WorldWideScience

Sample records for extremely difficult problems

  1. 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.

  2. 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.

  3. Why Is the Overheating Problem Difficult: the Role of Entropy

    Science.gov (United States)

    Liou, Meng-Sing

    2013-01-01

    The development of computational fluid dynamics over the last few decades has yielded enormous successes and capabilities being routinely employed today; however there remain some open problems to be properly resolved-some are fundamental in nature and some resolvable by operational changes. These two categories are distinguished and broadly explored previously. One, that belongs to the former, is the so-called overheating problem, especially in rarefying flow. This problem up to date still dogs every method known to the author; a solution to it remains elusive. The study in this paper concludes that: (1) the entropy increase is quantitatively linked to the increase in the temperature increase, (2) it is argued that the overheating is inevitable in the current shock capturing or traditional finite difference framework, and (3) a simple hybrid method is proposed that removes the overheating problem in the rarefying problems, but also retains the property of accurate shock capturing. This remedy (enhancement of current numerical methods) can be included easily in the present Eulerian codes.

  4. Homotopy of extremal problems theory and applications

    CERN Document Server

    Korovin, Sergey K; Emelyanov, Stanislav V; Bulatov, Alexander V

    2007-01-01

    This monograph provides a thorough treatment of parameter-dependent extremal problems with local minimum values that remain unchanged under changes of the parameter. The authors consider the theory as well the practical treatment of those problems, both in finite-dimensional as well as in infinite-dimensional spaces. Various applications are considered, e.g., variational calculus, control theory and bifurcations theory. Thorough treatment of parameter-dependent extremal problems with local minimum values. Includes many applications, e.g., variational calculus, control theory and bifurcations t

  5. Multiple Population Theory: Extreme helium population problem

    OpenAIRE

    Yi, Sukyoung K.

    2009-01-01

    The spreads in chemical abundances inferred by recent precision observations suggest that some or possibly all globular clusters can no longer be considered as simple stellar populations. The most striking case is omega Cen in the sense that its bluest main-sequence despite its high metallicity demands an extreme helium abundance of Y > 0.4. I focus on this issue of "the extreme helium population problem" in this review.

  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. Neurodevelopmental problems and extremes in BMI

    Directory of Open Access Journals (Sweden)

    Nóra Kerekes

    2015-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-11-01

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

  9. 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...

  10. A Cascade Optimization Strategy for Solution of Difficult Multidisciplinary Design Problems

    Science.gov (United States)

    Patnaik, Surya N.; Coroneos, Rula M.; Hopkins, Dale A.; Berke, Laszlo

    1996-01-01

    A research project to comparatively evaluate 10 nonlinear optimization algorithms was recently completed. A conclusion was that no single optimizer could successfully solve all 40 problems in the test bed, even though most optimizers successfully solved at least one-third of the problems. We realized that improved search directions and step lengths, available in the 10 optimizers compared, were not likely to alleviate the convergence difficulties. For the solution of those difficult problems we have devised an alternative approach called cascade optimization strategy. The cascade strategy uses several optimizers, one followed by another in a specified sequence, to solve a problem. A pseudorandom scheme perturbs design variables between the optimizers. The cascade strategy has been tested successfully in the design of supersonic and subsonic aircraft configurations and air-breathing engines for high-speed civil transport applications. These problems could not be successfully solved by an individual optimizer. The cascade optimization strategy, however, generated feasible optimum solutions for both aircraft and engine problems. This paper presents the cascade strategy and solutions to a number of these problems.

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

    Directory of Open Access Journals (Sweden)

    Vitart M. J.

    2006-11-01

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

  12. ALGORITHM FOR SOLVING EXTREME SCHEDULING PROBLEMS

    OpenAIRE

    Gennady A. Berketov

    2015-01-01

    The article considers the original algorithmfor solving the generalized problem ofscheduling theory, based on the branch and bound method. Task schedulingperform works (operations) and restrictions on resources used often occur with scheduling discrete manufacturing operations, optimizing network implementationschedules of scientific, economic or technical projects. Tools to solve suchproblems are included in the decisionsupport system ACS in many businesses.The effectiveness of the proposed ...

  13. Still a difficult business? Negotiating alcohol-related problems in general practice consultations.

    Science.gov (United States)

    Rapley, Tim; May, Carl; Frances Kaner, Eileen

    2006-11-01

    This paper describes general practitioners' (GPs) experiences of detecting and managing alcohol and alcohol-related problems in consultations. We undertook qualitative research in two phases in the North-East of England. Initially, qualitative interviews with 29 GPs explored their everyday work with patients with alcohol-related issues. We then undertook group interviews--two with GPs and one with a primary care team--where they discussed and challenged findings of the interviews. The GPs reported routinely discussing alcohol with patients with a range of alcohol-related problems. GPs believed that this work is important, but felt that until patients were willing to accept that their alcohol consumption was problematic they could achieve very little. They tentatively introduced alcohol as a potential problem, re-introduced the topic periodically, and then waited until the patient decided to change their behaviour. They were aware that they could identify and manage more patients. A lack of time and having to work with the multiple problems that patients brought to consultations were the main factors that stopped GPs managing more risky drinkers. Centrally, we compared the results of our study with [Thom, B., & Tellez, C. (1986). A difficult business-Detecting and managing alcohol-problems in general-practice. British Journal of Addiction, 81, 405-418] seminal study that was undertaken 20 years ago. We show how the intellectual, moral, emotional and practical difficulties that GPs currently face are quite similar to those faced by GPs from 20 years ago. As the definition of what could constitute abnormal alcohol consumption has expanded, so the range of consultations that they may have to negotiate these difficulties in has also expanded.

  14. Interactive film scenes for tutor training in problem-based learning (PBL): dealing with difficult situations.

    Science.gov (United States)

    Bosse, Hans M; Huwendiek, Soeren; Skelin, Silvia; Kirschfink, Michael; Nikendei, Christoph

    2010-07-06

    In problem-based learning (PBL), tutors play an essential role in facilitating and efficiently structuring tutorials to enable students to construct individual cognitive networks, and have a significant impact on students' performance in subsequent assessments. The necessity of elaborate training to fulfil this complex role is undeniable. In the plethora of data on PBL however, little attention has been paid to tutor training which promotes competence in the moderation of specific difficult situations commonly encountered in PBL tutorials. Major interactive obstacles arising in PBL tutorials were identified from prior publications. Potential solutions were defined by an expert group. Video clips were produced addressing the tutor's role and providing exemplary solutions. These clips were embedded in a PBL tutor-training course at our medical faculty combining PBL self-experience with a non-medical case. Trainees provided pre- and post-intervention self-efficacy ratings regarding their PBL-related knowledge, skills, and attitudes, as well as their acceptance and the feasibility of integrating the video clips into PBL tutor-training (all items: 100 = completely agree, 0 = don't agree at all). An interactive online tool for PBL tutor training was developed comprising 18 video clips highlighting difficult situations in PBL tutorials to encourage trainees to develop and formulate their own intervention strategies. In subsequent sequences, potential interventions are presented for the specific scenario, with a concluding discussion which addresses unresolved issues. The tool was well accepted and considered worth the time spent on it (81.62 +/- 16.91; 62.94 +/- 16.76). Tutors considered the videos to prepare them well to respond to specific challenges in future tutorials (75.98 +/- 19.46). The entire training, which comprised PBL self-experience and video clips as integral elements, improved tutor's self-efficacy with respect to dealing with problematic situations (pre

  15. Improved extremal optimization for the asymmetric traveling salesman problem

    Science.gov (United States)

    Chen, Yu-Wang; Zhu, Yao-Jia; Yang, Gen-Ke; Lu, Yong-Zai

    2011-11-01

    This paper presents an improved extremal optimization (IEO) algorithm for solving the asymmetric traveling salesman problem (ATSP). At each update step, the IEO algorithm proceeds through two main steps: extremal dynamics and cooperative optimization. As an improvement of extremal optimization (EO), the IEO provides a general combinatorial optimization framework by emphasizing the step of cooperative optimization. In the paper, an effective cooperative optimization strategy with combination of greedy search and random walk is designed in terms of the microscopic characteristics of the ATSP solutions. Simulation results on a set of benchmark ATSP instances show that the proposed IEO algorithm provides satisfactory performance on computational effectiveness and efficiency.

  16. Constraint Algorithm for Extremals in Optimal Control Problems

    CERN Document Server

    Barbero-Linan, Maria

    2007-01-01

    A characterization of different kinds of extremals of optimal control problems is given if we take an open control set. A well known constraint algorithm for implicit differential equations is adapted to the study of such problems. Some necessary conditions of Pontryagin's Maximum Principle determine the primary constraint submanifold for the algorithm. Some examples in the control literature, such as subRiemannian geometry and control-affine systems, are revisited to give, in a clear geometric way, a subset where the abnormal, normal and strict abnormal extremals stand.

  17. Problems in psychiatric care of 'difficult patients': a Delphi-study

    NARCIS (Netherlands)

    Koekkoek, B.W.; Meijel, B.K.G. van; Schene, A.H.; Hutschemaekers, G.J.M.

    2009-01-01

    Aims - 'difficult patients' may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where

  18. Problems in psychiatric care of 'difficult patients': a Delphi-study

    NARCIS (Netherlands)

    Koekkoek, B.W.; Meijel, B.K.G. van; Schene, A.H.; Hutschemaekers, G.J.M.

    2009-01-01

    Aims - 'difficult patients' may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where p

  19. EXTREMISM AND TERRORISM AS GLOBAL PROBLEMS OF MODERN SOCIETY

    Directory of Open Access Journals (Sweden)

    Lilia Yu. TAOVA

    2016-01-01

    Full Text Available The problem of combating terrorism and extremism in Russia is one of the most important due to the fact that respect for and protection of the rights and freedoms of man and citizen is the responsibility of the state (Art. 2 of the Constitution. Constitution of the Russian Federation, the bearer of sovereignty and the only source of power in the state defined by its multi-ethnic people, as well as approved by the ideological diversity, equality before the law, religious and public associations. However, the contradictions of social, economic and legal issues arising from this diversity, as well as trying to find a way out of them, are one of the urgent problems of modern world and domestic policy. The article tells about methods of struggle against extremism and terrorism.

  20. On the universal method to solve extremal problems

    OpenAIRE

    Brinkhuis, Jan

    2005-01-01

    textabstractSome applications of the theory of extremal problems to mathematics and economics are made more accessible to non-experts. 1.The following fundamental results are known to all users of mathematical techniques, such as economist, econometricians, engineers and ecologists: the fundamental theorem of algebra, the Lagrange multiplier rule, the implicit function theorem, separation theorems for convex sets, orthogonal diagonalization of symmetric matrices. However, full explanations, i...

  1. [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.

  2. EXTREMISM AND TERRORISM ‒ GLOBAL PROBLEMS OF MODERN SOCIETY

    Directory of Open Access Journals (Sweden)

    Lily Yu. Taova

    2016-01-01

    Full Text Available The problem of combating terrorism and extremism in Russia is one of the most important due to the fact that respect for and protection of the rights and freedoms of man and citizen is the responsibility of the state (Art. 2 of the Constitution.Constitution of the Russian Federation, the bearer of sovereignty and the only source of power in the state defined by its multi-ethnic people, as well as approved by the ideological diversity, equality before the law, religious and public associations. However, the contradictions of social, economic and legal issues arising from this diversity, as well as trying to find a way out of them, are one of the urgent problems of modern world and domestic policy. Terrorism is an international scale is a powerful structure, with their equipment, and the possibility of failure. Unfortunately, modern terrorism is able to wage war and to participate in armed conflicts.Terrorism has become a very profitable business on a global scale with its own capital. Now there is a very active territorial expansion of terrorist activity, moreover, it is becoming more violent and sophisticated. The terrorist attacks have become inhuman, unmanageable and unexplained. The need to combat extremism and its extreme form - terrorist acts, including the international level for a long time is relevant to the Russian state, and especially for its law enforcement officials, and represent a real threat to the national security of the Russian Federation.The problem under consideration is that democracy must provide maximum guarantees of freedom of opinion, assembly and association, at the same time, to protect themselves from the forces whose ideology denies these principles. The article tells about methods of struggle against extremism and terrorism.

  3. Interesting and Difficult Mathematical Problems: Changing Teachers' Views by Employing Multiple-Solution Tasks

    Science.gov (United States)

    Guberman, Raisa; Leikin, Roza

    2013-01-01

    The study considers mathematical problem solving to be at the heart of mathematics teaching and learning, while mathematical challenge is a core element of any educational process. The study design addresses the complexity of teachers' knowledge. It is aimed at exploring the development of teachers' mathematical and pedagogical conceptions…

  4. Editorial: ICTs for Developing Countries - are there Realistic Answers to the Difficult Problems?

    Directory of Open Access Journals (Sweden)

    Andrew Wenn

    2014-09-01

    Full Text Available Welcome, to this, the first special edition of the Journal for Business Systems, Governance and Ethics. This issue is devoted entirely to the problems of deploying, using and maintaining information and communications technology (ICT in lesser-developed countries (LDCs. When the call for submissions for this special issue went out in late 2006, this journal was less than 12 months old, although, of course, it had been in the planning stages for longer than this.

  5. Automatic mesh adaptivity for CADIS and FW-CADIS neutronics modeling of difficult shielding problems

    Energy Technology Data Exchange (ETDEWEB)

    Ibrahim, A. M.; Peplow, D. E.; Mosher, S. W.; Wagner, J. C.; Evans, T. M. [Oak Ridge National Laboratory, P.O. Box 2008, Oak Ridge, TN 37831 (United States); Wilson, P. P.; Sawan, M. E. [University of Wisconsin-Madison, 1500 Engineering Dr., Madison, WI 53706 (United States)

    2013-07-01

    The CADIS and FW-CADIS hybrid Monte Carlo/deterministic techniques dramatically increase the efficiency of neutronics modeling, but their use in the accurate design analysis of very large and geometrically complex nuclear systems has been limited by the large number of processors and memory requirements for their preliminary deterministic calculations and final Monte Carlo calculation. Three mesh adaptivity algorithms were developed to reduce the memory requirements of CADIS and FW-CADIS without sacrificing their efficiency improvement. First, a macro-material approach enhances the fidelity of the deterministic models without changing the mesh. Second, a deterministic mesh refinement algorithm generates meshes that capture as much geometric detail as possible without exceeding a specified maximum number of mesh elements. Finally, a weight window coarsening algorithm de-couples the weight window mesh and energy bins from the mesh and energy group structure of the deterministic calculations in order to remove the memory constraint of the weight window map from the deterministic mesh resolution. The three algorithms were used to enhance an FW-CADIS calculation of the prompt dose rate throughout the ITER experimental facility. Using these algorithms resulted in a 23.3% increase in the number of mesh tally elements in which the dose rates were calculated in a 10-day Monte Carlo calculation and, additionally, increased the efficiency of the Monte Carlo simulation by a factor of at least 3.4. The three algorithms enabled this difficult calculation to be accurately solved using an FW-CADIS simulation on a regular computer cluster, obviating the need for a world-class super computer. (authors)

  6. Cryptoschemes Based on Difficulty of Simultaneous Solving Two Different Difficult Problems

    Directory of Open Access Journals (Sweden)

    A.N. Berezin

    2013-10-01

    Full Text Available The paper proposes a general method for construction cryptoschemes based on difficulty of simultaneous solving factoring (FP and discrete logarithm modulo prime problem (DLpP. The proposed approach is applicable for construction digital signatures (usual, blind, collective, public key encryption algorithms, public key distribution protocols, and cryptoschemes of other types. Moreover, the proposed approach provides reducing the signature size and increasing the rate of the cryptoschemes, while comparing with the known designs of the digital signature protocols based on the FP and DLpP.

  7. Antibiotic resistance – why is the problem so difficult to solve?

    Directory of Open Access Journals (Sweden)

    Sören Höjgård

    2012-08-01

    Full Text Available Antibiotic resistance has been increasing along with antibiotic use. At the same time, the supply of new drugs to replace those rendered inefficient by the development has been dwindling, leading to concerns that we may soon lack efficient means to treat bacterial infections. Though the problem has received considerable interest, there are no indications that the situation is about to change. The present review maintains that this is because the two objectives - preserving the efficiency of existing drugs and increasing the supply of new ones - are partly opposing. Hence, creating an incentive structure compatible with both of them is not easy. Nevertheless, it is suggested that levying a fee on the use of antibiotics, and earmarking the proceeds from this fee for subsidizing development of new antibiotics, would be an important step towards increasing incentives for a better antibiotic stewardship while preserving incentives to develop new substances.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-01-01

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

  9. Difficult Asthma

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

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

    Science.gov (United States)

    Silberman, Mel

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

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

    Science.gov (United States)

    Silberman, Mel

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

  13. Some Problems of Extremes in Geometry and Construction

    Science.gov (United States)

    Yanovsky, Levi

    2008-01-01

    Two original problems in geometry are presented with solutions utilizing to differential calculus: (a) rectangle inscribed in a sector; (b) point on the ray of the angle. The possibility of applying mathematics in general and differential calculus in particular for solution of practical problems is discussed. (Contains 8 figures.)

  14. Extreme dry spells: Problem of rounding and Bayesian solution

    Science.gov (United States)

    Cindric Kalin, Ksenija; Pasaric, Zoran

    2016-04-01

    Two theoretically justified models of extremes are applied to dry spell (DS) series: The generalized Pareto distribution is applied to peak-over-threshold data (POT-GP), and the Generalized Extreme Value distribution is applied to the annual maxima (AM-GEV). DS data are categorized according to three precipitation-per-day thresholds (1, 5 and 10 mm). The well-known classical methods for parameter estimation (L-moments and Maximum Likelihood) are applied both to measured and to simulated DS time series. When applied within the GEV model, both methods yield very similar results. Somewhat surprisingly, in the case of the GP model, these methods lead to substantially different estimates of parameters, as well as return values. This is found to be a consequence of the fact that DS values are recorded discretely as a whole number of days, whereas the classical extreme value distributions are intended for continuous data. The inference is further evaluated within the Bayesian paradigm, where the process of rounding can be incorporated in a straightforward manner. The study confirmed precautionary estimations when applying the AM-GEV model in comparison with the simpler AM-Gumbel model. Regarding POT-GP modelling, the Bayesian approach reveals a high uncertainty that can occur in parameter estimations when very high thresholds are considered. It is found that there are no clear criteria in the assessment of some optimal threshold, nor is there a necessity for its detection. Instead, Bayesian inference provides a reasonable overall picture of the range of thresholds compatible with the GP-model. Furthermore, it is concluded that when using rounded data, all three GP parameters should be assessed. The location estimates should be compatible with the theoretical value of 0.5. Although the present study is performed mainly on the DS series from two stations in Croatia spanning the period of 1961-2010, the authors believe that the methodology developed here is applicable to

  15. On $L^1$ extremal problem for entire functions

    CERN Document Server

    Yuditskii, Peter

    2012-01-01

    We generalized the Korkin-Zolotarev theorem to the case of entire functions having the smallest $L^1$ norm on a system of intervals $E$. If $\\bbC\\setminus E$ is a domain of Widom type with the Direct Cauchy Theorem we give an explicit formula for the minimal deviation. Important relations between the problem and the theory of canonical systems with reflectionless resolvent functions are shown.

  16. Reconfiguration of Analog Electronics for Extreme Environments: Problem or Solution?

    Science.gov (United States)

    Stoica, Adrian; Zebulum, Ricardo; Keymeulen, Didier; Guo, Xin

    2005-01-01

    This paper argues in favor of adaptive reconfiguration as a technique to expand the operational envelope of analog electronics for extreme environments (EE). In addition to hardening-by-process and hardening-by-design, "hardening-by-reconfiguration", when applicable, could be used to mitigate drifts, degradation, or damage on electronic devices (chips) in EE, by using re-configurable devices and an adaptive self-reconfiguration of their circuit topology. Conventional circuit design exploits device characteristics within a certain temperature/radiation range; when that is exceeded, the circuit function degrades. On a reconfigurable device, although component parameters change in EE, as long as devices still operate, albeit degraded, a new circuit design, suitable for new parameter values, may be mapped into the reconfigurable structure to recover the initial circuit function. Partly degraded resources are still used, while completely damaged resources are bypassed. Designs suitable for various environmental conditions can be determined prior to operation or can be determined in-situ, by adaptive reconfiguration algorithms running on built-in digital controllers. Laboratory demonstrations of this technique were performed by JPL in several independent experiments in which bulk CMOS reconfigurable devices were exposed to, and degraded by, low temperatures (approx. 196 C), high temperatures (approx.300 C) or radiation (300kRad TID), and then recovered by adaptive reconfiguration using evolutionary search algorithms. Taking this technology from Technology Readiness Level (TRL) 3 to TRL 5 is the target of a current NASA project.

  17. Using Feasible Direction to Find All Alternative Extreme Optimal Points for Linear Programming Problem

    Directory of Open Access Journals (Sweden)

    S. F. Tantawy

    2007-01-01

    Full Text Available We presented a feasible direction method to find all optimal extreme points for the linear programming problem. Our method depends on the conjugate gradient projection method starting with an initial point we generate a sequence of feasible directions towards all alternative extremes.

  18. Why do people buy dogs with potential welfare problems related to extreme conformation and inherited disease?

    DEFF Research Database (Denmark)

    Sandøe, Peter; Kondrup, Sara Vincentzen; Bennett, P.C.

    2017-01-01

    number of dog breeds suffer from welfare problems due to extreme phenotypes and high levels of inherited diseases but the popularity of such breeds is not declining. Using a survey of owners of two popular breeds with extreme physical features (French Bulldog and Chihuahua), one with a high load...

  19. Extreme values and the level-crossing problem: an application to the Feller process.

    Science.gov (United States)

    Masoliver, Jaume

    2014-04-01

    We review the question of the extreme values attained by a random process. We relate it to level crossings to one boundary (first-passage problems) as well as to two boundaries (escape problems). The extremes studied are the maximum, the minimum, the maximum absolute value, and the range or span. We specialize in diffusion processes and present detailed results for the Wiener and Feller processes.

  20. Extreme values and the level-crossing problem: An application to the Feller process

    Science.gov (United States)

    Masoliver, Jaume

    2014-04-01

    We review the question of the extreme values attained by a random process. We relate it to level crossings to one boundary (first-passage problems) as well as to two boundaries (escape problems). The extremes studied are the maximum, the minimum, the maximum absolute value, and the range or span. We specialize in diffusion processes and present detailed results for the Wiener and Feller processes.

  1. On Some Numbers Related to Extremal Combinatorial Sum Problems

    Directory of Open Access Journals (Sweden)

    D. Petrassi

    2014-01-01

    Full Text Available Let n, d, and r be three integers such that 1≤r, d≤n. Chiaselotti (2002 defined γn,d,r as the minimum number of the nonnegative partial sums with d summands of a sum ∑1=1nai≥0, where a1,…,an are n real numbers arbitrarily chosen in such a way that r of them are nonnegative and the remaining n-r are negative. Chiaselotti (2002 and Chiaselotti et al. (2008 determine the values of γn,d,r for particular infinite ranges of the integer parameters n, d, and r. In this paper we continue their approach on this problem and we prove the following results: (i γ(n,d,r≤(rd+(rd-1 for all values of n, d, and r such that (d-1/dn-1≤r≤(d-1/dn; (ii γd+2,d,d=d+1.

  2. Extremal Problems in Minkowski Space related to Minimal Networks

    CERN Document Server

    Swanepoel, Konrad J

    1996-01-01

    We solve the following problem of Z. F\\"uredi, J. C. Lagarias and F. Morgan [FLM]: Is there an upper bound polynomial in $n$ for the largest cardinality of a set S of unit vectors in an n-dimensional Minkowski space (or Banach space) such that the sum of any subset has norm less than 1? We prove that |S|\\leq 2n and that equality holds iff the space is linearly isometric to \\ell^n_\\infty, the space with an n-cube as unit ball. We also remark on similar questions raised in [FLM] that arose out of the study of singularities in length-minimizing networks in Minkowski spaces.

  3. The nonequilibrium quantum many-body problem as a paradigm for extreme data science

    Science.gov (United States)

    Freericks, J. K.; Nikolić, B. K.; Frieder, O.

    2014-12-01

    Generating big data pervades much of physics. But some problems, which we call extreme data problems, are too large to be treated within big data science. The nonequilibrium quantum many-body problem on a lattice is just such a problem, where the Hilbert space grows exponentially with system size and rapidly becomes too large to fit on any computer (and can be effectively thought of as an infinite-sized data set). Nevertheless, much progress has been made with computational methods on this problem, which serve as a paradigm for how one can approach and attack extreme data problems. In addition, viewing these physics problems from a computer-science perspective leads to new approaches that can be tried to solve more accurately and for longer times. We review a number of these different ideas here.

  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. The development of personality extremity from childhood to adolescence: relations to internalizing and externalizing problems.

    Science.gov (United States)

    Van den Akker, Alithe L; Prinzie, Peter; Deković, Maja; De Haan, Amaranta D; Asscher, Jessica J; Widiger, Thomas

    2013-12-01

    This study investigated the development of personality extremity (deviation of an average midpoint of all 5 personality dimensions together) across childhood and adolescence, as well as relations between personality extremity and adjustment problems. For 598 children (mean age at Time 1 = 7.5 years), mothers and fathers reported the Big Five personality dimensions 4 times across 8 years. Children's vector length in a 5-dimensional configuration of the Big Five dimensions represented personality extremity. Mothers, fathers, and teachers reported children's internalizing and externalizing problems at the 1st and final measurement. In a cohort-sequential design, we modeled personality extremity in children and adolescents from ages 6 to 17 years. Growth mixture modeling revealed a similar solution for both mother and father reports: a large group with relatively short vectors that were stable over time (mother reports: 80.3%; father reports: 84.7%) and 2 smaller groups with relatively long vectors (i.e., extreme personality configuration). One group started out relatively extreme and decreased over time (mother reports: 13.2%; father reports: 10.4%), whereas the other group started out only slightly higher than the short vector group but increased across time (mother reports: 6.5%; father reports: 4.9%). Children who belonged to the increasingly extreme class experienced more internalizing and externalizing problems in late adolescence, controlling for previous levels of adjustment problems and the Big Five personality dimensions. Personality extremity may be important to consider when identifying children at risk for adjustment problems. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  7. Simulation study for analysis of binary responses in the presence of extreme case problems

    Directory of Open Access Journals (Sweden)

    Rekaya Romdhane

    2011-11-01

    Full Text Available Abstract Background Estimates of variance components for binary responses in presence of extreme case problems tend to be biased due to an under-identified likelihood. The bias persists even when a normal prior is used for the fixed effects. Methods A simulation study was carried out to investigate methods for the analysis of binary responses with extreme case problems. A linear mixed model that included a fixed effect and random effects of sire and residual on the liability scale was used to generate binary data. Five simulation scenarios were conducted based on varying percentages of extreme case problems, with true values of heritability equal to 0.07 and 0.17. Five replicates of each dataset were generated and analyzed with a generalized prior (g-prior of varying weight. Results Point estimates of sire variance using a normal prior were severely biased when the percentage of extreme case problems was greater than 30%. Depending on the percentage of extreme case problems, the sire variance was overestimated when a normal prior was used by 36 to 102% and 25 to 105% for a heritability of 0.17 and 0.07, respectively. When a g-prior was used, the bias was reduced and even eliminated, depending on the percentage of extreme case problems and the weight assigned to the g-prior. The lowest Pearson correlations between true and estimated fixed effects were obtained when a normal prior was used. When a 15% g-prior was used instead of a normal prior with a heritability equal to 0.17, Pearson correlations between true and fixed effects increased by 11, 20, 23, 27, and 60% for 5, 10, 20, 30 and 75% of extreme case problems, respectively. Conversely, Pearson correlations between true and estimated fixed effects were similar, within datasets of varying percentages of extreme case problems, when a 5, 10, or 15% g-prior was included. Therefore this indicates that a model with a g-prior provides a more adequate estimation of fixed effects. Conclusions The

  8. Kuhn-Tucker sufficiency for global minimum of multi-extremal mathematical programming problems

    Science.gov (United States)

    Jeyakumar, V.; Srisatkunrajah, S.; Huy, N. Q.

    2007-11-01

    The Kuhn-Tucker Sufficiency Theorem states that a feasible point that satisfies the Kuhn-Tucker conditions is a global minimizer for a convex programming problem for which a local minimizer is global. In this paper, we present new Kuhn-Tucker sufficiency conditions for possibly multi-extremal nonconvex mathematical programming problems which may have many local minimizers that are not global. We derive the sufficiency conditions by first constructing weighted sum of square underestimators of the objective function and then by characterizing the global optimality of the underestimators. As a consequence, we derive easily verifiable Kuhn-Tucker sufficient conditions for general quadratic programming problems with equality and inequality constraints. Numerical examples are given to illustrate the significance of our criteria for multi-extremal problems.

  9. Eating Problems at Age 6 Years in a Whole Population Sample of Extremely Preterm Children

    Science.gov (United States)

    Samara, Muthanna; Johnson, Samantha; Lamberts, Koen; Marlow, Neil; Wolke, Dieter

    2010-01-01

    Aim: The aim of this study was to investigate the prevalence of eating problems and their association with neurological and behavioural disabilities and growth among children born extremely preterm (EPC) at age 6 years. Method: A standard questionnaire about eating was completed by parents of 223 children (125 males [56.1%], 98 females [43.9%])…

  10. Countering the Pedagogy of Extremism: Reflective Narratives and Critiques of Problem-Based Learning

    Science.gov (United States)

    Woo, Chris W. H.; Laxman, Kumar

    2013-01-01

    This paper is a critique against "purist" pedagogies found in the literature of student-centred learning. The article reproves extremism in education and questions the absolutism and teleological truths expounded in exclusive problem-based learning. The paper articulates the framework of a unifying pedagogical practice through Eve…

  11. Extreme value problems without calculus: a good link with geometry and elementary maths

    Science.gov (United States)

    Ganci, Salvatore

    2016-11-01

    Some classical examples of problem solving, where an extreme value condition is required, are here considered and/or revisited. The search for non-calculus solutions appears pedagogically useful and intriguing as shown through a rich literature. A teacher, who teaches both maths and physics, (as happens in Italian High schools) can find in these kinds of problems a mind stimulating exercise compared with the standard solution obtained by the differential calculus. A good link between the geometric and analytical explanations is so established.

  12. Thymic selection of T-cell receptors as an extreme value problem

    CERN Document Server

    Kosmrlj, Andrej; Kardar, Mehran; Shakhnovich, Eugene I

    2009-01-01

    T lymphocytes (T cells) orchestrate adaptive immune responses upon activation. T cell activation requires sufficiently strong binding of T cell receptors (TCRs) on their surface to short peptides (p) derived from foreign proteins, which are bound to major histocompatibility (MHC) gene products (displayed on antigen presenting cells). A diverse and self-tolerant T cell repertoire is selected in the thymus. We map thymic selection processes to an extreme value problem and provide an analytic expression for the amino acid compositions of selected TCRs (which enable its recognition functions).

  13. [Our viewpoints on Deqi in the later ages after birth of classical works "The Yellow Emperor's Internal Classic" and "Canon of Difficult Medical Problems"].

    Science.gov (United States)

    Hao, Jie; Zhu, Jiang; Zhang, Peng; Xin, Si-Yuan; Qi, Dan-Dan; Hu, Ni-Juan; Lin, Chi; Wang, Pei; Zhao, Min-Yi; Hu, Shang-Qing; Wu, Gui-Wen

    2015-04-01

    In our previous paper, we analyzed "Deqi" in book Huangdi Neijing (The Yellow Emperor's Internal Classic) and Nanjing (Canon of Difficult Medical Problems) from "Zhishen"(Treating mentality) and Tiaoqi (Regulating qi). In the present paper, the authors discuss the connotations of "Deqi" and related events in the later ages of the abovementioned two classic books to the later stage of the Qing Dynasty when involves about 20 classical works as Zhenjiu Dacheng ( The Great Compendium of Acupuncture and Moxibustion), Zhenjing Zhinan (Guide to the classics of Acupuncture), Zhenjiu Daquan (A Complete Works of Acupuncture and Moxibustion) etc. from 1) close association between "Deqi" and patients' mental activity; 2) how to wait for arrival of qi if the needling does not induce "Deqi" for the time being; 3) how to identify "qi-arrival" and then, performing suitable manipulations; 4) Deqi and shallow- or deep-needling; 5) putting more emphasis on patients' feeling and reactions, rather than the practitioners perception beneath the needle which is described in book Huangdi Neijing; and 6) not withdrawing the acupuncture needles if qi does not arrive. Generally, in the later ages, the connotations of Deqi are enriched greatly.

  14. Improving extreme-scale problem solving: assessing electronic brainstorming effectiveness in an industrial setting.

    Science.gov (United States)

    Dornburg, Courtney C; Stevens, Susan M; Hendrickson, Stacey M L; Davidson, George S

    2009-08-01

    An experiment was conducted to compare the effectiveness of individual versus group electronic brainstorming to address difficult, real-world challenges. Although industrial reliance on electronic communications has become ubiquitous, empirical and theoretical understanding of the bounds of its effectiveness have been limited. Previous research using short-term laboratory experiments have engaged small groups of students in answering questions irrelevant to an industrial setting. The present experiment extends current findings beyond the laboratory to larger groups of real-world employees addressing organization-relevant challenges during the course of 4 days. Employees and contractors at a national laboratory participated, either in a group setting or individually, in an electronic brainstorm to pose solutions to a real-world problem. The data demonstrate that (for this design) individuals perform at least as well as groups in producing quantity of electronic ideas, regardless of brainstorming duration. However, when judged with respect to quality along three dimensions (originality, feasibility, and effectiveness), the individuals significantly (p < .05) outperformed the group. When quality is used to benchmark success, these data indicate that work-relevant challenges are better solved by aggregating electronic individual responses rather than by electronically convening a group. This research suggests that industrial reliance on electronic problem-solving groups should be tempered, and large nominal groups may be more appropriate corporate problem-solving vehicles.

  15. New Dandelion Algorithm Optimizes Extreme Learning Machine for Biomedical Classification Problems

    Directory of Open Access Journals (Sweden)

    Xiguang Li

    2017-01-01

    Full Text Available Inspired by the behavior of dandelion sowing, a new novel swarm intelligence algorithm, namely, dandelion algorithm (DA, is proposed for global optimization of complex functions in this paper. In DA, the dandelion population will be divided into two subpopulations, and different subpopulations will undergo different sowing behaviors. Moreover, another sowing method is designed to jump out of local optimum. In order to demonstrate the validation of DA, we compare the proposed algorithm with other existing algorithms, including bat algorithm, particle swarm optimization, and enhanced fireworks algorithm. Simulations show that the proposed algorithm seems much superior to other algorithms. At the same time, the proposed algorithm can be applied to optimize extreme learning machine (ELM for biomedical classification problems, and the effect is considerable. At last, we use different fusion methods to form different fusion classifiers, and the fusion classifiers can achieve higher accuracy and better stability to some extent.

  16. Thymic Selection of T-Cell Receptors as an Extreme Value Problem

    Science.gov (United States)

    Kosmrlj, Andrej; Chakraborty, Arup K.; Kardar, Mehran; Shakhnovich, Eugene I.

    2010-03-01

    T lymphocytes (T cells) orchestrate adaptive immune responses that clear pathogens from infected hosts. T cells recognize short peptides (p) derived from foreign proteins, which are bound to major histocompatibility complex (MHC) gene products (displayed on antigen- presenting cells). Recognition occurs when T cell receptor (TCR) proteins expressed on T cells bind sufficiently strongly to antigen- derived pMHC complexes on the surface of antigen-presenting cells. A diverse repertoire of self-tolerant TCR sequences is shaped during development of T cells in the thymus by processes called positive and negative selection. We map thymic selection processes to an extreme value problem and provide analytic expression for the amino acid composition of selected TCR sequences (which enable its recognition functions).

  17. 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.

  18. 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.

  19. Frontal Electroencephalogram Asymmetry, Salivary Cortisol, and Internalizing Behavior Problems in Young Adults Who Were Born at Extremely Low Birth Weight

    Science.gov (United States)

    Schmidt, Louis A.; Miskovic, Vladimir; Boyle, Michael; Saigal, Saroj

    2010-01-01

    The authors examined internalizing behavior problems at middle childhood, adolescence, and young adulthood and brain-based measures of stress vulnerability in 154 right-handed, nonimpaired young adults (M age = 23 years): 71 (30 males, 41 females) born at extremely low birth weight (ELBW; less than 1,000 g) and 83 (35 males, 48 females) controls…

  20. Problemas que dificultam a implementação do planejamento de saúde Health planning and the problems that make its implementation difficult

    Directory of Open Access Journals (Sweden)

    Aldo da Fonseca Tinôco

    1980-06-01

    Full Text Available São relacionados alguns problemas que dificultam a atividade de planejadores e administradores de sistemas de serviços de saúde quando se propõem a desenvolver ações planejadas no campo da saúde pública. Entre estes destacam-se aqueles que se referem à eleição de técnica, fixação de prioridades, organização e integração de serviços, informação estatística e decisão política.Some problems that handicap the activity of health administrators and planners when they try to develop planned activities in public health are listed. Among such problems those regarding choice of techniques, establishment of priorities, organization and integration of services, statistical information, and policy decisions stand out.

  1. 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…

  2. 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

  3. Self-Regulation: A New Perspective on Learning Problems Experienced by Children Born Extremely Preterm

    Science.gov (United States)

    Lynn, Lisa N.; Cuskelly, Monica; O'Callaghan, Michael J.; Gray, Peter H.

    2011-01-01

    Survival rates are increasing for children born extremely preterm, yet despite the majority of these children having IQ scores within the average range, 50-70% of these children have later school difficulties. This paper reviews factors associated with academic difficulties in these children, emphasizing the contributions of executive functions…

  4. Testing Vegetation Flammability: The Problem of Extremely Low Ignition Frequency and Overall Flammability Score

    Directory of Open Access Journals (Sweden)

    Zorica Kauf

    2014-01-01

    Full Text Available In the recent decades changes in fire regimes led to higher vulnerability of fire prone ecosystems, with vegetation being the only component influencing fire regime which can be managed in order to reduce probability of extreme fire events. For these management practices to be effective reliable information on the vegetation flammability is being crucial. Epiradiator based testing methods are one of the methods commonly used to investigate vegetation flammability and decrease in ignition frequency is always interpreted as a decrease in flammability. Furthermore, gathered information is often combined into a single flammability score. Here we present results of leaf litter testing which, together with previously conducted research on similar materials, show that material with very low ignition frequency under certain testing conditions can be extremely flammable if testing conditions are slightly changed. Additionally, our results indicate that combining measured information into one single flammability score, even though sometimes useful, is not always meaningful and should be performed with caution.

  5. 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

  6. 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.

  7. 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

  8. The limits of the adaptation of life to extreme conditions (in connection with problems of exobiology)

    Science.gov (United States)

    Aksenov, S. I.

    1973-01-01

    Accommodation is discussed as a universal evolutionary principle which essentially will apply to all life forms, regardless of chemical base (carbon, silicon, etc.). Life forms must either adapt to extreme conditions or perish, and for any life form an extremum factor is any significant deviation in environmental parameters. The possibility of life forms existing in specific extraterrestrial environments is discussed, and a conclusion is drawn which unequivocally states that through many forms of accommodation life is possible in many different environments.

  9. CHRISTMAS 2014 : GOING TO EXTREMES Nintendo related injuries and other problems: review

    NARCIS (Netherlands)

    Jalink, Maarten B.; Heineman, Erik; Pierie, Jean-Pierre E. N.; Hoedemaker, Henk O. ten Cate

    2014-01-01

    Objective To identify all reported cases of injury and other problems caused by using a Nintendo video gaming system. Design Review. Data sources and review methods Search of PubMed and Embase in June 2014 for reports on injuries and other problems caused by using a Nintendo gaming system. Results M

  10. CHRISTMAS 2014 : GOING TO EXTREMES Nintendo related injuries and other problems: review

    NARCIS (Netherlands)

    Jalink, Maarten B.; Heineman, Erik; Pierie, Jean-Pierre E. N.; Hoedemaker, Henk O. ten Cate

    2014-01-01

    Objective To identify all reported cases of injury and other problems caused by using a Nintendo video gaming system. Design Review. Data sources and review methods Search of PubMed and Embase in June 2014 for reports on injuries and other problems caused by using a Nintendo gaming system. Results

  11. The Eigenvalue Method for Extremal Problems on Infinite Vertex-Transitive Graphs

    NARCIS (Netherlands)

    DeCorte, P.E.B.

    2015-01-01

    This thesis is about maximum independent set and chromatic number problems on certain kinds of infinite graphs. A typical example comes from the Witsenhausen problem: For $n \\geq 2$, let $S^{n-1} := \\{ x \\in \\R^n : \\|x\\|_2 =1 \\}$ be the unit sphere in $\\R^n$, and let $G=(V,E)$ be the graph with $V =

  12. 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.

  13. [Hygienic problems of population health maintenance under the extremal conditions of North].

    Science.gov (United States)

    Potapov, A I; Istomin, A V; Shushkova, T S; Ustiushin, B V; Iudina, T V; Maĭmulov, V G; Raengulov, B M; Shagdarova, A N

    2005-01-01

    A range of multi-sided studies, carried out in various regions of Far North (Jamalo-Nenets autonomous region, Komi republic, Sakha republic (Yakutia)) have established the leading hygienic risk factors of population health deterioration, including those characteristic of small nationalities of North. The consideration of the obtained data, including regional alimentary status peculiarities, the condition of metabolic processes and antioxidant balance of the organism, allowed establishment of effective approaches to the maintenance of notherners' health. These approaches are based upon the optimization of nutrition as an element of population health control under extremal conditions.

  14. 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.

  15. Non-linear time series extreme events and integer value problems

    CERN Document Server

    Turkman, Kamil Feridun; Zea Bermudez, Patrícia

    2014-01-01

    This book offers a useful combination of probabilistic and statistical tools for analyzing nonlinear time series. Key features of the book include a study of the extremal behavior of nonlinear time series and a comprehensive list of nonlinear models that address different aspects of nonlinearity. Several inferential methods, including quasi likelihood methods, sequential Markov Chain Monte Carlo Methods and particle filters, are also included so as to provide an overall view of the available tools for parameter estimation for nonlinear models. A chapter on integer time series models based on several thinning operations, which brings together all recent advances made in this area, is also included. Readers should have attended a prior course on linear time series, and a good grasp of simulation-based inferential methods is recommended. This book offers a valuable resource for second-year graduate students and researchers in statistics and other scientific areas who need a basic understanding of nonlinear time ...

  16. A PROCESS FOR SOLVING A FEW EXTREME EIGENPAIRS OF LARGE SPARSE POSITIVE DEFINITE GENERALIZED EIGENVALUE PROBLEM

    Institute of Scientific and Technical Information of China (English)

    Chong-hua Yu; O. Axelsson

    2000-01-01

    In this paper, an algorithm for computing some of the largest (smallest) generalized eigenvalues with corresponding eigenvectors of a sparse symmetric positive definite matrix pencil is presented. The algorithm uses an iteration function and inverse power iteration process to get the largest one first, then executes m-1Lanczos-like steps to get initial approximations of the next m - 1 ones, without computing any Ritz pair, for which a procedure combining Rayleigh quotient iteration with shifted inverse power iteration is used to obtain more accurate eigenvalues and eigenvectors. This algorithm keeps the advantages of preserving sparsity of the original matrices as in Lanczos method and RQI and converges with a higher rate than the method described in[12] and provides a simple technique to compute initial approximate pairs which are guaranteed to converge to the wanted m largest eigenpairs using RQI. In addition, it avoids some of the disadvantages of Lanczos and RQI, for solving extreme eigenproblems. When symmetric positive definfite linear systems must be solved in the process, an algebraic multilevel iteration method (AMLI) is applied. The algorithm is fully parallelizable.

  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. The butterfly effect in the extreme-mass ratio inspiral problem

    CERN Document Server

    Amaro-Seoane, Pau; Cuadra, Jorge; Armitage, Philip J

    2011-01-01

    Measurements of gravitational waves from the inspiral of a stellar-mass compact object into a massive black hole (MBH) are unique probes to test General Relativity (GR) and MBH properties, as well as the stellar distribution about these holes in galactic nuclei. Current data analysis techniques can provide us with parameter estimation with very narrow errors. However, an EMRI is not a two-body problem, since other stellar bodies orbiting nearby will influence the capture orbit. Any deviation from the isolated inspiral of the binary will induce a small, though observable deviation from the idealised waveform which could be misinterpreted as a failure of GR. Based on conservative analysis of mass segregation in a Milky Way like nucleus, we estimate that the possibility that a star has a semi-major axis comparable to that of the EMRI is non-negligible. This star introduces an observable perturbation in the orbit in the case in which we consider only loss of energy via gravitational radiation at periapsis. When c...

  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. A note on: A modified generalized extremal optimization algorithm for the quay crane scheduling problem with interference constraints

    Science.gov (United States)

    Trunfio, Roberto

    2015-06-01

    In a recent article, Guo, Cheng and Wang proposed a randomized search algorithm, called modified generalized extremal optimization (MGEO), to solve the quay crane scheduling problem for container groups under the assumption that schedules are unidirectional. The authors claim that the proposed algorithm is capable of finding new best solutions with respect to a well-known set of benchmark instances taken from the literature. However, as shown in this note, there are some errors in their work that can be detected by analysing the Gantt charts of two solutions provided by MGEO. In addition, some comments on the method used to evaluate the schedule corresponding to a task-to-quay crane assignment and on the search scheme of the proposed algorithm are provided. Finally, to assess the effectiveness of the proposed algorithm, the computational experiments are repeated and additional computational experiments are provided.

  3. A ten-year review of lower extremity burns in diabetics: small burns that lead to major problems.

    Science.gov (United States)

    Barsun, Alura; Sen, Soman; Palmieri, Tina L; Greenhalgh, David G

    2013-01-01

    Diabetes mellitus with its resulting neurovascular changes may lead to an increased risk of burns and impaired wound healing. The purpose of this article is to review 10 years of experience with foot and lower leg burns in patients with diabetes at a single adult burn center. Patients with lower extremity burns and diabetes mellitus, between May 1999 and December 2009, were identified in the Trauma Registry of the American College of Surgeons database, and their charts were reviewed for data related to their outcomes. Sixty-eight diabetic patients, 87% male, with a mean age of 54 years, sustained foot or lower extremity burns with 37 having burns resulting from insensate feet. The pathogenesis included walking on a hot or very cold surface (8), soaking feet in hot water (22), warming feet on or near something hot such as a heater (13), or spilling hot water (7). The majority of patients were taking insulin (59.6%) or oral hyperglycemic medications (34.6%). Blood sugar levels were not well controlled (mean glucose, 215.8 mg/dl; mean hemoglobin A1c, 9.08%). Renal disease was common with admission serum blood urea nitrogen (27.5 mg/dl) and creatinine (2.21 mg/dl), and 13 were on dialysis preinjury. Cardiovascular problems were common with 39 (57%) having hypertension or cardiac disease, 3 having peripheral vascular disease, and 9, previous amputations. The mean burn size was 4.2% TBSA (range, 0.5-15%) with 57% being full thickness. Despite the small burn, the mean length of stay was 15.2 days (range, 1-95), with 5.65 days per 1% TBSA. Inability to heal these wounds was evident in 19 patients requiring readmission (one required 10 operative procedures). At least one patient sustained more than one burn. There were 62 complications with 30 episodes of infection (cellulitis, 28; osteomyelitis, 4; deep plantar infections, 2; ruptured Achilles tendon, 1) and 3 deaths. Eleven patients needed amputations (7 below-knee amputations, 4 transmetatarsal amputations, and 20 toe

  4. Management of difficult urticaria

    Directory of Open Access Journals (Sweden)

    Yadav Sudha

    2009-01-01

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

  5. 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!

  6. Why do people buy dogs with potential welfare problems related to extreme conformation and inherited disease? A representative study of Danish owners of four small dog breeds

    DEFF Research Database (Denmark)

    Sandøe, Peter; Kondrup, Sara Vincentzen; Bennett, P.C.

    2017-01-01

    number of dog breeds suffer from welfare problems due to extreme phenotypes and high levels of inherited diseases but the popularity of such breeds is not declining. Using a survey of owners of two popular breeds with extreme physical features (French Bulldog and Chihuahua), one with a high load...... of inherited diseases not directly related to conformation (Cavalier King Charles Spaniel), and one representing the same size range but without extreme conformation and with the same level of disease as the overall dog population (Cairn Terrier), we investigated this seeming paradox. We examined planning...... and motivational factors behind acquisition of the dogs, and whether levels of experienced health and behavior problems were associated with the quality of the owner-dog relationship and the intention to re-procure a dog of the same breed. Owners of each of the four breeds (750/breed) were randomly drawn from...

  7. 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.

  8. 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.

  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. Why do people buy dogs with potential welfare problems related to extreme conformation and inherited disease? A representative study of Danish owners of four small dog breeds

    Science.gov (United States)

    Kondrup, S. V.; Bennett, P. C.; Forkman, B.; Meyer, I; Proschowsky, H. F.; Serpell, J. A.; Lund, T. B.

    2017-01-01

    A number of dog breeds suffer from welfare problems due to extreme phenotypes and high levels of inherited diseases but the popularity of such breeds is not declining. Using a survey of owners of two popular breeds with extreme physical features (French Bulldog and Chihuahua), one with a high load of inherited diseases not directly related to conformation (Cavalier King Charles Spaniel), and one representing the same size range but without extreme conformation and with the same level of disease as the overall dog population (Cairn Terrier), we investigated this seeming paradox. We examined planning and motivational factors behind acquisition of the dogs, and whether levels of experienced health and behavior problems were associated with the quality of the owner-dog relationship and the intention to re-procure a dog of the same breed. Owners of each of the four breeds (750/breed) were randomly drawn from a nationwide Danish dog registry and invited to participate. Of these, 911 responded, giving a final sample of 846. There were clear differences between owners of the four breeds with respect to degree of planning prior to purchase, with owners of Chihuahuas exhibiting less. Motivations behind choice of dog were also different. Health and other breed attributes were more important to owners of Cairn Terriers, whereas the dog’s personality was reported to be more important for owners of French Bulldogs and Cavalier King Charles Spaniels but less important for Chihuahua owners. Higher levels of health and behavior problems were positively associated with a closer owner-dog relationship for owners of Cavalier King Charles Spaniels and Chihuahuas but, for owners of French Bulldogs, high levels of problems were negatively associated with an intention to procure the same breed again. In light of these findings, it appears less paradoxical that people continue to buy dogs with welfare problems. PMID:28234931

  12. Why do people buy dogs with potential welfare problems related to extreme conformation and inherited disease? A representative study of Danish owners of four small dog breeds.

    Science.gov (United States)

    Sandøe, P; Kondrup, S V; Bennett, P C; Forkman, B; Meyer, I; Proschowsky, H F; Serpell, J A; Lund, T B

    2017-01-01

    A number of dog breeds suffer from welfare problems due to extreme phenotypes and high levels of inherited diseases but the popularity of such breeds is not declining. Using a survey of owners of two popular breeds with extreme physical features (French Bulldog and Chihuahua), one with a high load of inherited diseases not directly related to conformation (Cavalier King Charles Spaniel), and one representing the same size range but without extreme conformation and with the same level of disease as the overall dog population (Cairn Terrier), we investigated this seeming paradox. We examined planning and motivational factors behind acquisition of the dogs, and whether levels of experienced health and behavior problems were associated with the quality of the owner-dog relationship and the intention to re-procure a dog of the same breed. Owners of each of the four breeds (750/breed) were randomly drawn from a nationwide Danish dog registry and invited to participate. Of these, 911 responded, giving a final sample of 846. There were clear differences between owners of the four breeds with respect to degree of planning prior to purchase, with owners of Chihuahuas exhibiting less. Motivations behind choice of dog were also different. Health and other breed attributes were more important to owners of Cairn Terriers, whereas the dog's personality was reported to be more important for owners of French Bulldogs and Cavalier King Charles Spaniels but less important for Chihuahua owners. Higher levels of health and behavior problems were positively associated with a closer owner-dog relationship for owners of Cavalier King Charles Spaniels and Chihuahuas but, for owners of French Bulldogs, high levels of problems were negatively associated with an intention to procure the same breed again. In light of these findings, it appears less paradoxical that people continue to buy dogs with welfare problems.

  13. 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...

  14. Extremity dosimetry problems during the handling of radionuclides syringes in nuclear medicine: A Monte Carlo radiation transport simplified approach

    Energy Technology Data Exchange (ETDEWEB)

    Mariotti, F., E-mail: francesca.mariotti@bologna.enea.i [ENEA-BAS-ION IRP Radiation Protection Institute, Via dei Colli 16, 40136, Bologna (Italy); Gualdrini, G. [ENEA-BAS-ION IRP Radiation Protection Institute, Via dei Colli 16, 40136, Bologna (Italy)

    2011-04-15

    The ORAMED (Optimization of RAdiation protection for MEDical staff) Working Tasks (WP4) is addressed at evaluating extremity doses (and dose distributions across the hands) of medical staff working in nuclear medicine departments, to study the influence of protective devices such as syringe and vial shields, to improve such devices when possible and to propose 'levels of reference doses' for each standard nuclear medicine procedure. In particular task 4 is concerned with the study of the extremity dosimetry for the hand of operators devoted to the preparation and administration stages of the usage, for example, of {sup 99m}Tc, {sup 18}F and {sup 90}Y (Zevalin) radionuclides. The aim of this report consists in the study of photon-electron equilibrium conditions at 0.07 mm in the skin to justify a simplified 'kerma approximation' approach in the planned complex Monte Carlo voxel hand modeling. Furthermore a detailed investigation on primary electron and secondary bremsstrahlung photon transport from {sup 90}Y to speed up the calculations was performed. The results obtained in the simplified investigated conditions could be of help for the production calculations, introducing, if necessary, suited correction factors applicable to the complex condition results.

  15. Drastic Measures for Difficult Times

    Science.gov (United States)

    Galuszka, Peter

    2008-01-01

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

  16. Existence and uniqueness of extreme point of total power rate functional for hot rolling problem with rigid-plastic SCM model

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The total power rate functional for hot rolling problem with the rigid-plastic SCM model is considered.The gradient operator of the plastic deformation power rate functional is deduced.It is strictly monotone mapping.Further,it is proved that the frictional power rate functional is a convex functional and the tensional stress power rate functional is a linear one.Hence,the total power rate functional is a strictly convex functional.By using nonlinear functional analysis methods,the existence and uniqueness of extreme point of the functional is obtained.

  17. What is the essence of the so-called century lasting difficult problem in classic physics, the “problem of turbulence”%号称经典物理留下的世纪难题“湍流问题”的实质是什么?

    Institute of Scientific and Technical Information of China (English)

    周恒; 张涵信

    2012-01-01

    Turbulence has always been viewed as a century lasting difficult problem in classic physics, hence it is also viewed as a very important basic scientific problem. In this paper, starting from a brief review of the history of turbulence research, we analyze why there seems is a gap separating researches on homogeneous isotropic turbulence and researches on real turbulence, why the former did not make substantial contribution to solving problems of real turbulence, while the latter should be the main focus of the further basic research of turbulence, and how the real turbulence problem can be solved gradually. In conclusions, we list several points worth attention in the turbulence research.%一直以来,湍流都被认为是经典物理留下的世纪难题,因而也被认为是一个重大的基础科学问题.本文简单回顾湍流研究历史,分析了均匀各向同性湍流的研究和真实湍流的研究间为何存在鸿沟.为何前者不能解决真实湍流问题,而后者则是今后应重点开展的湍流基础研究,和如何逐步解决真实的湍流问题.在结论中提出了今后湍流研究中值得注意的几个方面.

  18. LDRD final report for improving human effectiveness for extreme-scale problem solving : assessing the effectiveness of electronic brainstorming in an industrial setting.

    Energy Technology Data Exchange (ETDEWEB)

    Dornburg, Courtney C.; Stevens, Susan Marie; Davidson, George S.; Hendrickson, Stacey M. Langfitt

    2008-09-01

    An experiment was conducted comparing the effectiveness of individual versus group electronic brainstorming in order to address difficult, real world challenges. While industrial reliance on electronic communications has become ubiquitous, empirical and theoretical understanding of the bounds of its effectiveness have been limited. Previous research using short-term, laboratory experiments have engaged small groups of students in answering questions irrelevant to an industrial setting. The present experiment extends current findings beyond the laboratory to larger groups of real-world employees addressing organization-relevant challenges over the course of four days. Employees and contractors at a national security laboratory participated, either in a group setting or individually, in an electronic brainstorm to pose solutions to a 'wickedly' difficult problem. The data demonstrate that (for this design) individuals perform at least as well as groups in producing quantity of electronic ideas, regardless of brainstorming duration. However, when judged with respect to quality along three dimensions (originality, feasibility, and effectiveness), the individuals significantly (p<0.05) out-performed the group working together. When idea quality is used as the benchmark of success, these data indicate that work-relevant challenges are better solved by aggregating electronic individual responses, rather than electronically convening a group. This research suggests that industrial reliance upon electronic problem solving groups should be tempered, and large nominal groups might be the more appropriate vehicle for solving wicked corporate issues.

  19. 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

  20. [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.

  1. 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

  2. Improving human effectiveness for extreme-scale problem solving : final report (assessing the effectiveness of electronic brainstorming in an industrial setting).

    Energy Technology Data Exchange (ETDEWEB)

    Dornburg, Courtney C.; Stevens, Susan Marie; Bauer, Travis L.; Davidson, George S.; Forsythe, James Chris; Hendrickson, Stacey M. Langfitt

    2007-09-01

    An experiment was conducted comparing the effectiveness of individual versus group electronic brainstorming in order to address difficult, real world challenges. While industrial reliance on electronic communications has become ubiquitous, empirical and theoretical understanding of the bounds of its effectiveness have been limited. Previous research using short-term, laboratory experiments have engaged small groups of students in answering questions irrelevant to an industrial setting. The current experiment extends current findings beyond the laboratory to larger groups of real-world employees addressing organization-relevant challenges over the course of four days. Findings are twofold. First, the data demonstrate that (for this design) individuals perform at least as well as groups in producing quantity of electronic ideas, regardless of brainstorming duration. However, when judged with respect to quality along three dimensions (originality, feasibility, and effectiveness), the individuals significantly (p<0.05) out performed the group working together. The theoretical and applied (e.g., cost effectiveness) implications of this finding are discussed. Second, the current experiment yielded several viable solutions to the wickedly difficult problem that was posed.

  3. Solving the Difficult Problems of Management Information System based on VF Design%基于VF设计的管理信息系统的疑难问题解析

    Institute of Scientific and Technical Information of China (English)

    李建斌

    2012-01-01

    This paper mainly analyzes severai diffidult problems of management information system based on VF design, inciuding the testing count of undamaged decomposing for extensive relation mode, the realization of management information system for performing program at independent Vf environment and the method of realizing automatic fixing route found by system.%主要进行基于VF设计的管理信息系统的几个疑难问题的解析,包括对泛关系模式无损分解的测试算法,以及实现管理信息系统可执行程序独立于VF环境和实现系统自动寻找安装路径的方法。

  4. The difficult medical emergency call

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Kjærulff, Thora Majlund; Viereck, Søren

    2017-01-01

    BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories and the ......BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories...... and the effect of categorization on mortality. METHODS: Register-based study in a 2-year period based on emergency call data from the emergency medical dispatch center in Copenhagen combined with nationwide register data. Logistic regression analysis (N = 78,040 individuals) was used for identification...

  5. The difficult medical emergency call

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Kjærulff, Thora Majlund; Viereck, Søren

    2017-01-01

    BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories and the ......BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories...... and the effect of categorization on mortality. METHODS: Register-based study in a 2-year period based on emergency call data from the emergency medical dispatch center in Copenhagen combined with nationwide register data. Logistic regression analysis (N = 78,040 individuals) was used for identification...

  6. Research on the Difficult Problems on Commodity Crimes of Selling False Registered Brands%销售假冒注册商标的商品罪疑难问题研究

    Institute of Scientific and Technical Information of China (English)

    邓忠

    2012-01-01

    理论界对销售假冒注册商标的商品罪研究较多,但仍有许多新问题,例如对本罪"明知"和"既未遂"的认定尚无定论,大有讨论的必要。销售假冒注册商标的商品罪以明知是假冒注册商标的商品为前提,而对于明知的要求是知道或者应当知道;对于"应当知道"的理解,应坚持主客观相一致的原则,综合案件的各种证据进行推定;对于销售假冒注册商标的商品罪的未遂形态认定,应充分利用相关刑法理论和实践经验;在既未遂形态竞合的情况下,应采用既遂吸收未遂的方法进行定罪处罚,但在量刑上应进行适当的修改、改善,以期对司法实践有所助益。%Though there have been many studies on commodity crimes of selling false registered brands among scholars,there are still many new problems.For example,there are no definitions for the items,"awareness" and "unsuccessful committment",which is necessary for us to discuss.The commodity crimes of selling false registered brands takes "awareness" as premise.However,"awareness" means that the criminals know or should know their guilts.The understanding of that "criminals should know their guilts" should be based on the agreement between subjectiveness and objectiveness.Furthermore,the understanding should be based on comprehensive study on proofs involved in the case.The definition on the "unsuccessful committment" of the commidity crimes should be based on criminal law and practical experience.When "committment" is mentioned together with "unsuccessful committment",we should apply the method that "committment" includes "unsuccessful committment" to convict and punish the that criminals.While as to the measurement of penalty,we should make some revision or improvement,so as to be helpful to judicial practice.

  7. Problems

    Directory of Open Access Journals (Sweden)

    Yekini Shehu

    2010-01-01

    real Banach space which is also uniformly smooth using the properties of generalized f-projection operator. Using this result, we discuss strong convergence theorem concerning general H-monotone mappings and system of generalized mixed equilibrium problems in Banach spaces. Our results extend many known recent results in the literature.

  8. Highly indefinite multigrid for eigenvalue problems

    Energy Technology Data Exchange (ETDEWEB)

    Borges, L.; Oliveira, S.

    1996-12-31

    Eigenvalue problems are extremely important in understanding dynamic processes such as vibrations and control systems. Large scale eigenvalue problems can be very difficult to solve, especially if a large number of eigenvalues and the corresponding eigenvectors need to be computed. For solving this problem a multigrid preconditioned algorithm is presented in {open_quotes}The Davidson Algorithm, preconditioning and misconvergence{close_quotes}. Another approach for solving eigenvalue problems is by developing efficient solutions for highly indefinite problems. In this paper we concentrate on the use of new highly indefinite multigrid algorithms for the eigenvalue problem.

  9. 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.

  10. Fusion proteins as alternate crystallization paths to difficult structure problems

    Science.gov (United States)

    Carter, Daniel C.; Rueker, Florian; Ho, Joseph X.; Lim, Kap; Keeling, Kim; Gilliland, Gary; Ji, Xinhua

    1994-01-01

    The three-dimensional structure of a peptide fusion product with glutathione transferase from Schistosoma japonicum (SjGST) has been solved by crystallographic methods to 2.5 A resolution. Peptides or proteins can be fused to SjGST and expressed in a plasmid for rapid synthesis in Escherichia coli. Fusion proteins created by this commercial method can be purified rapidly by chromatography on immobilized glutathione. The potential utility of using SjGST fusion proteins as alternate paths to the crystallization and structure determination of proteins is demonstrated.

  11. Bluefin tuna fishing and ranching: a difficult management problem

    NARCIS (Netherlands)

    Stefano, de V.; Heijden, van der P.G.M.

    2007-01-01

    The fish processing industry and consumers in Japan are willing to pay high (and sometimes outrageous) prices for fresh bluefin tuna with fat content and flesh colour just right to be served raw as sashimi or sushi. This willingness was and still is the economic incentive for a high fishing pressure

  12. Fever of unknown origin - a difficult diagnostic problem

    OpenAIRE

    2012-01-01

    Introdução: Os principais diagnósticos a considerar numa febre de etiologia indeterminada incluem as causas infecciosas, reumatológicas, imunológicas e neoplásicas. Caso clínico: Apresentamos o caso de uma criança de quatro anos do sexo masculino, observada por febre, cervicalgia e claudicação da marcha. Detectou-se anemia e marcadores inflamatórios elevados. No internamento foi-se evidenciando palidez, exantema maculo-papular em pico febril e adenomegalias cervicais. A avaliaç...

  13. The Entrepreneurial University: A Fine Answer to a Difficult Problem?

    Science.gov (United States)

    Soares, Virgilio A. Meira; Amaral, Alberto M. S. C.

    1999-01-01

    Analyzes changes in the relationship between universities and society and in government attitudes toward higher education institutions, and explores different institutional reactions to the greater demands of society. The concept of the entrepreneurial university is examined critically, based on recent theory and institutional quality audits in…

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

    DEFF Research Database (Denmark)

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

    2006-01-01

    , and global scales. Unfortunately, this process is very difficult to measure, and existing methods are problematic for different reasons in different places at different times. In this paper, we review the major approaches that have been taken to measure denitrification in terrestrial and aquatic environments...... based on stable isotopes, (8) in situ gradients with atmospheric environmental tracers, and (9) molecular approaches. Our review makes it clear that the prospects for improved quantification of denitrification vary greatly in different environments and at different scales. While current methodology allows...... for the production of accurate estimates of denitrification at scales relevant to water and air quality and ecosystem fertility questions in some systems (e.g., aquatic sediments, well-defined aquifers), methodology for other systems, especially upland terrestrial areas, still needs development. Comparison of mass...

  15. Thyroid Carcinoma and Radiation some Difficult Problems in Screening Programs

    Directory of Open Access Journals (Sweden)

    Fredrick.Ellyin

    1980-07-01

    Full Text Available Thus the data show a re lationship between radiation and the development of thyroid ca rci noma and i mp l y that s eeking and r emoving such tumors woul d be beneficial . As in most situations, however, this s i mp l e r elationship is clouded by a va r i e t y of associated prob l ems , which mus t be ca r efull y considered."nThe surgical pr oce dure r e c ommended f or r emoval o f a nodule in an irradiated gland was a total l obe c t omy on t he contralateral side . If t he contralateral side by a surgeon with a speci a l interest in the field wa s found abnormal on i ns pe c t i on during t he s urgery , a ne ar total thyroidectomy was indicated.

  16. Clostridium difficile phages: still difficult?

    Directory of Open Access Journals (Sweden)

    Katherine Rose Hargreaves

    2014-04-01

    Full Text Available Phages that infect Clostridium difficile were first isolated for typing purposes in the 1980s, but their use was short lived. However, the rise of C. difficile epidemics over the last decade has triggered a resurgence of interest in using phages to combat this pathogen. Phage therapy is an attractive treatment option for C. difficile infection, however developing suitable phages is challenging. In this review we summarise the difficulties faced by researchers in this field, and we discuss the solutions and strategies used for the development of C. difficile phages for use as novel therapeutics.Epidemiological data has highlighted the diversity and distribution of C. difficile, and shown that novel strains continue to emerge in clinical settings. In parallel with epidemiological studies, advances in molecular biology have bolstered our understanding of C. difficile biology, and our knowledge of phage-host interactions in other bacterial species. These three fields of biology have therefore paved the way for future work on C. difficile phages to progress and develop. Benefits of using C. difficile phages as therapeutic agents include the fact that they have highly specific interactions with their bacterial hosts. Studies also show that they can reduce bacterial numbers in both in vitro and in vivo systems. Genetic analysis has revealed the genomic diversity among these phages and provided an insight into their taxonomy and evolution.No strictly virulent C. difficile phages have been reported and this contributes to the difficulties with their therapeutic exploitation. Although treatment approaches using the phage-encoded endolysin protein have been explored, the benefits of using whole-phages are such that they remain a major research focus. Whilst we don’t envisage working with C. difficile phages will be problem free, sufficient study should inform future strategies to facilitate their development to combat this problematic pathogen.

  17. 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 ...

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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...

  8. 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....

  9. 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

  10. 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)

  11. 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…

  12. 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...

  13. 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…

  14. [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.

  15. 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)

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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

  4. Psychological and psycho-vegetative technologies of diagnostics and correction the behavior of professionals working in extreme conditions (state of problem and prospective studies

    Directory of Open Access Journals (Sweden)

    Bulygina V.G.

    2016-10-01

    Full Text Available The article is devoted to promising areas of research regulatory processes (self-control оf the professionals working in special and extreme conditions of professional activity. The actuality of creation a comprehensive compact of the selection methods, adaptation the technologies to professional tasks, methods of psychological assistance of the specialists of hazardous occupations was shown. It was done an overview of foreign studies of the features of psychological regulation and self-control in stressful situations, neurophysiological correlates of self-control and aggressive behavior. The results of trainings of the development of the capacity for self-control, increasing resistance to the negative effects of mental exhaustion, were described. There were expounded the results of domestic investigations of the association between the self-regulation of behavior and profile of reactivity among mentally healthy and ill persons. The necessity of the development of psychodiagnostic and psychological programs for specialists in the professions of risk, aimed to improve the efficiency of regulatory processes for the adaptation to the conditions of professional activity.

  5. 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.

  6. 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...

  7. [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.

  8. [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.

  9. Unexpected difficult intubation due to subglottic ring

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. 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.

  12. 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...

  13. 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...

  14. 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...

  15. 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.

  16. LAMB PROBLEM

    Directory of Open Access Journals (Sweden)

    Terent'eva Elena Olegovna

    2013-09-01

    Full Text Available Inner and outer Lamb problems are of extreme importance for various applications in geophysics, as these problems are often used for simulation of wave fields accompanying earthquakes. Solutions of the outer Lamb problem of concentrated force impact applied to the free surface of an elastic half-plane are analyzed in this article. Two solutions are compared: the analytical solution obtained in 1984 and the solution obtained in a modern FEM complex Abaqus.

  17. LAMB PROBLEM

    OpenAIRE

    Terent'eva Elena Olegovna

    2013-01-01

    Inner and outer Lamb problems are of extreme importance for various applications in geophysics, as these problems are often used for simulation of wave fields accompanying earthquakes. Solutions of the outer Lamb problem of concentrated force impact applied to the free surface of an elastic half-plane are analyzed in this article. Two solutions are compared: the analytical solution obtained in 1984 and the solution obtained in a modern FEM complex Abaqus.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. Mesopotamia, A Difficult but Interesting Topic.

    Science.gov (United States)

    Kavett, Hyman

    1979-01-01

    Describes a method to help students become participants in historical analysis rather than observers of ancient history. Mesopotamia is used as a case study of a culture for which opportunities exist for conjecture, hypothesis formation, research, extrapolation, problem solving, and statements of causality. (Author/DB)

  3. Changing Jobs in Difficult Financial Times

    Science.gov (United States)

    Brown, Wayne

    2009-01-01

    Starting a new CIO job is always a challenge. There is a new department and institution to learn about, people to meet, and problems to solve. There is always plenty to learn and projects to realize. Throwing in economic challenges to the new-job transition can feel like one is attempting to climb a mountain without any gear. Fortunately, there…

  4. Mesopotamia, A Difficult but Interesting Topic.

    Science.gov (United States)

    Kavett, Hyman

    1979-01-01

    Describes a method to help students become participants in historical analysis rather than observers of ancient history. Mesopotamia is used as a case study of a culture for which opportunities exist for conjecture, hypothesis formation, research, extrapolation, problem solving, and statements of causality. (Author/DB)

  5. 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

  6. 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.

  7. 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)

  8. 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.

  9. 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.

  10. 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...

  11. 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.

  12. 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.

  13. 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.

  14. Extreme Folding

    Science.gov (United States)

    Demaine, Erik

    2012-02-01

    Our understanding of the mathematics and algorithms behind paper folding, and geometric folding in general, has increased dramatically over the past several years. These developments have found a surprisingly broad range of applications. In the art of origami, it has helped spur the technical origami revolution. In engineering and science, it has helped solve problems in areas such as manufacturing, robotics, graphics, and protein folding. On the recreational side, it has led to new kinds of folding puzzles and magic. I will give an overview of the mathematics and algorithms of folding, with a focus on new mathematics and sculpture.

  15. Life versus disease in difficult diabetes care

    DEFF Research Database (Denmark)

    Knudsen, Vibeke Zoffmann

    2005-01-01

    Conflicts in problem solving are known from diabetes research on patients with good glycemic control but have rarely been studied in the care of patients with poor glycemic control. Equally, the different perspectives of health care providers and patients have not been a focus in previous studies....... The authors studied the interactions between health care providers and 11 diabetes patients with poor glycemic control in a grounded theory study at a Danish university hospital. Keeping Life and Disease Apart was identified as a core category. It involved a pattern of conflicts both between and within...

  16. AN EXTREMAL APPROACH TO BIRKHOFF QUADRATURE FORMULAS

    Institute of Scientific and Technical Information of China (English)

    Ying-guang Shi

    2001-01-01

    As we know, a solution of an extremal problem with Hermite interpolation constraints is a system of nodes of corresponding Gaussian Hermite quadrature formula (the so-called Jacobi approach). But this conclusion is violated for a Birkhoff quadrature formula. In this paper an extremal problem with Birkhoff interpolation constraints is discussed, from which a large class of Birkhoff quadrature formulas may be derived.

  17. 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.

  18. Reaction Workup Planning: A Structured Flowchart Approach, Exemplified in Difficult Aqueous Workup of Hydrophilic Products

    Science.gov (United States)

    Hill, George B.; Sweeney, Joseph B.

    2015-01-01

    Reaction workup can be a complex problem for those facing novel synthesis of difficult compounds for the first time. Workup problem solving by systematic thinking should be inculcated as mid-graduate-level is reached. A structured approach is proposed, building decision tree flowcharts to analyze challenges, and an exemplar flowchart is presented…

  19. Risk analysis and solving the nuclear waste siting problem

    Energy Technology Data Exchange (ETDEWEB)

    Inhaber, H.

    1993-12-01

    In spite of millions of dollars and countless human resources being expended on finding nuclear wastes sites, the search has proved extremely difficult for the nuclear industry. This may be due to the approach followed, rather than inadequacies in research or funding. A new approach to the problem, the reverse Dutch auction, is suggested. It retains some of the useful elements of the present system, but it also adds new ones.

  20. Challenging problems in algebra

    CERN Document Server

    Posamentier, Alfred S

    1996-01-01

    Over 300 unusual problems, ranging from easy to difficult, involving equations and inequalities, Diophantine equations, number theory, quadratic equations, logarithms, more. Detailed solutions, as well as brief answers, for all problems are provided.

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

    Science.gov (United States)

    Özkan, Ahmet Selim; Nasır, Serdar Nazif

    2015-10-01

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

  2. 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...

  3. 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 “ ...

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Methods and scales in soil erosion studies in Spain: problems and perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Ruiz, J. M.

    2009-07-01

    Soil erosion is a major problem in some areas of Spain. Research groups have studied a variety of aspects of this problem indifferent environments, and at a range of scales using a diversity of methods, from piquettes and rainfall simulation to experimental plots, catchment and large regional areas. This has increased knowledge and identified the main problems: farmland abandonment, badlands erosion, the effects of land use changes, and the role of extreme events and erosion in certain crops (particularly vineyards). However, comparison of results among various research groups has been difficult, posing problems in developing solutions from State and Regional administrators. (Author) 73 refs.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. [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.

  14. '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.

  15. 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

  16. New algorithm for extreme temperature measurements

    NARCIS (Netherlands)

    Damean, N.

    2000-01-01

    A new algorithm for measurement of extreme temperature is presented. This algorithm reduces the measurement of the unknown temperature to the solving of an optimal control problem, using a numerical computer. Based on this method, a new device for extreme temperature measurements is projected. It co

  17. 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

  18. Estimation of Extreme Responses and Failure Probability of Wind Turbines under Normal Operation by Controlled Monte Carlo Simulation

    DEFF Research Database (Denmark)

    Sichani, Mahdi Teimouri

    order statistical moments. The results obtained by extrapolation of the extreme values to the stipulated design period of the wind turbine depend strongly on the relevance of these adopted extreme value distributions. The problem is that this relevance cannot be decided from the data obtained....... The solution of the Fokker-Planck-Kolmogorov (FPK) equation for systems governed by a stochastic differential equation driven by Gaussian white noise will give the sought time variation of the probability density function. However the analytical solution of the FPK is available for only a few dynamic systems...... and the numerical solution is difficult for dynamic problem of more than 2-3 degrees of freedom. This confines the applicability of the FPK to a very narrow range of problems. On the other hand the recently introduced Generalized Density Evolution Method (GDEM), has opened a new way toward realization...

  19. 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.

  20. 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.

  1. 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

  2. Les relations ville-port à Rio de Janeiro : entre difficultés et perspectives de développement As relações cidade-porto no Rio de Janeiro: entre dificuldades e perspectivas de desenvolvimento City-port relationships in Rio de Janeiro: development´s problems and prospects

    Directory of Open Access Journals (Sweden)

    Bertrand Cozic

    2012-06-01

    Full Text Available La réorganisation productive à l’œuvre depuis le début des années 70 projette chaque fois un peu plus les villes et les ports comme des acteurs majeurs de l’intégration des territoires dans les flux issus de la mondialisation. A Rio de Janeiro, depuis la fin des années 90,  nous observons de nombreuses initiatives de modernisation du système portuaire et de revitalisation des friches portuaires de la ville. Le port est actuellement très dynamique au niveau national dans le domaine des conteneurs, des véhicules (roll-on/roll-off, du pétrole et de ses dérivés (port d’appui logistique de la Petrobras et enfin du tourisme avec le transport de passagers. Cependant, les relations ville-port à Rio de Janeiro sont caractérisées par de sérieuses difficultés. Jusqu’à présent, les autorités portuaires, la ville, les acteurs privés et la société civile n’ont pas réussi à formuler un véritable projet de développement concerté autour de la ville et du port.Les relations ville-port à Rio de Janeiro sont encore très fortement influencées par des pratiques issues de l’ère industrielle du pays, présentant les deux entités comme incompatibles. D’un côté, la ville cherche à revitaliser ses friches portuaires en développant de grands projets urbains à vocation touristique sur le modèle de nombreuses expériences internationales ; de l’autre, le port cherche à développer ses activités pour faire face aux flux croissants issus de la mondialisation. Pourtant, de véritables politiques de développement innovantes sont expérimentées à travers le monde, comme c’est le cas en Europe dans les villes portuaires de la « rangée Nord » (Northern Range ou encore en Espagne, ou nous assistons au développement conjoint des deux dynamiques à travers l’élaboration de stratégies économiques concertées.     A reorganização produtiva em curso desde o inicio da década de 70 projeta cada vez mais as

  3. 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

  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. A preliminary investigation on the utility of temporal features of Force Myography in the two-class problem of grasp vs. no-grasp in the presence of upper-extremity movements.

    Science.gov (United States)

    Sadarangani, Gautam P; Menon, Carlo

    2017-05-16

    In upper-extremity stroke rehabilitation applications, the potential use of Force Myography (FMG) for detecting grasping is especially relevant, as the presence of grasping may be indicative of functional activity, which is a key goal of rehabilitation. To date, most FMG research has focused on the classification of the raw FMG signal (i.e. instantaneous FMG samples) in order to determine the state of the hand. However, given the temporal nature of force generation during grasping, the use of temporal feature extraction techniques may yield increased accuracy. In this study, the effectiveness of classifying temporal features of the FMG signal for the two-class grasp detection problem of "grasp" versus "no grasp" (i.e. no object in hand) was evaluated with ten healthy participants. The experimental protocol comprised grasp and move tasks, requiring the use of six different grasp types frequently used in daily living, in conjunction with arm and hand movements. Data corresponding to arm and hand movements without grasping were also included to evaluate robustness to false positives. The temporal features evaluated were mean absolute value (MAV), root mean squared (RMS), linear fit (LF), parabolic fit (PF), and autoregressive model (AR). Off-line classification performance of the five temporal features, with a 0.5 s extraction window, were determined and compared to that of the raw FMG signal using area under the receiver operating curve (AUC). The raw FMG signal yielded AUC of 0.819 ± 0.098. LF and PF resulted in the greatest increases in classification performance, and provided statistically significant increases in performance. The largest increase obtained was with PF, yielding AUC of 0.869 ± 0.061, corresponding to a 6.1% relative increase over the raw FMG signal. Despite the additional fitting term provided by PF, classification performance did not significantly improve with PF when compared to LF. The results obtained indicate that temporal feature

  10. [Difficult patient in dentistry. Construction of a model of personal attributes for identification].

    Science.gov (United States)

    Peñaranda Hernández, P M

    1989-01-01

    The communication between the dentist and the patient, or what we have called dentist-patient relationship constitute itself a clue to solve primary problems derived of the professional practice. In this relationship with patients, the dentist may face what we have called difficult patient. This difficult patient have several behavioral characteristics which can alter the dentist emotional equilibrium, the capacity of making proper diagnosis and finally a successful treatment may not be obtain as an end result. The difficult patient behavior may be explained by a variety of factors such as: the type of pathology, the office environment, the community and/or institution to which the patient belongs, the dentist emotional circumstance and at last the patient life style. In this research work, we interview 50 professionals from the metropolitan area with an average of 18 years in practiCe, each dentist explained situations in which the patient behavior could be typified as difficult. A number of 202 difficult patient cases were obtained and they were classified into 14 categories. 5 categories presented a higher frequency: a) Schedule and/or appointment timing. b) Patients not following instructions and/or altering treatment. c) Anxious patients. d) Patients unhappy with their treatment. e) Authoritarian patients or patients without good manners. This 5 categories were present in the 60% of the situations and can be taken as a model with specific behavioral characteristics as to identify the difficult patient. This is valuable in order to manage this type of patients and be successful.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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.

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

    CERN Document Server

    Stern, David

    2013-01-01

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

  19. 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.

  20. [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.

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    Murthy

    2014-08-01

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

  3. 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.

  4. Improvised purification methods for obtaining individual drinking water supply under war and extreme shortage conditions.

    Science.gov (United States)

    Kozlicic, A; Hadzic, A; Bevanda, H

    1994-01-01

    Supplying an adequate amount of drinking water to a population is a complex problem that becomes an extremely difficult task in war conditions. In this paper, several simple methods for obtaining individual supplies of drinking water by filtration of atmospheric water with common household items are reported. Samples of atmospheric water (rain and snow) were collected, filtered, and analyzed for bacteriological and chemical content. The ability of commonly available household materials (newspaper, filter paper, gauze, cotton, and white cotton cloth) to filter water from the environmental sources was compared. According to chemical and biological analysis, the best results were obtained by filtering melted snow from the ground through white cotton cloth. Atmospheric water collected during war or in extreme shortage conditions can be purified with simple improvised filtering techniques and, if chlorinated, used as an emergency potable water source.

  5. Les difficultés d’accès au système judiciaire au Pérou : la justice communautaire comme alternative Problems of Access to Justice in Peru: Community Justice as Alternative Poder judicial comunal en los Andes y la Amazonía del Perú: una aproximación desde los organos de resolución de conflictos entre los Aymaras y los Aguarunas

    Directory of Open Access Journals (Sweden)

    Antonio Peña Jumpa

    2012-05-01

    Full Text Available Cet article traite des difficultés d’accès au système judiciaire au Pérou puis étudie l’hypothèse de la justice communautaire comme alternative à ces barrières (économiques, sociales et culturelles. Dans un premier temps sont identifiées et décrites les trois principales barrières auxquelles sont confrontés les citoyens péruviens pour accéder aux instances judiciaires. Face à ce contexte est proposée l’alternative de la justice communautaire qui est aujourd’hui mise en œuvre par les communautés Aymaras et Aguarunas et qui, comme nous le verrons, semble une proposition viable pour la nation.This article is about access to law problems in Peru, taking up the hypothesis that community justice might be an alternative to those barriers (economic, social and cultural. The first section describes the three main obstacles confronting Peruvian citizens in obtaining hearings.  In this context, an alternative is proposed in the form of the community justice currently practiced by Aymaraand Aguaruna communities and which, as we shall see, seems to be a viable option for the nation at large.El presente ensayo trata sobre las barreras de acceso al sistema de justicia en el Perú y el desarrollo de la justicia comunal como alternativa en ese contexto. Primero se explica el contenido de tres principales barreras que experimenta la mayoría de la población peruana cuando trata de acceder al sistema de justicia del Estado: barreras económicas, barreras sociales y barreras culturales. Luego se explica el contenido y alcances de la Justicia Comunal, la misma que se efectiviza en comunidades andinas como la de los Aymaras y en comunidades amazónicas como la de los Aguarunas. Al final se hace una síntesis de la importancia de la Justicia Comunal en el Perú que al relacionarla con las barreras de acceso antes mencionadas, aparece como una propuesta de solución.

  6. Emergency incisional hernia repair: a difficult problem waiting for a solution

    Directory of Open Access Journals (Sweden)

    Zafar Hasnain

    2012-01-01

    Full Text Available Abstract Background Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue. Methods Between 2000 and 2010 a total of 60 patients underwent emergency surgery for incarcerated incisional hernia with associated bowel obstruction with placement of permanent prosthetic mesh. The wound was closed after hernia repair in 55 patients while it was left open to granulate in 5 patients. Results In the group of patients with primary wound closure, 11 patients developed superficial surgical site infection, 5 developed deep wound infection and one patient had cellulitis. These patients were treated with wound debridement and antibiotics. Mesh removal was required in one patient. There were no infections in the group of patients who had their surgical wounds left open. One patient in this group died on the fifth postoperative day from septicemia. Conclusion Use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. in contaminated field is associated with high risk of wound infection.

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

    DEFF Research Database (Denmark)

    Filippone, Antonino

    1996-01-01

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

  8. Association of Chronic Pancreatitis and Malignant Main Duct IPMN: A Rare but Difficult Clinical Problem.

    Science.gov (United States)

    Berger, Zoltán; De La Fuente, Hernán; Meneses, Manuel; Matamala, Fernanda; Sepúlveda, Makarena; Rojas, Claudia

    2017-01-01

    We report the case of a 70-year-old woman who consulted for recurrent short episodes of mild-to-moderate abdominal pain. Dilated main pancreatic duct was seen on CAT scan and magnetic resonance, with multiple calcifications and intraductal stones, typical in CP. However, for a more pronounced cystic dilatation in the pancreatic head, we could not exclude the coexistence of a main duct IPMN. ERCP was performed, with pancreatic sphincterotomy and extraction of pancreatic stones, but, at the same time, mucin extrusion was seen from the dilated duct through the papilla. Pancreatoduodenectomy was performed. Surgery and histology confirmed malignant IPMN with the typical image of chronic pancreatitis and intraductal stones in the vicinity. The patient is doing well 4 years after the surgery, without recurrence of the malignant disease, with changes of chronic pancreatitis in the pancreatic remnant. This paper discusses the possible relationships between the two entities and emphasizes the need of differential diagnosis.

  9. Association of Chronic Pancreatitis and Malignant Main Duct IPMN: A Rare but Difficult Clinical Problem

    Directory of Open Access Journals (Sweden)

    Zoltán Berger

    2017-01-01

    Full Text Available We report the case of a 70-year-old woman who consulted for recurrent short episodes of mild-to-moderate abdominal pain. Dilated main pancreatic duct was seen on CAT scan and magnetic resonance, with multiple calcifications and intraductal stones, typical in CP. However, for a more pronounced cystic dilatation in the pancreatic head, we could not exclude the coexistence of a main duct IPMN. ERCP was performed, with pancreatic sphincterotomy and extraction of pancreatic stones, but, at the same time, mucin extrusion was seen from the dilated duct through the papilla. Pancreatoduodenectomy was performed. Surgery and histology confirmed malignant IPMN with the typical image of chronic pancreatitis and intraductal stones in the vicinity. The patient is doing well 4 years after the surgery, without recurrence of the malignant disease, with changes of chronic pancreatitis in the pancreatic remnant. This paper discusses the possible relationships between the two entities and emphasizes the need of differential diagnosis.

  10. Solving difficult problems creatively: A role for energy optimised deterministic/stochastic hybrid computing

    Directory of Open Access Journals (Sweden)

    Tim ePalmer

    2015-10-01

    Full Text Available How is the brain configured for creativity? What is the computational substrate for ‘eureka’ moments of insight? Here we argue that creative thinking arises ultimately from a synergy between low-energy stochastic and energy-intensive deterministic processing, and is a by-product of a nervous system whose signal-processing capability per unit of available energy has become highly energy optimised. We suggest that the stochastic component has its origin in thermal noise affecting the activity of neurons. Without this component, deterministic computational models of the brain are incomplete.

  11. 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

  12. Can we predict a difficult intubation in cleft lip/palate patients?

    Science.gov (United States)

    Arteau-Gauthier, Isabelle; Leclerc, Jacques E; Godbout, Audrey

    2011-10-01

    To find predictors of a difficult intubation in infants with an isolated or a syndromic cleft lip/palate. Retrospective review: single-blind trial. Tertiary care centre. A total of 145 infants born with cleft lip/palate were enrolled. Three clinical and seven lip/palate anatomic parameters were evaluated. The grade of intubation was determined by the anesthesiologist at the time of the labioplasty/staphylorrhaphy surgery at 3 and 10 months, respectively. Intubation grade. The relative risk of a difficult intubation in the cleft lip, cleft palate without the Pierre Robin sequence, cleft lip-palate, and cleft palate with Pierre Robin sequence groups was 0, 2.7, 10, and 23%, respectively. The infants born with the Pierre Robin sequence had a statistically significant higher intubation grade. The degree of difficulty was increased in cases with early airway and feeding problems (p intubation grade with statistical significance (p  =  .0323). Infants born with Pierre Robin sequence have a statistically significantly higher risk of difficult intubation. Within this group, of all the studied factors, a clinical history of early airway and feeding problems was the best predictor of a difficult endotracheal intubation. In cleft palate patients without any cleft lip, larger width of the cleft is also a significant predictor.

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

    Science.gov (United States)

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

    2016-01-01

    Difficult airway, a scenario with potentially life threatening outcome, is routinely encountered by an anesthesiologist leaving him with the dilemma of whether to use regional anesthesia (RA) or general anesthesia. Our study aims to look into this problem. The literature search was performed in the Google, PubMed, and Medscape using key words “regional anesthesia, difficult airway, pregnancy, ventilation, intubation, epidural anesthesia, nerve blocks.” More than 38 free full articles and books published from the year 1987 to 2014 were retrieved and studied. At first sight, RA may appear to offer an ideal solution as it helps to avoid the problem of difficult airway. However, the possibility of a total spinal block, failed or incomplete RA, local anesthetic toxicity or unforeseen surgical complication may make it imperative that the airway is secured. The correct decision can only be made by the anesthetist when all the relevant clinical information is taken into account. It is also important to ensure that before considering RA in a patient of difficult airway, an anesthesiologist must have a preformulated strategy for intubation. PMID:27212743

  14. Risk Factors Assessment of the Difficult Intubation using Intubation Difficulty Scale (IDS).

    Science.gov (United States)

    K Nasa, Vaibhav; S Kamath, Shaila

    2014-07-01

    The major responsibility of anaesthesiologist is to maintain adequate gas exchange in his patients in all circumstances and this require that patency of upper airway is constantly maintained. Problems with upper airway management are among the most frequent causes of anaesthetic mishaps. Using intubation difficulty scale (IDS) we made an attempt to objectively assess the predictors of difficult intubation. We assessed classical bedside tests such as modified Mallampati test, Thyromental distance test and also neck extension test. We prospectively observed 400 patients undergoing general anaesthesia with endotracheal intubation, for each patient intubation difficulty score was recorded during intubation. Risk factors assessment of difficult intubation done using IDS. Risk factor assessed includes modified mallampati class III and IV, thyromental distance ≤ 6cm and neck extension intubation (IDS, 0 to 2), slightly difficult intubation (IDS, 3 to 4) and difficult intubation (IDS 5). Preoperative airway assessment was done by thyromental distance measurement, neck extension measurement and modified mallampati test. Data was analysed using Receiver operating characteristic curve (ROC) and area under curve (AUC) for each test computed. pintubation was 8% and there were no failure to intubate the trachea. The AUC were as follows: modified Mallampati test 0.473 (ppredictor of difficult intubation (IDS≥5) in comparison to Thyromental test and modified mallampati test.

  15. 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.

  16. 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.

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. Extremism from the perspective of a system approach

    Directory of Open Access Journals (Sweden)

    Zinchenko, Yury P.

    2014-03-01

    Full Text Available Extremism is seen as a complex, multilevel, and multicomponent phenomenon. The problems of modern science in understanding extremism are revealed. The following bases of extremism as a system phenomenon are singled out: social factors, latent extremism, and extremist acts. It is demonstrated that a system approach makes it possible to shape a notion of a subject as a system, to identify patterns of the manifestations of the given phenomenon, and to translate them into concrete practices.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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...

  11. Differential equations problem solver

    CERN Document Server

    Arterburn, David R

    2012-01-01

    REA's Problem Solvers is a series of useful, practical, and informative study guides. Each title in the series is complete step-by-step solution guide. The Differential Equations Problem Solver enables students to solve difficult problems by showing them step-by-step solutions to Differential Equations problems. The Problem Solvers cover material ranging from the elementary to the advanced and make excellent review books and textbook companions. They're perfect for undergraduate and graduate studies.The Differential Equations Problem Solver is the perfect resource for any class, any exam, and

  12. 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...

  13. 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.

  14. 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…

  15. 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.

  16. 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…

  17. 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.

  18. 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…

  19. 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…

  20. 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…

  1. 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

  2. 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…

  3. 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

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. [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.

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

    Science.gov (United States)

    Li, Qinghai; Shi, Weiping; Yang, Renshu

    2016-01-01

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

  13. 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.

  14. 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...

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    Rodica Ioana Lung

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

  17. Folded Fields as the Source of Extreme Radio-Wave Scattering in the Galactic Center

    CERN Document Server

    Goldreich, P; Goldreich, Peter

    2006-01-01

    A strong case has been made that radio waves from sources within about half a degree of the Galactic Center undergo extreme diffractive scattering. However, problems arise when standard (``Kolmogorov'') models of electron density fluctuations are employed to interpret the observations of scattering in conjunction with those of free-free radio emission. Specifically, the outer scale of a Kolmogorov spectrum of electron density fluctuations is constrained to be so small that it is difficult to identify an appropriate astronomical setting. Moreover, an unacceptably high turbulent heating rate results if the outer scale of the velocity field coincides with that of the density fluctuations. We propose an alternative model based on folded magnetic field structures that have been reported in numerical simulations of small-scale dynamos. Nearly isothermal density variations across thin current sheets suffice to account for the scattering. There is no problem of excess turbulent heating because the outer scale for the...

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

    Science.gov (United States)

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

    2014-01-01

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

  19. [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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. [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.

  6. 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...

  7. 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...

  8. 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 ...

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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...

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. Why is it so difficult to explain the decline in traffic fatalities?

    DEFF Research Database (Denmark)

    Elvik, Rune

    2016-01-01

    ) Data are incomplete or missing about many potentially relevant variables. (4) Some variables are affected by measurement errors or discontinuities in time series. (5) Many of the explanatory variables are very highly correlated with each other and with time. These problems are illustrated using Norway...... argues that it is difficult to give a scientifically rigorous explanation of the decline in traffic fatalities. There are five main problems: (1) There are very many potentially relevant explanatory variables. (2) Some of the relevant explanatory variables change slowly at an almost constant rate. (3...... as an example. It is shown that the problems listed above can result in models that are non-sensical although they pass formal tests of model quality. The lesson is that one should never judge how good a model is merely in terms of formal criteria. Some strategies for developing more meaningful models...

  1. The Positive Effect of Resilience on Stress and Business Outcomes in Difficult Work Environments.

    Science.gov (United States)

    Shatté, Andrew; Perlman, Adam; Smith, Brad; Lynch, Wendy D

    2017-02-01

    To examine whether resilience has a protective effect in difficult work environments. A survey of 2063 individuals measured individual resilience, stress, burnout, sleep problems, likelihood of depression, job satisfaction, intent to quit, absences, and productivity. It also measured work characteristics: job demands, job influence, and social support. Multivariate and logistic regression models examined the main effects and interactions of resilience and job characteristics. High strain work environments (high demand, low influence, and low support) have an unfavorable effect on all outcomes. Resilience has a protective effect on all outcomes. For stress, burnout, and sleep, higher resilience has a more protective effect under low-strain conditions. For depression, absence and productivity, resilience has a more protective effect when job strain is high. Workers with high resilience have better outcomes in difficult work environments.

  2. Banach空间非线性脉冲积分-微分方程终值问题的极值解%EXTREMAL SOLUTIONS OF TERMINAL VALUE PROBLEMS FOR NONLINEAR IMPULSIVE INTEGRO-DIFFERENTIAL EQUATIONS IN BANACH SPACES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The comparison principle is first established,and then the lower and upper solution method and the monotone iterative technique are employed to the study of terminal value problems for the first order nonlinear impulsive integro-differential equations in Banach spaces.Finally,the existence theorem on the maximal and minimal solutions is obtained.

  3. Searching for extremal PPT entangled states

    CERN Document Server

    Augusiak, Remigiusz; Kus, Marek; Lewenstein, Maciej

    2009-01-01

    We formulate a simple operational criterion allowing to judge if a given entangled state with positive partial transpose (PPTES) is extremal in the convex set of all PPTES. The criterion reduces the problem to the question of existence of solutions of a system of linear equations. We apply this criterion to search for extremal PPTES in qubit--ququart systems. We show that the only candidates for extremal PPTES have ranks of the state and its partial transposition (5,5) or (5,6) (equivalently (6,5)). While we show that in the case of (5,5) there do exist extremal states, we conjecture that there are no such states in the case of (5,6), and discuss possible ways to prove this statement.

  4. 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.)

  5. 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.

  6. 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.)

  7. 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...

  8. 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

  9. Extremal black holes in N=2 supergravity

    NARCIS (Netherlands)

    Katmadas, S.

    2011-01-01

    An explanation for the entropy of black holes has been an outstanding problem in recent decades. A special case where this is possible is that of extremal black holes in N=2 supergravity in four and five dimensions. The best developed case is for black holes preserving some supersymmetry (BPS), whic

  10. Extremal black holes in N=2 supergravity

    NARCIS (Netherlands)

    Katmadas, S.

    2011-01-01

    An explanation for the entropy of black holes has been an outstanding problem in recent decades. A special case where this is possible is that of extremal black holes in N=2 supergravity in four and five dimensions. The best developed case is for black holes preserving some supersymmetry (BPS), whic

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. Outcomes for extremely premature infants.

    Science.gov (United States)

    Glass, Hannah C; Costarino, Andrew T; Stayer, Stephen A; Brett, Claire M; Cladis, Franklyn; Davis, Peter J

    2015-06-01

    social problems is critical for children born at these early gestational ages.The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, because therapy and supportive care continue to change, the outcomes of extremely low birth weight infants are ever evolving. Efforts to minimize injury, preserve growth, and identify interventions focused on antioxidant and anti-inflammatory pathways are now being evaluated. Thus, treating and preventing long-term deficits must be developed in the context of a "moving target."

  17. 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.

  18. 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 ...

  19. 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.

  20. Books to Help Kids Deal with Difficult Times, I.

    Science.gov (United States)

    Klein, Norma

    1987-01-01

    An author of books for young adults discusses the need for realism in adolescent literature as a means of helping teenagers to cope with real problems and describes her most recent book, which deals with euthanasia. (CLB)

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. Evaluation of Genetic Algorithm Concepts using Model Problems. Part 1; Single-Objective Optimization

    Science.gov (United States)

    Holst, Terry L.; Pulliam, Thomas H.

    2003-01-01

    A genetic-algorithm-based optimization approach is described and evaluated using a simple hill-climbing model problem. The model problem utilized herein allows for the broad specification of a large number of search spaces including spaces with an arbitrary number of genes or decision variables and an arbitrary number hills or modes. In the present study, only single objective problems are considered. Results indicate that the genetic algorithm optimization approach is flexible in application and extremely reliable, providing optimal results for all problems attempted. The most difficult problems - those with large hyper-volumes and multi-mode search spaces containing a large number of genes - require a large number of function evaluations for GA convergence, but they always converge.

  9. Progressive problems higher grade physics

    CERN Document Server

    Kennedy, William

    2001-01-01

    This book fully covers all three Units studied in Scotland's Higher Grade Physics course, providing a systematic array of problems (from the simplest to the most difficult) to lead variously abled pupils to examination success.

  10. 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

  11. 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

  12. On extreme points of the diffusion polytope

    Science.gov (United States)

    Hay, M. J.; Schiff, J.; Fisch, N. J.

    2017-05-01

    We consider a class of diffusion problems defined on simple graphs in which the populations at any two vertices may be averaged if they are connected by an edge. The diffusion polytope is the convex hull of the set of population vectors attainable using finite sequences of these operations. A number of physical problems have linear programming solutions taking the diffusion polytope as the feasible region, e.g. the free energy that can be removed from plasma using waves, so there is a need to describe and enumerate its extreme points. We review known results for the case of the complete graph Kn, and study a variety of problems for the path graph Pn and the cyclic graph Cn. We describe the different kinds of extreme points that arise, and identify the diffusion polytope in a number of simple cases. In the case of increasing initial populations on Pn the diffusion polytope is topologically an n-dimensional hypercube.

  13. 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

  14. 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.

  15. 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

  16. 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...

  17. 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...

  18. 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...

  19. Continuity of Extremal Elements in Uniformly Convex Spaces

    OpenAIRE

    Ferguson, Timothy

    2013-01-01

    In this paper, we study the problem of finding the extremal element for a linear functional over a uniformly convex Banach space. We show that a unique extremal element exists and depends continuously on the linear functional, and vice versa. Using this, we simplify and clarify Ryabykh's proof that for any linear functional on a uniformly convex Bergman space with kernel in a certain Hardy space, the extremal functional belongs to the corresponding Hardy space.

  20. 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.

  1. 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...

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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...

  8. 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.

  9. Dynamics of extremal black holes

    CERN Document Server

    Giddings, Steven B

    1992-01-01

    Particle scattering and radiation by a magnetically charged, dilatonic black hole is investigated near the extremal limit at which the mass is a constant times the charge. Near this limit a neighborhood of the horizon of the black hole is closely approximated by a trivial product of a two-dimensional black hole with a sphere. This is shown to imply that the scattering of long-wavelength particles can be described by a (previously analyzed) two-dimensional effective field theory, and is related to the formation/evaporation of two-dimensional black holes. The scattering proceeds via particle capture followed by Hawking re-emission, and naively appears to violate unitarity. However this conclusion can be altered when the effects of backreaction are included. Particle-hole scattering is discussed in the light of a recent analysis of the two-dimensional backreaction problem. It is argued that the quantum mechanical possibility of scattering off of extremal black holes implies the potential existence of additional ...

  10. 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.

  11. 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.

  12. Why IV Setup for Stream Ciphers is Difficult

    DEFF Research Database (Denmark)

    Zenner, Erik

    2007-01-01

    In recent years, the initialization vector (IV) setup has proven to be the most vulnerable point when designing secure stream ciphers. In this paper, we take a look at possible reasons why this is the case, identifying numerous open research problems in cryptography.......In recent years, the initialization vector (IV) setup has proven to be the most vulnerable point when designing secure stream ciphers. In this paper, we take a look at possible reasons why this is the case, identifying numerous open research problems in cryptography....

  13. QCD matter in extreme environments

    CERN Document Server

    Fukushima, Kenji

    2011-01-01

    We review various theoretical approaches to the states of QCD matter out of quarks and gluons in extreme environments such as the high-temperature states at zero and finite baryon density and the dimensionally reduced state under an intense magnetic field. The topics at high temperature include the Polyakov loop and the 't Hooft loop in the perturbative regime, the Polyakov loop behaviour and the phase transition in some of non-perturbative methods; the strong-coupling expansion, the large-Nc limit and the holographic QCD models. These analyses are extended to hot and dense matter with a finite baryon chemical potential. We point out that the difficulty in the finite-density problem has similarity to that under a strong magnetic field. We make a brief summary of results related to the topological contents probed by the magnetic field and the Chiral Magnetic Effect. We also address the close connection to the (1+1) dimensional system.

  14. Weather extremes could affect agriculture

    Science.gov (United States)

    Balcerak, Ernie

    2012-05-01

    As Earth's climate warms, agricultural producers will need to adapt. Changes, especially increases in extreme events, are already having an impact on food production, according to speakers at a 1 May session on agriculture and food security at the AGU Science Policy Conference. Christopher Field, director of the Department of Global Ecology at the Carnegie Institution for Science of Washington, D. C., pointed out the complex factors that come into play in understanding food security, including spatially varying controls and stresses, incomplete models, and the potential for threshold responses. Factors that are likely to cause problems include increasing population; increasing preference for meat, which needs more land and energy inputs to produce; climate change; and increasing use of agricultural lands for biomass energy.

  15. 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.

  16. Often Difficult--But Worth It. Collaboration among Professionals.

    Science.gov (United States)

    Walker, Joyce A.

    1988-01-01

    A joint effort between the Minnesota Extension Service and University of Minnesota School of Medicine produced a community-based research and educational program on stress, depression, and suicide prevention. The Teens in Distress program represents a successful collaborative effort and illustrates the potential problems when Extension…

  17. Interdisciplinarity in Swiss Schools: A Difficult Step into the Future

    Science.gov (United States)

    Ghisla, Gianni; Bausch, Luca; Bonoli, Lorenzo

    2016-01-01

    Multi- and interdisciplinary education is a major postulate in the Swiss school system and has considerable weight in educational programs and learning objectives, both in compulsory school and at the upper secondary school level. However, materializing this postulate still poses problems at the political and institutional level, where the…

  18. 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...

  19. Immunosuppressive drugs and young adults: a difficult combination

    NARCIS (Netherlands)

    Tielen, M.; Jedeloo, Susan; Staa, Anneloes van; Weimar, W.

    2008-01-01

    In our center we encounter serious problems with a number young adult (18- 25yrs) renal transplant recipients that are non-compliant to the medication regime. This could well be one of the reasons for the significantly worse unadjusted 10 years kidney graft survival in this patient group compared to

  20. 下肢创伤性截肢后残端问题的影响因素及其手术治疗%Surgical strategies for stump problems following trauma-related amputation of lower extremity

    Institute of Scientific and Technical Information of China (English)

    刘克敏; 王安庆; 唐涛; 赵利; 崔寿昌

    2010-01-01

    目的 探讨下肢创伤性截肢后残端问题的影响因素及其手术治疗.方法 1992年11月至2008年8月共收治72例(80侧)下肢踝关节以上创伤性截肢后因残端问题而进行手术治疗的患者,其中男47例,女25例;年龄9~60岁,平均(28.8±12.4)岁.小腿截肢48侧,大腿截肢32侧.从受伤截肢到因残端问题接受手术治疗的时间平均为32.7个月.对患者残端问题进行评价,将性别、单双侧截肢、截肢部位(大腿与小腿)、致伤原因作为因素,截肢到首次残端修整术时间、软组织多余臃肿、皮肤明显瘢痕、皮肤溃疡、神经瘤、骨刺作为水平,统计分析每一因素与各水平间的关系.通过ADL评分评价手术后的效果.结果 14侧行胫腓骨融合术,12侧残端修整术≥2次,双侧截肢者13例21侧(8例双侧残端同时修整),再截肢5侧.80侧残端问题中有53侧(66.3%)原始截肢时未行残端肌肉固定成形术,瘢痕多者42侧(52.5%),神经瘤38侧(47.5%),软组织过多臃肿皱褶24侧(30.0%),皮肤溃疡14侧(17.5%).原始截肢到首次残端修整术的时间小腿截肢比大腿截肢长,差异存统计学意义(P=0.030);大腿截肢软组织臃肿多于小腿截肢,差异有统计学意义(P=0.007);单侧截肢患者骨刺发生率高于舣侧截肢患者,差异有统计学意义(P=0.018).41例患者入院时ADL评分平均为(85.31±7.24)分,出院时为(95.40±3.92)分,差异有统计学意义(t=-11.536,P=0.000).结论 单双侧截肢、截肢部位是影响下肢创伤性截肢后残端问题的重要因素.选择适当的患者进行残端修整术及胫腓骨融合术可获得良好疗效.%Objective To investigate the surgical management strategies for stump problems fol-lowing trauma-related amputation of lower limb. Methods From November 1992 to August 2008, 72 consecutive patients, who had been troubled by stump problems after above-the-ankle amputation due to trauma, underwent revision surgery of the stump. They were

  1. A study to investigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Omer Kurtipek

    2012-01-01

    Full Text Available 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 I-II, adult patients scheduled tonsillectomy under general anesthesia. Same anesthetic protocol was used in two groups. Intubation difficulties were assessed by Mallampati grading, Wilson sum score, Laryngoscopic grading (Cormack and Lehane, a line joining the angle of the mouth and tragus of the ear with the horizontal, sternomental distance, and tyromental distance. Demographic properties, time-dependent hemodynamic variables, doses of reversal agent, anesthesia and operation times, and recovery parameters were recorded. Results: Significant difference was detected between groups in terms of BMI, Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, tyromental distance, doses of reversal agent, and recovery parameters. Conclusion: OSA patient′s DI ratio is higher than that of non-OSA patients. BMI Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, and tyromental distance evaluation might be predictors for DI in patients with OSA.

  2. Outcomes for Extremely Premature Infants

    Science.gov (United States)

    Glass, Hannah C.; Costarino, Andrew T.; Stayer, Stephen A.; Brett, Claire; Cladis, Franklyn; Davis, Peter J.

    2015-01-01

    Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for four years and is now approximately 11.5%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23–24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal EDC. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91–95% (compared to 85–89%) avoids excess mortality. However, final analyses of data from these trials have not been published, so definitive recommendations are still pending The development of neonatal neurocognitive care visits may improve neurocognitive outcomes in this high-risk group. Long-term follow up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages. The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, since therapy and supportive care continue to change, the outcomes of ELBW infants are ever evolving. Efforts to minimize injury, preserve

  3. Self-organized optimization algorithm with extremal dynamics for the traveling salesman problem%基于极值动力学的自组织优化算法求解TSP问题

    Institute of Scientific and Technical Information of China (English)

    吴婷; 陈玉旺; 汪烨

    2010-01-01

    旅行商问题(traveling salesman problem,TSP)具有很强的理论研究和工程应用价值.在定义离散状态变量和局部适应度的基础上,分析了TSP优化解的微观特征;将自组织临界(self-organized criticality,SOC)的概念引入到组合优化领域,提出了一种基于极值动力学的自组织优化算法.该算法利用快速下降和间断涨落的动态搜索过程,高效地遍历解空间中的局部最优解.针对TSPLIB中典型实例,计算结果表明其求解效率和优化性能均优于模拟退火和遗传算法等优化方法.文中算法提供了一种全新的思路,有助于从系统角度理解组合优化问题的复杂性,并分析合理的优化动力学过程.

  4. 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.

  5. 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.

  6. 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.

  7. 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 ...

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. Governance of wicked climate adaptation problems

    NARCIS (Netherlands)

    Termeer, C.J.A.M.; Dewulf, A.; Breeman, G.E.

    2013-01-01

    Climate change adaptation has been called a “wicked problem par excellence.” Wicked problems are hard to define because ‘the formulation of the problem is the problem; they are considered a symptom of another problem; they are highly resistant to solutions and extremely interconnected with other

  14. Governance of wicked climate adaptation problems

    NARCIS (Netherlands)

    Termeer, C.J.A.M.; Dewulf, A.; Breeman, G.E.

    2013-01-01

    Climate change adaptation has been called a “wicked problem par excellence.” Wicked problems are hard to define because ‘the formulation of the problem is the problem; they are considered a symptom of another problem; they are highly resistant to solutions and extremely interconnected with other pro

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

    Science.gov (United States)

    Bickel, Janet; Rosenthal, Susan L

    2011-10-01

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

  16. 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.

  17. 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.

  18. 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.

  19. [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.

  20. 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.

  1. 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.

  2. 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.

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

    Science.gov (United States)

    Gong, Han; Cosker, Darren

    2016-09-01

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

  4. 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.

  5. 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.

  6. Extreme fatigue and malaise--a syndrome caused by badly cleaned wall-to-wall carpets?

    Science.gov (United States)

    Nexø, E; Skov, P G; Gravesen, S

    1983-01-01

    Complaints connected with the indoor climate are often vague and a cause-effect relationship is difficult to demonstrate. The present paper describes two patients suffering from symptoms in the form of extreme fatigue and malaise. The patients connected their problems to the poorly cleaned working place. We found the working place to be covered with badly cleaned wall-to-wall carpet. Examination of 12 employees showed five to have symptoms related to the working place. Four of the five had precipitating antibodies against extracts of dust collected from the carpets and two of the five had a positive prick test to the same extract. After removal of the carpets all symptoms disappeared. We conclude that vague symptoms related to the indoor climate may be induced by accumulation of organic dust.

  7. DIRECTIONS OF EXTREME TOURISM IN UKRAINE

    Directory of Open Access Journals (Sweden)

    L. V. Martseniuk

    2016-02-01

    Full Text Available Purpose. In the world market of tourist services the extreme tourism is very popular, as it does not require the significant financial costs and enables year on year to increase the offers of holiday packages, associated with active travel. Ukraine has significant potential for the development of extreme kinds of rest, but it is not developed enough. Forms of extreme tourism are unknown for domestic tourists, and therefore, they formed a negative attitude. The aim of the article is the analysis of extreme resort potential of Ukraine and promotion of the development of extreme tourism destinations in the travel market. Theoretical and methodological basis of research is the system analysis of the problems of ensuring the competitiveness of the tourism industry, theoretical principles of economic science in the field of the effectiveness of extreme tourism and management of tourist flows. Methodology. The author offers the directions of tourist flows control, which differ from the current expansion of services to tourists in Ukraine. The development of extreme tourism with the help of co-operation of railways and sport federations was proposed. Findings. During the research the author proved that the implementation of the tasks will be promote: 1 increase in budget revenues at all levels of the inner extreme tourism; 2 raise the image of Ukraine and Ukrainian Railways; 3 increase the share of tourism and resorts in the gross domestic product to the level of developed countries; 4 bringing the number of employees in tourism and resorts to the level of developed countries; 5 the creation of an effective system of monitoring the quality of tourist services; 6 the creation of an attractive investment climate for attracting the investment in the broad development of tourism, engineering and transport and municipal infrastructure; 7 improvement the safety of tourists, ensure the effective protection of their rights and legitimate interests and

  8. Problem Solving

    Science.gov (United States)

    Kinsella, John J.

    1970-01-01

    Discussed are the nature of a mathematical problem, problem solving in the traditional and modern mathematics programs, problem solving and psychology, research related to problem solving, and teaching problem solving in algebra and geometry. (CT)

  9. 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.

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. The Difficult Way of Social Psychology in Russia

    Directory of Open Access Journals (Sweden)

    Galina M. Andreeva

    2009-01-01

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

  18. The Distribution of Consciousness: A Difficult Cartesian Chart

    Directory of Open Access Journals (Sweden)

    Marcello Massimini

    2016-04-01

    Full Text Available If we were asked to draw a graph to represent the distribution of consciousness in the world around us (from dolphins to honeybees based on objective criteria, we would definitely be in trouble. The two objective parameters that have been traditionally considered as a guide – the complexity of behavior and brain size – lead to paradoxical conclusions and turn out to be unsatisfactory, to say the least. We need to find novel, reliable metrics. However, these can be identified, validated and calibrated only if we first tackle seriously the problem of recognizing consciousness in our fellow humans, a task which is far from being obvious.

  19. HotSense: a high temperature piezoelectric platform for sensing and monitoring in extreme environments (Conference Presentation)

    Science.gov (United States)

    Stevenson, Tim; Wines, Thomas; Martin, David; Vickers, William; Laws, Michael

    2016-04-01

    Effective monitoring of asset integrity subject to corrosion and erosion while minimizing the exposure of personnel to difficult and hazardous working environments has always been a major problem in many industries. One solution of this problem is permanently installed ultrasonic monitoring equipment which can continuously provide information on the rate of corrosion or cracking, even in the most severe environments and at extreme temperatures to prevent the need for shutdown. Here, a permanently installed 5 MHz ultrasonic monitoring system based on our HotSense® technology is designed and investigated. The system applicability for wall thickness, crack monitoring and weld inspection in high temperature environments is demonstrated through experimental studies on a range of Schedule 40 pipes at temperatures up to 350 °C continuously. The applicability for this technology to be distributed to Aerospace and Nuclear sectors are also explored and preliminary results discussed.

  20. Plasma Physics of Extreme Astrophysical Environments

    CERN Document Server

    Uzdensky, Dmitri A

    2014-01-01

    Certain classes of astrophysical objects, namely magnetars and central engines of supernovae and gamma-ray bursts (GRBs), are characterized by extreme physical conditions not encountered elsewhere in the Universe. In particular, they possess magnetic fields that exceed the critical quantum field of 44 teragauss. Figuring out how these complex ultra-magnetized systems work requires understanding various plasma processes, both small-scale kinetic and large-scale magnetohydrodynamic (MHD). However, an ultra-strong magnetic field modifies the underlying physics to such an extent that many relevant plasma-physical problems call for building QED-based relativistic quantum plasma physics. In this review, after describing the extreme astrophysical systems of interest and identifying the key relevant plasma-physical problems, we survey the recent progress in the development of such a theory. We discuss how a super-critical field modifies the properties of vacuum and matter and outline the basic theoretical framework f...

  1. Difficult airway in a patient with Marshall-Smith syndrome.

    Science.gov (United States)

    Antila, H; Laitio, T; Aantaa, R; Silvoniemi, P; Pakkanen, A

    1998-01-01

    Marshall-Smith syndrome is a rare clinical disorder characterized by accelerated bone maturation, dysmorphic facial features, airway abnormalities and death in early infancy because of respiratory complications. Although patients with Marshall-Smith syndrome have several features with potential anaesthetic problems, previous reports about anaesthetic management of these patients do not exist. We present a case, in which severe hypoxia developed rapidly after routine anaesthesia induction in an eight-month-old male infant with this syndrome. After several unsuccessful attempts the airway was finally secured by blind oral intubation. After 2 weeks, laryngeal anatomy was examined with fibreoptic laryngoscopy which revealed significant laryngomalacia. Laryngoscopy was performed without problems with ketamine anaesthesia and spontaneous breathing. The possibility of a compromised airway should always be borne in mind when anaesthetizing patients with Marshall-Smith syndrome. Anaesthesia maintaining spontaneous breathing is safest for children with this syndrome. If tracheal intubation or muscle relaxation is required, precautions are needed to maintain a patent airway. Muscle relaxants should possibly be avoided before intubation.

  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. 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

  8. Conformal properties of the extremal Schwarzschild de-Sitter spacetime

    CERN Document Server

    Gasperin, Edgar

    2015-01-01

    The conformal structure of the extremal Schwarzschild de-Sitter spacetime is analysed using the extended conformal Einstein field equations. Initial data for an asymptotic initial value problem for the extremal Schwarzschild de-Sitter spacetime is obtained. Using the insights gained from the analysis of the reference spacetime we consider nonlinear perturbations close to the extremal Schwarzschild de-Sitter spacetime. We show that small enough perturbations of initial data for the extremal Schwarzschild de-Sitter spacetime, away from the singularity, give rise to a solution to the Einstein field equations which exists to the future and has an asymptotic structure similar to that of the extremal Schwarzschild de-Sitter spacetime. Similarly, we obtain an existence and stability result for asymptotic initial data close to that of the extremal Schwarzschild de-Sitter spacetime in the non-singular region.

  9. Biodiesel production from castor oil in Brazil: A difficult reality

    Energy Technology Data Exchange (ETDEWEB)

    Silva Cesar, Aldara da, E-mail: aldara@dep.ufscar.b [Federal University of Sao Carlos, Gepai - Grupo de Estudos e Pesquisas Agroindustriais, Departamento de Engenharia de Producao - UFSCar, Rodovia Washington Luis, km 235 - CEP 13565-905 - Sao Carlos - SP (Brazil); Otavio Batalha, Mario [Federal University of Sao Carlos, Gepai - Grupo de Estudos e Pesquisas Agroindustriais, Departamento de Engenharia de Producao - UFSCar, Rodovia Washington Luis, km 235 - CEP 13565-905 - Sao Carlos - SP (Brazil)

    2010-08-15

    The Brazilian National Program for Production and Use of Biodiesel (PNPB in Portuguese) has created a huge demand for biodiesel in Brazil. The PNPB is strongly based on social development through the inclusion of family farmers in projects integrated with biodiesel power plants. Among the various oilseeds, castor bean (Ricinus communis L.) was identified as the ideal one to promote social development in the semi-arid region. However, although promising, the mechanisms of the federal program are still insufficient to promote the effective participation of family farmers. This research shows that companies are facing huge problems in implementing contracts with family farmers. It describes and analyzes the functioning dynamics of this agro-production chain. This paper addresses the identification and the discussion of these obstacles, in order to increase the competitiveness of the biodiesel agribusiness chain, based on castor oil social projects in Brazil.

  10. Biodiesel production from castor oil in Brazil. A difficult reality

    Energy Technology Data Exchange (ETDEWEB)

    Silva Cesar, Aldara da; Otavio Batalha, Mario [Federal University of Sao Carlos, Gepai - Grupo de Estudos e Pesquisas Agroindustriais, Departamento de Engenharia de Producao - UFSCar, Rodovia Washington Luis, km 235 - CEP 13565-905 - Sao Carlos (Brazil)

    2010-08-15

    The Brazilian National Program for Production and Use of Biodiesel (PNPB in Portuguese) has created a huge demand for biodiesel in Brazil. The PNPB is strongly based on social development through the inclusion of family farmers in projects integrated with biodiesel power plants. Among the various oilseeds, castor bean (Ricinus communis L.) was identified as the ideal one to promote social development in the semi-arid region. However, although promising, the mechanisms of the federal program are still insufficient to promote the effective participation of family farmers. This research shows that companies are facing huge problems in implementing contracts with family farmers. It describes and analyzes the functioning dynamics of this agro-production chain. This paper addresses the identification and the discussion of these obstacles, in order to increase the competitiveness of the biodiesel agribusiness chain, based on castor oil social projects in Brazil. (author)

  11. Upper extremity disorders in performing artists.

    Science.gov (United States)

    Rozmaryn, L M

    1993-03-01

    Studies in the past decade have shown that a significant proportion of instrumentalists report musculoskeletal problems severely affecting their musical performance. Musicians endure daily intensive use of their upper extremities, frequently placing them in bizarre positions. Their training schedules are rigorous and long term Predisposing factors to, and treatment for, overuse syndromes, tendinitis, and tendon trauma commonly encountered by musical performers are discussed at length. Nerve entrapment has also surfaced as a major problem in musicians, and the means of evaluation and treatment and the role of surgery are put forth. Techniques for studying and analyzing the difficulties faced by instrumentalists are summarized.

  12. Productive friction: how difficult business partnerships can accelerate innovation.

    Science.gov (United States)

    Hagel, John; Brown, John Seely

    2005-02-01

    Companies are becoming more dependent on business partners, but coordinating with outsiders takes its toll. Negotiating terms, monitoring performance, and, if needs are not being met, switching from one partner to another require time and money. Such transaction costs, Ronald Coase explained in his 1937 essay "The Nature of the Firm," drove many organizations to bring their activities in-house. But what if Coase placed too much emphasis on these costs? What if friction between companies can be productive? Indeed, as John Hagel and John Seely Brown point out, interactions between organizations can yield benefits beyond the goods or services contracted for. Companies get better at what they do--and improve faster than their competitors--by working with outsiders whose specialized capabilities complement their own. Different enterprises bring different perspectives and competencies. When these enterprises tackle a problem together, they dramatically increase the chances for innovative solutions. Of course, misunderstandings often arise when people with different backgrounds and skill sets try to collaborate. Opposing sides may focus on the distance that separates them rather than the common challenges they face. How can companies harness friction so that it builds capabilities? Start by articulating performance goals that everyone buys into. Then make sure people are using tangible prototypes to wrangle over. Finally, assemble teams with committed people who bring different perspectives to the table. As individual problems are being addressed, take care that the underpinnings of shared meaning and trust are also being woven between the companies. Neither can be dictated--but they can be cultivated. Without them, the performance fabric quickly unravels, and business partnerships disintegrate into rivalrous competition.

  13. Upper extremity injuries in Danish children aged 6–12, mechanisms, and risk factors

    DEFF Research Database (Denmark)

    Nauta, J.; Jespersen, Eva; Verhagen, Evert

    2017-01-01

    Although injuries to the upper extremity are most costly, the picture of the upper extremity injury problem remains incomplete. This study is the first to describe the etiology and mechanisms of upper extremity injuries in Danish children. A 2.5-year observational prospective cohort study was con...... childhood injury prevention.......Although injuries to the upper extremity are most costly, the picture of the upper extremity injury problem remains incomplete. This study is the first to describe the etiology and mechanisms of upper extremity injuries in Danish children. A 2.5-year observational prospective cohort study...... was conducted to record upper extremity injuries in 1048 children. Data were weekly collected by sending a text message. A total of 176 upper extremity injuries were reported (128 acute injuries). Of the acute upper extremity injuries, 55% were sprains, 47% occurred in the hand/wrist, and 53% of cases were...

  14. The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data

    Directory of Open Access Journals (Sweden)

    Garrett Joanne M

    2006-10-01

    Full Text Available Abstract Background Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients. Methods We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration. Results In unadjusted analyses, physicians who reported high frustration with patients were younger (p 55 per week, higher stress, practice in a medicine subspeciality, and greater number of patients with psychosocial problems or substance abuse. Conclusion Personal and practice characteristics of physicians who report high frustration with patients differ from those of other physicians. Understanding factors contributing to physician frustration with patients may allow us to improve the quality of patient-physician relationships.

  15. 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.

  16. 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.

  17. [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.

  18. Competition Based Neural Networks for Assignment Problems

    Institute of Scientific and Technical Information of China (English)

    李涛; LuyuanFang

    1991-01-01

    Competition based neural networks have been used to solve the generalized assignment problem and the quadratic assignment problem.Both problems are very difficult and are ε approximation complete.The neural network approach has yielded highly competitive performance and good performance for the quadratic assignment problem.These neural networks are guaranteed to produce feasible solutions.

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

    Science.gov (United States)

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

    2013-12-01

    endocytosis and vesicle transport, precursor mineralogies etc.) is surprisingly incomplete and in many cases based on descriptive rather than mechanistic approaches; (2) in analogy to all metazoans, biomineralization processes of mollusks and brachiopods are complex and involve different mechanisms for different elements. The combined uptake of specific elements both from inorganic and metabolic sources represents a major problem. Despite all of these problems, field experiments document that these biominerals respond to the aquatic geochemistry and the physical properties (temperature, salinity, pH etc.) of their environment, albeit in a more complex manner than conventionally assumed. Significant advances in multi-proxy research, however, require a more holistic view of the physico-chemical and biological processes involved. The present contribution represents a first tentative step towards this goal.

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

    Directory of Open Access Journals (Sweden)

    Butyrin Andrey Yur'evich

    2014-02-01

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

  1. Wind simulation for extreme and fatigue loads

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, M.; Larsen, G.C.; Mann, J.; Ott, S.; Hansen, K.S.; Pedersen, B.J.

    2004-01-01

    Measurements of atmospheric turbulence have been studied and found to deviate from a Gaussian process, in particular regarding the velocity increments over small time steps, where the tails of the pdf are exponential rather than Gaussian. Principles for extreme event counting and the occurrence of cascading events are presented. Empirical extreme statistics agree with Rices exceedence theory, when it is assumed that the velocity and its time derivative are independent. Prediction based on the assumption that the velocity is a Gaussian process underpredicts the rate of occurrence of extreme events by many orders of magnitude, mainly because the measured pdf is non-Gaussian. Methods for simulation of turbulent signals have been developed and their computational efficiency are considered. The methods are applicable for multiple processes with individual spectra and probability distributions. Non-Gaussian processes are simulated by the correlation-distortion method. Non-stationary processes are obtained by Bezier interpolation between a set of stationary simulations with identical random seeds. Simulation of systems with some signals available is enabled by conditional statistics. A versatile method for simulation of extreme events has been developed. This will generate gusts, velocity jumps, extreme velocity shears, and sudden changes of wind direction. Gusts may be prescribed with a specified ensemble average shape, and it is possible to detect the critical gust shape for a given construction. The problem is formulated as the variational problem of finding the most probable adjustment of a standard simulation of a stationary Gaussian process subject to relevant event conditions, which are formulated as linear combination of points in the realization. The method is generalized for multiple correlated series, multiple simultaneous conditions, and 3D fields of all velocity components. Generalization are presented for a single non-Gaussian process subject to relatively

  2. Meniere's disease: Still a mystery disease with difficult differential diagnosis.

    Science.gov (United States)

    Vassiliou, A; Vlastarakos, P V; Maragoudakis, P; Candiloros, D; Nikolopoulos, T P

    2011-01-01

    One hundred and forty-six years after its first description, the differential diagnosis of Meniere's disease remains very challenging. The aim of the present study is to review the current knowledge on the advantages and disadvantages of the new diagnostic methods for Meniere's disease. The importance of accurate diagnosis for primary healthcare systems is also discussed. An extensive search of the literature was performed in Medline and other available database sources. Information from electronic links and related books were also included. Controlled clinical studies, prospective cohort studies, retrospective cohort studies, cross-sectional studies, case reports, written guidelines, systematic reviews, and books were selected. The typical clinical triad of symptoms from the vestibular and cochlear systems (recurrent vertigo, fluctuating sensorineural hearing loss and tinnitus) is usually the key for clinical diagnosis. Glycerol dehydration test and electrocochleography are the main diagnostic tests in current practice, while vestibular evoked myogenic potentials may be used in disease staging. Imagine techniques are not specific enough to set alone the diagnosis of Meniere's disease, although they may be necessary to exclude other pathologies. Recently developed 3D MRI protocols can delineate the perilymphatic/endolymphatic spaces of the inner ear and aid diagnosis. Meniere's disease is a continuous problem for the patients and affects their quality of life. Taking into account the frequent nature of the disease in certain countries, efforts for reliable diagnosis, prompt referral, and successful management are undoubtedly cost-effective for healthcare systems.

  3. Analyzing a 35-Year Hourly Data Record: Why So Difficult?

    Science.gov (United States)

    Lynnes, Chris

    2014-01-01

    At the Goddard Distributed Active Archive Center, we have recently added a 35-Year record of output data from the North American Land Assimilation System (NLDAS) to the Giovanni web-based analysis and visualization tool. Giovanni (Geospatial Interactive Online Visualization ANd aNalysis Infrastructure) offers a variety of data summarization and visualization to users that operate at the data center, obviating the need for users to download and read the data themselves for exploratory data analysis. However, the NLDAS data has proven surprisingly resistant to application of the summarization algorithms. Algorithms that were perfectly happy analyzing 15 years of daily satellite data encountered limitations both at the algorithm and system level for 35 years of hourly data. Failures arose, sometimes unexpectedly, from command line overflows, memory overflows, internal buffer overflows, and time-outs, among others. These serve as an early warning sign for the problems likely to be encountered by the general user community as they try to scale up to Big Data analytics. Indeed, it is likely that more users will seek to perform remote web-based analysis precisely to avoid the issues, or the need to reprogram around them. We will discuss approaches to mitigating the limitations and the implications for data systems serving the user communities that try to scale up their current techniques to analyze Big Data.

  4. Some Difficult-to-pass Tests of Randomness

    Directory of Open Access Journals (Sweden)

    George Marsaglia

    2002-01-01

    Full Text Available We describe three tests of randomness-- tests that many random number generators fail. In particular, all congruential generators-- even those based on a prime modulus-- fail at least one of the tests, as do many simple generators, such as shift register and lagged Fibonacci. On the other hand, generators that pass the three tests seem to pass all the tests in the Diehard Battery of Tests. Note that these tests concern the randomness of a generator's output as a sequence of independent, uniform 32-bit integers. For uses where the output is converted to uniform variates in [0,1, potential flaws of the output as integers will seldom cause problems after the conversion. Most generators seem to be adequate for producing a set of uniform reals in [0,1, but several important applications, notably in cryptography and number theory-- for example, establishing probable primes, complexity of factoring algorithms, random partitions of large integers-- may require satisfactory performance on the kinds of tests we describe here.

  5. AIRWAY ASSESSMENT FOR ANTICIPATION OF DIFFICULT INTUBATION: A DOUBLE BLIND COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ushakumary

    2016-05-01

    Full Text Available BACKGROUND AND AIMS In this era of high technology, we still face an ageless problem in anaesthesia – the difficult airway. In 1997, Smarajith Sur Roy of India introduced a new airway index to predict difficult intubation. Aim of the study is to compare the new airway index with modified Mallampati classification and also with Cormack and Lehane grading for predicting intubation difficulty. MATERIALS AND METHODS The study was conducted on 200 patients undergoing various surgeries at a Government Medical College Hospital. Patients between the age group of 15 to 50 years and belonging to American Society of Anaesthesiologist Grade 1 or 2 were selected. Patients were graded using Modified Mallampati classification. Then in hyperextended neck, the distance between the angle of mandible and the midpoint of Symphysis menti (Variable A and the distance between the symphysis menti and the thyroid notch (Variable B were taken in centimetres and A/B ratio calculated. This ratio is the New Airway Index. After premedication and induction of anaesthesia, laryngoscopy was done, Cormack and Lehane grade noted and intubation difficulty assessed. The predictive value of the new airway index was compared against modified Mallampati classification as well as Cormack and Lehane grading and statistical significance assessed. RESULTS The observations made on the calculation of the new airway index were, 1. When the airway index was 1, the intubation was very easy, irrespective of the findings of Mallampati classification and Cormack and Lehane Grade was 1; 2. When the index was 1 to 1.399, the intubation was easier and the laryngoscopic findings were of Cormack and Lehane Grade II; 3. When the index was 1.4 or more, the intubation was difficult and they belonged to Cormack and Lehane Grade III. The predictability was also statistically very significant when compared with modified Mallampati classification (p<0.001 – Chi square test - test for single proportion

  6. 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...

  7. "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.

  8. 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.

  9. 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!

  10. Simplicity of extremal eigenvalues of the Klein-Gordon equation

    CERN Document Server

    Koppen, Mario; Winklmeier, Monika

    2010-01-01

    We consider the spectral problem associated with the Klein-Gordon equation for unbounded electric potentials. If the spectrum of this problem is contained in two disjoint real intervals and the two inner boundary points are eigenvalues, we show that these extremal eigenvalues are simple and possess strictly positive eigenfunctions. Examples of electric potentials satisfying these assumptions are given.

  11. Structural Identification Problem

    Directory of Open Access Journals (Sweden)

    Suvorov Aleksei

    2016-01-01

    Full Text Available The identification problem of the existing structures though the Quasi-Newton and its modification, Trust region algorithms is discussed. For the structural problems, which could be represented by means of the mathematical modelling of the finite element code discussed method is extremely useful. The nonlinear minimization problem of the L2 norm for the structures with linear elastic behaviour is solved by using of the Optimization Toolbox of Matlab. The direct and inverse procedures for the composition of the desired function to minimize are illustrated for the spatial 3D truss structure as well as for the problem of plane finite elements. The truss identification problem is solved with 2 and 3 unknown parameters in order to compare the computational efforts and for the graphical purposes. The particular commands of the Matlab codes are present in this paper.

  12. Extreme Growth of Enstrophy on 2D Bounded Domains

    Science.gov (United States)

    Protas, Bartosz; Sliwiak, Adam

    2016-11-01

    We study the vortex states responsible for the largest instantaneous growth of enstrophy possible in viscous incompressible flow on 2D bounded domain. The goal is to compare these results with estimates obtained using mathematical analysis. This problem is closely related to analogous questions recently considered in the periodic setting on 1D, 2D and 3D domains. In addition to systematically characterizing the most extreme behavior, these problems are also closely related to the open question of the finite-time singularity formation in the 3D Navier-Stokes system. We demonstrate how such extreme vortex states can be found as solutions of constrained variational optimization problems which in the limit of small enstrophy reduce to eigenvalue problems. Computational results will be presented for circular and square domains emphasizing the effect of geometric singularities (corners of the domain) on the structure of the extreme vortex states. Supported by an NSERC (Canada) Discovery Grant.

  13. Does it work? Why does it work? Reconciling difficult questions.

    Science.gov (United States)

    Hayhow, Rosemarie

    2011-01-01

    , from research outside the field of communication difficulty, and from the process of making sense of the experiences of both clinicians and clients who use the approach. The questions 'Does it work?' and 'How does it work?' are important and require different methods of investigation. Particular treatments may be viewed as better suited to one research methodology over another, but limiting research to one fails to provide the information that practitioners need in order to justify what they do and effectively to solve problems encountered in the application of particular approaches. © 2010 Royal College of Speech & Language Therapists.

  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. 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

  16. Data Converters Performance at Extreme Temperatures

    Science.gov (United States)

    Rejeshuni, Rarnesham; Kumar, Nikil; Mao, James; Keymeulen, Didier; Zebulum, Ricardo S.; Stoica, Adrian

    2006-01-01

    Space missions often require radiation and extreme-temperature hardened electronics to survive the harsh environments beyond earth's atmosphere. Traditional approaches to preserve electronics incorporate shielding, insulation and redundancy at the expense of power and weight. However, a novel way of bypassing these problems is the concept of evolutionary hardware. A reconfgurable device, consisting of several switches interconnected with analog/digital parts, is controlled by an evolutionary processor (EP). When the EP detects degradation in the circuit it sends signals to reconfgure the switches, thus forming a new circuit with the desired output. This concept has been developed since the mid-90s, but one problem remains - the EP cannot degrade substantially. For this reason, extensive testing at extreme temperatures (-180' to 120(deg)C) has been done on devices found on FPGA boards (taking the role of the EP) such as the Analog to Digital and the Digital to Analog Converter. Analysis of the results has shown that FPGA boards implementing EP with some compensation may be a practical solution to evolving circuits. This paper describes results on the tests of data converters at extreme temperatures.

  17. 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.

  18. 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.

  19. 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...

  20. 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.

  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. Solving the Maximum Weighted Clique Problem Based on Parallel Biological Computing Model

    Directory of Open Access Journals (Sweden)

    Zhaocai Wang

    2015-01-01

    Full Text Available The maximum weighted clique (MWC problem, as a typical NP-complete problem, is difficult to be solved by the electronic computer algorithm. The aim of the problem is to seek a vertex clique with maximal weight sum in a given undirected graph. It is an extremely important problem in the field of optimal engineering scheme and control with numerous practical applications. From the point of view of practice, we give a parallel biological algorithm to solve the MWC problem. For the maximum weighted clique problem with m edges and n vertices, we use fixed length DNA strands to represent different vertices and edges, fully conduct biochemical reaction, and find the solution to the MVC problem in certain length range with O(n2 time complexity, comparing to the exponential time level by previous computer algorithms. We expand the applied scope of parallel biological computation and reduce computational complexity of practical engineering problems. Meanwhile, we provide a meaningful reference for solving other complex problems.

  5. 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.

  6. SPECIFICITY OF SELF-PRESERVATION MOTIVATION IN EXTREME SITUATION

    Directory of Open Access Journals (Sweden)

    Ekaterina Anatolevna Karacheva

    2015-02-01

    Full Text Available The article presents the results of the study motivation of self-preservation in an extreme situation. Usually extreme situation unfold from the point of view of functioning, health, high negative level mental stress and tension. The extreme situation is the situation of human activity to which man acts, carrying out certain activities. The article provides an overview of russian and foreign authors dealing with this problem. Theoretical models of motivation of self-preservation Z. Freud, A. Maslow, G. Murray, M. Magomed-Eminov. The study explores the leading motivation in an extreme situation and analyzed the levels of motivation of self-preservation. The study was conducted in the Afghan veterans, using a method of unfinished sentences and other. Identified two levels of motivation of self-preservation: individual and personal. Revealed that the motivation of self-preservation is the leading motivation in an extreme situation.

  7. Detecting change-points in extremes

    KAUST Repository

    Dupuis, D. J.

    2015-01-01

    Even though most work on change-point estimation focuses on changes in the mean, changes in the variance or in the tail distribution can lead to more extreme events. In this paper, we develop a new method of detecting and estimating the change-points in the tail of multiple time series data. In addition, we adapt existing tail change-point detection methods to our specific problem and conduct a thorough comparison of different methods in terms of performance on the estimation of change-points and computational time. We also examine three locations on the U.S. northeast coast and demonstrate that the methods are useful for identifying changes in seasonally extreme warm temperatures.

  8. A new Class of Extremal Composites

    DEFF Research Database (Denmark)

    Sigmund, Ole

    2000-01-01

    The paper presents a new class of two-phase isotropic composites with extremal bulk modulus. The new class consists of micro geometrics for which exact solutions can be proven and their bulk moduli are shown to coincide with the Hashin-Shtrikman bounds. The results hold for two and three dimensions...... and for both well- and non-well-ordered isotropic constituent phases. The new class of composites constitutes an alternative to the three previously known extremal composite classes: finite rank laminates, composite sphere assemblages and Vigdergauz microstructures. An isotropic honeycomb-like hexagonal...... microstructure belonging to the new class of composites has maximum bulk modulus and lower shear modulus than any previously known composite. Inspiration for the new composite class comes from a numerical topology design procedure which solves the inverse homogenization problem of distributing two isotropic...

  9. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel–Feil syndrome

    Science.gov (United States)

    Bhat, Ravi; Mane, Rajesh S.; Patil, Manjunath C.; Suresh, S. N.

    2014-01-01

    The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA. PMID:25191201

  10. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome

    Directory of Open Access Journals (Sweden)

    Ravi Bhat

    2014-01-01

    Full Text Available The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel′s deformity (wherein the scapulae ride high on the back, synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA. After intubation, we used second smaller endotracheal tube (ETT to stabilize and elongate the first ETT while removing the LMA.

  11. Determining extreme parameter correlation in ground water models

    DEFF Research Database (Denmark)

    Hill, Mary Cole; Østerby, Ole

    2003-01-01

    In ground water flow system models with hydraulic-head observations but without significant imposed or observed flows, extreme parameter correlation generally exists. As a result, hydraulic conductivity and recharge parameters cannot be uniquely estimated. In complicated problems, such correlation...... correlation coefficients, but it required sensitivities that were one to two significant digits less accurate than those that required using parameter correlation coefficients; and (3) both the SVD and parameter correlation coefficients identified extremely correlated parameters better when the parameters...

  12. Balance Problems

    Science.gov (United States)

    ... you are having balance problems, see your doctor. Balance disorders can be signs of other health problems, such ... cases, treating the illness that is causing the disorder will help with the balance problem. Exercises, a change in diet, and some ...

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

    Directory of Open Access Journals (Sweden)

    Chiara Bozzano

    2013-03-01

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

  14. Conformational origin of a difficult coupling in a human growth hormone releasing factor analog.

    Science.gov (United States)

    Deber, C M; Lutek, M K; Heimer, E P; Felix, A M

    1989-01-01

    During the solid-phase synthesis of the human growth hormone releasing factor (GRF) analog [Ala15, Leu27, Asn28] -GRF(1-32)-OH, incorporation of Boc-Gln16 was determined to be incomplete. While aggregation of growing resin-bound peptide chains with concomitant beta-sheet formation and "precipitation" has been proposed to account in general for such "difficult coupling," no feature of sequence in the Gln16 region of this GRF analog provided an immediate rationale for this result. We now report 500 MHz 1H NMR spectra of a series of resin-bound GRF segments surrounding the Gln16 position (19-32 through 14-32), swelled in dimethylsulfoxide-d6 solutions [GRF(14-32) = Leu14-Ala-Gln-Leu-Ser(Bzl)-Ala-Arg(Tos)-Lys(CIZ)-Leu- Leu-Gln-Asp(OcHex)-Ile-Leu-Asn-Arg(Tos)-Gln-Gln-Gly32-PAM resin]. While relatively sharp spectra are observed for GRF(19-32), components with resonances broadened by an order-of-magnitude appear in spectra of the 18-32 and 17-32 peptide-resin, and the entire spectrum of 16-32 is ill-resolved and highly broadened. Subsequent spectra sharpen again (15-32, 14-32). These combined synthesis/spectroscopic experimental results, in conjunction with predictive analyses using standard Chou-Fasman 2 degrees structure parameters, suggest that the completeness of the Gln16 coupling is hindered by formation of a specific, folded beta-sheet/beta-turn structure in GRF(16-32) (with the turn located at 18-21, "upstream" of the difficult coupling site), and accompanying aggregation of peptide chains. This analysis suggests that awareness of such potential beta-sheet/beta-turn sequences can guide analog choices, and/or facilitate pre-programming of synthesis steps in anticipation of problem couplings.

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

    Directory of Open Access Journals (Sweden)

    Claire E Stevenson

    2014-08-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  17. 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…

  18. 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…

  19. Hemiequilibrium problems

    Directory of Open Access Journals (Sweden)

    Muhammad Aslam Noor

    2004-01-01

    Full Text Available We consider a new class of equilibrium problems, known as hemiequilibrium problems. Using the auxiliary principle technique, we suggest and analyze a class of iterative algorithms for solving hemiequilibrium problems, the convergence of which requires either pseudomonotonicity or partially relaxed strong monotonicity. As a special case, we obtain a new method for hemivariational inequalities. Since hemiequilibrium problems include hemivariational inequalities and equilibrium problems as special cases, the results proved in this paper still hold for these problems.

  20. On some interconnections between combinatorial optimization and extremal graph theory

    Directory of Open Access Journals (Sweden)

    Cvetković Dragoš M.

    2004-01-01

    Full Text Available The uniting feature of combinatorial optimization and extremal graph theory is that in both areas one should find extrema of a function defined in most cases on a finite set. While in combinatorial optimization the point is in developing efficient algorithms and heuristics for solving specified types of problems, the extremal graph theory deals with finding bounds for various graph invariants under some constraints and with constructing extremal graphs. We analyze by examples some interconnections and interactions of the two theories and propose some conclusions.

  1. 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.

  2. 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

  3. 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…

  4. 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 ...

  5. Extremal Optimization: Methods Derived from Co-Evolution

    Energy Technology Data Exchange (ETDEWEB)

    Boettcher, S.; Percus, A.G.

    1999-07-13

    We describe a general-purpose method for finding high-quality solutions to hard optimization problems, inspired by self-organized critical models of co-evolution such as the Bak-Sneppen model. The method, called Extremal Optimization, successively eliminates extremely undesirable components of sub-optimal solutions, rather than ''breeding'' better components. In contrast to Genetic Algorithms which operate on an entire ''gene-pool'' of possible solutions, Extremal Optimization improves on a single candidate solution by treating each of its components as species co-evolving according to Darwinian principles. Unlike Simulated Annealing, its non-equilibrium approach effects an algorithm requiring few parameters to tune. With only one adjustable parameter, its performance proves competitive with, and often superior to, more elaborate stochastic optimization procedures. We demonstrate it here on two classic hard optimization problems: graph partitioning and the traveling salesman problem.

  6. 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.

  7. Off-pump transapical closure of a mitral periprosthetic leak: a new approach to a difficult problem.

    Science.gov (United States)

    Gaia, Diego Felipe; Breda, João Roberto; Fischer, Claudio Henrique; Palma, José Honório

    2013-12-01

    A 60-year old male patient with multiple risk factors and two previous interventions over the mitral valve was admitted to the emergency unit with symptoms of cardiac failure. Initial examination revealed a competent mitral bioprosthesis with severe perivalvular mitral insufficiency. Based on previous experiences with transapical procedures, a transapical transcatheter closure of the perivalvular leak was performed. The apex was punctured with a 7 French introducer sheath, and a hydrophilic guidewire was advanced with the aid of a right Judkins catheter and positioned across the defect in the left atrium. Fluoroscopic and tridimensional transoesophageal echocardiography was used to guide the manoeuvre. Next, a long introducer sheath was advanced through the guidewire and positioned inside the left atrium. Two Amplatzer Vascular Plug II (St Jude Medical) were deployed, resulting in a significant reduction in the perivalvular leak. The procedure was considered to be successful. The patient regained consciousness, and the orotracheal tube was removed in the operating theatre. No neurological deficits were detected, and the patient was transferred to the intensive care unit. The patient recovered well and was transferred to the ward after 1 day. Discharge was accomplished after 4 days.

  8. To Get Rid of a Difficult Employee, a College May Hush Up Problems in a Professor's Past.

    Science.gov (United States)

    Leatherman, Courtney

    1996-01-01

    The common practice of keeping negative information about a faculty member quiet if he agrees to resign quietly is criticized by some who find it unethical or illegal. They feel employers should disclose full employment records. Others warn that colleges may invade the privacy of a professor or defame him by passing on unsubstantiated charges to a…

  9. Reenactment of televised content by 2-year olds: toddlers use language learned from television to solve a difficult imitation problem.

    Science.gov (United States)

    Barr, Rachel; Wyss, Nancy

    2008-12-01

    Parents commonly label objects on television and for some programs, verbal labels are also provided directly via voice-over. The present study investigated whether toddlers' imitation performance from television would be facilitated if verbal labels were presented on television via voice-over or if they were presented by parents who were co-viewing with their toddlers. Sixty-one 2-year olds were randomly assigned to one of four experimental groups (voice-over video, parent video, parent video no label, parent live) or to a baseline control condition. Toddlers were tested with novel objects after a 24h delay. Although, all experimental groups imitated significantly more target actions than the baseline control group, imitation was facilitated by novel labels regardless of whether those labels were provided by parents or by voice-over on television. These findings have important implications for toddler learning from television.

  10. To Get Rid of a Difficult Employee, a College May Hush Up Problems in a Professor's Past.

    Science.gov (United States)

    Leatherman, Courtney

    1996-01-01

    The common practice of keeping negative information about a faculty member quiet if he agrees to resign quietly is criticized by some who find it unethical or illegal. They feel employers should disclose full employment records. Others warn that colleges may invade the privacy of a professor or defame him by passing on unsubstantiated charges to a…

  11. Solving the factorization problem with P systems

    Institute of Scientific and Technical Information of China (English)

    Alberto Leporati; Claudio Zandron; Giancarlo Mauri

    2007-01-01

    P systems have been used many times to face with computationally difficult problems, such as NP-complete decision problems and NP-hard optimization problems. In this paper we focus our attention on another computationally intractable problem: factorization. In particular, we first propose a simple method to encode binary numbers using multisets. Then, we describe three families of P systems: the first two allow to add and to multiply two binary encoded numbers, respectively, and the third solves the factorization problem.

  12. Conditional simulation of extremal Gaussian processes

    CERN Document Server

    Dombry, Clément

    2012-01-01

    Recently the regular conditional distributions of max-infinitely divisible processes were derived by \\citet{Dombry2011} and although these conditional distributions have complicated closed forms, \\citet{Dombry2011b} introduce an algorithm to get conditional realizations of Brown-Resnick processes. In this paper we derive the regular conditional distributions of the max-stable process introduced by \\citet{Schlather2002} and adapt the framework of \\citet{Dombry2011b} to this specific process. We test the methods on simulated data and give an application to extreme temperatures in Switzerland. Results show that the proposed sampling scheme provide accurate conditional simulations and can handle real-sized problems.

  13. Configuration Management for eXtreme Programming

    DEFF Research Database (Denmark)

    Asklund, U.; Bendix, Lars Gotfred; Ekman, T.

    2003-01-01

    Extreme programming (XP) is a software development method that prescribes the use of 12 different practices. Four of these practices (collective code ownership, continuous integration, small releases and refactoring) can indeed be given good support by the use of simple configuration management (CM...... on those CM aspects that are related to co-ordination and release. Furthermore, we found that even a simple CM tool will do as long as it supports the copy-merge model to allow and support parallel work. Overall none of the four CM-related XP practices caused any particular problems to the developers...

  14. Einstein Manifolds and Extremal Kahler Metrics

    CERN Document Server

    LeBrun, Claude

    2010-01-01

    In joint work with Chen and Weber, the author has elsewhere shown that CP2#2(-CP2) admits an Einstein metric. The present paper presents a new and rather different proof of the existence of such an Einstein metric, using a variational approach which simultaneously casts new light on the related uniqueness problem. Our results include new existence theorems for extremal Kahler metrics, and these allow one to prove the above existence statement by deforming the Kahler-Einstein metric on CP2#3(-CP2) until bubbling-off occurs.

  15. Crafting, Crafting, Crafting - Extreme Programming in Classroom?

    Directory of Open Access Journals (Sweden)

    Marcus BITZL

    2008-10-01

    Full Text Available Extreme Programming (XP shows several interesting approaches which are very attractive for education. It is centered around early and incremental creation of working software. In the following, the chances XP offers for class are shown - especially for use in a class project, but also for practical phases in all lessons where programming is useful. Finally several common problems which can occur with XP will be shown as well as how to deal with them to make the use in class as smooth as possible.

  16. (Extreme) Core-collapse Supernova Simulations

    Science.gov (United States)

    Mösta, Philipp

    2017-01-01

    In this talk I will present recent progress on modeling core-collapse supernovae with massively parallel simulations on the largest supercomputers available. I will discuss the unique challenges in both input physics and computational modeling that come with a problem involving all four fundamental forces and relativistic effects and will highlight recent breakthroughs overcoming these challenges in full 3D simulations. I will pay particular attention to how these simulations can be used to reveal the engines driving some of the most extreme explosions and conclude by discussing what remains to be done in simulation work to maximize what we can learn from current and future time-domain astronomy transient surveys.

  17. 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.

  18. Complex extreme learning machine applications in terahertz pulsed signals feature sets.

    Science.gov (United States)

    Yin, X-X; Hadjiloucas, S; Zhang, Y

    2014-11-01

    This paper presents a novel approach to the automatic classification of very large data sets composed of terahertz pulse transient signals, highlighting their potential use in biochemical, biomedical, pharmaceutical and security applications. Two different types of THz spectra are considered in the classification process. Firstly a binary classification study of poly-A and poly-C ribonucleic acid samples is performed. This is then contrasted with a difficult multi-class classification problem of spectra from six different powder samples that although have fairly indistinguishable features in the optical spectrum, they also possess a few discernable spectral features in the terahertz part of the spectrum. Classification is performed using a complex-valued extreme learning machine algorithm that takes into account features in both the amplitude as well as the phase of the recorded spectra. Classification speed and accuracy are contrasted with that achieved using a support vector machine classifier. The study systematically compares the classifier performance achieved after adopting different Gaussian kernels when separating amplitude and phase signatures. The two signatures are presented as feature vectors for both training and testing purposes. The study confirms the utility of complex-valued extreme learning machine algorithms for classification of the very large data sets generated with current terahertz imaging spectrometers. The classifier can take into consideration heterogeneous layers within an object as would be required within a tomographic setting and is sufficiently robust to detect patterns hidden inside noisy terahertz data sets. The proposed study opens up the opportunity for the establishment of complex-valued extreme learning machine algorithms as new chemometric tools that will assist the wider proliferation of terahertz sensing technology for chemical sensing, quality control, security screening and clinic diagnosis. Furthermore, the proposed

  19. Extremal eigenvalues of measure differential equations with fixed variation

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    In this paper we will study eigenvalues of measure differential equations which are motivated by physical problems when physical quantities are not absolutely continuous.By taking Neumann eigenvalues of measure differential equations as an example,we will show how the extremal problems can be completely solved by exploiting the continuity results of eigenvalues in weak* topology of measures and the Lagrange multiplier rule for nonsmooth functionals.These results can give another explanation for extremal eigenvalues of SturmLiouville operators with integrable potentials.

  20. 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.

  1. Skin disorders associated with bilateral lower extremity amputation.

    Science.gov (United States)

    Almassi, F; Mousavi, B; Masumi, M; Souroush, M R; Honari, G

    2009-10-15

    We conducted this study to determine the types and frequency of skin problems among war related bilateral lower limb amputees. Three hundred and thirty five cases were examined for dermatologic problems in about 20 years (20 +/- 3.89) after bilateral lower extremity amputation. The subjects were injured during the Iraq-Iran war. Descriptive statistics were used. At least one skin problem was found in 189 (56.4%) of the amputees. Three hundred and nineteen skin problems were diagnosed in 189 amputees. The most common skin problems were contact dermatitis 39.5% (n=126), calluses 26.6% (n=85), folliculitis 14.42% (n=46) and ulcers 7.2% (n=23). The skin problems were more frequently seen in subjects with bilateral below the knee amputation. Skin problems were highly incident in our amputees. The substantial multidisciplinary rehabilitation team included a dermatologist, orthopedic surgeon, prosthetist and physical therapist is recommended to prevent and diagnose these problems on time.

  2. Computational problems in engineering

    CERN Document Server

    Mladenov, Valeri

    2014-01-01

    This book provides readers with modern computational techniques for solving variety of problems from electrical, mechanical, civil and chemical engineering. Mathematical methods are presented in a unified manner, so they can be applied consistently to problems in applied electromagnetics, strength of materials, fluid mechanics, heat and mass transfer, environmental engineering, biomedical engineering, signal processing, automatic control and more.   • Features contributions from distinguished researchers on significant aspects of current numerical methods and computational mathematics; • Presents actual results and innovative methods that provide numerical solutions, while minimizing computing times; • Includes new and advanced methods and modern variations of known techniques that can solve difficult scientific problems efficiently.  

  3. 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.)

  4. Multiphase composites with extremal bulk modulus

    DEFF Research Database (Denmark)

    Gibiansky, L. V.; Sigmund, Ole

    2000-01-01

    This paper is devoted to the analytical and numerical study of isotropic elastic composites made of three or more isotropic phases. The ranges of their effective bulk and shear moduli are restricted by the Hashin-Shtrikman-Walpole (HSW) bounds. For two-phase composites, these bounds are attainable......, that is, there exist composites with extreme bulk and shear moduli. For multiphase composites, they may or may not be attainable depending on phase moduli and volume fractions. Sufficient conditions of attainability of the bounds and various previously known and new types of optimal composites...... are described. Most of our new results are related to the two-dimensional problem. A numerical topology optimization procedure that solves the inverse homogenization problem is adopted and used to look for two-dimensional three-phase composites with a maximal effective bulk modulus. For the combination...

  5. Detecting Extreme Events in Gridded Climate Data

    Energy Technology Data Exchange (ETDEWEB)

    Ramachandra, Bharathkumar [North Carolina State University (NCSU), Raleigh; Gadiraju, Krishna [North Carolina State University (NCSU), Raleigh; Vatsavai, Raju [North Carolina State University (NCSU), Raleigh; Kaiser, Dale Patrick [ORNL; Karnowski, Thomas Paul [ORNL

    2016-01-01

    Detecting and tracking extreme events in gridded climatological data is a challenging problem on several fronts: algorithms, scalability, and I/O. Successful detection of these events will give climate scientists an alternate view of the behavior of different climatological variables, leading to enhanced scientific understanding of the impacts of events such as heat and cold waves, and on a larger scale, the El Nin o Southern Oscillation. Recent advances in computing power and research in data sciences enabled us to look at this problem with a different perspective from what was previously possible. In this paper we present our computationally efficient algorithms for anomalous cluster detection on climate change big data. We provide results on detection and tracking of surface temperature and geopotential height anomalies, a trend analysis, and a study of relationships between the variables. We also identify the limitations of our approaches, future directions for research and alternate approaches.

  6. [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.

  7. 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.

  8. 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)

  9. ON A PROBLEM OF E. REICH

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    In 1981, E. Reich established a theorem which stated a sufficient condition for a quasiconformal mapping to be a unique extremal mapping with the given boundary value, and asked whether or not such a uniquely extremal mapping was a Teichmuller mapping in his remark. In this paper, the above open problem was solved and consequently the theorem was strengthened.

  10. 2008+ solved problems in electromagnetics

    CERN Document Server

    Nasar, Syed

    2007-01-01

    SciTech Publishing is reissuing this extremely valuable learning resource, originally published in 1992 in the Schaum's Problem-Solving Series for students of electromagnetics and those who wish to refresh and solidify their understanding of its challenging applications. Problem-solving drill helps develop confidence, but few textbooks offer the answers, never mind the complete solutions, to their chapter exercises. Here noted author Professor Syed Nasar has divided the book's problems into topic areas similar to a textbook and presented a wide array of problems, followed immediately by their

  11. Dynamics of Universe in Problems

    CERN Document Server

    Bolotin, Yu L; Ivashkevych, G I; Lemets, O A; Yerokhin, D A

    2009-01-01

    We do not know books of problems on cosmology including its recent achievements. However we believe that such a book would be extremely useful for the youth poured in the last decade into that one of the most actively developing field of science. We suggest to cosmological community to create a joint collaboration "Dynamics of Universe in Problems". Now we propose first 500 problems as our contribution into that beginning. If our project will make an interest then it is needed to think how to organize technically the international collaboration in that direction. In any case we plan to update our "database" monthly, including 30-50 new problems every time.

  12. The difficult issue of age assessment on pedo-pornographic material.

    Science.gov (United States)

    Cattaneo, Cristina; Ritz-Timme, Stefanie; Gabriel, Peter; Gibelli, Daniele; Giudici, Elena; Poppa, Pasquale; Nohrden, Doerte; Assmann, Sabine; Schmitt, Roland; Grandi, Marco

    2009-01-10

    The issue of juvenile pornography has seen an increase in the past few years of the number of expert opinions requested to forensic pathologists, paediatricians and other various experts within the forensic and medical fields concerning the age of represented individuals. Regardless of the entity of the problem, no actual method exists which can allow us to give an objective and scientific answer, particularly in the postpubertal stage. Using parameters related to sexual maturation can be very dangerous. Nonetheless some experts still insist with similar types of "expertises". This study aims at verifying the ability of different experts in assessing age of postpubertal individuals represented in pornographic material. Results underline the difficulties and major uncertainties of age evaluation by visual observation of photographic material particularly when the subjects have reached the sexual maturation stage - and therefore in verifying whether the individual is above or below 18 years of age (an important age limit for most European countries as far as this type of crime is concerned). Furthermore the study stresses the need both to search for an alternate approach and to apply extreme caution in judicial evaluation.

  13. 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.

  14. 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....

  15. 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 $\\C\\P^1\\times\\C\\P^1$.

  16. 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

  17. 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

  18. 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

  19. 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.

  20. Learning Problems

    Science.gov (United States)

    ... de los dientes Video: Getting an X-ray Learning Problems KidsHealth > For Kids > Learning Problems Print A ... for how to make it better. What Are Learning Disabilities? Learning disabilities aren't contagious, but they ...