19. On the Probability of Occurrence of Extreme Space Weather Events

    Science.gov (United States)

    Riley, Pete

    2012-01-01

    By virtue of their rarity, extreme space weather events, such as the Carrington event of 1859, are difficult to study, their rates of occurrence are difficult to estimate, and prediction of a specific future event is virtually impossible. Additionally, events may be extreme relative to one parameter but normal relative to others. In this study, we analyze several measures of the severity of space weather events (flare intensity, coronal mass ejection speeds, Dst, and greater than 30 MeV proton fluences as inferred from nitrate records) to estimate the probability of occurrence of extreme events. By showing that the frequency of occurrence scales as an inverse power of the severity of the event, and assuming that this relationship holds at higher magnitudes, we are able to estimate the probability that an event larger than some criteria will occur within a certain interval of time in the future. For example, the probability of another Carrington event (based on Dst less than - 850 nT) occurring within the next decade is approximately 12%. We also identify and address several limitations with this approach. In particular, we assume time stationarity, and thus, the effects of long-term space climate change are not considered. While this technique cannot be used to predict specific events, it may ultimately be useful for probabilistic forecasting.

  20. On the Probability of Occurrence of Extreme Space Weather Events

    Science.gov (United States)

    Riley, Pete

    2012-01-01

    By virtue of their rarity, extreme space weather events, such as the Carrington event of 1859, are difficult to study, their rates of occurrence are difficult to estimate, and prediction of a specific future event is virtually impossible. Additionally, events may be extreme relative to one parameter but normal relative to others. In this study, we analyze several measures of the severity of space weather events (flare intensity, coronal mass ejection speeds, Dst, and greater than 30 MeV proton fluences as inferred from nitrate records) to estimate the probability of occurrence of extreme events. By showing that the frequency of occurrence scales as an inverse power of the severity of the event, and assuming that this relationship holds at higher magnitudes, we are able to estimate the probability that an event larger than some criteria will occur within a certain interval of time in the future. For example, the probability of another Carrington event (based on Dst less than - 850 nT) occurring within the next decade is approximately 12%. We also identify and address several limitations with this approach. In particular, we assume time stationarity, and thus, the effects of long-term space climate change are not considered. While this technique cannot be used to predict specific events, it may ultimately be useful for probabilistic forecasting.

  1. A technique for re-utilizing catheter insertion sites in children with difficult central venous access.

    Science.gov (United States)

    Johnson, S M; Garnett, G M; Woo, R K

    2017-01-01

    Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down." A separate exit site is then created for the new catheter and it is tunneled to the "cut-down" site per routine. The non-functioning catheter is then removed from the surgical field. The proximal fibrous sheath is finally cannulated either directly with the new catheter or with a wire/dilator system. This technique effectively re-uses the same venous access point while allowing for a complete change of the physical line and external site. Twenty attempts at this technique were made in twelve patients; six patients underwent the site re-utilization procedure multiple times. Re-using the fibrous tunnel to re-cycle the internal catheter site was successful in seventeen of twenty attempts. All patients had chronic conditions leading to difficult long-term central venous access [short bowel syndrome (6), hemophilia (2), cystic fibrosis (1), chronic need for central IV access (3)]. Indications for catheter replacement included catheter occlusion/mechanical failure/breakage (9), dislodgement (6), infection (1), and inadequate catheter length due to patient growth (4). Broviac/Hickman catheter sites were most commonly re-used (13; one failure); re-using a portcath site was successful in 5 of 7 attempts. There were no short term infections or mechanical complications. We describe a novel technique for salvaging tunneled central venous catheter access sites. This technique is well suited

  2. Assessing Climate Variability using Extreme Rainfall and ...

    African Journals Online (AJOL)

    user1

    As noted by the Bureau of Meteorology, Canada, to examine whether such ... their local climate, a threshold considered extreme in one part of Australia could be ... (extreme frequency); the average intensity of rainfall from extreme events.

  3. Wind Turbine Extreme Gust Control. Recognition and Control of extreme operation gusts and wind direction changes

    Energy Technology Data Exchange (ETDEWEB)

    Kanev, S.K.; Van Engelen, T.G. [ECN Wind Energy, Petten (Netherlands)

    2008-10-15

    This report presents the research activities and achieved results on extreme event recognition (EER) and control (EEC). This work has been performed within the framework of WP3 of the SenterNovem project Sustainable Control (SusCon). An extreme wind gust with direction change can lead to large loads on the turbine (causing fatigue) and unnecessary turbine shut-downs by the supervisory system due to rotor overspeed. The proposed EER algorithm is based on a nonlinear observer (extended Kalman filter) that estimates the oblique wind inflow angle and the blade effective wind speed signals, which are then used by a detection algorithm (CUSUM test) to recognize extreme events. The nonlinear observer requires that blade root bending moments measurements (in-plane and out-of-plane) are available. Once an extreme event is detected, an EEC algorithm is activated that (1) tries to prevent the rotor speed from exceeding the overspeed limit by fast collective blade pitching, and (2) reduces 1p blade loads by means of individual pitch control algorithm, designed in an H1 optimal control setting. The method is demonstrated on a complex nonlinear test turbine model.

  4. Are hourly precipitation extremes increasing faster than daily precipitation extremes?

    Science.gov (United States)

    Barbero, Renaud; Fowler, Hayley; Blenkinsop, Stephen; Lenderink, Geert

    2016-04-01

    Extreme precipitation events appear to be increasing with climate change in many regions of the world, including the United States. These extreme events have large societal impacts, as seen during the recent Texas-Oklahoma flooding in May 2015 which caused several billion in damages and left 47 deaths in its path. Better understanding of past changes in the characteristics of extreme rainfall events is thus critical for reliable projections of future changes. Although it has been documented in several studies that daily precipitation extremes are increasing across parts of the contiguous United States, very few studies have looked at hourly extremes. However, this is of primary importance as recent studies on the temperature scaling of extreme precipitation have shown that increases above the Clausius-Clapeyron (~ 7% °C-1) are possible for hourly precipitation. In this study, we used hourly precipitation data (HPD) from the National Climatic Data Center and extracted more than 1,000 stations across the US with more than 40 years of data spanning the period 1950-2010. As hourly measurements are often associated with a range of issues, the data underwent multiple quality control processes to exclude erroneous data. While no significant changes were found in annual maximum precipitation using both hourly and daily resolution datasets, significant increasing trends in terms of frequency of episodes exceeding present-day 95th percentiles of wet hourly/daily precipitation were observed across a significant portion of the US. The fraction of stations with significant increasing trends falls outside the confidence interval range during all seasons but the summer. While less than 12% of stations exhibit significant trends at the daily scale in the wintertime, more than 45% of stations, mostly clustered in central and Northern United States, show significant increasing trends at the hourly scale. This suggests that short-duration storms have increased faster than daily

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

    OpenAIRE

    Culpepper, Larry

    2013-01-01

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

  6. Behavioral Problems in Children and Adolescents with Difficult-To-Treat Asthma

    NARCIS (Netherlands)

    Verkleij, Marieke; van de Griendt, Erik-Jonas; Kaptein, Ad A.; van Essen-Zandvliet, Liesbeth; Duiverman, Eric; Geenen, Rinie

    2011-01-01

    Background. The aim of this study was to quantify behavioral problems in clinically treated children and adolescents with asthma and to examine the association of these problems and quality of life with difficult-to-treat asthma. Methods. Clinical patients with difficult-to-treat asthma (n = 31) and

  7. The relationship between clinical outcomes and medication adherence in difficult-to-control asthma.

    Science.gov (United States)

    Murphy, Anna C; Proeschal, Amandine; Brightling, Christopher E; Wardlaw, Andrew J; Pavord, Ian; Bradding, Peter; Green, Ruth H

    2012-08-01

    Medication non-adherence and the clinical implications in difficult-to-control asthma were audited. Prescription issue data from 115 patients identified sub-optimal adherence (asthma (p=0.008). The majority of patients with difficult-to-control asthma are non-adherent with their asthma medication. Non-adherence is correlated with poor clinical outcomes.

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

    Science.gov (United States)

    Pandey, Jatin; Singh, Manjari

    2015-01-01

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

  9. 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…

  10. Rising Precipitation Extremes across Nepal

    Directory of Open Access Journals (Sweden)

    Ramchandra Karki

    2017-01-01

    Full Text Available As a mountainous country, Nepal is most susceptible to precipitation extremes and related hazards, including severe floods, landslides and droughts that cause huge losses of life and property, impact the Himalayan environment, and hinder the socioeconomic development of the country. Given that the countrywide assessment of such extremes is still lacking, we present a comprehensive picture of prevailing precipitation extremes observed across Nepal. First, we present the spatial distribution of daily extreme precipitation indices as defined by the Expert Team on Climate Change Detection, Monitoring and Indices (ETCCDMI from 210 stations over the period of 1981–2010. Then, we analyze the temporal changes in the computed extremes from 76 stations, featuring long-term continuous records for the period of 1970–2012, by applying a non-parametric Mann−Kendall test to identify the existence of a trend and Sen’s slope method to calculate the true magnitude of this trend. Further, the local trends in precipitation extremes have been tested for their field significance over the distinct physio-geographical regions of Nepal, such as the lowlands, middle mountains and hills and high mountains in the west (WL, WM and WH, respectively, and likewise, in central (CL, CM and CH and eastern (EL, EM and EH Nepal. Our results suggest that the spatial patterns of high-intensity precipitation extremes are quite different to that of annual or monsoonal precipitation. Lowlands (Terai and Siwaliks that feature relatively low precipitation and less wet days (rainy days are exposed to high-intensity precipitation extremes. Our trend analysis suggests that the pre-monsoonal precipitation is significantly increasing over the lowlands and CH, while monsoonal precipitation is increasing in WM and CH and decreasing in CM, CL and EL. On the other hand, post-monsoonal precipitation is significantly decreasing across all of Nepal while winter precipitation is decreasing

  11. Book review: Extreme ocean waves

    Science.gov (United States)

    Geist, Eric L.

    2017-01-01

    Extreme Ocean Waves”, edited by E. Pelinovsky and C. Kharif, second edition, Springer International Publishing, 2016; ISBN: 978-3-319-21574-7, ISBN (eBook): 978-3-319-21575-4The second edition of “Extreme Ocean Waves” published by Springer is an update of a collection of 12 papers edited by Efim Pelinovsky and Christian Kharif following the April 2007 meeting of the General Assembly of the European Geosciences Union. In this edition, three new papers have been added and three more have been substantially revised. Color figures are now included, which greatly aids in reading several of the papers, and is especially helpful in visualizing graphs as in the paper on symbolic computation of nonlinear wave resonance (Tobisch et al.). A note on terminology: extreme waves in this volume broadly encompass different types of waves, including deep-water and shallow-water rogue waves (which are alternatively termed freak waves), and internal waves. One new paper on tsunamis (Viroulet et al.) is now included in the second edition of this volume. Throughout the book, the reader will find a combination of laboratory, 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 a dramatic instance of damaging extreme waves that recently occurred in 2014.

  12. Extreme lattices: symmetries and decorrelation

    Science.gov (United States)

    Andreanov, A.; Scardicchio, A.; Torquato, S.

    2016-11-01

    We study statistical and structural properties of extreme lattices, which are the local minima in the density landscape of lattice sphere packings in d-dimensional Euclidean space {{{R}}d} . Specifically, we ascertain statistics of the densities and kissing numbers as well as the numbers of distinct symmetries of the packings for dimensions 8 through 13 using the stochastic Voronoi algorithm. The extreme lattices in a fixed dimension of space d (d≥slant 8 ) are dominated by typical lattices that have similar packing properties, such as packing densities and kissing numbers, while the best and the worst packers are in the long tails of the distribution of the extreme lattices. We also study the validity of the recently proposed decorrelation principle, which has important implications for sphere packings in general. The degree to which extreme-lattice packings decorrelate as well as how decorrelation is related to the packing density and symmetry of the lattices as the space dimension increases is also investigated. We find that the extreme lattices decorrelate with increasing dimension, while the least symmetric lattices decorrelate faster.

  13. 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.

  14. Pure dysarthria due to an insular infarction.

    Science.gov (United States)

    Hiraga, Akiyuki; Tanaka, Saiko; Kamitsukasa, Ikuo

    2010-06-01

    Cortical infarction presenting with pure dysarthria is rarely reported. Previous studies have reported pure dysarthria due to cortical stroke at the precentral gyrus or middle frontal gyrus. We report a 72-year-old man who developed pure dysarthria caused by an acute cortical infarction in the insular cortex. The role of the insula in language has been difficult to assess clinically because of the rarity of pure insular strokes. Our patient showed pure dysarthria without aphasia, indicating that pure dysarthria can be the sole manifestation of insular infarctions.

  15. Why Is It So Difficult to Gef Information in China?%Why Is It So Difficult to Gef Information in China?

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    You may reel contused and puzzled after living in China for some time as an expat, not only because of its 5000-yearoriental cult-tire and its very complicated language, but also, every day, you'll find it is always so difficult to get full infor- mation here. Why is that?

  16. Influence of extreme weather disasters on global crop production.

    Science.gov (United States)

    Lesk, Corey; Rowhani, Pedram; Ramankutty, Navin

    2016-01-07

    In recent years, several extreme weather disasters have partially or completely damaged regional crop production. While detailed regional accounts of the effects of extreme weather disasters exist, the global scale effects of droughts, floods and extreme temperature on crop production are yet to be quantified. Here we estimate for the first time, to our knowledge, national cereal production losses across the globe resulting from reported extreme weather disasters during 1964-2007. We show that droughts and extreme heat significantly reduced national cereal production by 9-10%, whereas our analysis could not identify an effect from floods and extreme cold in the national data. Analysing the underlying processes, we find that production losses due to droughts were associated with a reduction in both harvested area and yields, whereas extreme heat mainly decreased cereal yields. Furthermore, the results highlight ~7% greater production damage from more recent droughts and 8-11% more damage in developed countries than in developing ones. Our findings may help to guide agricultural priorities in international disaster risk reduction and adaptation efforts.

  17. Future increases in extreme precipitation exceed observed scaling rates

    Science.gov (United States)

    Bao, Jiawei; Sherwood, Steven C.; Alexander, Lisa V.; Evans, Jason P.

    2017-01-01

    Models and physical reasoning predict that extreme precipitation will increase in a warmer climate due to increased atmospheric humidity. Observational tests using regression analysis have reported a puzzling variety of apparent scaling rates including strong rates in midlatitude locations but weak or negative rates in the tropics. Here we analyse daily extreme precipitation events in several Australian cities to show that temporary local cooling associated with extreme events and associated synoptic conditions reduces these apparent scaling rates, especially in warmer climatic conditions. A regional climate projection ensemble for Australia, which implicitly includes these effects, accurately and robustly reproduces the observed apparent scaling throughout the continent for daily precipitation extremes. Projections from the same model show future daily extremes increasing at rates faster than those inferred from observed scaling. The strongest extremes (99.9th percentile events) scale significantly faster than near-surface water vapour, between 5.7-15% °C-1 depending on model details. This scaling rate is highly correlated with the change in water vapour, implying a trade-off between a more arid future climate or one with strong increases in extreme precipitation. These conclusions are likely to generalize to other regions.

  18. 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 < 0.05) with difficult laryngoscopy. Patients undergoing oromaxillofacial surgery and cardiac surgery showed a significantly higher rate of CML III/IV findings. The general incidence of difficult laryngoscopy in 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.

  19. Credit where due.

    Science.gov (United States)

    Friedman, Steven G

    2016-08-01

    The history of medicine is filled with stories of tireless researchers who failed to get credit for their hard work. Examples of this include Rosalind Franklin, who helped to elucidate the structure of DNA; Frederick Banting, who helped to discover insulin; and Jay McLean, who discovered heparin. The founding of the field of vascular surgery provides one of the most vivid examples of uncredited work. Even though Alexis Carrel was an unpaid, untitled assistant in Charles Guthrie's laboratory, it was Carrel alone who received a Nobel Prize for their work. In an attempt to give credit where due, the reasons for this injustice are described. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  20. Streamflow response to increasing precipitation extremes altered by forest management

    Science.gov (United States)

    Kelly, Charlene N.; McGuire, Kevin J.; Miniat, Chelcy Ford; Vose, James M.

    2016-04-01

    Increases in extreme precipitation events of floods and droughts are expected to occur worldwide. The increase in extreme events will result in changes in streamflow that are expected to affect water availability for human consumption and aquatic ecosystem function. We present an analysis that may greatly improve current streamflow models by quantifying the impact of the interaction between forest management and precipitation. We use daily long-term data from paired watersheds that have undergone forest harvest or species conversion. We find that interactive effects of climate change, represented by changes in observed precipitation trends, and forest management regime, significantly alter expected streamflow most often during extreme events, ranging from a decrease of 59% to an increase of 40% in streamflow, depending upon management. Our results suggest that vegetation might be managed to compensate for hydrologic responses due to climate change to help mitigate effects of extreme changes in precipitation.

  1. Functional metagenomics of extreme environments.

    Science.gov (United States)

    Mirete, Salvador; Morgante, Verónica; González-Pastor, José Eduardo

    2016-04-01

    The bioprospecting of enzymes that operate under extreme conditions is of particular interest for many biotechnological and industrial processes. Nevertheless, there is a considerable limitation to retrieve novel enzymes as only a small fraction of microorganisms derived from extreme environments can be cultured under standard laboratory conditions. Functional metagenomics has the advantage of not requiring the cultivation of microorganisms or previous sequence information to known genes, thus representing a valuable approach for mining enzymes with new features. In this review, we summarize studies showing how functional metagenomics was employed to retrieve genes encoding for proteins involved not only in molecular adaptation and resistance to extreme environmental conditions but also in other enzymatic activities of biotechnological interest.

  2. Mitochondriogenesis genes and extreme longevity.

    Science.gov (United States)

    Santiago, Catalina; Garatachea, Nuria; Yvert, Thomas; Rodríguez-Romo, Gabriel; Santos-Lozano, Alejandro; Fiuza-Luces, Carmen; Lucia, Alejandro

    2013-02-01

    Genes of the proliferator-activated receptor delta (PPARD)-peroxisome proliferator-activated receptor γ coactivator 1α (PPARGC1A, also termed PGC1-α)-nuclear respiratory factor (NRF)-mitochondrial transcription Factor A (TFAM) mitochondriogenesis pathway can influence health/disease phenotypes, yet their association with extreme longevity is not known. We studied the association of five common polymorphisms in genes of this pathway (rs2267668, rs8192678, rs6949152, rs12594956, rs1937) and extreme longevity using a case (107 centenarians)-control (284 young adults) design. We found no between-group differences in allele/genotype frequencies, except for CC genotype in rs1937 (p=0.003), with no representation in controls (0%), versus 2.8% in centenarians (2 men, 1 woman). In summary, the studied genetic variants of the PPARD-PPARGC1A-NRF-TFAM pathway were not associated with extreme longevity, yet a marginal association could exist for rs1937.

  3. Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study

    Science.gov (United States)

    Shyam, Radhey; Sachan, Pushplata; Singh, Prithvi Kumar; Singh, Gyan Prakash; Bhatia, Vinod Kumar; Chandra, Girish; Singh, Dinesh

    2017-01-01

    Introduction Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation. Materials and Methods After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes. Results All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (pmanagement of patients with difficult airways.

  4. [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.

  5. Extreme Conditions Modeling Workshop Report

    Energy Technology Data Exchange (ETDEWEB)

    Coe, R. G.; Neary, V. S.; Lawson, M. J.; Yu, Y.; Weber, J.

    2014-07-01

    Sandia National Laboratories (SNL) and the National Renewable Energy Laboratory (NREL) hosted the Wave Energy Converter (WEC) Extreme Conditions Modeling (ECM) Workshop in Albuquerque, NM on May 13th-14th, 2014. The objective of the workshop was to review the current state of knowledge on how to model WECs in extreme conditions (e.g. hurricanes and other large storms) and to suggest how U.S. Department of Energy (DOE) and national laboratory resources could be used to improve ECM methods for the benefit of the wave energy industry.

  6. Automation Rover for Extreme Environments

    Science.gov (United States)

    Sauder, Jonathan; Hilgemann, Evan; Johnson, Michael; Parness, Aaron; Hall, Jeffrey; Kawata, Jessie; Stack, Kathryn

    2017-01-01

    Almost 2,300 years ago the ancient Greeks built the Antikythera automaton. This purely mechanical computer accurately predicted past and future astronomical events long before electronics existed1. Automata have been credibly used for hundreds of years as computers, art pieces, and clocks. However, in the past several decades automata have become less popular as the capabilities of electronics increased, leaving them an unexplored solution for robotic spacecraft. The Automaton Rover for Extreme Environments (AREE) proposes an exciting paradigm shift from electronics to a fully mechanical system, enabling longitudinal exploration of the most extreme environments within the solar system.

  7. Extreme Weather and Natural Disasters

    CERN Document Server

    Healey, Justin

    2012-01-01

    Australia is a vast land in which weather varies significantly in different parts of the continent. Recent extreme weather events in Australia, such as the Queensland floods and Victorian bushfires, are brutal reminders of nature's devastating power. Is global warming increasing the rate of natural disasters? What part do La Niña and El Niño play in the extreme weather cycle? Cyclones, floods, severe storms, bushfires, landslides, earthquakes, tsunamis - what are the natural and man-made causes of these phenomena, how predictable are they, and how prepared are we for the impacts of natural dis

  8. Uncommon upper extremity compression neuropathies.

    Science.gov (United States)

    Knutsen, Elisa J; Calfee, Ryan P

    2013-08-01

    Hand surgeons routinely treat carpal and cubital tunnel syndromes, which are the most common upper extremity nerve compression syndromes. However, more infrequent nerve compression syndromes of the upper extremity may be encountered. Because they are unusual, the diagnosis of these nerve compression syndromes is often missed or delayed. This article reviews the causes, proposed treatments, and surgical outcomes for syndromes involving compression of the posterior interosseous nerve, the superficial branch of the radial nerve, the ulnar nerve at the wrist, and the median nerve proximal to the wrist. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Statistical Model of Extreme Shear

    DEFF Research Database (Denmark)

    Hansen, Kurt Schaldemose; Larsen, Gunner Chr.

    2005-01-01

    In order to continue cost-optimisation of modern large wind turbines, it is important to continuously increase the knowledge of 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, describes 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 full-scale measurements recorded with a high sampling rate...

  10. 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.

  11. 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.

  12. Predicting difficult laryngoscopy using ultrasound measurement of distance from skin to epiglottis.

    Science.gov (United States)

    Pinto, J; Cordeiro, L; Pereira, C; Gama, R; Fernandes, H L; Assunção, J

    2016-06-01

    Unpredicted difficult intubation can have severe consequences, and it is a significant source of morbidity and mortality. Although recent studies indicate that specific ultrasonography (US) measurements may be predictors of difficult laryngoscopy, their use is still limited, and its quantification is missing. The purpose of this prospective observational study is to evaluate the use of US-measured distance from skin to epiglottis (DSE) for difficult laryngoscopy prediction. In a double-blind study, standard preintubation, screening tests, and DSE were obtained from 74 adult patients requiring endotracheal intubation. The relationship between difficult laryngoscopy and DSE was evaluated using a t test. A comparative analysis of its predictive performance with common clinical preintubation screening tests was performed using bootstrapping. We found that increasing DSE is strongly associated with difficult laryngoscopy (P < .001, 2-sided t test). We showed that a cutoff value of 27.5 mm was able to predict difficult laryngoscopy with an accuracy of 74.3%, a sensitivity of 64.7%, and a specificity of 77.1%. Our work demonstrates that the DSE can be effectively used to predict difficult laryngoscopy. Moreover, combining DSE with the modified Mallampati score in a decision tree significantly improves the predictive power over either test alone. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Understanding relations between breeding bird species and extreme weather

    Science.gov (United States)

    Allstadt, A.; Bateman, B.; Pidgeon, A. M.; Radeloff, V.; Vavrus, S. J.; Keuler, N.; Clayton, M.; Albright, T.; Thogmartin, W.; Heglund, P.

    2013-12-01

    Extreme weather events are increasing in frequency due to climate change. Extreme weather events like periods of drought or cold snaps may impose hardship on many animal and plant populations. However, little is known about biotic response to extreme events. For example, some species experience population size changes in association with extreme weather, and some do not. However the mechanisms responsible for observed declines in avian abundance following heat waves and drought are not clear. Our goal was to characterize the population changes of North American bird species in relation to temperature and precipitation extremes using North American Breeding Bird Survey (BBS) data. We derived standardized measures of extreme precipitation and air temperature based on phase 2 NASA Land Data Assimilation System (NLDAS-2), an hourly 1/8 degree resolution land surface forcing dataset, and modeled population responses, during the breeding season, of 363 bird species. Of those species in which a change was observed, many demonstrated decreases in total population size, suggesting either mortality or reproductive failure (or both) are the causative mechanisms of this decline. A greater proportion of population changes were associated with extreme conditions in the same year than in the previous year. Some species exhibited population decreases in areas of extreme weather and increases in areas with environmental conditions more favorable to breeding while overall abundance remained relatively constant, which might indicate movement. The patterns of bird population changes in relation to extreme weather events provide insight for planners as they consider modifications to our national protected area network that will limit threats posed by climate change to bird populations.

  14. 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

  15. Are extreme events (statistically) special? (Invited)

    Science.gov (United States)

    Main, I. G.; Naylor, M.; Greenhough, J.; Touati, S.; Bell, A. F.; McCloskey, J.

    2009-12-01

    We address the generic problem of testing for scale-invariance in extreme events, i.e. are the biggest events in a population simply a scaled model of those of smaller size, or are they in some way different? Are large earthquakes for example ‘characteristic’, do they ‘know’ how big they will be before the event nucleates, or is the size of the event determined only in the avalanche-like process of rupture? In either case what are the implications for estimates of time-dependent seismic hazard? One way of testing for departures from scale invariance is to examine the frequency-size statistics, commonly used as a bench mark in a number of applications in Earth and Environmental sciences. Using frequency data however introduces a number of problems in data analysis. The inevitably small number of data points for extreme events and more generally the non-Gaussian statistical properties strongly affect the validity of prior assumptions about the nature of uncertainties in the data. The simple use of traditional least squares (still common in the literature) introduces an inherent bias to the best fit result. We show first that the sampled frequency in finite real and synthetic data sets (the latter based on the Epidemic-Type Aftershock Sequence model) converge to a central limit only very slowly due to temporal correlations in the data. A specific correction for temporal correlations enables an estimate of convergence properties to be mapped non-linearly on to a Gaussian one. Uncertainties closely follow a Poisson distribution of errors across the whole range of seismic moment for typical catalogue sizes. In this sense the confidence limits are scale-invariant. A systematic sample bias effect due to counting whole numbers in a finite catalogue makes a ‘characteristic’-looking type extreme event distribution a likely outcome of an underlying scale-invariant probability distribution. This highlights the tendency of ‘eyeball’ fits to unconsciously (but

  16. When the U.S. Stock Market Becomes Extreme?

    Directory of Open Access Journals (Sweden)

    Sofiane Aboura

    2014-05-01

    Full Text Available Over the last three decades, the world economy has been facing stock market crashes, currency crisis, the dot-com and real estate bubble burst, credit crunch and banking panics. As a response, extreme value theory (EVT provides a set of ready-made approaches to risk management analysis. However, EVT is usually applied to standardized returns to offer more reliable results, but remains difficult to interpret in the real world. This paper proposes a quantile regression to transform standardized returns into theoretical raw returns making them economically interpretable. An empirical test is carried out on the S&P500 stock index from 1950 to 2013. The main results indicate that the U.S stock market becomes extreme from a price variation of ±1.5% and the largest one-day decline of the 2007–2008 period is likely, on average, to be exceeded one every 27 years.

  17. Intralesional immunotherapy for difficult to treat warts with Mycobacterium w vaccine

    Science.gov (United States)

    Garg, Shilpa; Baveja, Sukriti

    2014-01-01

    Background: Immunotherapy is an evolving therapeutic modality for the treatment of warts. We conducted a study to assess the efficacy and safety of intralesional Mycobacterium w vaccine for the treatment of warts at sites that were difficult to treat. Materials and Methods: Thirty patients with at least one wart present on either the plantar surface of their feet, palms, volar aspect of their fingers, or periungual or subungual region, were treated with 0.1 ml of killed Mycobacterium w vaccine given intralesionally in a single wart, without any prior sensitisation dose. Thereafter, a single injection of 0.1 ml of vaccine was given at intervals of four weeks in a single wart till there was complete resolution of the warts or a maximum of 10 injections. Treatment was stopped if there was no response after three injections. The patients were followed up for at least six months. Results: Out of the 30 patients, 28 (93.33%) patients had complete resolution of their warts, both at the injected and distant sites. The mean (SD) time for complete clearance of warts was 43.71(32.82) days and the mean (SD) dose of vaccine that was required for complete clearance of warts was 0.186 ml (0.101). Four patients (14.28%) had a recurrence of warts. The treatment was well-tolerated and the side effects were reversible in the majority of the patients. Conclusion: In comparison to the earlier studies using Mycobacterium w vaccine for the treatment of warts, our study was different in the following aspects: No sensitisation dose was given, only a single wart was injected at a time and the duration between the period of injections was increased to four weeks. With all these changes we eliminated the complications due to the sensitisation dose and achieved good results. This study provides new insight into the dose and schedule of treatment of this evolving therapeutic modality. PMID:25722598

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

    Directory of Open Access Journals (Sweden)

    Irina Valeryevna Sharf

    2016-03-01

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

  19. Spontaneous resolution of extreme thrombocytosis in 2 children.

    Science.gov (United States)

    Aviner, Shraga; Even-Or, Ehud; Tamary, Hannah

    2012-05-01

    Essential thrombocytosis (ET) is rare in children, sometimes difficult to be distinguished from secondary thrombocytosis. This report concerns 2 children with extreme thrombocytosis of 4100 × 10(9)/L and 1644 × 10(9)/L with partial and complete remission at 3 months and 4 years from diagnosis, with a follow-up of 4 and 17 years, respectively, with no cytoreduction therapy. Diagnosis of ET was suggested according to accepted criteria. However, spontaneous remission of the thrombocytosis argues for the diagnosis of secondary thrombocytosis. These patients highlight the complexity of distinguishing childhood ET from secondary thrombocytosis and the need for cautious personalized decision on cytoreduction therapy.

  20. Verrucous carcinoma of the esophagus: a rare variant of squamous cell carcinoma for which a preoperative diagnosis can be a difficult one to make.

    Science.gov (United States)

    Chu, Quyen; Jaganmohan, Sathya; Kelly, Brandi; Hobley, James

    2011-01-01

    Verrucous carcinoma of the esophagus is an extremely rare entity. It is associated with severe epithelial hyperplasia and parakeratosis of the epithelial layers. Superficial biopsies are usually falsely negative for malignant cells, as the biopsied mucosa usually demonstrates the hyperplastic epithelium. The tumor spread is through submucosal and paraesophageal infiltration. Endoscopically, verrucous carcinoma appears as a wartlike, exophytic lesion, hence the name verrucous. The diagnosis can be difficult to make, even after repeated endoscopic biopsies. We report a rare case of verrucous carcinoma of the esophagus in a 45-year-old man whose final pathologic diagnosis was confirmed only after an Ivor-Lewis esophagectomy was performed.

  1. My favorite tips for engaging the difficult patient on consultation-liaison psychiatry services.

    Science.gov (United States)

    Knesper, David J

    2007-06-01

    Disengagement is the main enemy for the consultation-liaison psychiatrist. The goal of the first interview is to transform the unwilling, uncooperative, and often difficult and hostile patient into an engaged interview participant. Otherwise, the interview is an unproductive interrogation and an unpleasant power struggle. Once the difficult patient is engaged, the more typical psychiatric interview can begin. The three interview-engagement tips or techniques described are among the author's favorite ways to overcome the impediments to engagement most often associated with difficult patients.

  2. Extreme conditions (p, T, H)

    Energy Technology Data Exchange (ETDEWEB)

    Mesot, J. [Lab. for Neutron Scattering ETH Zurich, Zurich (Switzerland) and Paul Scherrer Institute, Villigen (Switzerland)

    1996-11-01

    The aim of this paper is to summarize the sample environment which will be accessible at the SINQ. In order to illustrate the type of experiments which will be feasible under extreme conditions of temperature, magnetic field and pressure at the SINQ a few selected examples are also given. (author) 7 figs., 14 refs.

  3. Extreme cervical elongation after sacrohysteropexy

    NARCIS (Netherlands)

    Vierhout, M.E.; Futterer, J.J.

    2013-01-01

    We present a case of extreme cervical elongation with a cervix of 12 cm after an unusual operation in which the uterine corpus was directly fixed to the promontory, and which became symptomatic after 8 years. The possible pathophysiology of cervical elongation is discussed. Diagnosing a case of seve

  4. Astrobiology: Life in Extreme Environments

    Science.gov (United States)

    Kaur, Preeti

    2011-01-01

    Astrobiology is the study of the origin, evolution and distribution of life in the universe. It seeks to answer two important scientific questions: how did we get here and are we alone in the universe? Scientists begin by studying life on Earth and its limits. The discovery of extremophiles on Earth capable of surviving extremes encourages the…

  5. Extreme Energy Events Monitoring report

    CERN Document Server

    Baimukhamedova, Nigina

    2015-01-01

    Following paper reflects the progress I made on Summer Student Program within Extreme Energy Events Monitor project I was working on. During 8 week period I managed to build a simple detector system that is capable of triggering events similar to explosions (sudden change in sound levels) and measuring approximate location of the event. Source codes are available upon request and settings described further.

  6. Generic Hurricane Extreme Seas State

    DEFF Research Database (Denmark)

    Wehmeyer, Christof; Skourup, Jesper; Frigaard, Peter

    2012-01-01

    the US east coast and the Gulf of Mexico (1851 - 2009) and Japanese east coast (1951 -2009) form the basis for Weibull extreme value analyses to determine return period respective maximum wind speeds. Unidirectional generic sea state spectra are obtained by application of the empirical models...

  7. Astrobiology: Life in Extreme Environments

    Science.gov (United States)

    Kaur, Preeti

    2011-01-01

    Astrobiology is the study of the origin, evolution and distribution of life in the universe. It seeks to answer two important scientific questions: how did we get here and are we alone in the universe? Scientists begin by studying life on Earth and its limits. The discovery of extremophiles on Earth capable of surviving extremes encourages the…

  8. Extreme precipitation and extreme streamflow in the Dongjiang River Basin in southern China

    Directory of Open Access Journals (Sweden)

    W. Wang

    2007-07-01

    Full Text Available Extreme hydro-meteorological events have become the focus of more and more studies in the last decade. Due to the complexity of the spatial pattern of changes in precipitation processes, it is still hard to establish a clear view of how precipitation has changed and how it will change in the future. In the present study, changes in extreme precipitation and streamflow processes in the Dongjiang River Basin in southern China are investigated. It was shown that little change is observed in annual extreme precipitation in terms of various indices, but some significant changes are found in the precipitation processes on a monthly basis. The result indicates that when detecting climate changes, besides annual indices, seasonal variations in extreme events should be considered as well. Despite of little change in annual extreme precipitation series, significant changes are detected in several annual extreme flood flow and low-flow series, mainly at the stations along the main channel of Dongjiang River, which are affected significantly by the operation of several major reservoirs. The result highlights the importance of evaluating the impacts of human activities in assessing the changes of extreme streamflows. In addition, three non-parametric methods that are not-commonly used by hydro-meteorology community, i.e., Kolmogorov–Smirnov test, Levene's test and quantile test, are introduced and assessed by Monte Carlo simulation in the present study to test for changes in the distribution, variance and the shift of tails of different groups of dataset. Monte Carlo simulation result shows that, while all three methods work well for detecting changes in two groups of data with large data size (e.g., over 200 points in each group and big difference in distribution parameters (e.g., over 100% increase of scale parameter in Gamma distribution, none of them are powerful enough for small data sets (e.g., less than 100 points and small distribution

  9. A study to investigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome

    OpenAIRE

    Omer Kurtipek; Berrin Isik; Mustafa Arslan; Yusuf Unal; Yusuf Kizil; Yusuf Kemaloglu

    2012-01-01

    Background and Aim: Obstructive sleep apnea (OSA) syndrome is predisposed to the development of upper airway obstruction during sleep, and it poses considerable problem for anesthetic management. Difficult intubation (DI) is an important problem for management of anesthesia. In this clinical research, we aim to investigate the relationship between DI and prediction criteria of DI in cases with OSA. Materials and Methods: We studied 40 [OSA (Group O, n = 20) and non-OSA, (Group C, n = 20)] ASA...

  10. Defect formation in single layer graphene under extreme ultraviolet irradiation

    NARCIS (Netherlands)

    Gao, An; Zoethout, E.; Zoethout, E.; Sturm, Jacobus Marinus; Lee, Christopher James; Bijkerk, Frederik

    2014-01-01

    We study extreme ultraviolet (EUV) radiation induced defects in single-layer graphene. Two mechanisms for inducing defects in graphene were separately investigated: photon induced chemical reactions between graphene and background residual gases, and breaking sp2 bonds, due to photon and/or photoele

  11. Ischemic pain in the extremities and Raynaud's phenomenon.

    NARCIS (Netherlands)

    Devulder, J.; Suijlekom, H. van; Dongen, R.T.M. van; Diwan, S.; Mekhail, N.; Kleef, M. van; Huygen, F.

    2011-01-01

    Two important groups of disorders result from an insufficient blood supply to the extremities: critical vascular disease and the Raynaud's phenomenon. The latter can be subdivided into a primary and a secondary type. Critical ischemic disease is often caused by arteriosclerosis due to hypertension o

  12. Reducing uncertainty in prediction of dune erosion during extreme conditions

    NARCIS (Netherlands)

    Den Heijer, C.; Reniers, A.J.H.M.; Van de Graaff, J.; Van Gelder, P.H.A.J.M.

    2008-01-01

    Coastal dunes protect low lying coastal areas against the sea. Extreme waves and water levels during severe storms may cause breaching of the dunes. Consequently, serious damage due to flooding and direct wave attack could occur, resulting in loss of life and property. Proper coastal management impl

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

    Directory of Open Access Journals (Sweden)

    Gangadharan Lakshmi

    2011-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Juan MORENO; Anders Pape Mφller

    2011-01-01

    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.

  15. 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].

  16. 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.

  17. Extremal non-BPS black holes and entropy extremization

    CERN Document Server

    Lópes-Cardoso, G; Lust, D; Perz, J; Cardoso, Gabriel Lopes; Grass, Viviane; Lust, Dieter; Perz, Jan

    2006-01-01

    At the horizon, a static extremal black hole solution in N=2 supergravity in four dimensions is determined by a set of so-called attractor equations which, in the absence of higher-curvature interactions, can be derived as extremization conditions for the black hole potential or, equivalently, for the entropy function. We contrast both methods by explicitly solving the attractor equations for a one-modulus prepotential associated with the conifold. We find that near the conifold point, the non-supersymmetric solution has a substantially different behavior than the supersymmetric solution. We analyze the stability of the solutions and the extrema of the resulting entropy as a function of the modulus. For the non-BPS solution the region of attractivity and the maximum of the entropy do not coincide with the conifold point.

  18. 'SIMPLES': a structured primary care approach to adults with difficult asthma.

    Science.gov (United States)

    Ryan, Dermot; Murphy, Anna; Ställberg, Björn; Baxter, Noel; Heaney, Liam G

    2013-09-01

    The substantial majority of patients with asthma can expect minimal breakthrough symptoms on standard doses of inhaled corticosteroids with or without additional add-on therapies. SIMPLES is a structured primary care approach to the review of a person with uncontrolled asthma which encompasses patient education monitoring, lifestyle and pharmacological management and addressing support needs which will achieve control in most patients. The small group of patients presenting with persistent asthma symptoms despite being prescribed high levels of treatment are often referred to as having 'difficult asthma'. Some will have difficult, 'therapy resistant' asthma, some will have psychosocial problems which make it difficult for them to achieve asthma control and some may prove to have an alternative diagnosis driving their symptoms. A few patients will benefit from referral to a 'difficult asthma' clinic. The SIMPLES approach, aligned with close co-operation between primary and specialist care, can identify this patient group, avoid inappropriate escalation of treatment, and streamline clinical assessment and management.

  19. Multidisciplinary Conservative Treatment of Difficult Bile Duct Stones: A Real Alternative to Surgery

    Directory of Open Access Journals (Sweden)

    E. Masci

    1997-01-01

    case of symptomatic hyperamylasemia and 3 cases of macrohematuria. In conclusion, extracorporeal lithotripsy combined with endoscopic and/or percutaneous treatment is a real alternative to surgery for difficult stones.

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

    LENUS (Irish Health Repository)

    Malik, M A

    2009-11-01

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