WorldWideScience

Sample records for extremely difficult problems

  1. What Makes a Beam Shaping Problem Difficult

    International Nuclear Information System (INIS)

    Romero, Louis; Dickey, Fred M.

    2000-01-01

    The authors have discussed the three factors that they believe are the most important in determining the difficulty of a beam shaping problem: scaling, smoothness, and coherence. The arguments have been almost completely based on considering how these factors influence beam shaping lenses that were designed using geometrical optics. However, they believe that these factors control the difficulty of beam shaping problems even if one does not base ones design strategy on geometrical optics. For example, they have shown that a lens designed using geometrical optics will not work well unless β is large. However, they have also shown that if β is small the uncertainty principle shows that it is impossible to do a good job of beam shaping no matter how one designs ones lens

  2. Rules and technical tricks in extremely difficult laparoscopic cholecystectomies

    Directory of Open Access Journals (Sweden)

    Liviu Drăghici

    2017-11-01

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

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

    Science.gov (United States)

    DiMaio, Frank

    2017-01-01

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

  4. Simultaneous Optimization of Tallies in Difficult Shielding Problems

    International Nuclear Information System (INIS)

    Peplow, Douglas E.; Evans, Thomas M.; Wagner, John C.

    2008-01-01

    Monte Carlo is quite useful for calculating specific quantities in complex transport problems. Many variance reduction strategies have been developed that accelerate Monte Carlo calculations for specific tallies. However, when trying to calculate multiple tallies or a mesh tally, users have had to accept different levels of relative uncertainty among the tallies or run separate calculations optimized for each individual tally. To address this limitation, an extension of the CADIS (Consistent Adjoint Driven Importance Sampling) method, which is used for difficult source/detector problems, has been developed to optimize several tallies or the cells of a mesh tally simultaneously. The basis for this method is the development of an importance function that represents the importance of particles to the objective of uniform Monte Carlo particle density in the desired tally regions. This method utilizes the results of a forward discrete ordinates solution, which may be based on a quick, coarse-mesh calculation, to develop a forward-weighted source for the adjoint calculation. The importance map and the biased source computed from the adjoint flux are then used in the forward Monte Carlo calculation to obtain approximately uniform relative uncertainties for the desired tallies. This extension is called forward-weighted CADIS, or FW-CADIS

  5. A technical solution to a difficult problem - An update

    International Nuclear Information System (INIS)

    Asselstine, J.K.

    1985-01-01

    A goal of the Reduced Enrichment Research and Test Reactor Program (RERTR) established by the U.S. Department of Energy is to develop the technical means needed to utilize LEU instead of HEU fuels in research and test reactors and to do so without operational penalties and without affecting safety characteristics. This goal has been pursued now for seven years in cooperation with many of you who are participants in this conference. The program has made significant progress in the development, demonstration and application of new LEU research reactor fuels. According to recent projections, the percentage of HEU fuel in international commerce which is technically replaceable with LEU fuels has been growing steadily as research continues. There appears to be no technical barrier to eventual replacement of HEU fuel with LEU fuel in research and test reactors. While there are many politically complex and technically difficult issues involved in nonproliferation, I conclude that the use of highly enriched weapons grade uranium as a fuel in civilian research reactors stands out as one problem which has a straight forward technical solution. The technical solution is the effort you in the RERTR program are embarked on. Once that solution is in hand, the operators of research reactors are urged to take political and legal initiatives to make the conversion happen. By effecting this conversion they will help minimize the trade in highly enriched uranium and make the world a little safer

  6. A technical solution to a difficult problem - An update

    Energy Technology Data Exchange (ETDEWEB)

    Asselstine, J K

    1985-07-01

    A goal of the Reduced Enrichment Research and Test Reactor Program (RERTR) established by the U.S. Department of Energy is to develop the technical means needed to utilize LEU instead of HEU fuels in research and test reactors and to do so without operational penalties and without affecting safety characteristics. This goal has been pursued now for seven years in cooperation with many of you who are participants in this conference. The program has made significant progress in the development, demonstration and application of new LEU research reactor fuels. According to recent projections, the percentage of HEU fuel in international commerce which is technically replaceable with LEU fuels has been growing steadily as research continues. There appears to be no technical barrier to eventual replacement of HEU fuel with LEU fuel in research and test reactors. While there are many politically complex and technically difficult issues involved in nonproliferation, I conclude that the use of highly enriched weapons grade uranium as a fuel in civilian research reactors stands out as one problem which has a straight forward technical solution. The technical solution is the effort you in the RERTR program are embarked on. Once that solution is in hand, the operators of research reactors are urged to take political and legal initiatives to make the conversion happen. By effecting this conversion they will help minimize the trade in highly enriched uranium and make the world a little safer.

  7. Unstable values: A difficult problem for risk assessment

    International Nuclear Information System (INIS)

    Fischhoff, B.; Slovic, P.; Lichtenstein, S.

    1983-01-01

    People with somewhat rudimentary value concepts and those searching for values are compared to one another. In order to solve problems of instability the authors look into and evaluates problems like: psychophysics of concepts of values, definition of the object of the question, influencing the outlook of the persons interviewed, changes in the interviewed persons and sensitivity analysis. (DG) [de

  8. The Markov moment problem and extremal problems

    CERN Document Server

    Kreĭn, M G; Louvish, D

    1977-01-01

    In this book, an extensive circle of questions originating in the classical work of P. L. Chebyshev and A. A. Markov is considered from the more modern point of view. It is shown how results and methods of the generalized moment problem are interlaced with various questions of the geometry of convex bodies, algebra, and function theory. From this standpoint, the structure of convex and conical hulls of curves is studied in detail and isoperimetric inequalities for convex hulls are established; a theory of orthogonal and quasiorthogonal polynomials is constructed; problems on limiting values of integrals and on least deviating functions (in various metrics) are generalized and solved; problems in approximation theory and interpolation and extrapolation in various function classes (analytic, absolutely monotone, almost periodic, etc.) are solved, as well as certain problems in optimal control of linear objects.

  9. The Difficult Patron in the Academic Library: Problem Issues or Problem Patrons?

    Science.gov (United States)

    Simmonds Patience L.; Ingold, Jane L.

    2002-01-01

    Identifies difficult patron issues in academic libraries from the librarians' perspectives and offers solutions to try and prevent them from becoming problems. Topics include labeling academic library users; eliminating sources of conflict between faculty and library staff; and conflicts between students and library staff. (Author/LRW)

  10. 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.

  11. Discussion of difficult problems of early diagnosis of pancreatic cancer

    Directory of Open Access Journals (Sweden)

    GUO Xiaozhong

    2014-08-01

    Full Text Available Pancreatic cancer is a common malignant neoplasm of the pancreas with an extremely high mortality. Currently, the early diagnosis of pancreatic cancer is still not ideal. Attention should be paid to some clinical warning symptoms, such as unexplained abdominal and back pain, jaundice, and unexpected diabetes. Additionally, the combined use of CA19-9, CEA, and other tumor markers, the attention to biochemical indicators, the detection of mutation in KAI1 or p53 gene, and the exploration of the value of miRNA in clinical diagnosis are of great significance. On the other hand, ultrasound, CT, MRCP, ERCP, PET-CT, and other imaging methods, as well as effective collection of cytology specimens, should be performed. Thus, there is hope for the early diagnosis of pancreatic cancer.

  12. 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

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

    International Nuclear Information System (INIS)

    DiMaio, Frank

    2013-01-01

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

  14. Why Do Disadvantaged Filipino Children Find Word Problems in English Difficult?

    Science.gov (United States)

    Bautista, Debbie; Mulligan, Joanne

    2010-01-01

    Young Filipino students are expected to solve mathematical word problems in English, a language that many encounter only in schools. Using individual interviews of 17 Filipino children, we investigated why word problems in English are difficult and the extent to which the language interferes with performance. Results indicate that children could…

  15. Beyond Psychometrics: The Difference between Difficult Problem Solving and Complex Problem Solving

    Directory of Open Access Journals (Sweden)

    Jens F. Beckmann

    2017-10-01

    Full Text Available In this paper we argue that a synthesis of findings across the various sub-areas of research in complex problem solving and consequently progress in theory building is hampered by an insufficient differentiation of complexity and difficulty. In the proposed framework of person, task, and situation (PTS, complexity is conceptualized as a quality that is determined by the cognitive demands that the characteristics of the task and the situation impose. Difficulty represents the quantifiable level of a person’s success in dealing with such demands. We use the well-documented “semantic effect” as an exemplar for testing some of the conceptual assumptions derived from the PTS framework. We demonstrate how a differentiation between complexity and difficulty can help take beyond a potentially too narrowly defined psychometric perspective and subsequently gain a better understanding of the cognitive mechanisms behind this effect. In an empirical study a total of 240 university students were randomly allocated to one of four conditions. The four conditions resulted from contrasting the semanticity level of the variable labels used in the CPS system (high vs. low and two instruction conditions for how to explore the CPS system’s causal structure (starting with the assumption that all relationships between variables existed vs. starting with the assumption that none of the relationships existed. The variation in the instruction aimed at inducing knowledge acquisition processes of either (1 systematic elimination of presumptions, or (2 systematic compilation of a mental representation of the causal structure underpinning the system. Results indicate that (a it is more complex to adopt a “blank slate” perspective under high semanticity as it requires processes of inhibiting prior assumptions, and (b it seems more difficult to employ a systematic heuristic when testing against presumptions. In combination, situational characteristics, such as the

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

    Science.gov (United States)

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

    2009-09-01

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

  17. 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...

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

    Science.gov (United States)

    Chen, S. S.

    2017-12-01

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

  19. 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.

  20. 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.

  1. A nuclear-armed Iran: a difficult but not impossible policy problem - Lecture note

    International Nuclear Information System (INIS)

    Sitt, Bernard

    2006-01-01

    This lecture note makes an analysis of a report by Barry R. Posen from The Century Foundation (TCF) and entitled: 'A nuclear-armed Iran: a difficult but not impossible policy problem' (28 Dec 2006). In this report, the author believes that diplomacy would be the ideal outcome in handling the nuclear bomb situation in Iran, but containment and deterrence will be effective if diplomacy fails. He challenges the common fears that arise from Iran's potential possession of a bomb: The fear that Iran would use nuclear threats against nonnuclear neighbors; The fear that Iran would use nuclear weapons to annihilate the state of Israel. To ensure effective deterrence, the United States would need to pursue a strategy of coexistence with a nuclear Iran. In order to do so, the US would have to renew its commitment to the security of the Middle East; US involvement would be required to prevent regional proliferation and to ensure the protection of Iran's neighbors. The present Lecture note analyzes and discusses the 4 threats of a nuclear Iran that need to be dissuaded: a risky and more violent foreign policy; the blackmailing of some neighbor countries; the supply of nuclear weapons to non-state actors; and nuclear strikes against Israel despite inevitable retaliatory measures

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

    NARCIS (Netherlands)

    Koekkoek, Bauke; van Meijel, Berno; Schene, Aart; Hutschemaekers, Giel

    2009-01-01

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

  3. 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

  4. On the universal method to solve extremal problems

    NARCIS (Netherlands)

    J. 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

  5. Parental Reflective Functioning Moderates the Relationship between Difficult Temperament in Infancy and Behavior Problems in Toddlerhood

    Science.gov (United States)

    Wong, Kristyn; Stacks, Ann M.; Rosenblum, Katherine L.; Muzik, Maria

    2017-01-01

    This study assessed the links between infant negative affect, parental reflective functioning (RF), and toddler behavior problems in a sample of 84 women and their infants. Mothers provided self-report demographic data and completed the Infant Behavior Questionnaire-Revised during a home visit when the infant was 7 months old. They also completed…

  6. Predicting Growth Curves of Early Childhood Externalizing Problems: Differential Susceptibility of Children with Difficult Temperament

    Science.gov (United States)

    Mesman, Judi; Stoel, Reinoud; Bakermans-Kranenburg, Marian J.; van IJzendoorn, Marinus H.; Juffer, Femmie; Koot, Hans M.; Alink, Lenneke R. A.

    2009-01-01

    Using an accelerated longitudinal design, the development of externalizing problems from age 2 to 5 years was investigated in relation to maternal psychopathology, maternal parenting, gender, child temperament, and the presence of siblings. The sample consisted of 150 children selected at age 2-3 years for having high levels of externalizing…

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

    International Nuclear Information System (INIS)

    Ibrahim, A. M.; Peplow, D. E.; Mosher, S. W.; Wagner, J. C.; Evans, T. M.; Wilson, P. P.; Sawan, M. E.

    2013-01-01

    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)

  8. Automatic mesh adaptivity for hybrid Monte Carlo/deterministic neutronics modeling of difficult shielding problems

    International Nuclear Information System (INIS)

    Ibrahim, Ahmad M.; Wilson, Paul P.H.; Sawan, Mohamed E.; Mosher, Scott W.; Peplow, Douglas E.; Wagner, John C.; Evans, Thomas M.; Grove, Robert E.

    2015-01-01

    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 macromaterial 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 decouples 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, eliminating the need for a world-class super computer

  9. Transductive and matched-pair machine learning for difficult target detection problems

    Science.gov (United States)

    Theiler, James

    2014-06-01

    This paper will describe the application of two non-traditional kinds of machine learning (transductive machine learning and the more recently proposed matched-pair machine learning) to the target detection problem. The approach combines explicit domain knowledge to model the target signal with a more agnostic machine-learning approach to characterize the background. The concept is illustrated with simulated data from an elliptically-contoured background distribution, on which a subpixel target of known spectral signature but unknown spatial extent has been implanted.

  10. [Analysis of difficult problems on European Union laws and regulations of traditional herbal medicinal products].

    Science.gov (United States)

    Qu, Li-Ping; Zhang, Xiao-Qun; Xiong, Yan; Wang, Yi-Tao; Zou, Wen-Jun

    2017-10-01

    Registration of Chinese patent medicine in European Union (EU) is of great significance to the internationalization of traditional Chinese medicine as EU market acts as an important position in the global botanical market. In retrospect, the domestic studies on EU regulations of traditional herbal medicinal products have been conducted for more than 10 years, but there is still some cognitive bias and lack of research. In this paper, a review of the relevant research progress and the main misunderstanding problems about Directive 2004/24/EC, like the centralized and decentralized supervision system of traditional herbal medicinal products in the EU, marketing authorization procedures for traditional herbal medicinal products, Community Herbal Monograph and List Entries, would be systematically analyzed, so as to provide reference for the registration of Chinese patent medicine in EU. Copyright© by the Chinese Pharmaceutical Association.

  11. QUALITATIVE ANALYSIS OF EXTREMAL PROBLEMS IN ARBITRARY DOMAINS

    Directory of Open Access Journals (Sweden)

    Samokhin Mikhail Vasilevich

    2012-10-01

    The author considers the problems concerning where B is either a unit sphere in the (D space or one of the classes , p>1. He shows the possibility of the results concerning the characteristic of extreme functions, their uniqueness, the possilble presentation of the functions from the classes and with the use of the Cauchy-Stieltjes integrals in the component of the D\\ suppµ set and the boundary behavior of an extreme function from the (D class. One should note that the given mathematical system can be implemented for making decisions in the field of construction engineering and structural analysis, it can provide research assistants and engineers with the background necessary for developing sound solutions and rational proposals.

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

    International Nuclear Information System (INIS)

    Callstrom, Matthew R.; Charboneau, J. William; Atwell, Thomas D.; Farrell, Michael A.; Welch, Timothy J.; Maus, Timothy P.; Goetz, Matthew P.; Rubin, Joseph

    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.)

  13. What Makes Difficult History Difficult?

    Science.gov (United States)

    Gross, Magdalena H.; Terra, Luke

    2018-01-01

    All modern nation-states have periods of difficult history that teachers fail to address or address inadequately. The authors present a framework for defining difficult histories and understanding what makes them difficult. These events 1) are central to a nation's history, 2) contradict accepted histories or values, 3) connect with present…

  14. 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…

  15. Support of the extremal measure in a vector equilibrium problem

    International Nuclear Information System (INIS)

    Lapik, M A

    2006-01-01

    A generalization of the Mhaskar-Saff functional is obtained for a vector equilibrium problem with an external field. As an application, the supports of the equilibrium measures are found in a special vector equilibrium problem with Nikishin matrix.

  16. On the Fermat-Lagrange principle for mixed smooth convex extremal problems

    International Nuclear Information System (INIS)

    Brinkhuis, Ya

    2001-01-01

    A simple geometric condition that can be attached to an extremal problem of a fairly general form included in a family of problems is indicated. This is used to demonstrate that the task of formulating a uniform condition for smooth convex problems can be satisfactorily accomplished. On the other hand, the necessity of this new condition of optimality is proved under certain technical assumptions

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

    NARCIS (Netherlands)

    van den Akker, A.L.; Prinzie, P.; Deković, M.; de Haan, A.D.; Asscher, J.J.; Widiger, T.

    2013-01-01

    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

  18. Difficult Children

    DEFF Research Database (Denmark)

    Christensen, Else

    . 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...... in contact with their peers, more attention-related problems and less emotional or psychological resources. Furthermore the mothers experience more trouble in child rearing than what is found in an average family. The results are important in the way that they attract attention to the child’s own situation...... 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...

  19. 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.

  20. The problem of defining contemporary right-wing extremism in political theory

    Directory of Open Access Journals (Sweden)

    Đorić Marija

    2016-01-01

    Full Text Available The subject matter of research in this paper is theoretical controversy related to the definition of right-wing extremism. Given the fact that extremism is a variable, amorphous and insufficiently researched phenomenon, largely conditioned by time, space, political and cultural differences, there is a great confusion in the field of political science when defining right-wing extremism. The problem of researching right-wing extremism is additionally complicated by various terms that are being used in the contemporary literature as its synonyms, such as right-wing radicalism, neo-Fascism, ultra-radicalism, etc. In order to provide the most valid theoretical determination of right-wing extremism, the author provides a detailed analysis of all the components constituting this phenomenon and examines their causality. In the political praxis, the term extremism is extensively abused, which additionally complicates its determination. Videlicet, politicians often use term 'extremist' in order to discredit their political opponents. While during the French revolution aristocracy saw the bourgeoisie as extremists, the members of the working class later stated that the bourgeoisie were extremists. The problem lies in the fact that, in politics, extremists are not only the ones who use violence as modus operandi; indeed, it is also used by political opponents who do not belong to the extreme political option. Another aggravating factor in defining right-wing extremism is that many administrative and academic definitions do not make a clear distinction between extremism and related phenomena, such as terrorism, radicalism and populism. Extremism is most often equaled with terrorism, which gives rise to another problem in defining this phenomenon. The relation between extremism and terrorism is the relation of general and specific. Namely, every act of terrorism is concurrently considered to be an act of extremism, but not vice versa, given the fact that

  1. 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…

  2. Non-Supersymmetric (but) Extreme Black Holes, Scalar Hair and Other Open Problems

    CERN Document Server

    Ortín, Tomas

    1999-01-01

    We give a brief overview of black-hole solutions in four-dimensional supergravity theories and their extremal and supersymmetric limits. We also address problems like cosmic censorship and no-hair theorems in supergravity theories. While supergravity by itself seems not to be enough to enforce cosmic censorship and absence of primary scalar hair, superstring theory may be.

  3. 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.

  4. Case management services for work related upper extremity disorders. Integrating workplace accommodation and problem solving.

    Science.gov (United States)

    Shaw, W S; Feuerstein, M; Lincoln, A E; Miller, V I; Wood, P M

    2001-08-01

    A case manager's ability to obtain worksite accommodations and engage workers in active problem solving may improve health and return to work outcomes for clients with work related upper extremity disorders (WRUEDs). This study examines the feasibility of a 2 day training seminar to help nurse case managers identify ergonomic risk factors, provide accommodation, and conduct problem solving skills training with workers' compensation claimants recovering from WRUEDs. Eight procedural steps to this case management approach were identified, translated into a training workshop format, and conveyed to 65 randomly selected case managers. Results indicate moderate to high self ratings of confidence to perform ergonomic assessments (mean = 7.5 of 10) and to provide problem solving skills training (mean = 7.2 of 10) after the seminar. This training format was suitable to experienced case managers and generated a moderate to high level of confidence to use this case management approach.

  5. Difficult airway in a patient with Coffin-Siris syndrome.

    Science.gov (United States)

    Dimaculangan, D; Lokhandwala, B; Wlody, D; Gross, R

    2001-02-01

    We report on a patient with Coffin-Siris syndrome and consider a potential association between this condition and difficult intubation. Although this inherited condition is extremely rare, anesthesiologists should be aware of its existence and prepare for potential airway management problems whenever it is encountered.

  6. Bidirectional extreme learning machine for regression problem and its learning effectiveness.

    Science.gov (United States)

    Yang, Yimin; Wang, Yaonan; Yuan, Xiaofang

    2012-09-01

    It is clear that the learning effectiveness and learning speed of neural networks are in general far slower than required, which has been a major bottleneck for many applications. Recently, a simple and efficient learning method, referred to as extreme learning machine (ELM), was proposed by Huang , which has shown that, compared to some conventional methods, the training time of neural networks can be reduced by a thousand times. However, one of the open problems in ELM research is whether the number of hidden nodes can be further reduced without affecting learning effectiveness. This brief proposes a new learning algorithm, called bidirectional extreme learning machine (B-ELM), in which some hidden nodes are not randomly selected. In theory, this algorithm tends to reduce network output error to 0 at an extremely early learning stage. Furthermore, we find a relationship between the network output error and the network output weights in the proposed B-ELM. Simulation results demonstrate that the proposed method can be tens to hundreds of times faster than other incremental ELM algorithms.

  7. 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 industrial reliance on electronic problem-solving groups should be tempered, and large nominal groups may be more appropriate corporate problem-solving vehicles.

  8. An Improved Real-Coded Population-Based Extremal Optimization Method for Continuous Unconstrained Optimization Problems

    Directory of Open Access Journals (Sweden)

    Guo-Qiang Zeng

    2014-01-01

    Full Text Available As a novel evolutionary optimization method, extremal optimization (EO has been successfully applied to a variety of combinatorial optimization problems. However, the applications of EO in continuous optimization problems are relatively rare. This paper proposes an improved real-coded population-based EO method (IRPEO for continuous unconstrained optimization problems. The key operations of IRPEO include generation of real-coded random initial population, evaluation of individual and population fitness, selection of bad elements according to power-law probability distribution, generation of new population based on uniform random mutation, and updating the population by accepting the new population unconditionally. The experimental results on 10 benchmark test functions with the dimension N=30 have shown that IRPEO is competitive or even better than the recently reported various genetic algorithm (GA versions with different mutation operations in terms of simplicity, effectiveness, and efficiency. Furthermore, the superiority of IRPEO to other evolutionary algorithms such as original population-based EO, particle swarm optimization (PSO, and the hybrid PSO-EO is also demonstrated by the experimental results on some benchmark functions.

  9. 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.

  10. 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.

  11. 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.

  12. A Fiducial Approach to Extremes and Multiple Comparisons

    Science.gov (United States)

    Wandler, Damian V.

    2010-01-01

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

  13. 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

  14. Chronic Expanding Hematoma in the Extremities: A Clinical Problem of Adhesion to the Surrounding Tissues

    Science.gov (United States)

    Okamoto, Takeshi; Matsuda, Shuichi

    2017-01-01

    Chronic expanding hematoma is characterized by continuous growth of a blood collection. We analyzed the clinical features of 7 patients with chronic expanding hematomas in the extremities, with an average age of 65.6 years. All lesions occurred in the lower extremities, with 4 seen in the thigh and 3 in the knee region. Six patients had subcutaneous hematomas, while 1 was deep-seated in the thigh. The magnetic resonance features of the lesion were compatible with those of a standard hematoma. A low signal intensity on T1- and T2-weighted imaging at the pseudocapsule was also characteristic. Cystic features were seen in 5 of 7 patients. All lesions were resected together with their pseudocapsule. In the subcutaneous lesions, it was necessary to resect adherent fascia, with or without involved skin. In the deep-seated thigh lesion, the common peroneal nerve was completely adherent to the pseudocapsule, a phenomenon from absence of the common peroneal nerve which appeared after resection. Chronic expanding hematomas of the extremities are predominantly located in the subcutaneous tissue of the lower extremity. The surrounding pseudocapsule is adherent to the adjacent tissues, and clinicians must be aware of this, especially when resecting a deep-seated lesion. PMID:28642872

  15. Chronic Expanding Hematoma in the Extremities: A Clinical Problem of Adhesion to the Surrounding Tissues

    Directory of Open Access Journals (Sweden)

    Akio Sakamoto

    2017-01-01

    Full Text Available Chronic expanding hematoma is characterized by continuous growth of a blood collection. We analyzed the clinical features of 7 patients with chronic expanding hematomas in the extremities, with an average age of 65.6 years. All lesions occurred in the lower extremities, with 4 seen in the thigh and 3 in the knee region. Six patients had subcutaneous hematomas, while 1 was deep-seated in the thigh. The magnetic resonance features of the lesion were compatible with those of a standard hematoma. A low signal intensity on T1- and T2-weighted imaging at the pseudocapsule was also characteristic. Cystic features were seen in 5 of 7 patients. All lesions were resected together with their pseudocapsule. In the subcutaneous lesions, it was necessary to resect adherent fascia, with or without involved skin. In the deep-seated thigh lesion, the common peroneal nerve was completely adherent to the pseudocapsule, a phenomenon from absence of the common peroneal nerve which appeared after resection. Chronic expanding hematomas of the extremities are predominantly located in the subcutaneous tissue of the lower extremity. The surrounding pseudocapsule is adherent to the adjacent tissues, and clinicians must be aware of this, especially when resecting a deep-seated lesion.

  16. 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

  17. Model of geophysical fields representation in problems of complex correlation-extreme navigation

    Directory of Open Access Journals (Sweden)

    Volodymyr KHARCHENKO

    2015-09-01

    Full Text Available A model of the optimal representation of spatial data for the task of complex correlation-extreme navigation is developed based on the criterion of minimum deviation of the correlation functions of the original and the resulting fields. Calculations are presented for one-dimensional case using the approximation of the correlation function by Fourier series. It is shown that in the presence of different geophysical map data fields their representation is possible by single template with optimal sampling without distorting the form of the correlation functions.

  18. 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.

  19. An Extremal Eigenvalue Problem for a Two-Phase Conductor in a Ball

    International Nuclear Information System (INIS)

    Conca, Carlos; Mahadevan, Rajesh; Sanz, Leon

    2009-01-01

    The pioneering works of Murat and Tartar (Topics in the mathematical modeling of composite materials. PNLDE 31. Birkhaeuser, Basel, 1997) go a long way in showing, in general, that problems of optimal design may not admit solutions if microstructural designs are excluded from consideration. Therefore, assuming, tactilely, that the problem of minimizing the first eigenvalue of a two-phase conducting material with the conducting phases to be distributed in a fixed proportion in a given domain has no true solution in general domains, Cox and Lipton only study conditions for an optimal microstructural design (Cox and Lipton in Arch. Ration. Mech. Anal. 136:101-117, 1996). Although, the problem in one dimension has a solution (cf. Krein in AMS Transl. Ser. 2(1):163-187, 1955) and, in higher dimensions, the problem set in a ball can be deduced to have a radially symmetric solution (cf. Alvino et al. in Nonlinear Anal. TMA 13(2):185-220, 1989), these existence results have been regarded so far as being exceptional owing to complete symmetry. It is still not clear why the same problem in domains with partial symmetry should fail to have a solution which does not develop microstructure and respecting the symmetry of the domain. We hope to revive interest in this question by giving a new proof of the result in a ball using a simpler symmetrization result from Alvino and Trombetti (J. Math. Anal. Appl. 94:328-337, 1983)

  20. 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 ...

  1. 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...

  2. Why Translation Is Difficult

    DEFF Research Database (Denmark)

    Carl, Michael; Schaeffer, Moritz Jonas

    2017-01-01

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

  3. Dealing with difficult pasts

    DEFF Research Database (Denmark)

    McAtackney, Laura

    2013-01-01

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

  4. The 50-th anniversary of the Federal Department for Biomedical and Extreme Problems at the Ministry of Health of Russia

    International Nuclear Information System (INIS)

    Reva, V.D.

    1997-01-01

    Due to the 50-th anniversary of the Federal Department for Biomedical and Extreme Problems of the Ministry of Health of Russian Federation, formerly the Third Main Department of the USSR Ministry of Health the, basic stages are considered of the establishment and development of this system amalgamating treatment-and-prophylactic, sanitary-and-antiepidemic, scientific and industrial institutions aimed at the health protection of personnel dealing with ionizing radiation. Organizational and staff structures are discussed as well as activities of the institutions of the Department under present economic conditions

  5. 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

    OpenAIRE

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

    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...

  6. The difficult wind power

    International Nuclear Information System (INIS)

    Groenaas, Sigbjoern

    2005-01-01

    The article presents a brief survey of the conditions for wind power production in Norway and points out that several areas should be well suited. A comparison to Danish climate is made. The wind variations, turbulence problems and regional conditions are discussed

  7. D Mapping of Cultural Heritage: Special Problems and best Practices in Extreme Case-Studies

    Science.gov (United States)

    Patias, P.; Kaimaris, D.; Georgiadis, Ch.; Stamnas, A.; Antoniadis, D.; Papadimitrakis, D.

    2013-07-01

    Photogrammetrey has a long successful history in the area of 3D modelling and documentation of cultural heritage monuments. In some cases an extensive study, preparation and the application of novel solutions is required for the successful documentation and 3D modelling of monuments. In most of the cases the problem that we have to face is difficulties regarding accessing, photographing, and measuring the monument from the optimal distance, in combination with the need for a high spatial resolution mapping. This paper is highlighting the special problems and the novel solutions, performed during mapping of two significant cultural heritage monuments in Greece. The Roussanou monastery (1527-1529 A.C., Meteora, Center Greece) and its underlying rock, had to be photographed and measured from a far distance and measured with various spatial resolutions. In the lakeside Neolithic settlement of Dispilio (6.000 B.C., western Greece) the enclosure which is covered with vegetation above a height of 3 m, had to be measured with high spatial resolution. The combined use of a laser scanner, a digital camera equipped with a telephoto lens and UAV allowed the successful mapping and the production of orthophotomaps in each case.

  8. Difficult diagnoses in the skeletal radiology

    International Nuclear Information System (INIS)

    Freyschmidt, Juergen

    2013-01-01

    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.

  9. Identifying barriers to recovery from work related upper extremity disorders: use of a collaborative problem solving technique.

    Science.gov (United States)

    Shaw, William S; Feuerstein, Michael; Miller, Virginia I; Wood, Patricia M

    2003-08-01

    Improving health and work outcomes for individuals with work related upper extremity disorders (WRUEDs) may require a broad assessment of potential return to work barriers by engaging workers in collaborative problem solving. In this study, half of all nurse case managers from a large workers' compensation system were randomly selected and invited to participate in a randomized, controlled trial of an integrated case management (ICM) approach for WRUEDs. The focus of ICM was problem solving skills training and workplace accommodation. Volunteer nurses attended a 2 day ICM training workshop including instruction in a 6 step process to engage clients in problem solving to overcome barriers to recovery. A chart review of WRUED case management reports (n = 70) during the following 2 years was conducted to extract case managers' reports of barriers to recovery and return to work. Case managers documented from 0 to 21 barriers per case (M = 6.24, SD = 4.02) within 5 domains: signs and symptoms (36%), work environment (27%), medical care (13%), functional limitations (12%), and coping (12%). Compared with case managers who did not receive the training (n = 67), workshop participants identified more barriers related to signs and symptoms, work environment, functional limitations, and coping (p Problem solving skills training may help focus case management services on the most salient recovery factors affecting return to work.

  10. Clinical review: Management of difficult airways

    Science.gov (United States)

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

    2006-01-01

    Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway. PMID:17184555

  11. Clinical review: management of difficult airways.

    Science.gov (United States)

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

    2006-01-01

    Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway.

  12. LIHTC Difficult to Develop Areas

    Data.gov (United States)

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

  13. 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

  14. Difficult to control atopic dermatitis

    NARCIS (Netherlands)

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

    2013-01-01

    textabstractDifficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for

  15. 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

  16. Crisis management during anaesthesia: difficult intubation.

    Science.gov (United States)

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

    2005-06-01

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

  17. Management of the difficult airway.

    Science.gov (United States)

    Schwartz, D E; Wiener-Kronish, J P

    1991-09-01

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

  18. 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.

  19. An assessment of problems experienced with operating solar systems in Canada and the northern United States. Une evaluation des difficultes rencontrees avec les systemes solaires installes au Canada et au nord des Etats-Unis

    Energy Technology Data Exchange (ETDEWEB)

    Lorriman, D

    1978-01-01

    As part of a study examining the performance of materials and components used in solar heating systems, this report addresses the actual experience with operational systems. It intends to identify factors which tend to shorten the service life of solar components, and deals with the potential problems of various components and actual problems encountered in Canada and the USA. The first part of this report considers flat plate collectors, the dominant type of solar collector in use. Specific problems are discussed in the areas of condensation, dust and dirt; breakage, cracking, chemical degradation, and loss of transmissivity of cover plates; leakage and structural failure of glazings; corrosion, erosion, impact damage, joint/bond failure, and other problems with absorber plates; degradation, discoloration, and application deficiencies of absorber coatings; and outgassing, degradation, and instability of insulation material. The second part deals with general problems of solar systems: freezing, boiling, corrosion, and inflammability of heat transfer fluids; heat transfer fluid transport, connections, storage, and control; installation-related problems such as excess snow collection, ice dam formation, leakage, and movement of components; maintenance and repair; and other considerations including safety, standards, and aesthetics. An appendix gives a brief discussion of some problems encountered with evacuated tube collectors found at two sites. 87 refs., 75 figs., 10 tabs.

  20. Difficult to control atopic dermatitis

    Science.gov (United States)

    2013-01-01

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

  1. 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.

  2. Working in a difficult regime

    International Nuclear Information System (INIS)

    Pesic, M.; Cupac, S.

    1996-01-01

    RA and RB, the two research reactors at the Vinca Institute of Nuclear sciences were built in the late 1950s. Both were designed according to the national (former Yugoslavia) plan for developing nuclear energy. Although some modifications have been successfully made, they are now suffering from problems of ageing and funding since the attitude to the country's nuclear program has changed. Some of the equipment is fit for a museum. But the problem of ageing components is only one of the difficulties faced by the operators, they also cope with the political and financial conditions prevailing in the country

  3. Difficult physician-patient relationships.

    Science.gov (United States)

    Reifsteck, S W

    1998-01-01

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

  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. Rectal compliance as a routine measurement: extreme volumes have direct clinical impact and normal volumes exclude rectum as a problem.

    Science.gov (United States)

    Felt-Bersma, R J; Sloots, C E; Poen, A C; Cuesta, M A; Meuwissen, S G

    2000-12-01

    The clinical impact of rectal compliance and sensitivity measurement is not clear. The aim of this study was to measure the rectal compliance in different patient groups compared with controls and to establish the clinical effect of rectal compliance. Anorectal function tests were performed in 974 consecutive patients (284 men). Normal values were obtained from 24 controls. Rectal compliance measurement was performed by filling a latex rectal balloon with water at a rate of 60 ml per minute. Volume and intraballoon pressure were measured. Volume and pressure at three sensitivity thresholds were recorded for analysis: first sensation, urge, and maximal toleration. At maximal toleration, the rectal compliance (volume/pressure) was calculated. Proctoscopy, anal manometry, anal mucosal sensitivity, and anal endosonography were also performed as part of our anorectal function tests. No effect of age or gender was observed in either controls or patients. Patients with fecal incontinence had a higher volume at first sensation and a higher pressure at maximal toleration (P = 0.03), the presence of a sphincter defect or low or normal anal pressures made no difference. Patients with constipation had a larger volume at first sensation and urge (P 500 ml had complaints of constipation. No correlation between rectal and anal mucosal sensitivity was found. Rectal compliance measurement with a latex balloon is easily feasible. In this series of 974 patients, some patient groups showed an abnormal rectal visceral sensitivity and compliance, but there was an overlap with controls. Rectal compliance measurement gave a good clinical impression about the contribution of the rectum to the anorectal problem. Patients with proctitis and pouchitis had the smallest rectal compliance. A maximal toleration volume 500 ml was only seen in constipated patients, and therapy should be given to prevent further damage to the pelvic floor. Values close to or within the normal range rule out the

  6. 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

  7. Counseling parents of difficult adolescents.

    Science.gov (United States)

    Joseph-DiCaprio, Julia

    2010-09-01

    The relationship between parent and child changes during adolescence. During that transition time, some youths may be challenging rules, engaging in risky behaviors, or failing to disclose their activities to their parents. Physicians and other health care providers are in a position to counsel not only youths about problem behaviors but also parents about how to more effectively deal with their children. One of the things they can recommend is an approach known as authoritative parenting. This approach has been shown to promote higher school achievement and self-esteem, and result in less depression and anxiety and more self-reliance among youths. This article describes the approach and offers physicians tips about what they can say to parents.

  8. Chronicle of a difficult relationship

    International Nuclear Information System (INIS)

    Kroker, Holger

    2011-01-01

    50 years ago, the first German nuclear power plant went online in Kahl on the Main. Visions were high in the early days of this industry, and during its first years it seemed to be headed for success. By the mid-1970s 21 reactors had been commissioned, or were already operating. But then the winds changed, people began to turn against nuclear power, public discussion was marked by heated disputes around projects such as Brokdorf, Kalkar, Wackersdorf and Gorleben. In the face of these problems, the nuclear sector failed to develop an effective strategy for regaining public support on a permanent basis. The accidents in the power plants of Harrisburg, USA, and Chernobyl contributed to making nuclear power unpopular in society. At the time of its domestic crisis, German nuclear technology achieved successes abroad. The French-German AREVA group became a world market leader in the fields of reactor design and construction, servicing, maintenance and modernization. In the domestic market, however, all signs seem to point to an end of nuclear energy in the medium run. (orig.)

  9. Optimization with Extremal Dynamics

    International Nuclear Information System (INIS)

    Boettcher, Stefan; Percus, Allon G.

    2001-01-01

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

  10. 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

  11. Self-teaching neural network learns difficult reactor control problem

    International Nuclear Information System (INIS)

    Jouse, W.C.

    1989-01-01

    A self-teaching neural network used as an adaptive controller quickly learns to control an unstable reactor configuration. The network models the behavior of a human operator. It is trained by allowing it to operate the reactivity control impulsively. It is punished whenever either the power or fuel temperature stray outside technical limits. Using a simple paradigm, the network constructs an internal representation of the punishment and of the reactor system. The reactor is constrained to small power orbits

  12. 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...

  13. Technology improves upper extremity rehabilitation.

    Science.gov (United States)

    Kowalczewski, Jan; Prochazka, Arthur

    2011-01-01

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

  14. 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.

  15. Nostalgia: retreat or support in difficult times?

    Science.gov (United States)

    Batcho, Krystine Irene

    2013-01-01

    The relationship between nostalgia and coping during difficult times was explored in 2 empirical studies. In the first, 80 undergraduates, 60 women and 20 men, completed the Nostalgia Inventory, a measure of nostalgia proneness, the COPE Inventory, a dispositional measure of strategies for coping with stressful events, and the Childhood Survey, a survey of impressions of childhood experiences. Nostalgia proneness correlated with use of adaptive coping, including emotional social support, expressing emotions, turning to religion, and suppressing competing activities, and did not correlate with escapist or avoidance strategies, including denial, behavioral disengagement, and substance abuse. Nostalgia proneness was related positively to favorable emotional and behavioral childhood experiences and did not correlate with adverse experiences. Favorable impressions of childhood correlated positively with adaptive coping strategies and inversely with dysfunctional ones, whereas unfavorable childhood experiences correlated positively with dysfunctional coping. Regression analyses suggested that the relationship between nostalgia proneness and certain coping strategies may be mediated in part by childhood experiences. In a second study, 100 undergraduates, 86 women and 14 men, completed the Nostalgia Inventory, recalled autobiographical memories that illustrated how childhood is either special or similar to their present life, and rated their likely use of strategies in dealing with 2 hypothetical problems. Nostalgia proneness correlated with emotional and instrumental social coping and with the goal-directed strategies of planning, taking action, and positive reframing. Further research is recommended to explore the role of childhood memories in coping and to identify mechanisms that mediate the relationship between nostalgia and coping.

  16. 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

  17. Diagnosis and management of deep vein thrombosis of the upper extremity: a review

    International Nuclear Information System (INIS)

    Baarslag, Henk J.; Reekers, Jim A.; Koopman, Maria M.W.; Beek, Edwin J.R. van

    2004-01-01

    Deep vein thrombosis of the upper extremity is an increasing clinical problem due to the use of long-term indwelling catheters for chemotherapy or long-term feeding. The clinical diagnosis is difficult to make, and various imaging modalities have been used for this purpose. The use of (interventional) radiological procedures has been advancing in recent years. This review describes the clinical background, the imaging modalities that may be employed, treatment options and outcome of patients with upper extremity thrombosis. (orig.)

  18. Relations between work and upper extremity musculoskeletal problems (UEMSP) and the moderating role of psychosocial work factors on the relation between computer work and UEMSP.

    Science.gov (United States)

    Nicolakakis, Nektaria; Stock, Susan R; Abrahamowicz, Michal; Kline, Rex; Messing, Karen

    2017-11-01

    Computer work has been identified as a risk factor for upper extremity musculoskeletal problems (UEMSP). But few studies have investigated how psychosocial and organizational work factors affect this relation. Nor have gender differences in the relation between UEMSP and these work factors  been studied. We sought to estimate: (1) the association between UEMSP and a range of physical, psychosocial and organizational work exposures, including the duration of computer work, and (2) the moderating effect of psychosocial work exposures on the relation between computer work and UEMSP. Using 2007-2008 Québec survey data on 2478 workers, we carried out gender-stratified multivariable logistic regression modeling and two-way interaction analyses. In both genders, odds of UEMSP were higher with exposure to high physical work demands and emotionally demanding work. Additionally among women, UEMSP were associated with duration of occupational computer exposure, sexual harassment, tense situations when dealing with clients, high quantitative demands and lack of prospects for promotion, and among men, with low coworker support, episodes of unemployment, low job security and contradictory work demands. Among women, the effect of computer work on UEMSP was considerably increased in the presence of emotionally demanding work, and may also be moderated by low recognition at work, contradictory work demands, and low supervisor support. These results suggest that the relations between UEMSP and computer work are moderated by psychosocial work exposures and that the relations between working conditions and UEMSP are somewhat different for each gender, highlighting the complexity of these relations and the importance of considering gender.

  19. Correlation analysis of extremely low-frequency variations of the natural electromagnetic Earth field and the problem of detecting periodical gravitational radiation

    International Nuclear Information System (INIS)

    Balakin, A.B.; Murzakhanov, Z.G.; Grunskaya, L.V.

    1994-01-01

    A proposal on the experimental detection of extremely low-frequency variations of the electromagnetic Earth field at the gravitational-wave frequency and method for correlation processing results of the experiments are described. 14 refs

  20. 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

  1. How Difficult It Is to Be God

    DEFF Research Database (Denmark)

    Wilson, Fiona

    2014-01-01

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

  2. The greenhouse effect and extreme weather

    International Nuclear Information System (INIS)

    Groenaas, Sigbjoern; Kvamstoe, Nils Gunnar

    2002-01-01

    The article asserts that an anthropogenic global warming is occurring. This greenhouse effect is expected to cause more occurrences of extreme weather. It is extremely difficult, however, to relate specific weather catastrophes to global warming with certainty, since such extreme weather conditions are rare historically. The subject is controversial. The article also discusses the public debate and the risk of floods

  3. 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

  4. Difficult intubation: are you prepared for it?

    Science.gov (United States)

    Balcom, C

    1994-01-01

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

  5. Preoperative Ultrasonography as a Predictor of Difficult ...

    African Journals Online (AJOL)

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

  6. Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A ...

    African Journals Online (AJOL)

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

  7. The long shadows of the difficult past?

    DEFF Research Database (Denmark)

    Wolnik, Kevin; Busse, Britta; Tholen, Jochen

    2017-01-01

    This paper focuses on the question of how young people today evaluate the Second World War today and how this ‘difficult past’ determines their political attitudes. Furthermore, the channels through which the current young generation in Europe is informed about the events dating back to the first...... half of the twentieth century (e.g. parents and grandparents, schools, the media) are examined. The theoretical basis chosen for addressing these questions is the work of Mannheim (1928) on the formation of successive generations, and the theories of collective memories and identities of Eisenstadt...... and his followers. Our empirical evidence comes from a transnational comparison of young people’s memories of this difficult past in Denmark, Finland and Germany. From a historical perspective a comparison of the three countries is particularly interesting as they played different roles during the Second...

  8. Clinical review: Management of difficult airways

    OpenAIRE

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

    2006-01-01

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

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

    International Nuclear Information System (INIS)

    Rahayu, Anita

    2013-01-01

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

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. Chernobyl: Chronicle of difficult weeks [videorecording

    Energy Technology Data Exchange (ETDEWEB)

    Volodymyr, S

    1987-07-01

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

  15. The reentry catheter: a second chance for endoluminal reentry at difficult lower extremity subintimal arterial recanalizations.

    Science.gov (United States)

    Etezadi, Vahid; Benenati, James F; Patel, Parag J; Patel, Rahul S; Powell, Alex; Katzen, Barry T

    2010-05-01

    From January 2005 to July 2008, a retrospective study was conducted at a single institution to investigate technical success of the use of a reentry device (Outback LTD reentry catheter) in aortoiliac and femoropopliteal artery recanalization in 34 patients (18 men; mean age +/- SD, 72 years +/- 11) in whom the conventional guide wires and catheters failed to reenter the true lumen. True lumen reentry was achieved in 87% (n = 23) and 91% (n = 11) of patients with femoropopliteal and aortoiliac occlusions, respectively. The overall technical success rate with the device was 88% (n = 34). The device success rate in Transatlantic Inter-Society Consensus II class D lesions was significantly lower than in lower lesion classes (71.4% vs 100%; P < .05). No procedure-related complications were encountered. In conclusion, the use of the reentry catheter enhances the likelihood of successful subintimal recanalization of chronic occlusions in femoropopliteal and aortoiliac arteries.

  16. 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...... patients and health professionals, which disempowered them in problem solving. Three approaches to problem solving were identified: A compliance-expecting approach kept the pattern unchanged, a failure-expecting approach deadlocked the pattern, and a mutuality-expecting approach appeared to neutralize...

  17. 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.

  18. The Difficult Stoma: Challenges and Strategies

    Science.gov (United States)

    Strong, Scott A.

    2016-01-01

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

  19. Dealing with the difficult older patient.

    Science.gov (United States)

    Laurence, M K

    1986-05-15

    Physicians are often asked to intervene when elderly patients in acute or long-term care facilities are disruptive, demanding or abusive. Though medication may be the immediate response, it often fails to solve the problem, which, being situational and behavioural, calls for a situational and behavioural solution. An organized approach to solving such problems is presented that takes into account the interactions among the patient, family, staff, setting and circumstances. The role of the physician as leader in the process is also discussed.

  20. Flexible Fiberoptic Endoscopy in Difficult Intubations

    NARCIS (Netherlands)

    Edens, E. Th.; Sia, R. L.

    1981-01-01

    Intubation problems sometimes occur very suddenly and can be divided into two groups. The expected ones include the patients with a short neck and long teeth, cellulitis of the tongue, large oropharyngeal tumors, obstructing laryngeal tumors, congenital and acquired maxillofacial deformities,

  1. 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…

  2. 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

    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...... 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...

  3. Environmental risk evaluation of difficult substances in USES 2.0

    NARCIS (Netherlands)

    Beelen P van; ECO

    1998-01-01

    An inventory is given of the problems which arise when difficult substances are evaluated with the Uniform System for the Evaluation of Substances (USES). It gives an indication about the different classes of chemicals which can give problems in USES. Further, it describes the problems which occur

  4. 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. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Identifying difficult concepts in introductory programming

    OpenAIRE

    Humar, Klaudija

    2014-01-01

    In this diploma thesis we try to find the answer to why students experience difficulties in introductory programming. We ask ourselves what causes most problems while trying to understand concepts in introductory programming, generating code and designing algorithms. In the first section we introduce programming language Python as the first programming language being taught to students. We compare it with programming language Pascal and stress the advantages of Python that seem important ...

  6. 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.

  7. Evolution caused by extreme events.

    Science.gov (United States)

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

    2017-06-19

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

  8. Processing a difficult urethane elastomer system

    International Nuclear Information System (INIS)

    Gillespie, T.J.

    1977-01-01

    A detailed study of an adiprene/butanediol/trimethylolpropane elastomer system and the associated production process was performed to assess the importance of various processing factors on the physical properties of the system. Results indicated that control of the curing cycle, material ratio, moisture in the curing agent and elastomer, mixing, and vacuum level was necessary. Sufficient control of the manual process could not be obtained to eliminate significant physical property variability. An automatic metering, mixing and dispensing machine was purchased for laboratory evaluation. After modification, including the addition of a high shear vacuum type mixer, and with close vacuum and temperature control, material property variability was still at an unacceptable level. A tracer agent was introduced into the curing agent system to assess the distribution of the curing agent in the elastomer. Machine evaluation using the tracer agent indicated that distribution of the curing agent in the elastomer was very poor is spite of the high shear mixing configuration. The addition of an oscillating motion to the mixing configuration. The addition of an oscillating motion to the mixing system significantly improved curing agent distribution and eliminated material property variability problems. 16 figures, 3 tables

  9. 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.

  10. Lymphoscintigraphy of the lower extremity

    International Nuclear Information System (INIS)

    Abbasi, N.Z.

    1990-01-01

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

  11. Acceptance issues for large items and difficult waste

    International Nuclear Information System (INIS)

    Palmer, J.; Lock, Peter

    2002-01-01

    Peter Lock described some particular cases which had given rise to difficult acceptance issues at NIREX, ranging from large size items to the impacts of chemicals used during decontamination on the mobility of radionuclides in a disposal facility: The UK strategy for intermediate level and certain low level radioactive waste disposal is based on production of cementitious waste-forms packaged in a standard range of containers as follows: 500 litre Drum - the normal container for most operational ILW (0.8 m diameter x 1.2 m high); 3 m"3 Box - a larger container for solid wastes (1.72 m x 1.72 m plan x 1.2 m high); 3 m"3 Drum - a larger container for in-drum mixing and immobilisation of sludge waste-forms (1.72 m diameter x 1.2 m high); 4 m Box - for large items of waste, especially from decommissioning (4.0 m x 2.4 m plan x 2.2 m high); 2 m LLW Box - for higher-density wastes (2.0 m x 2.4 m plan x 2.2 m high). In addition the majority of LLW is packaged by supercompaction followed by grouting in modified ISO freight containers (6 m x 2.5 m x 2.5 m). Some wastes do not fit easily into this strategy. These wastes include: very large items, (too big for the 4 m box) which, if dealt with whole, pose transport and disposal problems. These items are discussed further in Section 2; waste whose characteristics make packaging difficult. Such wastes are described in more detail in Section 3

  12. Risk analysis and solving the nuclear waste siting problem

    International Nuclear Information System (INIS)

    Inhaber, H.

    1993-01-01

    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

  13. 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.

  14. 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.

  15. 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 “ ...

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

    Directory of Open Access Journals (Sweden)

    Tomislav Svoboda

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

  17. The Difficult Chore of Measuring Coordination by EXAFS

    International Nuclear Information System (INIS)

    Ravel, B.; Kelly, S. D.

    2007-01-01

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

  18. 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.

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

    Science.gov (United States)

    2010-01-01

    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. PMID:20587075

  20. 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.

  1. Statistical techniques for modeling extreme price dynamics in the energy market

    International Nuclear Information System (INIS)

    Mbugua, L N; Mwita, P N

    2013-01-01

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

  2. Hygienic diagnosis in extreme conditions

    International Nuclear Information System (INIS)

    Sofronov, G.A.

    1997-01-01

    Review for book by M.P. Zakharchenko, S.A. Lopatin, G.N. Novozhilov, V.I. Zakharov Hygienic diagnosis in extreme conditions is presented discussing the problem of people health preservation under extreme conditions. Hygienic diagnosis is considered illustrated by cases of hostilities (Afghan War), earthquake response in Armenia (1988) and Chernobyl accident response. Attention is paid to the estimation of radiation doses to people and characteristics of main types of dosimeters. The high scientific level of the book is marked

  3. Validated questionnaires heighten detection of difficult asthma comorbidities.

    Science.gov (United States)

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

    2017-04-01

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

  4. Therapist reactions in self-experienced difficult situations: an exploration

    NARCIS (Netherlands)

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

    2007-01-01

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

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

    OpenAIRE

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

    2017-01-01

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

  6. Infill sampling criteria to locate extremes

    CSIR Research Space (South Africa)

    Watson, AG

    1995-07-01

    Full Text Available Three problem-dependent meanings for engineering ''extremes'' are motivated, established, and translated into formal geostatistical (model-based) criteria for designing infill sample networks. (I) Locate an area within the domain of interest where a...

  7. 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.

  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. Guidelines and algorithms for managing the difficult airway.

    Science.gov (United States)

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

    2018-01-01

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

  10. 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

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

    Science.gov (United States)

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

    2018-03-01

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

  12. Distraction during learning with hypermedia: Difficult tasks help to keep task goals on track

    Directory of Open Access Journals (Sweden)

    Katharina eScheiter

    2014-03-01

    Full Text Available In educational hypermedia environments, students are often confronted with potential sources of distraction arising from additional information that, albeit interesting, is unrelated to their current task goal. The paper investigates the conditions under which distraction occurs and hampers performance. Based on theories of volitional action control it was hypothesized that interesting information, especially if related to a pending goal, would interfere with task performance only when working on easy, but not on difficult tasks. In Experiment 1, 66 students learned about probability theory using worked examples and solved corresponding test problems, whose task difficulty was manipulated. As a second factor, the presence of interesting information unrelated to the primary task was varied. Results showed that students solved more easy than difficult probability problems correctly. However, the presence of interesting, but task-irrelevant information did not interfere with performance. In Experiment 2, 68 students again engaged in example-based learning and problem solving in the presence of task-irrelevant information. Problem-solving difficulty was varied as a first factor. Additionally, the presence of a pending goal related to the task-irrelevant information was manipulated. As expected, problem-solving performance declined when a pending goal was present during working on easy problems, whereas no interference was observed for difficult problems. Moreover, the presence of a pending goal reduced the time on task-relevant information and increased the time on task-irrelevant information while working on easy tasks. However, as revealed by mediation analyses these changes in overt information processing behavior did not explain the decline in problem-solving performance. As an alternative explanation it is suggested that goal conflicts resulting from pending goals claim cognitive resources, which are then no longer available for learning and

  13. Estimation of extreme risk regions under multivariate regular variation

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sirvinskiene Giedre

    2012-04-01

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

  15. Pediatric lower extremity mower injuries.

    Science.gov (United States)

    Hill, Sean M; Elwood, Eric T

    2011-09-01

    Lawn mower injuries in children represent an unfortunate common problem to the plastic reconstructive surgeon. There are approximately 68,000 per year reported in the United States. Compounding this problem is the fact that a standard treatment algorithm does not exist. This study follows a series of 7 pediatric patients treated for lower extremity mower injuries by a single plastic surgeon. The extent of soft tissue injury varied. All patients were treated with negative pressure wound therapy as a bridge to definitive closure. Of the 7 patients, 4 required skin grafts, 1 required primary closure, 1 underwent a lower extremity amputation secondary to wounds, and 1 was repaired using a cross-leg flap. Function limitations were minimal for all of our patients after reconstruction. Our basic treatment algorithm is presented with initial debridement followed by the simplest method possible for wound closure using negative pressure wound therapy, if necessary.

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

    African Journals Online (AJOL)

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

  17. 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

  18. Difficult Sudoku Puzzles Created by Replica Exchange Monte Carlo Method

    OpenAIRE

    Watanabe, Hiroshi

    2013-01-01

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

  19. Atomic collisions under extreme conditions in space

    International Nuclear Information System (INIS)

    Itikawa, Yukikazu

    1987-01-01

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

  20. 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.

  1. Electrons at low altitudes: a difficult background problem for soft x-ray astronomy

    International Nuclear Information System (INIS)

    Seward, F.D.; Grader, R.J.; Toor, A.; Buginyon, G.A.; Hill, R.W.

    1973-01-01

    Quasti-trapped and precipitating electrons have been observed with rocket-borne x-ray astronomy detectors in the altitude range 150 to 500 km. Because the flights occurred at low magnetic latitudes the electrons were unexpected. Data from many flights are combined to derive altitude dependence, an average electron spectrum, and variation with solar activity. Development of electron-rejecting collimators is discussed, and laboratory and flight data on these collimators are presented. (U.S.)

  2. Nuclear DNA Replication in Trypanosomatids: There Are No Easy Methods for Solving Difficult Problems.

    Science.gov (United States)

    da Silva, Marcelo S; Pavani, Raphael S; Damasceno, Jeziel D; Marques, Catarina A; McCulloch, Richard; Tosi, Luiz Ricardo Orsini; Elias, Maria Carolina

    2017-11-01

    In trypanosomatids, etiological agents of devastating diseases, replication is robust and finely controlled to maintain genome stability and function in stressful environments. However, these parasites encode several replication protein components and complexes that show potentially variant composition compared with model eukaryotes. This review focuses on the advances made in recent years regarding the differences and peculiarities of the replication machinery in trypanosomatids, including how such divergence might affect DNA replication dynamics and the replication stress response. Comparing the DNA replication machinery and processes of parasites and their hosts may provide a foundation for the identification of targets that can be used in the development of chemotherapies to assist in the eradication of diseases caused by these pathogens. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. 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.

  4. Afterword. On Enlightenment and the Most Difficult Problem of the Human Species

    Directory of Open Access Journals (Sweden)

    James Scott Johnston

    2015-11-01

    Full Text Available In this Afterword, I discuss the papers contained in the dossier in regards to a central issue for Kant: leadership. The issue for Kant is the paradox of the human species’ need for a master that is human yet morally perfect. This of course is an as-yet unobtainable requirement that Kant thinks can only be properly met through a civil constitution. The issues of elitism and the tension between a ‘maximal’ and ‘minimal’ Enlightenment in light of Kant’s requirement will be discussed.

  5. Solving difficult problems creatively: a role for energy optimised deterministic/stochastic hybrid computing.

    Science.gov (United States)

    Palmer, Tim N; O'Shea, Michael

    2015-01-01

    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 (ultimately quantum decoherent) noise affecting the activity of neurons. Without this component, deterministic computational models of the brain are incomplete.

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

    Science.gov (United States)

    Fiester, Autumn

    2012-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    Science.gov (United States)

    Engelhardt, Thomas; Weiss, Markus

    2012-06-01

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

  9. How to manage a child with difficult asthma?

    Science.gov (United States)

    Saglani, Sejal; Fleming, Louise

    2016-08-01

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

  10. Performance testing of extremity dosimeters, Study 2

    International Nuclear Information System (INIS)

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

    1990-04-01

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

  11. 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.

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    Veretelnikova Yu.Ya.

    2013-03-01

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

  14. Angiography of the upper extremity

    International Nuclear Information System (INIS)

    Janevski, B.K.

    1982-01-01

    This thesis provides a description of the technical and medical aspects of arteriography of the upper extremity and an extensive analysis of the angiographic anatomy and pathology of 750 selective studies performed in more than 500 patients. A short historical review is provided of angiography as a whole and of arteriography of the hand in particular. The method of percutaneous transfemoral catheterization of the arteries of the upper extremity and particularly the arteries of the hand is considered, discussing the problems the angiographer encounters frequently, describing the angiographic complications which may occur and emphasizing the measures to keep them to a minimum. The use of vasodilators in hand angiography is discussed. A short description of the embryological patterns persisting in the arteries of the arm is included in order to understand the congenital variations of the arteries of the upper extremity. The angiographic patterns and clinical aspects of the most common pathological processes involving the arteries of the upper extremities are presented. Special attention is paid to the correlation between angiography and pathology. (Auth.)

  15. 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.

  16. 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.

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

    NARCIS (Netherlands)

    Bastiaanse, Roelien

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

  18. Difficult management of posterior urethra gunshot wound combined ...

    African Journals Online (AJOL)

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

  19. Seeking the best training model for difficult conversations in neonatology.

    Science.gov (United States)

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

    2016-05-01

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

  20. Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones

    DEFF Research Database (Denmark)

    Stage, J G; Moesgaard, F; Grønvall, S

    1998-01-01

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

  1. Confronting "Difficult Knowledge": Critical Aesthetics and War in the Classroom

    Science.gov (United States)

    Heybach Vivirito, Jessica A.

    2012-01-01

    This qualitative multi-site case study explores critical aesthetic experiences in teacher education classrooms, and advocates for the inclusion of theoretical and practical knowledge of "difficult knowledge," visual culture, and critical aesthetics in the classroom. Social reality consists of a perpetual stream of tragic and horrific…

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

    Science.gov (United States)

    Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

    2014-01-01

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

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

    Science.gov (United States)

    Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

    2014-01-01

    Objective What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Methods Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Results Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Conclusions Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process. PMID:25084274

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

    Science.gov (United States)

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

    2000-01-01

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

  5. Piecewise-linear and bilinear approaches to nonlinear differential equations approximation problem of computational structural mechanics

    OpenAIRE

    Leibov Roman

    2017-01-01

    This paper presents a bilinear approach to nonlinear differential equations system approximation problem. Sometimes the nonlinear differential equations right-hand sides linearization is extremely difficult or even impossible. Then piecewise-linear approximation of nonlinear differential equations can be used. The bilinear differential equations allow to improve piecewise-linear differential equations behavior and reduce errors on the border of different linear differential equations systems ...

  6. 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

  7. 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...

  8. 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.

  9. Emotional distance to so-called difficult patients

    DEFF Research Database (Denmark)

    Michaelsen, Jette Joost

    2012-01-01

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

  10. Difficult Tracheal Intubation in Obese Gastric Bypass patients

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

    Lauridsen, Karen M.; Madsen, Henning

    intercultural collaboration. The issues that arise seem to be grounded in linguistic, cultural and educational factors. This paper reports on and discusses a study of student responses to intercultural collaboration (in English) in two programmes at Aarhus University, Denmark. One conclusion...... is that the international students are more prepared to work in multicultural teams than their Danish peers. Another one tells us that once students have experience with the diversity of these teams, at least some of them become more open towards working in such teams in the future. It is interesting to discuss......Team Work in International Programs: Why is it so difficult? And what can we do about it? It is common knowledge that students often find it difficult to collaborate on assignments, projects, etc., but we require that they do so for a number of reasons, e.g. to learn how to work in teams or take...

  12. Interesting cases which were difficult to diagnose by CT

    International Nuclear Information System (INIS)

    Ueki, Koji; Okubo, Koichi; Shinohara, Shinji

    1981-01-01

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

  13. Distant Galaxy Clusters Hosting Extreme Central Galaxies

    Science.gov (United States)

    McDonald, Michael

    2014-09-01

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

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

    Science.gov (United States)

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

    2010-07-01

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

  15. 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

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

    Science.gov (United States)

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

    2015-10-01

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

  17. Medicare Home Health Services: A Difficult Program to Control

    Science.gov (United States)

    1981-09-25

    represent about one-third of all visits provided under the program. Family and friends altio provide similar services to the elderly and consequently...example, that the individual is to be confined to his or her home but that this does not necessarily mean that the patient is bedridden . At the same...34feebleness" and "insecurity" cannot be considered home- bound. We believe that in many cases (particularly for the elderly ) it would be extremely

  18. Extremity doses to interventional radiologists

    International Nuclear Information System (INIS)

    Wihtby, M.; Martin, C. J.

    2002-01-01

    Radiologists performing interventional procedures are often required to stand close to the patient's side when carrying out manipulations under fluoroscopic control. This can result in their extremities receiving a high radiation dose, due to scattered radiation. These doses are sometimes high enough to warrant that the radiologist in question be designated a classified radiation worker. Classification in the UK is a result of any worker receiving or likely to receive in the course of their duties in excess of 3/10ths of any annual dose limit (500mSv to extremities, skin). The doses to the legs of radiologists have received less attention than those to the hands, however the doses may be high, due to the proximity of the legs and feet to scattered radiation. The legs can be exposed to a relatively high level of scattered radiation as the radiation in produced from scatter of the un attenuated beam from the bottom of the patient couch. The routine monitoring of extremity doses in interventional radiology is difficult due to several factors. Firstly a wide range of interventional procedures in undertaken in every radiology department, and these procedures require many different techniques, equipment and skills. This means that the position the radiologist adopts in relation to scattering medium and therefore their exposure, depends heavily on the type of procedure. As the hands which manipulate the catheters within the patient are often located close to the patients side and to the area under irradiation, the distribution of dose across the hands can be variable, with very high localised doses, making routine monitoring difficult. The purpose of this study was to determine the magnitude and distribution of dose to the hands and legs of interventional radiologists carrying out a wide range of both diagnostic and therapeutic interventional procedures. To ascertain the most effective method of monitoring the highest dose in accordance with the Basic safety standards

  19. Extremal surface barriers

    International Nuclear Information System (INIS)

    Engelhardt, Netta; Wall, Aron C.

    2014-01-01

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

  20. 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

  1. 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.)

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

    International Nuclear Information System (INIS)

    Hongisto, M.; Nikula, A.

    1996-01-01

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

  3. An anatomy of countertransference: staff reactions to difficult psychiatric hospital patients.

    Science.gov (United States)

    Colson, D B; Allen, J G; Coyne, L; Dexter, N; Jehl, N; Mayer, C A; Spohn, H

    1986-09-01

    Countertransference among hospital staff was investigated as part of ongoing research on difficult-to-treat psychiatric hospital patients. Staff's ratings of their emotional reactions to 127 patients on long-term units were analyzed by factor analysis, and the resulting factors were correlated by discipline with patient problem behaviors. Among the conclusions were that different forms of psychopathology elicit characteristic patterns of emotional reaction from staff; that some dimensions of psychopathology, particularly suicidal-depressed behavior and violence-agitation, elicit different emotional reactions among different disciplines, thus laying the groundwork for division among staff; and that the more difficult the process of hospital treatment, the more likely staff will experience a variety of emotions.

  4. 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.

  5. [Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones].

    Science.gov (United States)

    Cuendis-Velázquez, A; Rojano-Rodríguez, M E; Morales-Chávez, C E; González Angulo-Rocha, A; Fernández-Castro, E; Aguirre-Olmedo, I; Torres-Ruiz, M F; Orellana-Parra, J C; Cárdenas-Lailson, L E

    2014-01-01

    Choledocholithiasis presents in 5-10% of the patients with biliary lithiasis. Numerous treatment algorithms have been considered for this disease, however, up to 10% of these therapeutic procedures may fail. Intraoperative choledochoscopy has become a useful tool in the treatment of patients with difficult-to-manage choledocholithiasis. To determine the usefulness of intraoperative choledochoscopy in the laparoendoscopic treatment of difficult stones that was carried out in our service. A cross-sectional study was conducted. The case records were reviewed of the patients that underwent intraoperative choledochoscopy during biliary tree exploration plus laparoscopic choledochoduodenal anastomosis within the time frame of March 1, 2011 and May 31, 2012, at the Hospital General Dr. Manuel Gea González. Transabdominal choledochoscopies were performed with active stone extraction when necessary, followed by peroral choledochoscopies through the recently formed bilioenteric anastomosis. The data were analyzed with descriptive statistics and measures of central tendency. The mean age was 71 years, 57% of the patients were women, and the ASA III score predominated. Active extraction of stones with 7 to 35mm diameters was carried out in 4 of the cases and the absence of stones in the biliary tract was corroborated in all the patients. The mean surgery duration was 18 minutes (range: 4 to 45min). Choledochoscopy is a safe and effective minimally invasive procedure for the definitive treatment of difficult stones. Copyright © 2013 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  6. Statistics of Extremes

    KAUST Repository

    Davison, Anthony C.; Huser, Raphaë l

    2015-01-01

    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

  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. Acute lower extremity ischaemia

    African Journals Online (AJOL)

    Acute lower extremity ischaemia. Acute lower limb ischaemia is a surgical emergency. ... is ~1.5 cases per 10 000 persons per year. Acute ischaemia ... Table 2. Clinical features discriminating embolic from thrombotic ALEXI. Clinical features.

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

    DEFF Research Database (Denmark)

    Witt, Flemming; Nielsen, Jørn Flohr

    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...

  10. Hemorrhagic herpes encephalitis: A difficult diagnosis in computed tomography

    International Nuclear Information System (INIS)

    Neumann, N.U.; Albert, H.H. von

    1982-01-01

    Herpes simplex encephalitis (HSE) is the most common sporadically appearing encephalitis in Central Europe. Differential diagnosis to brain tumors or spontaneous intercerebral hemorrhage is difficult. There are CT scan findings which are characteristic of HSE but there are no pathognomonic patterns. These characteristic findings are helpful in differential diagnosis to neoplastic or vascular processes. Thus, other diagnostic procedures (i.e. brain biopsy) to confirm diagnosis of HSE and effective therapy may be carried out in time. The difficulties in differential diagnosis are shown by the presented case. (orig.) [de

  11. 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.

  12. 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.

  13. Determination of difficult to measure actinides in radioactive liquid waste

    International Nuclear Information System (INIS)

    Drabova, V.; Galanda, D.; Dulanska, S.; Remenec, B.; Kuruc, J.

    2014-01-01

    In decommissioning of a nuclear facilities and radioactive waste treatment the activity of various radionuclides need to be measured for the waste characterization. Radiochemical separation of 241 Am, 237 Np and isotopes of plutonium was tested on model solution of evaporator concentrate sample for isolation of each of them for alpha-spectrometry analysis. This paper describes use of the molecular recognition technology product AnaLig(R)Pu-01 gel from IBC Advanced technologies, Inc. to effectively and selectively pre-concentrate, separate and recover difficult-to-measure actinides from model solution of evaporator concentrate samples which belong to the most difficult matrices to analyse. The method is suitable for analysing highly contaminated samples of radioactive waste in a relatively short time. For counting the alpha activity of 241 Am, 239,240 Pu, 238 Pu and 237 Np ORTEC 576A alpha-spectrometer equipped with ULTRA TM ion implanted silicon detectors (600 mm 2 active area) was used. The spectra were processed by using the Alpha-vision TM 32-bit emulation software from the EG and G ORTEC company. (authors)

  14. 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.

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

    Science.gov (United States)

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

    2018-04-05

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

  16. Extreme Programming: Maestro Style

    Science.gov (United States)

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

    2009-01-01

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

  17. PREDICTION OF THE EXTREMAL SHAPE FACTOR OF SPHEROIDAL PARTICLES

    Directory of Open Access Journals (Sweden)

    Daniel Hlubinka

    2011-05-01

    Full Text Available In the stereological unfolding problem for spheroidal particles the extremal shape factor is predicted. The theory of extreme values has been used to show that extremes of the planar shape factor of particle sections tend to the same limit distribution as extremes of the original shape factor for both the conditional and marginal distribution. Attention is then paid to the extreme shape factor conditioned by the particle size. Normalizing constants are evaluated for a parametric model and the numerical procedure is tested on real data from metallography.

  18. Extreme meteorological conditions

    International Nuclear Information System (INIS)

    Altinger de Schwarzkopf, M.L.

    1983-01-01

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

  19. Radon mitigation experience in difficult-to-mitigate schools

    International Nuclear Information System (INIS)

    Leovic, K.W.; Craig, A.B.

    1990-01-01

    Initial radon mitigation experience in schools has shown sub-slab depressurization (SSD) to be generally effective in reducing elevated levels of radon in schools that have a continuous layer of clean, coarse aggregate underneath the slab. However, mitigation experience is limited in schools without sub-slab aggregate and in schools with characteristics such as return-air ductwork underneath the slab or unducted return-air plenums in the drop ceiling that are open to the sub-slab area (via open tops of block walls). Mitigation of schools with utility tunnels and of schools constructed over crawl spaces is also limited. Three Maryland schools exhibiting some of the above characteristics are being researched to help understand the mechanisms that control radon entry and mitigation in schools where standard SSD systems are not effective. This paper discusses specific characteristics of potentially difficult-to-mitigate schools and, where applicable, details examples from the three Maryland schools

  20. 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.

  1. Ploughs for difficult seams of Bergbau AG Niederrhein

    Energy Technology Data Exchange (ETDEWEB)

    Klimek, K.-H.

    1989-06-29

    Ploughs for difficult seams have been used in five panels at collieries of Bergbau AG Niederrhein. It was determined during operation that short or standard ploughs achieve a 30% higher area rate of advance than double ploughs. Differences in pitch in the plough chain lead to regenerative operation of the motor with the greater chain pitch in the case of deviations over 1.5%. An excessively high pretensioning force depending on the wire diameter may lead to an increase in the no-load power up to 100%. In future special attention must be paid to observance of a defined cutting depth; systems for load equalisation and the tensioner for the plough chain which can be used during continuous operation, must be further developed. 6 refs., 4 figs., 1 tab.

  2. U. K. storage market improves after difficult start to year

    Energy Technology Data Exchange (ETDEWEB)

    Kingston, J

    1979-07-15

    According to J. Kingston of PD Oil and Chemical Storage Ltd., the present shortage of oil and product supplies has raised storage capacity rates and some tankage expansion is being considered, but there is no prospect of new terminal construction in the short-term without considerable hardening of storage tariffs. The few tanks under construction are for the specific requirements of certain chemical producers. PD Oil and Chemical operates three storage facilities at Barry, South Wales, where many tanks are specially lined for handling difficult products, Ipswich, and Purfleet, U.K., which have a total capacity of 733,600 cu m, as well as seven others in South Africa, Australia, Spain, France, the U.S., Canary Islands, and Cape Verde Islands in conjunction with subsidiary or associated companies. A table lists PD Oil and Chemical's facilities in the U.K., including location, type of storage, capacity, and accessibility.

  3. Cylindrical plunge grinding of difficult to grind materials

    International Nuclear Information System (INIS)

    Nakajima, Toshikatsu; Uno, Yoshiyuki; Kayahara, Masayuki.

    1983-01-01

    Cylindrical plunge grinding processes of titanium alloy and nickel-base superalloys with various kinds of conventional grinding wheels, which are known as difficult to grind materials, are experimentally investigated, analyzing size generation process, grinding force, surface roughness, wheel wear, grinding ratio and so on. For grinding titanium alloy Ti-6Al-4V, GC grinding wheel yields most superior grinding results which leads to lower grinding force, smaller residual stock, less wheel wear and higher grinding ratio up to about 3 with GC 80 L 9 V wheel. Then, for grinding nickelbase superalloys Waspaloy and Rene 41, WA 150 L 9 V wheel yields better grinding results in surface roughness, wheel wear, grinding ratio without chatter vibration though grinding force is higher, and the grinding ratio about 3 is obtained. Furthermore, higher plunge speed and speed ratio result in higher grinding efficiency though grinding force, surface roughness, wheel wear increase for grinding titanium alloy and nickel-base superalloys. (author)

  4. Difficult colonoscopy: air, carbon dioxide, or water insufflation?

    Science.gov (United States)

    Chaubal, Alisha; Pandey, Vikas; Patel, Ruchir; Poddar, Prateik; Phadke, Aniruddha; Ingle, Meghraj; Sawant, Prabha

    2018-04-01

    This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation). Patients with body mass index (BMI) less than 18 kg/m 2 or more than 30 kg/m 2 , or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation. The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation ( P carbon dioxide, and water insufflation ( P carbon dioxide for pain tolerance. This was seen in the subgroups with BMI 30 kg/m 2 .

  5. 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. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  6. 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.

  7. Taking a holistic approach to managing difficult stress fractures.

    Science.gov (United States)

    Miller, Timothy L; Best, Thomas M

    2016-09-09

    Stress fractures and other bony stress injuries occur along a spectrum of severity which can impact treatment and prognosis. When treating these injuries, it should be borne in mind that no two stress fractures behave exactly alike. Given that they are not a consistent injury, standardized treatment protocols can be challenging to develop. Treatment should be individualized to the patient or athlete, the causative activity, the anatomical site, and the severity of the injury. A holistic approach to the treatment of the most difficult stress fractures should be taken by orthopedists and sports medicine specialists. This approach is necessary to obtain optimal outcomes, minimize loss of fitness and time away from sports participation, and decrease the risk of recurrence.

  8. 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.

  9. 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....

  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),

  11. Tribal Colleges: The Original Extreme Makeover Experts

    Science.gov (United States)

    Powless, Donna

    2015-01-01

    In this article, the author states "our experience with education is a prime example in proving we are experts at problem-solving and are the originators of the extreme makeover." Educational institutions were introduced to the Native people in an outrageous manner--often as a mask for assimilating American Indians, routinely resulting…

  12. Acclimatization to extreme heat

    Science.gov (United States)

    Warner, M. E.; Ganguly, A. R.; Bhatia, U.

    2017-12-01

    Heat extremes throughout the globe, as well as in the United States, are expected to increase. These heat extremes have been shown to impact human health, resulting in some of the highest levels of lives lost as compared with similar natural disasters. But in order to inform decision makers and best understand future mortality and morbidity, adaptation and mitigation must be considered. Defined as the ability for individuals or society to change behavior and/or adapt physiologically, acclimatization encompasses the gradual adaptation that occurs over time. Therefore, this research aims to account for acclimatization to extreme heat by using a hybrid methodology that incorporates future air conditioning use and installation patterns with future temperature-related time series data. While previous studies have not accounted for energy usage patterns and market saturation scenarios, we integrate such factors to compare the impact of air conditioning as a tool for acclimatization, with a particular emphasis on mortality within vulnerable communities.

  13. 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 ...

  14. 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.

  15. Sexuality in persons with lower extremity amputations.

    Science.gov (United States)

    Bodenheimer, C; Kerrigan, A J; Garber, S L; Monga, T N

    2000-06-15

    There is a paucity of information regarding sexual functioning in persons with lower extremity amputations. The purpose of this study was to describe sexual and psychological functioning and health status in persons with lower extremity amputation. Self-report surveys assessed sexual functioning (Derogatis Inventory), depression (Beck Depression Inventory, anxiety (State-Trait Anxiety Inventory), and health status (Health Status Questionnaire) in a convenience sample of 30 men with lower extremity amputations. Mean age of the participants was 57 years (range 32-79). Mean duration since amputation was 23 months (range 3-634 months). Twenty one subjects (70%) had trans-tibial and seven subjects (23%) had trans-femoral amputations. A majority of subjects were experiencing problems in several domains of sexual functioning. Fifty three percent (n = 16) of the subjects were engaged in sexual intercourse or oral sex at least once a month. Twenty seven percent (n = 8) were masturbating at least once a month. Nineteen subjects (63%) reported orgasmic problems and 67% were experiencing erectile difficulties. Despite these problems, interest in sex was high in over 90% of the subjects. There was no evidence of increased prevalence of depression or anxiety in these subjects when compared to other outpatient adult populations. Sexual problems were common in the subjects studied. Despite these problems, interest in sex remained high. Few investigations have been directed toward identifying the psychological and social factors that may contribute to these problems and more research with a larger population is needed in this area.

  16. 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. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. 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…

  18. Past and future changes in extreme sea levels and waves

    Digital Repository Service at National Institute of Oceanography (India)

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

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

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

    International Nuclear Information System (INIS)

    Badami, Madhav G.

    2004-01-01

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

  20. 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.

  1. Relationships and their potential for change developed in difficult type 1 diabetes

    DEFF Research Database (Denmark)

    Zoffmann, Vibeke; Kirkevold, Marit

    2007-01-01

    Few researchers have explored how relationships between patients and providers might change problem solving in clinical practice. The authors used grounded theory to study dyads of 11 people with diabetes and poor glycemic control, and 8 nurses interacting in diabetes teams. Relational Potential...... for Change was identified as a core category that involved three types of relationships. Professionals mostly shifted between less effective relationships characterized by I-you-distant provider dominance and I-you-blurred sympathy. Although rarely seen, a third relationship, I-you-sorted mutuality proved...... more effective than the others in exploiting the Relational Potential for Change. The three types of relationship differed in (a) scope of problem solving, (b) the roles assigned to the patient and the professionals, (c) use of difficult feelings and different points of view, and (d) quality...

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

    Directory of Open Access Journals (Sweden)

    Venkateswaran Ramkumar

    2016-01-01

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

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

    Science.gov (United States)

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

    2015-11-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to

  4. An Improved Crow Search Algorithm Applied to Energy Problems

    Directory of Open Access Journals (Sweden)

    Primitivo Díaz

    2018-03-01

    Full Text Available The efficient use of energy in electrical systems has become a relevant topic due to its environmental impact. Parameter identification in induction motors and capacitor allocation in distribution networks are two representative problems that have strong implications in the massive use of energy. From an optimization perspective, both problems are considered extremely complex due to their non-linearity, discontinuity, and high multi-modality. These characteristics make difficult to solve them by using standard optimization techniques. On the other hand, metaheuristic methods have been widely used as alternative optimization algorithms to solve complex engineering problems. The Crow Search Algorithm (CSA is a recent metaheuristic method based on the intelligent group behavior of crows. Although CSA presents interesting characteristics, its search strategy presents great difficulties when it faces high multi-modal formulations. In this paper, an improved version of the CSA method is presented to solve complex optimization problems of energy. In the new algorithm, two features of the original CSA are modified: (I the awareness probability (AP and (II the random perturbation. With such adaptations, the new approach preserves solution diversity and improves the convergence to difficult high multi-modal optima. In order to evaluate its performance, the proposed algorithm has been tested in a set of four optimization problems which involve induction motors and distribution networks. The results demonstrate the high performance of the proposed method when it is compared with other popular approaches.

  5. Stellar extreme ultraviolet astronomy

    International Nuclear Information System (INIS)

    Cash, W.C. Jr.

    1978-01-01

    The design, calibration, and launch of a rocket-borne imaging telescope for extreme ultraviolet astronomy are described. The telescope, which employed diamond-turned grazing incidence optics and a ranicon detector, was launched November 19, 1976, from the White Sands Missile Range. The telescope performed well and returned data on several potential stellar sources of extreme ultraviolet radiation. Upper limits ten to twenty times more sensitive than previously available were obtained for the extreme ultraviolet flux from the white dwarf Sirius B. These limits fall a factor of seven below the flux predicted for the star and demonstrate that the temperature of Sirius B is not 32,000 K as previously measured, but is below 30,000 K. The new upper limits also rule out the photosphere of the white dwarf as the source of the recently reported soft x-rays from Sirius. Two other white dwarf stars, Feige 24 and G191-B2B, were observed. Upper limits on the flux at 300 A were interpreted as lower limits on the interstellar hydrogen column densities to these stars. The lower limits indicate interstellar hydrogen densitites of greater than .02 cm -3 . Four nearby stars (Sirius, Procyon, Capella, and Mirzam) were observed in a search for intense low temperature coronae or extended chromospheres. No extreme ultraviolet radiation from these stars was detected, and upper limits to their coronal emisson measures are derived

  6. Extremity x-ray

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003461.htm Extremity x-ray To use the sharing features on this page, ... in the body Risks There is low-level radiation exposure. X-rays are monitored and regulated to provide the ...

  7. 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

  8. 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...

  9. Pipeline developments 1998 and beyond : more choices, more difficult decisions

    International Nuclear Information System (INIS)

    VanderSchee, K.

    1998-01-01

    Some of the basic economic principles that drive gas prices and gas flows across North America, and the pressures these have placed on the pipeline sector, are reviewed. Of pressing importance to the natural gas industry in Western Canada is the prospect that in the near future industrial gas users in eastern Canada will have a wider array of pipeline choices available to them than ever before. This will mean that the users will face more offerings from more pipeline providers, forcing pipeline owners to make more difficult decisions regarding new pipeline capacity. Variables such as price, terms and conditions will become increasingly negotiable. Market power concerns also remain an important issue. As a result, there is increasing call for market-based financial regulation of pipelines. 'Market gaming' a condition where a firm manipulates the market to its own market advantage is also receiving considerable attention. The latter is of particular concern in the United States. Against this background, the nature of competition (or the lack of it) in natural gas transport, the influence of short-term service revenues for pipelines, pipeline commitments through subsidiaries, and concerns over short term pipeline valuations skewing investment decisions, are issues that will continue to invite much attention. Regarding market outlook, it was noted that significantly increased export capacity from Alberta could raise the costs of Alberta supplies to eastern Canadian end-users relative to other supply/transport options which may now be viable economic alternatives. figs

  10. Pipeline developments 1998 and beyond : more choices, more difficult decisions

    Energy Technology Data Exchange (ETDEWEB)

    VanderSchee, K. [EnergyERA (Canada)

    1998-12-31

    Some of the basic economic principles that drive gas prices and gas flows across North America, and the pressures these have placed on the pipeline sector, are reviewed. Of pressing importance to the natural gas industry in Western Canada is the prospect that in the near future industrial gas users in eastern Canada will have a wider array of pipeline choices available to them than ever before. This will mean that the users will face more offerings from more pipeline providers, forcing pipeline owners to make more difficult decisions regarding new pipeline capacity. Variables such as price, terms and conditions will become increasingly negotiable. Market power concerns also remain an important issue. As a result, there is increasing call for market-based financial regulation of pipelines. `Market gaming` a condition where a firm manipulates the market to its own market advantage is also receiving considerable attention. The latter is of particular concern in the United States. Against this background, the nature of competition (or the lack of it) in natural gas transport, the influence of short-term service revenues for pipelines, pipeline commitments through subsidiaries, and concerns over short term pipeline valuations skewing investment decisions, are issues that will continue to invite much attention. Regarding market outlook, it was noted that significantly increased export capacity from Alberta could raise the costs of Alberta supplies to eastern Canadian end-users relative to other supply/transport options which may now be viable economic alternatives. figs.

  11. 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.

  12. [Decubitus ulcer in the calcaneus region: rapid development, difficult recovery].

    Science.gov (United States)

    Fugazza, G; Bona, F

    1996-03-01

    Heel pressure sores frequently arise in patients kept in bed for a long time independently of their primary disease. In account of this event the authors completed a study concerning possible mutual relations between heel pressure sores and primary disease of the patients; to validate the pharmacological treatment in less severe sores and the surgical resolution in more serious cutaneous lesions. In the last 3 years (1992-1995) at the Rehabilitation Centre of Montescano the authors have treated 39 patients suffering from 63 different severe cutaneous lesions: from phlycten to deep necrosis. The therapeutic plane utilized pharmacological treatment for 1st, 2nd, 3rd degree pressure sores, and surgical treatment for 4th degree. Pharmacological treatment included: enzymatic drugs, bactericidal and bacteriostatic medicines and cicatrizing substances. Different healing times were related to different pressure sore severity. Surgical treatment consisted of transposition of flap into wound defect. This system caused considerable reduction in resolution times. The authors noticed how easily pressure sores arise in the heel region, and how difficultly they heal. This is probably connected with particular anatomical and vascular characteristics of this region.

  13. Radionuclides difficult to measure in waste packages. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Thierfeldt, S; Deckert, A [Brenk Systemplanung, Aachen (Germany)

    1995-11-01

    In this study nuclide specific correlation analyses between key nuclides that can be easily measured and nuclides that are difficult to measure are presented. Data are taken from studies and data compilations from various countries. The results of this study can serve to perform assays of the nuclide specific radionuclide contents in waste packages by gamma measurements of {sup 60}Co and {sup 137}Cs and calculation of the contents of other nuclides via the correlation analyses, sometimes referred to as `scaling factor method`. It can thus be avoided to have to take samples from the waste for separate analysis. An attempt is made to also investigate the physical and chemical backgrounds behind the proposed correlations. For example, a formation pathway common to the two nuclides to be correlated can be regarded as an explanation, if a good correlation is found. On the other hand, if the observed correlation is of poor quality, reasons may possibly lie in different behaviour of the two nuclides in the water system of the nuclear plant. This implies not only chemical solubility, transfer constants etc. in the water system, which would not only affect the proportionality between the two nuclides, but a different behavior in different parts of the water system must be assumed (e.g. different filter efficiencies etc). 47 refs, 57 figs, 40 tabs.

  14. 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.

  15. Plasma hot machining for difficult-to-cut materials, 1

    International Nuclear Information System (INIS)

    Kitagawa, Takeaki; Maekawa, Katsuhiro; Kubo, Akihiko

    1987-01-01

    Machinability of difficult-to-cut materials has been a great concern to manufacturing engineers since demands for new materials in the aerospace and nuclear industries are more and more increasing. The purpose of this study is to develop a hot machining to improve machinability of high hardness materials. A plasma arc is used for heating materials cut. The surface just after being heated is removed as a chip by tungsten carbide tools. The turning experiments of high hardness steels with aid of plasma arc heating show not only the decrease in cutting forces but also the following effectiveness: (1) The application of the plasma hot machining to the condition, under which a built-up edge (BUE) appears in turning 0.46%C steel, makes the BUE disappeared, bringing less flank wear. (2) In the case of 18%Mn steel cutting, deep groove wear on the end-cutting edge diminishes, and roughness of the machined surface is improved by the prevention from chatter. (3) Although the chilled cast iron has high hardness of above HB = 350, the plasma hot machining makes it possible to cut it with tungsten carbide tools having less chipping and flank wear. (author)

  16. Nuclear energy and public opinion - a difficult relationship

    International Nuclear Information System (INIS)

    Kaase, M.

    1990-01-01

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

  17. Red Indian Lake fishway, an innovative design for difficult conditions

    International Nuclear Information System (INIS)

    Helwig, P.C.; Goosney, R.; Smith, W.L.

    1993-01-01

    Red Indian Lake Dam is a large concrete gravity structure, 10-12 m high and 245 m long, in the Exploits River watershed in Newfoundland. The watershed is an ideal habitat for production of Atlantic salmon. Since 1985, the watershed above the dam has undergone an extensive stocking program to optimize the salmon production capacity of the upper reaches of the system. To sustain this development, a fishway was needed to permit returning salmon to bypass Red Indian Lake Dam, the last remaining migrational barrier. The difficulties with installing a fishway at the dam site included extreme variation in upstream water levels, the need to retrofit a fishway into an existing structure, and the necessity to attract fish into the fishway in competition with other flows from power plant, spillway, or waterfall. After examining several design approaches, an innovative design was developed incorporating two separate but interrelated flow ways: one to handle attraction water and the other for transportation water. The latter passage leads to a trap at the upper end of the fishway from which salmon are hoisted via a hopper/monorail system across the dam and into the lake. Construction of the fishway was staged over four phases between December 1985 and December 1988. 3 refs., 1 fig

  18. Soft tissue masses of extremities: MR findings

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-11-15

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

  19. Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy.

    Science.gov (United States)

    Greer, S E; Duthie, E; Cartolano, B; Koehler, K M; Maydick-Youngberg, D; Longaker, M T

    1999-09-01

    Subatmospheric pressure dressing (SPD) has been commercially available in the United States since 1995 as the vacuum-assisted closure (VAC) device. SPD increases local blood flow, decreases edema and bacterial count, and promotes the formation of granulation tissue. Despite recent clinical successes with the use of SPD in a variety of wound types, problems may occur with application of VAC system in certain areas of the body. The main limitation occurs when attempting to maintain an airtight seal over irregular surfaces surrounding a wound. For example, application of the adhesive drape and creation of a seal are particularly difficulty in the hip and perineum. In addition, wounds of the lower extremity can occur in multiple sites, posing the problem of providing a vacuum dressing to more than one wound from one suction pump machine. To address these challenging clinical wounds, we have developed techniques to allow the successful application of SPD to sacral pressure ulcers near the anus, and to multiple large lower extremity ulcers.

  20. The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters.

    Science.gov (United States)

    Shapiro, Johanna; Rakhra, Pavandeep; Wong, Adrianne

    2016-10-01

    Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.

  1. 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.

  2. Advanced Life Systems for Extreme Environments: An Arctic Application

    Science.gov (United States)

    Lewis, Carol E.; Stanford, Kerry L.; Bubenheim, David L.; Covington, Alan (Technical Monitor)

    1995-01-01

    The problems of obtaining adequate pure drinking water and disposing of liquid and solid waste in the U.S. Arctic, a region where virtually all water is frozen solid for much of the year, has led to unsanitary solutions (U.S. Arctic Research Commission). These solutions are also damaging to the environment. Sanitation and a safe water supply are particularly problems in rural villages. About one-fourth of Alaska's 86.000 Native residents live in these communities. They are without running water and use plastic buckets for toilets. The outbreak of diseases is believed to be partially attributable to exposure to human waste. Villages with the most frequent outbreaks of disease are those in which running water is difficult to obtain (Office of Technology Assessment, 1994). Waste is emptied into open lagoons, rivers, or onto the sea coast. It does not degrade rapidly and in addition to affecting human health, can be harmful to the fragile ecology of the Arctic and the indigenous wildlife and fish populations. Advanced Life Systems for Extreme Environments (ALSEE) provides a solution to sanitation and safe water problems. The system uses an advanced integrated technology developed for Antarctic and space applications. ALSEE uses the systems approach to address more than waste and water problems. By incorporating hydroponic horticulture and aquaculture into the waste treatment system, ALSEE addresses the quality and quantity of fresh foods available to Arctic residents. A temperate climate is required for year-round plant growth. ALSEE facilities can be designed to include a climate controlled area within the structure. This type of environment is a change from the long periods of darkness and cold found in the Arctic and can help alleviate stress so often associated with these extremes. While the overall concept of ALSEE projects is advanced, system facilities can be operated by village residents with appropriate training. ALSEE provides continuing training and

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

    Directory of Open Access Journals (Sweden)

    Benjamin Stielow

    2011-01-01

    Full Text Available 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.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.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.

  4. Techniques for assisting difficult delivery at caesarean section.

    Science.gov (United States)

    Waterfall, Heather; Grivell, Rosalie M; Dodd, Jodie M

    2016-01-31

    Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult caesarean birth may result in injury for the infant or complications for the mother. Methods to assist with delivery include vacuum or forceps extraction or manual delivery utilising fundal pressure. Medication that relaxes the uterus (tocolytic medication) may facilitate the birth of the baby at caesarean section. Delivery of the impacted head after prolonged obstructed labour can be associated with significant maternal and neonatal complication; to facilitate delivery of the head the surgeon may utilise either reverse breech extraction or head pushing. To compare the use of tocolysis (routine or selective use) with no use of tocolysis or placebo and to compare different extraction methods at the time of caesarean section for outcomes of infant birth trauma, maternal complications (particularly postpartum haemorrhage requiring blood transfusion), and long-term measures of infant and childhood morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies. All published, unpublished, and ongoing randomised controlled trials comparing the use of tocolytic agents (routine or selective) at caesarean section versus no use of tocolytic or placebo at caesarean section to facilitate the birth of the baby. Use of instrument versus manual delivery to facilitate birth of the baby. Reverse breech extraction versus head pushing to facilitate delivery of the deeply impacted fetal head. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Seven randomised controlled trials, involving 582 women undergoing caesarean section were included in this review. The risk of bias of included trials was variable, with some trials not adequately describing allocation or

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

    National Research Council Canada - National Science Library

    Reeves, Andrew T

    2005-01-01

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

  6. 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) (CPAP, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during 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

  7. Difficult reputations and the social reality of occupational medicine.

    Science.gov (United States)

    Draper, Elaine

    2008-01-01

    This response to Tee Guidotti's (2008) critique of Elaine Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' (2003) argues that a forthright examination of the conflicts of those working in the field of occupational medicine is essential to maintaining the health of the profession and to promoting constructive policies. Research for 'The Company Doctor' reveals how doctors walk a tightrope of professional demands on them. The author describes how corporate employment affects medicine and science and how professionals working in corporations are subject to the decisions of company managers and to economic and legal imperatives stemming from their status as corporate employees. Analyzing company doctors' role in confronting toxics and responding to liability fears in corporations, the author argues that problems of lost credibility, stigmatization, and tarnished reputation that company doctors describe largely stem from the organizational constraints, economic interests, and other aspects of the social context of their work. These social forces exert powerful pressure on the ethical framework and daily work lives of these professionals as well as on the reputation of their field. The author discusses ways in which the conflicting demands from being both a corporate employee and a physician are a social and structural problem beyond individual ethics.

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    Theresa Scognamiglio

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  12. Rhabdomyosarcoma of the extremity

    International Nuclear Information System (INIS)

    Rao, Bhaskar N

    1997-01-01

    Rhabdomyosarcoma is the most common soft tissue sarcoma accounting for almost 55%. These tumors arise from unsegmented mesoderm or primitive mesenchyma, which have the capacity to differentiate into muscle. Less than 5% occur in the first year of life. Extremity rhabdomyosarcoma are mainly seen in the adolescent years. The most common histologic subtype is the alveolar variant. Other characteristics of extremity rhabdomyosarcoma include a predilection for lymph node metastasis, a high local failure, and a relatively low survival rate. They often present as slow painless masses; however, lesions in the hand and foot often present as painful masses and imaging studies may show invasion of the bone. Initial diagnostic approaches include needle biopsy or incisional biopsy for larger lesions. Excisional biopsy is indicated preferably for lesions less than 2.5 cm. following this in most instances therapy is initiated with multi agent chemotherapy depending upon response, the next modality may be either surgery with intent to cure or radiation therapy. Amputation of an extremity for local control is not considered in most instances. Prognostic factors that have been determined over the years to be of significance by multi variant analysis have included age, tumor size, invasiveness, presence of either nodal or distant metastasis, and complete excision whenever feasible, with supplemental radiation therapy for local control

  13. Pulmonary embolism and difficult-to-treat asthma

    Directory of Open Access Journals (Sweden)

    Catarina Teles Martins

    2007-11-01

    Full Text Available Asthma control is a key point in patient management. GINA's most recent report emphasises the need to investigate uncontrolled asthma, of which non-compliance with treatment, COPD, smoking, chronic sinusitis, gastroesophageal reflux disease and obesity are the usual causes.The aim of this work is to evaluate the role of pulmonary thromboembolism (PTE in cases of difficult-to-treat asthma. We reviewed the case reports of patients with severe persistent asthma followed in our Asthma Outpatients Clinic between 2004 and 2006. We selected the ones that maintained uncontrolled disease despite an optimal therapeutical approach and investigated the causes.In this group (n = 254, 28 (11% had severe persistent asthma and their mean age was 44 ± SD18 years old. 86% were females. Of these, 57% (n = 16 had uncontrolled disease: 35% (n = 6 due to non-compliance with treatment; 29% (n = 5 pulmonary thrombombolism (scintigraphic confirmation; 12% (n = 2 severe rhinosinusitis; 6% (n = 1 hypereosinophilic syndrome; 6% (n = 1 persistent allergen exposure and 6% (n = 1 are still being investigated.Patients with TPE (mean age 56 ± SD9 years old; 80% females; 80% Caucasians were diagnosed with asthma as adults (mean age 37 ± SD14 years old. The mean time until the diagnosis of TPE was 18 ± SD12 years. Predisposing factors for TPE were venous insufficiency (40%, hypertension (40% and deficit of functional protein C and S (20%.All these patients received anticoagulant therapy (80% are still medicated. It should be noted that after the beginning of anticoagulants, 40% of the patients achieved control of their asthma and 40% have partially controlled disease. There were no hospital admissions for asthma exacerbations after the beginning of anticoagulation in this group.This study supports the inclusion of TPE in the group of comorbidities to consider while investigating uncontrolled

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

    International Nuclear Information System (INIS)

    Silva Cesar, Aldara da; Otavio Batalha, Mario

    2010-01-01

    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.

  15. 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.

  16. 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

  17. 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.

  18. Increase of manufacturability of manufacturing of difficult profile details

    Directory of Open Access Journals (Sweden)

    О.Ye. Semenovskiy

    2017-12-01

    Full Text Available The analysis of existing problems arising in the process of manufacturing such complex profile parts as gears is carried out. The possible ways of simplifying the technological processes with the aim of improving the economic performance of production, as well as reducing the defect are defined. The carried out researches of influence of chemical composition of steel, its structural parameters on technological characteristics. The choice of compositions of the chemical composition of steel with the optimal ratio of physical-mechanical and technological characteristics is substantiated. The causes of deformation of parts in the process of heat treatment are established. The developed criteria for estimating this value. At the same time, the task of not only qualitative but also quantitative evaluation of such technological properties as the propensity of steels to deformation in the course of chemical-thermal treatment is solved, with the aim of introducing a single characteristic that determines the tendency of the steel to deform during hardening. Reducing the propensity of steel to deformation allowed to increase the economic performance of production by reducing the number of finishing operations.

  19. Closure of difficult pharyngocutaneous fistula following salvage laryngectomy. Case report

    International Nuclear Information System (INIS)

    Suesada, Nobuko; Sakuraba, Minoru; Nagamatsu, Shogo; Miyamoto, Shimpei; Shinozaki, Takeshi; Hayashi, Ryuichi

    2013-01-01

    The patient was a 74-year-old man. A total laryngectomy was performed due to recurrence of laryngeal cancer after chemoradiotherapy (CRT). Postoperatively, a pharyngocutaneous fistula developed and patch-graft reconstruction using a pectoral major musculocutaneous flap was planned. However, due to expansion of the necrotic area, we needed to perform tubular reconstruction. Nevertheless, infection and pus discharge were observed and a second surgery was performed. Resection and reconstruction at the neck were considered impossible because advanced necrosis was seen at the cervical esophageal stump, and the operative procedure was changed to esophageal resection, gastric pull-up and free jejunum transfer. Although leakage was found at the jejunum-gastric anastomosis site by fluoroscopy on the 14th postoperative day, it disappeared through conservative therapy. In addition, oral ingestion was begun on the 28th postoperative day. At 6 months after the surgery, the patient was able to regularly intake food and no constriction of the tracheostoma was seen. In this case, unexpected expansion of the necrotic area was a significant problem. As for the causes, diminished blood flow to the esophagus due to total thyroidectomy and bilateral paratracheal lymph node dissection, and infection in the surrounding area, along with remarkable tissue damage with CRT were considered possible. In salvage surgery, attention will be necessary in evaluating necrotic range and selection of appropriate reconstructive procedure. (author)

  20. 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.

  1. [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.

  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. Upper extremity golf injuries.

    Science.gov (United States)

    Cohn, Michael A; Lee, Steven K; Strauss, Eric J

    2013-01-01

    Golf is a global sport enjoyed by an estimated 60 million people around the world. Despite the common misconception that the risk of injury during the play of golf is minimal, golfers are subject to a myriad of potential pathologies. While the majority of injuries in golf are attributable to overuse, acute traumatic injuries can also occur. As the body's direct link to the golf club, the upper extremities are especially prone to injury. A thorough appreciation of the risk factors and patterns of injury will afford accurate diagnosis, treatment, and prevention of further injury.

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

    International Nuclear Information System (INIS)

    Di Lucia, Lorenzo

    2013-01-01

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

  5. 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.

  6. Riedel's goitre - rare and difficult to diagnose reason

    International Nuclear Information System (INIS)

    Bula, G.; Truchanowski, W.; Gawrychowski, J.

    2009-01-01

    Introduction: The paper reports a female patient treated surgically for Riedel's goitre. A total of 4775 patients were treated surgically between 1 January 2000 and 31 December 2007 for various types of goitres. Thyroiditis was diagnosed in 193 (4.0%) cases. Among them Riedel's goitre was found in one (0.5%). Case report: A 51-year-old woman P.G. (case record No. 1377/2007) was admitted to our hospital with considerable dyspnea, both inspiratory and expiratory, accompanied by marked stridor and retrosternal goitre, the latter suspected of neoplasmic process. Thyroid gland was hard, its left lobe extending behind the sternum. No disorders in thyroid hormonal function or high antibody titre against thyroid peroxidase were observed. Ultrasonography revealed large thyroid gland with mediastinal invasion, nodulated and hypoechogenic. Fineneedle biopsy suggested thyroid colloidal tumor. X-ray of the chest and neck revealed wide upper portion of the mediastinum and narrow trachea. Laryngological examination confirmed paralysis of left vocal fold. The patient was operated under general endotracheal anesthesia. Both thyroid lobes were partially resected together with the isthmus, and malacic trachea was decompressed. No complications were observed during postoperative period. Paraffin histopathological examination confirmed the presence of Riedel's goitre.The patient was discharged in general good condition. She was under regular follow-up control and died 1.5 year after operation from further progress of the disease. Conclusions: Clinical course of Riedel's goitre may cause remarkable diagnostic problems, and requires a differentiation with thyroid malignant tumor. Surgical treatment of Riedel's goitres helps to quickly obtain correct diagnosis and improve both clinical condition and life comfort of the patients. (authors)

  7. Technology of magnetic abrasive finishing in machining of difficult-to-machine alloy complex surface

    Directory of Open Access Journals (Sweden)

    Fujian MA

    2016-10-01

    Full Text Available The technology of magnetic abrasive finishing is one of the important finishing technologies. Combining with low-frequency vibration and ultrasonic vibration, it can attain higher precision, quality and efficiency. The characteristics and the related current research of magnetic abrasive finishing, vibration assisted magnetic abrasive finishing and ultrasonic assisted magnetic abrasive finishing are introduced. According to the characteristics of the difficult-to-machine alloy's complex surface, the important problems for further study are presented to realize the finishing of complex surface with the technology of magnetic abrasive finishing, such as increasing the machining efficiency by enhancing the magnetic flux density of machining gap and compounding of magnetic energy and others, establishing of the control function during machining and the process planning method for magnetic abrasive finishing of complex surface under the space geometry restraint of complex surface on magnetic pole, etc.

  8. 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.

  9. Computational discovery of extremal microstructure families

    Science.gov (United States)

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

    2018-01-01

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

  10. Oral to nasal tube exchange under fibroscopic view: a new technique for nasal intubation in a predicted difficult airway.

    Science.gov (United States)

    Monclus, Enric; Garcés, Antonio; Artés, David; Mabrock, Maged

    2008-07-01

    For a predicted difficult airway, oral intubation techniques are well established in pediatric anesthesia, but nasotracheal intubation remains a problem. There are many reports concerning this, but the risk of bleeding, added to the lack of cooperation make this procedure difficult and hazardous. We describe a modification of the nasal intubation technique in two stages. First an oral intubation and then exchanging the oral for a nasal tube, in the case of a 13-year-old boy affected by an advanced stage of cherubism. Oral intubation using a laryngeal mask technique has already been reported, but problems appear during the exchange procedure and even more when direct laryngoscopy is impossible. Fiberscopic control of the exchange, and the introduction of a Cook Exchange Catheter into the trachea through the oral tube before withdrawal, permits oxygenation of the patient and acts as a guide for oral tube reintroduction if required.

  11. Chiral gravity, log gravity, and extremal CFT

    International Nuclear Information System (INIS)

    Maloney, Alexander; Song Wei; Strominger, Andrew

    2010-01-01

    We show that the linearization of all exact solutions of classical chiral gravity around the AdS 3 vacuum have positive energy. Nonchiral and negative-energy solutions of the linearized equations are infrared divergent at second order, and so are removed from the spectrum. In other words, chirality is confined and the equations of motion have linearization instabilities. We prove that the only stationary, axially symmetric solutions of chiral gravity are BTZ black holes, which have positive energy. It is further shown that classical log gravity--the theory with logarithmically relaxed boundary conditions--has finite asymptotic symmetry generators but is not chiral and hence may be dual at the quantum level to a logarithmic conformal field theories (CFT). Moreover we show that log gravity contains chiral gravity within it as a decoupled charge superselection sector. We formally evaluate the Euclidean sum over geometries of chiral gravity and show that it gives precisely the holomorphic extremal CFT partition function. The modular invariance and integrality of the expansion coefficients of this partition function are consistent with the existence of an exact quantum theory of chiral gravity. We argue that the problem of quantizing chiral gravity is the holographic dual of the problem of constructing an extremal CFT, while quantizing log gravity is dual to the problem of constructing a logarithmic extremal CFT.

  12. Le problème des hydrates dans le contexte de la production et du transport polyphasiques des pétroles bruts et des gaz naturels. Deuxième partie : les solutions possibles aux difficultés d'exploitation générées par les hydrates Hydrates Problem Within the Framework of Multiphase Production and Transport of Crude Oils and Natural Gases. Part Two: Possible Solutions to Exploitation Difficulties Generated by Hydrates

    Directory of Open Access Journals (Sweden)

    Behar E.

    2006-11-01

    Full Text Available L'exploitation en mer des gisements de combustibles fossiles fluides a amplifié le besoin d'accroître nos connaissances sur les hydrates qui sont susceptibles de boucher les installations de production, de traitement et de transport. La première partie rappelait la structure moléculaire des hydrates I, Il et H et décrivait ensuite succinctement l'analyse physico-chimique de leur formation, tant sur les plans thermodynamique que cinétique. Dans cette deuxième partie, les remèdes possibles aux problèmes rencontrés par les compagnies opératrices sont indiqués, essentiellement les inhibiteurs thermodynamiques classiques tels que les alcools ou les sels qui diminuent la température de formation des hydrates, et les additifs dispersants qui évitent la croissance et/ou l'agglomération des cristaux. Pour terminer, une boucle pilote de circulation originale est présentée, ses caractéristiques qui permettent la validation des additifs dispersants dans des conditions hydrodynamiques et physico-chimiques représentatives étant soulignées. Offshore exploitation of fossil fluid fuels has emphasized the need of improving our knowledge on hydrates which can plug production, treatment and transport facilities. The first part recalled the molecular structure of I, II and H hydrates, then the physical-chemistry of their formation was briefly reviewed from both the thermodynamic and the kinetic points of view. In this second part, the possible remedies to the problems met by operating companies are described, mainly classical thermodynamic inhibitors such as alcohols or salts which decrease the hydrates formation temperature, and dispersant additives which avoid crystals growth and/or agglomeration. At last an original circulation loop at pilot scale is presented, its characteristics which allow the testing of dispersant additives under representative hydrodynamic and physico-chemical conditions being outlined.

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

    Science.gov (United States)

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

    2013-12-01

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

  14. 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

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

    Science.gov (United States)

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

    2013-09-01

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

  16. The attitudes of neonatal nurses towards extremely preterm infants.

    Science.gov (United States)

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

    2012-08-01

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

  17. Local extremal problems for bounded analytic functions without zeros

    International Nuclear Information System (INIS)

    Prokhorov, D V; Romanova, S V

    2006-01-01

    In the class B(t), t>0, of all functions f(z,t)=e -t +c 1 (t)z+c 2 (t)z 2 +... that are analytic in the unit disc U and such that 0 0. We suggest an algorithm for determining those t>0 for which the canonical functions provide the local maximum of Re c n (t) in B(t). We describe the set of functionals Lf)=Σ k=0 n λ k c k for which the canonical functions provide the maximum of Re L(f) in B(t) for small and large values of t. The proofs are based on optimization methods for solutions of control systems of differential equations

  18. Local extremal problems for bounded analytic functions without zeros

    Science.gov (United States)

    Prokhorov, D. V.; Romanova, S. V.

    2006-08-01

    In the class B(t), t>0, of all functions f(z,t)=e^{-t}+c_1(t)z+c_2(t)z^2+\\dots that are analytic in the unit disc U and such that 00. We suggest an algorithm for determining those t>0 for which the canonical functions provide the local maximum of \\operatorname{Re}c_n(t) in B(t). We describe the set of functionals L(f)=\\sum_{k=0}^n\\lambda_kc_k for which the canonical functions provide the maximum of \\operatorname{Re}L(f) in B(t) for small and large values of t. The proofs are based on optimization methods for solutions of control systems of differential equations.

  19. The optimal graph partitioning problem

    DEFF Research Database (Denmark)

    Sørensen, Michael Malmros; Holm, Søren

    1993-01-01

    . This problem can be formulated as a MILP, which turns out to be completely symmetrical with respect to the p classes, and the gap between the relaxed LP solution and the optimal solution is the largest one possible. These two properties make it very difficult to solve even smaller problems. In this paper...

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

    Directory of Open Access Journals (Sweden)

    Moustafa Abdelaziz Moustafa

    2017-04-01

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

  1. Balance Problems

    Science.gov (United States)

    ... often, it could be a sign of a balance problem. Balance problems can make you feel unsteady. You may ... related injuries, such as a hip fracture. Some balance problems are due to problems in the inner ...

  2. Extremely secure identification documents

    International Nuclear Information System (INIS)

    Tolk, K.M.; Bell, M.

    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

  3. Are BALQSOs extreme accretors?

    Science.gov (United States)

    Yuan, M. J.; Wills, B. J.

    2002-12-01

    Broad Absorption Line (BAL) QSOs are QSOs with massive absorbing outflows up to 0.2c. Two hypothesis have been suggested in the past about the nature of BALQSOs: Every QSO might have BAL outflow with some covering factor. BALQSOs are those which happen to have outflow along our line of sight. BALQSOs have intrinsically different physical properties than non-BALQSOs. Based on BALQSO's optical emission properties and a large set of correlations linking many general QSO emission line and continuum properties, it has been suggested that BALQSOs might accrete at near Eddington limit with abundant of fuel supplies. With new BALQSO Hβ region spectroscopic observation conducted at UKIRT and re-analysis of literature data for low and high redshift non-BALQSOs, We confirm that BALQSOs have extreme Fe II and [O III] emission line properties. Using results derived from the latest QSO Hβ region reverberation mapping, we calculated Eddington ratios (˙ {M}/˙ {M}Edd) for our BAL and non-BALQSOs. The Fe II and [O III] strengths are strongly correlated with Eddington ratios. Those correlations link Eddington ratio to a large set of general QSO properties through the Boroson & Green Eigenvector 1. We find that BALQSOs have Eddington ratios close to 1. However, all high redshift, high luminosity QSOs have rather high Eddington ratios. We argue that this is a side effect from selecting the brightest objects. In fact, our high redshift sample might constitute BALQSO's high Eddington ratio orientation parent population.

  4. 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…

  5. 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.

  6. 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.

  7. 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.

  8. [Population problem, comprehension problem].

    Science.gov (United States)

    Tallon, F

    1993-08-01

    Overpopulation of developing countries in general, and Rwanda in particular, is not just their problem but a problem for developed countries as well. Rapid population growth is a key factor in the increase of poverty in sub-Saharan Africa. Population growth outstrips food production. Africa receives more and more foreign food, economic, and family planning aid each year. The Government of Rwanda encourages reduced population growth. Some people criticize it, but this criticism results in mortality and suffering. One must combat this ignorance, but attitudes change slowly. Some of these same people find the government's acceptance of family planning an invasion of their privacy. Others complain that rich countries do not have campaigns to reduce births, so why should Rwanda do so? The rate of schooling does not increase in Africa, even though the number of children in school increases, because of rapid population growth. Education is key to improvements in Africa's socioeconomic growth. Thus, Africa, is underpopulated in terms of potentiality but overpopulated in terms of reality, current conditions, and possibilities of overexploitation. Africa needs to invest in human resources. Families need to save, and to so, they must refrain from having many children. Africa should resist the temptation to waste, as rich countries do, and denounce it. Africa needs to become more independent of these countries, but structural adjustment plans, growing debt, and rapid population growth limit national independence. Food aid is a means for developed countries to dominate developing countries. Modernization through foreign aid has had some positive effects on developing countries (e.g., improved hygiene, mortality reduction), but these also sparked rapid population growth. Rwandan society is no longer traditional, but it is also not yet modern. A change in mentality to fewer births, better quality of life for living infants, better education, and less burden for women must occur

  9. Organizing of medical ensurance of human population under extreme conditions. Summaries of reports of scientific-practical conference

    International Nuclear Information System (INIS)

    1994-01-01

    Summary of reports are presented of Scientific-Practical conference on the organizing of medical ensurance of human population under extreme conditions including radiation accidents. The conference held in Moscow in October, 1994. It covered problems of organizing medical ensurance of population, medical surveillance problems, sanitary-hygienic and epidemiological problems (including radiation protection), and medical provision problems under extreme conditions

  10. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.

    Science.gov (United States)

    Costantino, Thomas G; Parikh, Aman K; Satz, Wayne A; Fojtik, John P

    2005-11-01

    We assess the success rate of emergency physicians in placing peripheral intravenous catheters in difficult-access patients who were unsuccessfully cannulated by emergency nurses. A technique using real-time ultrasonographic guidance by 2 physicians was compared with traditional approaches using palpation and landmark guidance. This was a prospective, systematically allocated study of all patients requiring intravenous access who presented to 2 university hospitals between October 2003 and March 2004. Inclusion criterion was the inability of any available nurse to obtain intravenous access after at least 3 attempts on a subgroup of patients who had a history of difficult intravenous access because of obesity, history of intravenous drug abuse, or chronic medical problems. Exclusion criterion was the need for central venous access. Patients presenting on odd days were allocated to the ultrasonographic-guided group, and those presenting on even days were allocated to the traditional-approach group. Endpoints were successful cannulation, number of sticks, time, and patient satisfaction. Sixty patients were enrolled, 39 on odd days and 21 on even days. Success rate was greater for the ultrasonographic group (97%) versus control (33%), difference in proportions of 64% (95% confidence interval [CI] 39% to 71%). The ultrasonographic group required less overall time (13 minutes versus 30 minutes, for a difference of 17 [95% CI 0.8 to 25.6]), less time to successful cannulation from first percutaneous puncture (4 minutes versus 15 minutes, for a difference of 11 [95% CI 8.2 to 19.4]), and fewer percutaneous punctures (1.7 versus 3.7, for a difference of 2.0 [95% CI 1.27 to 2.82]) and had greater patient satisfaction (8.7 versus 5.7, for a difference of 3.0 [95% CI 1.82 to 4.29]) than the traditional landmark approach. Ultrasonographic-guided peripheral intravenous access is more successful than traditional "blind" techniques, requires less time, decreases the number of

  11. A note on extreme sets

    Directory of Open Access Journals (Sweden)

    Radosław Cymer

    2017-10-01

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

  12. 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.

  13. 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.

  14. Likelihood estimators for multivariate extremes

    KAUST Repository

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

    2015-01-01

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

  15. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Resenhoeft, T.

    2006-07-01

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

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

    African Journals Online (AJOL)

    user1

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

  18. Attention-deficit hyperactivity disorder (ADHD), substance use disorders, and criminality: a difficult problem with complex solutions.

    Science.gov (United States)

    Knecht, Carlos; de Alvaro, Raquel; Martinez-Raga, Jose; Balanza-Martinez, Vicent

    2015-05-01

    The association between attention-deficit hyperactivity disorder (ADHD) and criminality has been increasingly recognized as an important societal concern. Studies conducted in different settings have revealed high rates of ADHD among adolescent offenders. The risk for criminal behavior among individuals with ADHD is increased when there is psychiatric comorbidity, particularly conduct disorder and substance use disorder. In the present report, it is aimed to systematically review the literature on the epidemiological, neurobiological, and other risk factors contributing to this association, as well as the key aspects of the assessment, diagnosis, and treatment of ADHD among offenders. A systematic literature search of electronic databases (PubMed, EMBASE, and PsycINFO) was conducted to identify potentially relevant studies published in English, in peer-reviewed journals. Studies conducted in various settings within the judicial system and in many different countries suggest that the rate of adolescent and adult inmates with ADHD far exceeds that reported in the general population; however, underdiagnosis is common. Similarly, follow-up studies of children with ADHD have revealed high rates of criminal behaviors, arrests, convictions, and imprisonment in adolescence and adulthood. Assessment of ADHD and comorbid condition requires an ongoing and careful process. When treating offenders or inmates with ADHD, who commonly present other comorbid psychiatric disorder complex, comprehensive and tailored interventions, combining pharmacological and psychosocial strategies are likely to be needed.

  19. A new Class of Extremal Composites

    DEFF Research Database (Denmark)

    Sigmund, Ole

    2000-01-01

    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......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...

  20. 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.

  1. 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.

  2. Management of the mangled extremity

    NARCIS (Netherlands)

    Prasarn, Mark L.; Helfet, David L.; Kloen, Peter

    2012-01-01

    The management of a mangled extremity continues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a

  3. A decade of weather extremes

    NARCIS (Netherlands)

    Coumou, Dim; Rahmstorf, Stefan

    The ostensibly large number of recent extreme weather events has triggered intensive discussions, both in- and outside the scientific community, on whether they are related to global warming. Here, we review the evidence and argue that for some types of extreme - notably heatwaves, but also

  4. 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

  5. Consistency of extreme flood estimation approaches

    Science.gov (United States)

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

    2017-04-01

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

  6. 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.

  7. Speech Problems

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Speech Problems KidsHealth / For Teens / Speech Problems What's in ... a person's ability to speak clearly. Some Common Speech and Language Disorders Stuttering is a problem that ...

  8. Extreme Value Theory Approach to Simultaneous Monitoring and Thresholding of Multiple Risk Indicators

    NARCIS (Netherlands)

    Einmahl, J.H.J.; Li, J.; Liu, R.Y.

    2006-01-01

    Risk assessments often encounter extreme settings with very few or no occurrences in reality.Inferences about risk indicators in such settings face the problem of insufficient data.Extreme value theory is particularly well suited for handling this type of problems.This paper uses a multivariate

  9. 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.)

  10. Statistical optimization of gold recovery from difficult leachable sulphide minerals using bacteria

    Energy Technology Data Exchange (ETDEWEB)

    Ahmed, Hussin A.M. [King Abdulaziz Univ., Jeddah (Saudi Arabia). Mining Engineering Dept.; El-Midany, Ayman A. [King Saud Univ., Riyadh (Saudi Arabia)

    2012-07-01

    Some of refractory gold ores represent one of the difficult processable ores due to fine dissemination and interlocking of the gold grains with the associated sulphide minerals. This makes it impossible to recover precious metals from sulphide matrices by direct cyanide leaching even at high consumption of cyanide solution. Research to solve this problem is numerous. Application of bacteria shows that, some types of bacteria have great affect on sulphides bio-oxidation and consequently facilitate the leaching process. In this paper, leaching of Saudi gold ore, from Alhura area, containing sulphides before cyanidation is studied to recover gold from such ores applying bacteria. The process is investigated using stirred reactor bio-leaching rather than heap bio-leaching. Using statistical analysis the main affecting variables under studied conditions were identified. The design results indicated that the dose of bacteria, retention time and nutrition K{sub 2}SO{sub 4} are the most significant parameters. The higher the bacterial dose and the bacterial nutrition, the better is the concentrate grade. Results show that the method is technically effective in gold recovery. A gold concentrate containing > 100 g/t gold was obtained at optimum conditions, from an ore containing < 2 g/t gold i.e., 10 ml bacterial dose, 6 days retention time, and 6.5 kg/t K{sub 2}SO{sub 4}as bacteria nutrition. (orig.)

  11. Incision extension is the optimal method of difficult gallbladder extraction at laparoscopic cholecystectomy.

    Science.gov (United States)

    Bordelon, B M; Hobday, K A; Hunter, J G

    1992-01-01

    An unsolved problem of laparoscopic cholecystectomy is the optimal method of removing the gallbladder with thick walls and a large stone burden. Proposed solutions include fascial dilatation, stone crushing, and ultrasonic, high-speed rotary, or laser lithotripsy. Our observation was that extension of the fascial incision to remove the impacted gallbladder was time efficient and did not increase postoperative pain. We reviewed the narcotic requirements of 107 consecutive patients undergoing laparoscopic cholecystectomy. Fifty-two patients required extension of the umbilical incision, and 55 patients did not have their fascial incision enlarged. Parenteral meperidine use was 39.5 +/- 63.6 mg in the patients requiring fascial incision extension and 66.3 +/- 79.2 mg in those not requiring fascial incision extension (mean +/- standard deviation). Oral narcotic requirements were 1.1 +/- 1.5 doses vs 1.3 +/- 1.7 doses in patients with and without incision extension, respectively. The wide range of narcotic use in both groups makes these apparent differences not statistically significant. We conclude that protracted attempts at stone crushing or expensive stone fragmentation devices are unnecessary for the extraction of a difficult gallbladder during laparoscopic cholecystectomy.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Stephanie M Carpenter

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

  14. 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.

  15. 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.

  16. 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.

  17. 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)

  18. 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.

  19. Risk analysis and solving the nuclear waste siting problem

    International Nuclear Information System (INIS)

    Inhaber, H.

    1994-01-01

    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. It allows natural market forces to set the level of compensation, rather than relying on close-door negotiations or theoretical calculations. Two flow charts show the pre-bid and post-bid steps of the reverse Duch auction system of Inhaber. It is assumed that a state wishes to site a waste facility somewhere in its boundaries. 22 refs., 3 figs

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    -specific assessment. Data from patients' pre-operative airway assessment are registered in the Danish Anaesthesia Database. Objective scores for intubation and mask ventilation grade the severity of airway managements. The accuracy of predicting difficult intubation and mask ventilation is measured for each group...... the examination and registration of predictors for difficult mask ventilation with a non-specified clinical airway assessment on prediction of difficult mask ventilation.Method/Design: We cluster-randomized 28 Danish departments of anaesthesia to airway assessment either by the SARI or by usual non...... that registration of the SARI and predictors for difficult mask ventilation are mandatory for the intervention group but invisible to controls....

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

    Directory of Open Access Journals (Sweden)

    D. Faranda

    2017-12-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

  3. Extreme-Scale Bayesian Inference for Uncertainty Quantification of Complex Simulations

    Energy Technology Data Exchange (ETDEWEB)

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

    2018-01-12

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

  4. Adaptive extremal optimization by detrended fluctuation analysis

    International Nuclear Information System (INIS)

    Hamacher, K.

    2007-01-01

    Global optimization is one of the key challenges in computational physics as several problems, e.g. protein structure prediction, the low-energy landscape of atomic clusters, detection of community structures in networks, or model-parameter fitting can be formulated as global optimization problems. Extremal optimization (EO) has become in recent years one particular, successful approach to the global optimization problem. As with almost all other global optimization approaches, EO is driven by an internal dynamics that depends crucially on one or more parameters. Recently, the existence of an optimal scheme for this internal parameter of EO was proven, so as to maximize the performance of the algorithm. However, this proof was not constructive, that is, one cannot use it to deduce the optimal parameter itself a priori. In this study we analyze the dynamics of EO for a test problem (spin glasses). Based on the results we propose an online measure of the performance of EO and a way to use this insight to reformulate the EO algorithm in order to construct optimal values of the internal parameter online without any input by the user. This approach will ultimately allow us to make EO parameter free and thus its application in general global optimization problems much more efficient

  5. 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....

  6. Racial Extremism in the Army

    National Research Council Canada - National Science Library

    Hudson, Walter M

    1998-01-01

    ... modem phenomenon of "skinheads." I then discuss the history of white supremacist extremism in the Army, culminating in the December, 1995 murders of two black civilians by soldiers assigned to the 82d Airborne Division at Fort Bragg, North Carolina...

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

    Science.gov (United States)

    Sunusi, Nurtiti

    2018-03-01

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

  8. Legacies from extreme drought increase ecosystem sensitivity to future extremes

    Science.gov (United States)

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

    2016-12-01

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

  9. 3D seismic experiment in difficult area in Japan; Kokunai nanchiiki ni okeru sanjigen jishin tansa jikken

    Energy Technology Data Exchange (ETDEWEB)

    Minegishi, M; Nakagami, K; Tanaka, H [Japan National Oil Corp., Tokyo (Japan). Technology Research Center

    1997-05-27

    Difficult area in this context means an exploration-difficult area supposed to store oil/gas but retarded in exploration for the lack of knowledge about the geological structure due to poor quality of available seismic survey records. Discussed in this paper is a survey conducted into an area covering the southern part of Noshiro-shi, Akita-ken, and Yamamoto-cho, Yamamoto-gun, Akita-ken. An area size suitable for data collection at a target depth of 2500m is determined using an interpretation structure compiled on the basis of available well data and 2D seismic survey data. The plan for siting shock points and receiving points is modified case by case as restrictive factors come to the surface (resulting from the complicated hilly terrain, presence of pipes for agricultural water, etc.). The peculiarities of seismic waves in the terrain are studied through the interpretation of the available well data and 2D seismic survey data for the construction of a 3D velocity model for the confirmation of the appropriateness of the plan for siting shock points and receiving points. Efforts are exerted through enhanced coordination with the contractor to acquire data so that a technologically best design may be won within the limits of the budget. The quality of the data obtained from this experiment is in general better than those obtained from previous experiments, yet many problems remain to be settled in future studies about exploration-difficult areas. 4 refs., 4 figs., 1 tab.

  10. Global predictability of temperature extremes

    Science.gov (United States)

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

    2018-05-01

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

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

    Science.gov (United States)

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

    2012-08-01

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

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

    Science.gov (United States)

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

    2007-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  14. Between Trauma and Perpetration: Psychoanalytical and Social Psychological Perspectives on Difficult Histories in the Israeli Context

    Science.gov (United States)

    Goldberg, Tsafrir

    2017-01-01

    This study explores the applicability of psychoanalytic trauma-centered perspectives and social psychological intergroup comparison perspectives to difficult histories of the Israeli context. The study describes 2 test cases of difficult histories in the Jewish-Israeli context at the levels of curriculum policy, teachers, and learners. The first…

  15. Difficult Knowledge and the English Classroom: A Catholic Framework Using Cormac McCarthy's "The Road"

    Science.gov (United States)

    Jarvie, Scott; Burke, Kevin

    2015-01-01

    In this article, the authors explore the generative possibilities of risk-taking in the Catholic school English classroom. They associate pedagogical risk with what Deborah Britzman (1998) has called "difficult knowledge"--content that causes students to consider social trauma. Incorporating difficult knowledge meaningfully requires…

  16. Explaining the Mind: Problems, Problems

    OpenAIRE

    Harnad, Stevan

    2001-01-01

    The mind/body problem is the feeling/function problem: How and why do feeling systems feel? The problem is not just "hard" but insoluble (unless one is ready to resort to telekinetic dualism). Fortunately, the "easy" problems of cognitive science (such as the how and why of categorization and language) are not insoluble. Five books (by Damasio, Edelman/Tononi...

  17. Lingual traction to facilitate fiber-optic intubation of difficult airways: a single-anesthesiologist randomized trial.

    Science.gov (United States)

    Ching, Yiu-Hei; Karlnoski, Rachel A; Chen, Henian; Camporesi, Enrico M; Shah, Vimal V; Padhya, Tapan A; Mangar, Devanand

    2015-04-01

    Flexible fiber-optic bronchoscope-guided orotracheal intubation is a valuable technique with demonstrated benefits in the management of difficult airways. Despite its popularity with anesthesia providers, the technique is not fail-safe and airway-related complications secondary to failed intubation attempts remain an important problem. We sought to determine the effect of incorporating lingual traction on the success rate of fiber-optic bronchoscope-guided intubation in patients with anticipated difficult airways. In this prospective, randomized, cohort study, we enrolled 91 adult patients with anticipated difficult airways scheduled for elective surgery to undergo fiber-optic bronchoscope-guided orotracheal intubation alone or with lingual traction by an individual anesthesiologist after induction of general anesthesia and neuromuscular blockade. A total of 78 patients were randomized: 39 patients to the fiber-optic bronchoscope-guided intubation with lingual traction group and 39 patients to the fiber-optic bronchoscope-guided intubation alone group. The primary endpoint was the rate of successful first attempt intubations. The secondary outcome was sore throat grade on post-operative day 1. Fiber-optic intubation with lingual traction compared to fiber-optic intubation alone resulted in a higher success rate (92.3 vs. 74.4 %, χ (2) = 4.523, p = 0.033) and greater odds for successful first attempt intubation (OR 4.138, 95 % CI 1.041-16.444, p = 0.044). Sore throat severity on post-operative day 1 was not significantly different but trended towards worsening grades with lingual traction. In this study, lingual traction was shown to be a valuable maneuver for facilitating fiber-optic bronchoscope-guided intubation in the management of patients with anticipated difficult airways.

  18. 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.  

  19. A compliant mechanism for inspecting extremely confined spaces

    Science.gov (United States)

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

    2017-11-01

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

  20. Improving working equine welfare in 'hard-win' situations, where gains are difficult, expensive or marginal.

    Science.gov (United States)

    Pritchard, Joy; Upjohn, Melissa; Hirson, Tamsin

    2018-01-01

    Brooke is a non-government organisation with working equine welfare programmes across Africa, Asia and Latin America. In 2014, staff from ten country programmes were asked to identify 'no-win' situations (subsequently reframed as 'hard-wins')-where improving equine welfare is proving difficult, expensive and/or marginal-in order to inform strategic decisions on how to approach, manage and mitigate for such situations. The Delphi-type consultation process had three phases. Round 1 posed five questions in the form of a workshop, survey and semi-structured interviews. Round 2 re-presented key themes and sense-checked initial conclusions. Round 3 reviewed the nature and prevalence of hard-win situations at an international meeting of all participants. Reasons given for hard-win situations included: no economic or social benefit from caring for working animals; poor resource availability; lack of empathy for working equids or their owners among wider stakeholders; deep-seated social issues, such as addiction or illegal working; areas with a high animal turnover or migratory human population; lack of community cooperation or cohesion; unsafe areas where welfare interventions cannot be adequately supported. Participants estimated the prevalence of hard-win situations as 40-70% of their work. They suggested some current ways of working that may be contributing to the problem, and opportunities to tackle hard-wins more effectively. Respondents agreed that if equine welfare improvements are to span generations of animals, interventions cannot rely on relatively simple, technical knowledge-transfer strategies and quick-wins alone. Programmes need to be more flexible and iterative and less risk-averse in their approaches to embedding good equine welfare practices in all relevant actors. Consultation recommendations informed development of Brooke's new global strategy, a revised organisational structure and redefinition of roles and responsibilities to streamline ways to

  1. Ideologies and Discourses: Extreme Narratives in Extreme Metal Music

    Directory of Open Access Journals (Sweden)

    Bojana Radovanović

    2016-10-01

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

  2. Prostate Problems

    Science.gov (United States)

    ... know the exact cause of your prostate problem. Prostatitis The cause of prostatitis depends on whether you ... prostate problem in men older than age 50. Prostatitis If you have a UTI, you may be ...

  3. General problems

    International Nuclear Information System (INIS)

    2005-01-01

    This article presents the general problems as natural disasters, consequences of global climate change, public health, the danger of criminal actions, the availability to information about problems of environment

  4. Learning Problems

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Learning Problems KidsHealth / For Kids / Learning Problems What's in ... for how to make it better. What Are Learning Disabilities? Learning disabilities aren't contagious, but they ...

  5. Ankle Problems

    Science.gov (United States)

    ... Read MoreDepression in Children and TeensRead MoreBMI Calculator Ankle ProblemsFollow this chart for more information about problems that can cause ankle pain. Our trusted Symptom Checker is written and ...

  6. The year 2000 problem as seen by manufacturers; Das Jahr-2000-Problem in deutschen Kernkraftwerken. Aus der Sicht der Hersteller

    Energy Technology Data Exchange (ETDEWEB)

    Graf, A. [Siemens AG, Erlangen (Germany). Bereich KWU

    1999-11-01

    The Y2K problem has many facets due mainly to two reasons: The extremely wide use of microcomputers, and the complexity of automation in modern industrial plants. For the past two years, Siemens AG has been checking the Y2K conformity of its products. The result of these investigations is this: All automation equipment, almost without exception, is in conformity with the year 2000 requirements as it works without the date function causing the errors. A few occasional malfunctions were discovered in older computer-supported operating and monitoring stations and in process computer applications. However, malfunctions are not going to cause failures of the system but only make its use more difficult. (orig.) [German] Ursache des Jahr-2000-Problems ist die Unfaehigkeit gewisser aelterer Software, das Jahresdatum 2000 beim Uebergang der letzten beiden Ziffern von '99' auf '00' richtig zu verarbeiten. Potenziell betroffen sind alle Geraete und Systeme, die in irgendeiner Form Rechner oder Mikrorechner enthalten. Das Jahr-2000-Problem ist sehr vielschichtig. Dies resultiert im Wesentlichen aus zwei Gruenden: Der extrem weiten Verbreitung von Mikrorechnern und der Komplexitaet der Automatisierung moderner Industrieanlagen. Die Siemens AG ueberprueft seit zwei Jahren die 2000-Jahr-Konformitaet ihrer Produkte. Ergebnis der Untersuchungen ist: Automatisierungsgeraete sind fast ausnahmslos Jahr-2000 konform, da sie ohne die fehlerverursachenden Datumsfunktionen auskommen. Vereinzelte Fehlfunktionen wurden in aelteren rechnergestuetzten Bedien- und Beobachtungssystemen sowie in Prozessrechneranwendungen gefunden. Fehlfunktionen fuehren jedoch meist nicht zum Versagen des Systems, sondern erschweren nur dessen Nutzung. In den sicherheitsrelevanten Bereichen der Kernkraftwerke werden ausschliesslich die vom Jahr-2000-Problem nicht betroffenen Automatisierungsgeraete eingesetzt. (orig.)

  7. Advanced Dynamically Adaptive Algorithms for Stochastic Simulations on Extreme Scales

    Energy Technology Data Exchange (ETDEWEB)

    Xiu, Dongbin [Univ. of Utah, Salt Lake City, UT (United States)

    2017-03-03

    The focus of the project is the development of mathematical methods and high-performance computational tools for stochastic simulations, with a particular emphasis on computations on extreme scales. The core of the project revolves around the design of highly efficient and scalable numerical algorithms that can adaptively and accurately, in high dimensional spaces, resolve stochastic problems with limited smoothness, even containing discontinuities.

  8. Religious extremism as a challenge to tertiary education in Nigeria ...

    African Journals Online (AJOL)

    Extremists use religion as a shield either for political or economic agenda and manipulate their gullible followers in order to impose their ideology on them. The reality of religious extremism in Nigeria is a challenge to tertiary education to search for a lasting solution that will enable Nigerians overcome the problem and focus ...

  9. Seasonal temperature extremes in Potsdam

    Science.gov (United States)

    Kundzewicz, Zbigniew; Huang, Shaochun

    2010-12-01

    The awareness of global warming is well established and results from the observations made on thousands of stations. This paper complements the large-scale results by examining a long time-series of high-quality temperature data from the Secular Meteorological Station in Potsdam, where observation records over the last 117 years, i.e., from January 1893 are available. Tendencies of change in seasonal temperature-related climate extremes are demonstrated. "Cold" extremes have become less frequent and less severe than in the past, while "warm" extremes have become more frequent and more severe. Moreover, the interval of the occurrence of frost has been decreasing, while the interval of the occurrence of hot days has been increasing. However, many changes are not statistically significant, since the variability of temperature indices at the Potsdam station has been very strong.

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

    Science.gov (United States)

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

    2017-09-01

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

  11. Childhood Obesity: A Heavy Problem

    Science.gov (United States)

    Costley, Kevin C.; Leggett, Timothy

    2010-01-01

    The youth of today are faced with a big problem; they are becoming more obese every day. The time of children playing outside all day and being extremely active has been overtaken by the television and video games. The days of sitting down as a family and eating a good healthy meal has been replaced by the rush to the nearest fast food…

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

    Directory of Open Access Journals (Sweden)

    Nalini Mahajan

    2011-01-01

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

  13. Statistical Model of Extreme Shear

    DEFF Research Database (Denmark)

    Hansen, Kurt Schaldemose; Larsen, Gunner Chr.

    2005-01-01

    In order to continue cost-optimisation of modern large wind turbines, it is important to continuously increase the knowledge of wind field parameters relevant to design loads. This paper presents a general statistical model that offers site-specific prediction of the probability density function...... by a model that, on a statistically consistent basis, describes the most likely spatial shape of an extreme wind shear event. Predictions from the model have been compared with results from an extreme value data analysis, based on a large number of full-scale measurements recorded with a high sampling rate...

  14. Automation Rover for Extreme Environments

    Science.gov (United States)

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

    2017-01-01

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

  15. Extreme Conditions Modeling Workshop Report

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-07-01

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

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

    Science.gov (United States)

    Cotter, James David; Tipton, Michael J

    2014-01-01

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

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

    LENUS (Irish Health Repository)

    Malik, M A

    2009-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Shih-Yi Lee

    2017-09-01

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

  19. Assessment of the Difficult Areas of the Senior Secondary School 2 ...

    African Journals Online (AJOL)

    Assessment of the Difficult Areas of the Senior Secondary School 2 (Two) ... Correlation between the students' perceived difficulty and their achievement in a test and ... Students need counseling, encouragement and enlightenment in order to ...

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Ishwar Singh

    2009-01-01

    Full Text Available The aim of the study was to assess and compare laryngoscopic view of Truview evo2 laryngoscope with that of Macintosh laryngoscope in patients with one or more predictors of difficult intubation (PDI. Moreover ease of intubation with Truview evo2 in terms of absolute time requirement was also aimed at. Patients for elective surgery requiring endotracheal intubation were initially assessed for three PDI parameters - modified Mallampati test, thyro-mental distance& Atlanto-occipital (AO joint extension. Patients with cumulative PDI scores of 2 to 5 (in a scale of 0 to 8 were evaluated for Cormack& Lehane (CL grading by Macintosh blade after standard induction. Cases with CL grade of two or more were further evaluated by Truview evo2 laryngoscope and corresponding CL grades were assigned. Intubation attempted under Truview evo2 vision and time required for each successful tracheal intubation (i.e. tracheal intubation completed within one minute was noted. Total fifty cases were studied. The CL grades assigned by Macintosh blade correlated well with the cumulative PDI scores assigned preoperatively, confirming there predictability. Truview evo2 improved laryngeal view in 92 % cases by one or more CL grade. Intubation with Truview evo2 was possible in 88% cases within stipulated time of one minute and mean time of 28.6 seconds with SD of 11.23 was reasonably quick. No significant complication like oro- pharyngeal trauma or extreme pressor response to laryngoscopy was noticed. To conclude, Truview evo2 proved to be a better tool than conventional laryngoscope in anticipated difficult situations.

  3. Study of neutronic problems related to the xenon instability in the pressurized water reactor

    International Nuclear Information System (INIS)

    Mathonniere, G.

    1988-03-01

    Xenon instabilities lead to increase initial errors. So it is extremely difficult to get an accurate calculation schema able to deal with these problems which are very important for electrical grid whose electronuclear output is large. The main task was to build a tridimensional calculation schema including nuclear, thermal hydraulic feedback. It was qualified by comparing its results with an actual experiment. Many technical problems were investigated through analytical studies or calculation results: time step, spatial mesh, finite element, convergence criterion, modelization for grids and fast control rod moves. Moreover, a 1D model, for less expensive, was studied. Its comparison with the 3D results allowed to check its accuracy and to validate the modelization of the radial laplacien and the modelization of the control rods [fr

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

    Directory of Open Access Journals (Sweden)

    Neamat I. Abdel rahman

    2016-01-01

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

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

    Science.gov (United States)

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

    2011-01-01

    Anesthetic technique in parturient with syringomyelia and Arnold–Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq™ laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold–Chiari type I malformation. PMID:22144932

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

    Directory of Open Access Journals (Sweden)

    Bensghir Mustapha

    2011-01-01

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

  7. New Methodologies for Development of High Efficient Machining of Difficult to Cut Materials

    International Nuclear Information System (INIS)

    Durante, S; Comoglio, M; Rostagno, M

    2011-01-01

    The article focuses on the automotive and aerospace industries. In these industries the need for enhanced materials performance is necessary if they are to remain competitive in global terms. Unfortunately the material properties, which make them so attractive to the aerospace and automotive industry can also make them difficult to machine. This paper will discuss integrated developments in machining techniques and cutting tools, which are emerging to cope with difficult to cut materials.

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

    Science.gov (United States)

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

    2017-12-21

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

  9. Sociale problemer

    DEFF Research Database (Denmark)

    Christensen, Anders Bøggild; Rasmussen, Tove; Bundesen, Peter Verner

    Sociale problemer kan betragtes som selve udgangspunktet for socialt arbejde, hvor ambitionen er at råde bod på problemerne og sikre, at udsatte borgere får en bedre tilværelse. Det betyder også, at diskussionen af sociale problemer er afgørende for den sociale grundfaglighed. I denne bog sætter en...... række fagfolk på tværs af det danske socialfaglige felt fokus på sociale problemer. Det diskuteres, hvad vi overhovedet forstår ved sociale problemer, hvordan de opstår, hvilke konsekvenser de har, og ikke mindst hvordan man som fagprofessionel håndterer sociale problemer i det daglige arbejde. Bogen er...... skrevet som lærebog til professionsuddannelser, hvor sociale problemer udgør en dimension, bl.a. socialrådgiver-, pædagog- og sygeplejerskeuddannelserne....

  10. Extreme conditions (p, T, H)

    Energy Technology Data Exchange (ETDEWEB)

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

    1996-11-01

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

  11. Book review: Extreme ocean waves

    Science.gov (United States)

    Geist, Eric L.

    2011-01-01

    ‘‘Extreme Ocean Waves’’ is a collection of ten papers edited by Efim Pelinovsky and Christian Kharif that followed the April 2007 meeting of the General Assembly of the European Geosciences Union. A note on terminology: extreme waves in this volume broadly encompass different types of waves, includ- ing deep-water and shallow-water rogue waves (alternatively termed freak waves), storm surges from cyclones, and internal waves. Other types of waves such as tsunamis or rissaga (meteotsunamis) are not discussed in this volume. It is generally implied that ‘‘extreme’’ has a statistical connotation relative to the average or significant wave height specific to each type of wave. Throughout the book, in fact, the reader will find a combination of theoretical and statistical/ empirical treatment necessary for the complete examination of this subject. In the introduction, the editors underscore the importance of studying extreme waves, documenting several dramatic instances of damaging extreme waves that occurred in 2007. 

  12. Extreme Energy Events Monitoring report

    CERN Document Server

    Baimukhamedova, Nigina

    2015-01-01

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

  13. Astrobiology: Life in Extreme Environments

    Science.gov (United States)

    Kaur, Preeti

    2011-01-01

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

  14. Nutrition security under extreme events

    Science.gov (United States)

    Martinez, A.

    2017-12-01

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

  15. Malignant bone tumors of the pelvis and of the extremities

    International Nuclear Information System (INIS)

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

    1981-01-01

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

  16. Determining extreme parameter correlation in ground water models

    DEFF Research Database (Denmark)

    Hill, Mary Cole; Østerby, Ole

    2003-01-01

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

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

    Science.gov (United States)

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

    2017-03-01

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

  18. Improving working equine welfare in 'hard-win' situations, where gains are difficult, expensive or marginal.

    Directory of Open Access Journals (Sweden)

    Joy Pritchard

    Full Text Available Brooke is a non-government organisation with working equine welfare programmes across Africa, Asia and Latin America. In 2014, staff from ten country programmes were asked to identify 'no-win' situations (subsequently reframed as 'hard-wins'-where improving equine welfare is proving difficult, expensive and/or marginal-in order to inform strategic decisions on how to approach, manage and mitigate for such situations.The Delphi-type consultation process had three phases. Round 1 posed five questions in the form of a workshop, survey and semi-structured interviews. Round 2 re-presented key themes and sense-checked initial conclusions. Round 3 reviewed the nature and prevalence of hard-win situations at an international meeting of all participants.Reasons given for hard-win situations included: no economic or social benefit from caring for working animals; poor resource availability; lack of empathy for working equids or their owners among wider stakeholders; deep-seated social issues, such as addiction or illegal working; areas with a high animal turnover or migratory human population; lack of community cooperation or cohesion; unsafe areas where welfare interventions cannot be adequately supported. Participants estimated the prevalence of hard-win situations as 40-70% of their work. They suggested some current ways of working that may be contributing to the problem, and opportunities to tackle hard-wins more effectively.Respondents agreed that if equine welfare improvements are to span generations of animals, interventions cannot rely on relatively simple, technical knowledge-transfer strategies and quick-wins alone. Programmes need to be more flexible and iterative and less risk-averse in their approaches to embedding good equine welfare practices in all relevant actors. Consultation recommendations informed development of Brooke's new global strategy, a revised organisational structure and redefinition of roles and responsibilities to

  19. A new extremity dosemeter for beta and gamma radiation

    International Nuclear Information System (INIS)

    Heinzelmann, M.; Pagenkamper, M.

    1988-01-01

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

  20. Important plasma problems in astrophysics

    International Nuclear Information System (INIS)

    Kulsrud, R.M.

    1995-01-01

    In astrophysics, plasmas occur under very extreme conditions. For example, there are ultrastrong magnetic fields in neutron stars, relativistic plasmas around black holes and in jets, extremely energetic particles such as cosmic rays in the interstellar medium, extremely dense plasmas in accretion disks, and extremely large magnetic Reynolds numbers in the interstellar medium. These extreme limits for astrophysical plasmas make plasma phenomena much simpler to analyze in astrophysics than in the laboratory. An understanding of such phenomena often results in an interesting way, by simply taking the extreme limiting case of a known plasma theory. The author will describe one of the more exciting examples and will attempt to convey the excitement he felt when he was first exposed to it. However, not all plasma astrophysical phenomena are so simple. There are certain important plasma phenomena in astrophysics that have not been so easily resolved. In fact, a resolution of them is blocking significant progress in astrophysical research. They have not yet yielded to attacks by theoretical astrophysicists nor to extensive numerical simulation. The author will attempt to describe one of the more important of these plasma--astrophysical problems, and discuss why its resolution is so important to astrophysics. This significant example is fast, magnetic reconnection. Another significant example is the large-magnetic-Reynolds number magnetohydrodynamics (MHD) dynamos

  1. Prevention through policy: Urban macroplastic leakages to the marine environment during extreme rainfall events

    OpenAIRE

    Axelsson, Charles; van Sebille, Erik

    2017-01-01

    The leakage of large plastic litter (macroplastics) into the ocean is a major environmental problem. A significant fraction of this leakage originates from coastal cities, particularly during extreme rainfall events. As coastal cities continue to grow, finding ways to reduce this macroplastic leakage is extremely pertinent. Here, we explore why and how coastal cities can reduce macroplastic leakages during extreme rainfall events. Using nine global cities as a basis, we establish that while c...

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

    Directory of Open Access Journals (Sweden)

    K R Brown

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

  3. [Ethical problems in organ transplantation].

    Science.gov (United States)

    Valenta, J; Treska, V; Hasman, D

    1999-02-01

    Organ transplantation is an accepted therapeutic method with good results, but it is connected with many not only medical but also ethical problems. One of the most important problems is the donor programme. In cadaverous donors the main ethical and legal question is the decision who can issue the consent with organ retrieval; in living donors it is the problem of motivation and financial compensation. Allocation of organs with low compatibility or from non-ideal donors, and the recipient's consent in these cases may involve difficult decisions.

  4. Hearing Problems

    Science.gov (United States)

    ... Read MoreDepression in Children and TeensRead MoreBMI Calculator Hearing ProblemsLoss in the ability to hear or discriminate ... This flow chart will help direct you if hearing loss is a problem for you or a ...

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

    Directory of Open Access Journals (Sweden)

    Juan MORENO, Anders Pape Møller

    2011-06-01

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

  6. A Case Report on Upper Extremity Pain of Cardiac Origin

    Directory of Open Access Journals (Sweden)

    Turgay Altınbilek

    2016-08-01

    Full Text Available Upper extremity pain can originate from the musculoskeletal system, or be a reflection of problems originating from various organs. Therefore, it is highly important to perform a detailed clinical evaluation on patients during differential diagnosis. In this case report, we present a 61 year-old male patient who was admitted with pain in both upper extremities and the upper back that presumed to be of cardiac origin following our clinical evaluations. The patient was referred to the cardiology department, where he was diagnosed with coronary heart disease. The patient’s complaints of pain were fully resolved through the application of an intracoronary stent.

  7. Classification of Near-Horizon Geometries of Extremal Black Holes.

    Science.gov (United States)

    Kunduri, Hari K; Lucietti, James

    2013-01-01

    Any spacetime containing a degenerate Killing horizon, such as an extremal black hole, possesses a well-defined notion of a near-horizon geometry. We review such near-horizon geometry solutions in a variety of dimensions and theories in a unified manner. We discuss various general results including horizon topology and near-horizon symmetry enhancement. We also discuss the status of the classification of near-horizon geometries in theories ranging from vacuum gravity to Einstein-Maxwell theory and supergravity theories. Finally, we discuss applications to the classification of extremal black holes and various related topics. Several new results are presented and open problems are highlighted throughout.

  8. The Difficult Patron Situation: A Window of Opportunity To Improve Library Service.

    Science.gov (United States)

    Sarkodie-Mensah, Kwasi

    2000-01-01

    Discusses the problem library patron from various fronts: historical, personality traits, importance of complaints, nature and types of problem patrons and their behavior, technology and the newly-bred problem patron, strategies for dealing with problem patrons, and ensuring that library administrators and other supervisors understand the need to…

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

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

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

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

    Directory of Open Access Journals (Sweden)

    Gernot Horstmann

    2016-08-01

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

  11. Flow cytometry of duodenal intraepithelial lymphocytes improves diagnosis of celiac disease in difficult cases.

    Science.gov (United States)

    Valle, Julio; Morgado, José Mario T; Ruiz-Martín, Juan; Guardiola, Antonio; Lopes-Nogueras, Miriam; García-Vela, Almudena; Martín-Sacristán, Beatriz; Sánchez-Muñoz, Laura

    2017-10-01

    Diagnosis of celiac disease is difficult when the combined results of serology and histology are inconclusive. Studies using flow cytometry of intraepithelial lymphocytes (IELs) have found that celiac patients have increased numbers of γδ IELs, along with a decrease in CD3-CD103 + IELs. The objective of this article is to assess the role of flow cytometric analysis of IELs in the diagnosis of celiac disease in difficult cases. A total of 312 patients with suspicion of celiac disease were included in the study. Duodenal biopsy samples were used for histological assessment and for flow cytometric analysis of IELs. In 46 out of 312 cases (14.7%) the combination of serology and histology did not allow the confirmation or exclusion of celiac disease. HLA typing had been performed in 42 of these difficult cases. Taking into account HLA typing and the response to a gluten-free diet, celiac disease was excluded in 30 of these cases and confirmed in the remaining 12. Flow cytometric analysis of IELs allowed a correct diagnosis in 39 out of 42 difficult cases (92.8%) and had a sensitivity of 91.7% (95% CI: 61.5% to 99.8%) and a specificity of 93.3% (95% CI: 77.9% to 99.2%) for the diagnosis of celiac disease in this setting. Flow cytometric analysis of IELs is useful for the diagnosis of celiac disease in difficult cases.

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

    Science.gov (United States)

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

    2016-01-01

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

  13. Deterring violent extremism in America by utilizing good counter-radicalization practices from abroad: a policy perspective

    OpenAIRE

    Bonanno, Amy Fires

    2017-01-01

    Approved for public release; distribution is unlimited The problem of violent extremism is approaching a critical point in America. American government and community leaders must find an effective approach to deterring violent extremism immediately. A national and comprehensive approach to deter violent extremism in America is currently lacking. This comparative policy perspective seeks to determine whether the United Kingdom and Australia have good practices to deter violent extremism tha...

  14. Extreme Conditions Modeling Workshop Report

    Energy Technology Data Exchange (ETDEWEB)

    Coe, Ryan Geoffrey [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Neary, Vincent Sinclair [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Lawon, Michael J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Yu, Yi-Hsiang [National Renewable Energy Lab. (NREL), Golden, CO (United States); Weber, Jochem [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2014-07-01

    Sandia National Laboratories (SNL) and the National Renewable Energy Laboratory (NREL) hosted the Wave Energy Converter (WEC) Extreme Conditions Modeling (ECM) Workshop in Albuquerque, New Mexico on May 13–14, 2014. The objective of the workshop was to review the current state of knowledge on how to numerically and experimentally model WECs in extreme conditions (e.g. large ocean storms) and to suggest how national laboratory resources could be used to improve ECM methods for the benefit of the wave energy industry. More than 30 U.S. and European WEC experts from industry, academia, and national research institutes attended the workshop, which consisted of presentations from W EC developers, invited keynote presentations from subject matter experts, breakout sessions, and a final plenary session .

  15. Extreme project. Progress report 2006

    International Nuclear Information System (INIS)

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

    2007-01-01

    The E.X.T.R.E.M.E. project introduced in 2005 to the S.E.S.U.R.E. / L.E.R.C.M. has for objectives to acquire data on the consequences of the extreme climatic meteorological episodes on the distribution of the artificial radioisotopes within the various compartments of the geosphere. This report presents the synthesis of the actions developed in 2006 in positioning and in co financing of the project by means of regional or national research programs (C.A.R.M.A., E.X.T.R.E.M.A., E.C.C.O.R.E.V.I.), of data acquisition, valuation and scientific collaboration. (N.C.)

  16. On causality of extreme events

    Directory of Open Access Journals (Sweden)

    Massimiliano Zanin

    2016-06-01

    Full Text Available Multiple metrics have been developed to detect causality relations between data describing the elements constituting complex systems, all of them considering their evolution through time. Here we propose a metric able to detect causality within static data sets, by analysing how extreme events in one element correspond to the appearance of extreme events in a second one. The metric is able to detect non-linear causalities; to analyse both cross-sectional and longitudinal data sets; and to discriminate between real causalities and correlations caused by confounding factors. We validate the metric through synthetic data, dynamical and chaotic systems, and data representing the human brain activity in a cognitive task. We further show how the proposed metric is able to outperform classical causality metrics, provided non-linear relationships are present and large enough data sets are available.

  17. Extreme Nonlinear Optics An Introduction

    CERN Document Server

    Wegener, Martin

    2005-01-01

    Following the birth of the laser in 1960, the field of "nonlinear optics" rapidly emerged. Today, laser intensities and pulse durations are readily available, for which the concepts and approximations of traditional nonlinear optics no longer apply. In this regime of "extreme nonlinear optics," a large variety of novel and unusual effects arise, for example frequency doubling in inversion symmetric materials or high-harmonic generation in gases, which can lead to attosecond electromagnetic pulses or pulse trains. Other examples of "extreme nonlinear optics" cover diverse areas such as solid-state physics, atomic physics, relativistic free electrons in a vacuum and even the vacuum itself. This book starts with an introduction to the field based primarily on extensions of two famous textbook examples, namely the Lorentz oscillator model and the Drude model. Here the level of sophistication should be accessible to any undergraduate physics student. Many graphical illustrations and examples are given. The followi...

  18. Promoting Exit from Violent Extremism

    DEFF Research Database (Denmark)

    Dalgaard-Nielsen, Anja

    2013-01-01

    A number of Western countries are currently adding exit programs targeting militant Islamists to their counterterrorism efforts. Drawing on research into voluntary exit from violent extremism, this article identifies themes and issues that seem to cause doubt, leading to exit. It then provides a ...... the influence attempt as subtle as possible, use narratives and self-affirmatory strategies to reduce resistance to persuasion, and consider the possibility to promote attitudinal change via behavioral change as an alternative to seek to influence beliefs directly....

  19. Racial Extremism in the Army

    Science.gov (United States)

    1998-04-01

    of Deference ...................................................................................................... 46 1. The Separation of Powers Doctrine...to the military. This deference has a two-fold basis. First, the separation of powers in the U.S. Constitution gives authority to the executive (and...Why should there be judicial deference to the Army’s policy on extremism? There are two principal reasons. First, the Constitution’s separation of powers doctrine

  20. Large Extremity Peripheral Nerve Repair

    Science.gov (United States)

    2016-12-01

    LM, de Crombrugghe B. Some recent advances in the chemistry and biology of trans- forming growth factor-beta. J Cell Biol 1987;105:1039e45. 12. Hao Y...SUPPLEMENTARY NOTES 14. ABSTRACT In current war trauma, 20-30% of all extremity injuries and >80% of penetrating injuries being associated with peripheral nerve...through both axonal advance and in revascularization of the graft following placement. We are confident that this technology may allow us to

  1. Problem Posing

    OpenAIRE

    Šilhavá, Marie

    2009-01-01

    This diploma thesis concentrates on problem posing from the students' point of view. Problem posing can be either seen as a teaching method which can be used in the class, or it can be used as a tool for researchers or teachers to assess the level of students' understanding of the topic. In my research, I compare three classes, one mathematics specialist class and two generalist classes, in their ability of problem posing. As an assessment tool it seemed that mathemathics specialists were abl...

  2. Reviewing Hit Discovery Literature for Difficult Targets: Glutathione Transferase Omega-1 as an Example.

    Science.gov (United States)

    Xie, Yiyue; Dahlin, Jayme L; Oakley, Aaron J; Casarotto, Marco G; Board, Philip G; Baell, Jonathan B

    2018-05-10

    Early stage drug discovery reporting on relatively new or difficult targets is often associated with insufficient hit triage. Literature reviews of such targets seldom delve into the detail required to critically analyze the associated screening hits reported. Here we take the enzyme glutathione transferase omega-1 (GSTO1-1) as an example of a relatively difficult target and review the associated literature involving small-molecule inhibitors. As part of this process we deliberately pay closer-than-usual attention to assay interference and hit quality aspects. We believe this Perspective will be a useful guide for future development of GSTO1-1 inhibitors, as well serving as a template for future review formats of new or difficult targets.

  3. The primary study of fistulae isolation for difficult-cured traumatic carotid cavernous by two accesses

    International Nuclear Information System (INIS)

    Wang Ziliang; Li Tianxiao; Zhai Shuiting; Cao Huicun; Xu Jiangyu; Bai Weixing; Liu Jian

    2007-01-01

    Objective: To investigate the feasibility and security of the isolation of fistulae for difficult-cured traumatic carotid cavernous by the anterio or inferior communicating artery. Methods: Five patients with difficult-cured TCCF including four males and one female. They were cathetered by both femoral arteries. Balloon-catheter directly attached to the near of fistulae and microcatheter conversely attached to the far of fistulae. Detachable balloons and micro coils were used to isolated the fistulae. Results: Five patients were cured with fistulae isolation and angiography did not show remnants fistulae in time. Clinical signs and symptoms got better and better. During follows-up no one recurred. Conclusions: The isolation of fistulae is a feasible and secure therapy for the difficult-cured traumatic direct carotid cavernous fistulae. (authors)

  4. Treatment of psychological factors in a child with difficult asthma: a case report.

    Science.gov (United States)

    Anbar, Ran D; Sachdeva, Shagun

    2011-07-01

    Difficult asthma is defined as the persistence of asthma symptoms, abnormal pulmonary function showing airway obstruction, and continued requirement for short-acting bronchodilator therapy, despite adequate treatment with inhaled corticosteroids. It calls for a thorough evaluation of the patient to look into alternate and complicating diagnoses. The authors report a case of a 9-year-old patient with difficult asthma who failed to respond to conventional therapy. Although it was recognized that he had a number of potential medical complicating factors including allergies, chronic sinusitis, and gastroesophageal reflux, a psychological intervention using hypnosis ultimately appeared to help alleviate his symptoms completely. Thus, psychological evaluation and intervention should be considered early in the course of management of a patient with difficult asthma, because it may help avoid time-consuming and expensive investigations of potential complicating factors, and it may yield rapid improvement in the patient's clinical condition.

  5. Typologies of extreme longevity myths.

    Science.gov (United States)

    Young, Robert D; Desjardins, Bertrand; McLaughlin, Kirsten; Poulain, Michel; Perls, Thomas T

    2010-01-01

    Purpose. Political, national, religious, and other motivations have led the media and even scientists to errantly accept extreme longevity claims prima facie. We describe various causes of false claims of extraordinary longevity. Design and Methods. American Social Security Death Index files for the period 1980-2009 were queried for individuals with birth and death dates yielding ages 110+ years of age. Frequency was compared to a list of age-validated supercentenarians maintained by the Gerontology Research Group who died during the same time period. Age claims of 110+ years and the age validation experiences of the authors facilitated a list of typologies of false age claims. Results. Invalid age claim rates increase with age from 65% at age 110-111 to 98% by age 115 to 100% for 120+ years. Eleven typologies of false claims were: Religious Authority Myth, Village Elder Myth, Fountain of Youth Myth (substance), Shangri-La Myth (geographic), Nationalist Pride, Spiritual Practice, Familial Longevity, Individual and/or Family Notoriety, Military Service, Administrative Entry Error, and Pension-Social Entitlement Fraud. Conclusions. Understanding various causes of false extreme age claims is important for placing current, past, and future extreme longevity claims in context and for providing a necessary level of skepticism.

  6. Moderate and extreme maternal obesity.

    LENUS (Irish Health Repository)

    Abdelmaboud, M O

    2012-05-01

    The aim of this study was to investigate the prevalence of moderate and extreme obesity among an Irish obstetric population over a 10-year period, and to evaluate the obstetric features of such pregnancies. Of 31,869 women delivered during the years 2000-2009, there were 306 women in the study group, including 173 in the moderate or Class 2 obese category (BMI 35-39.9) and 133 in the extreme or Class 3 obese category (BMI > or = 40).The prevalence of obese women with BMI > or = 35 was 9.6 per 1000 (0.96%), with an upward trend observed from 2.1 per 1000 in the year 2000, to 11.8 per 1000 in the year 2009 (P = 0.001). There was an increase in emergency caesarean section (EMCS) risk for primigravida versus multigravid women, within both obese categories (P < 0.001). However, there was no significant difference in EMCS rates observed between Class 2 and Class 3 obese women, when matched for parity. The prevalence of moderate and extreme obesity reported in this population is high, and appears to be increasing. The increased rates of abdominal delivery, and the levels of associated morbidity observed, have serious implications for such women embarking on pregnancy.

  7. Attribution of climate extreme events

    Science.gov (United States)

    Trenberth, Kevin E.; Fasullo, John T.; Shepherd, Theodore G.

    2015-08-01

    There is a tremendous desire to attribute causes to weather and climate events that is often challenging from a physical standpoint. Headlines attributing an event solely to either human-induced climate change or natural variability can be misleading when both are invariably in play. The conventional attribution framework struggles with dynamically driven extremes because of the small signal-to-noise ratios and often uncertain nature of the forced changes. Here, we suggest that a different framing is desirable, which asks why such extremes unfold the way they do. Specifically, we suggest that it is more useful to regard the extreme circulation regime or weather event as being largely unaffected by climate change, and question whether known changes in the climate system's thermodynamic state affected the impact of the particular event. Some examples briefly illustrated include 'snowmaggedon' in February 2010, superstorm Sandy in October 2012 and supertyphoon Haiyan in November 2013, and, in more detail, the Boulder floods of September 2013, all of which were influenced by high sea surface temperatures that had a discernible human component.

  8. Typologies of Extreme Longevity Myths

    Directory of Open Access Journals (Sweden)

    Robert D. Young

    2010-01-01

    Full Text Available Purpose. Political, national, religious, and other motivations have led the media and even scientists to errantly accept extreme longevity claims prima facie. We describe various causes of false claims of extraordinary longevity. Design and Methods. American Social Security Death Index files for the period 1980–2009 were queried for individuals with birth and death dates yielding ages 110+ years of age. Frequency was compared to a list of age-validated supercentenarians maintained by the Gerontology Research Group who died during the same time period. Age claims of 110+ years and the age validation experiences of the authors facilitated a list of typologies of false age claims. Results. Invalid age claim rates increase with age from 65% at age 110-111 to 98% by age 115 to 100% for 120+ years. Eleven typologies of false claims were: Religious Authority Myth, Village Elder Myth, Fountain of Youth Myth (substance, Shangri-La Myth (geographic, Nationalist Pride, Spiritual Practice, Familial Longevity, Individual and/or Family Notoriety, Military Service, Administrative Entry Error, and Pension-Social Entitlement Fraud. Conclusions. Understanding various causes of false extreme age claims is important for placing current, past, and future extreme longevity claims in context and for providing a necessary level of skepticism.

  9. Metacognition: Student Reflections on Problem Solving

    Science.gov (United States)

    Wismath, Shelly; Orr, Doug; Good, Brandon

    2014-01-01

    Twenty-first century teaching and learning focus on the fundamental skills of critical thinking and problem solving, creativity and innovation, and collaboration and communication. Metacognition is a crucial aspect of both problem solving and critical thinking, but it is often difficult to get students to engage in authentic metacognitive…

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Teena Bansal

    2016-04-01

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

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

    CERN Document Server

    Shaw, Peter J A

    2010-01-01

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

  13. The importance of subjective facial appearance on the ability of anesthesiologists to predict difficult intubation.

    Science.gov (United States)

    Connor, Christopher W; Segal, Scott

    2014-02-01

    Previously we demonstrated that a computer algorithm based on bedside airway examinations and facial photographs accurately classified easy and difficult airways. The extent of the ability of anesthesiologists to perform the same task is unknown. We hypothesized that providing photographs would add to the predictive ability of anesthesiologists over that achieved when provided only with the Mallampati (MP) score and the thyromental distance (TMD). We further hypothesized that human observers would implicitly bias their predictions toward more sensitive determination of difficult airways, rather than more specific determination of easy airways. Residents, fellows, and attending anesthesiologists with varying levels of experience (N = 160) were presented with MP and TMD information from 80 Caucasian men subjects. The same subjects' data, accompanied by 3 facial photographs in head-on and right and left profiles, were also presented. Anesthesiologists classified the airways as easy or difficult according to specified criteria ("easy" defined as a single attempt with a Macintosh 3 blade resulting in a grade 1 laryngoscopic view; "difficult" defined as >1 attempt by an operator with at least 12 months anesthesia experience, grade 3 or 4 laryngoscopic view, need for a second operator, or nonelective use of an alternative airway device). Accuracy, sensitivity, and specificity were calculated for each anesthesiologist. We further developed a cost function to quantify a relative bias toward avoiding an unexpectedly difficult intubation versus overpreparing for an easy intubation. One hundred sixty respondents completed the study. Presenting photographs improved respondents' sensitivity and accuracy in classifying airways, though specificity decreased slightly. Overall accuracy when given photographs was 61.6% (95% confidence interval, 60.8%-62.4%), which was significantly lower than the computer's performance of 87.5% (t test, P interval, 4.9:1-8.4:1). Anesthesiologists can

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

    Science.gov (United States)

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

    2017-08-01

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

  15. Assessment of the storz video Macintosh laryngoscope for use in difficult airways: A human simulator study.

    Science.gov (United States)

    Bair, Aaron E; Olmsted, Kalani; Brown, Calvin A; Barker, Tobias; Pallin, Daniel; Walls, Ron M

    2010-10-01

    Video laryngoscopy has been shown to improve glottic exposure when compared to direct laryngoscopy in operating room studies. However, its utility in the hands of emergency physicians (EPs) remains undefined. A simulated difficult airway was used to determine if intubation by EPs using a video Macintosh system resulted in an improved glottic view, was easier, was faster, or was more successful than conventional direct laryngoscopy. Emergency medicine (EM) residents and attending physicians at two academic institutions performed endotracheal intubation in one normal and two identical difficult airway scenarios. With the difficult scenarios, the participants used video laryngoscopy during the second case. Intubations were performed on a medium-fidelity human simulator. The difficult scenario was created by limiting cervical spine mobility and inducing trismus. The primary outcome was the proportion of direct versus video intubations with a grade I or II Cormack-Lehane glottic view. Ease of intubation (self-reported via 10-cm visual analog scale [VAS]), time to intubation, and success rate were also recorded. Descriptive statistics as well as medians with interquartile ranges (IQRs) are reported where appropriate. The Wilcoxon matched pairs signed-rank test was used for comparison testing of nonparametric data. Participants (n = 39) were residents (59%) and faculty. All had human intubation experience; 51% reported more than 100 prior intubations. On difficult laryngoscopy, a Cormack-Lehane grade I or II view was obtained in 20 (51%) direct laryngoscopies versus 38 (97%) of the video-assisted laryngoscopies (p < 0.01). The median VAS score for difficult airways was 50 mm (IQR = 28–73 mm) for direct versus 18 mm (IQR = 9–50 mm) for video (p < 0.01). The median time to intubation in difficult airways was 25 seconds (IQR = 16–44 seconds) for direct versus 20 seconds (IQR = 12–35 seconds) for video laryngoscopy (p < 0.01). All intubations were successful without

  16. Popular Problems

    DEFF Research Database (Denmark)

    Skovhus, Randi Boelskifte; Thomsen, Rie

    2017-01-01

    This article introduces a method to critical reviews and explores the ways in which problems have been formulated in knowledge production on career guidance in Denmark over a 10-year period from 2004 to 2014. The method draws upon the work of Bacchi focussing on the ‘What's the problem represented...... to be’ (WPR) approach. Forty-nine empirical studies on Danish youth career guidance were included in the study. An analysis of the issues in focus resulted in nine problem categories. One of these, ‘targeting’, is analysed using the WPR approach. Finally, the article concludes that the WPR approach...... provides a constructive basis for a critical analysis and discussion of the collective empirical knowledge production on career guidance, stimulating awareness of problems and potential solutions among the career guidance community....

  17. Sleep Problems

    Science.gov (United States)

    ... For Consumers Consumer Information by Audience For Women Sleep Problems Share Tweet Linkedin Pin it More sharing ... 101 KB) En Español Medicines to Help You Sleep Tips for Better Sleep Basic Facts about Sleep ...

  18. Mouth Problems

    Science.gov (United States)

    ... such as sores, are very common. Follow this chart for more information about mouth problems in adults. ... cancers. See your dentist if sharp or rough teeth or dental work are causing irritation. Start OverDiagnosisThis ...

  19. Kidney Problems

    Science.gov (United States)

    ... our e-newsletter! Aging & Health A to Z Kidney Problems Basic Facts & Information The kidneys are two ... kidney (renal) diseases are called nephrologists . What are Kidney Diseases? For about one-third of older people, ...

  20. Prospect for extreme field science

    Energy Technology Data Exchange (ETDEWEB)

    Tajima, T. [Ludwig Maximilian Univ. and Max Planck Institute for Quantum Optics, Garching (Germany); Japan Atomic Energy Agency, Kyoto and KEK, Tsukuba (Japan)

    2009-11-15

    The kind of laser extreme light infrastructure (ELI) provides will usher in a class of experiments we have only dreamed of for years. The characteristics that ELI brings in include: the highest intensity ever, large fluence, and relatively high repetition rate. A personal view of the author on the prospect of harnessing this unprecedented opportunity for advancing science of extreme fields is presented. The first characteristic of ELI, its intensity, will allow us to access, as many have stressed already, extreme fields that hover around the Schwinger field or at the very least the neighboring fields in which vacuum begins to behave as a nonlinear medium. In this sense, we are seriously probing the 'material' property of vacuum and thus the property that theory of relativity itself described and will entail. We will probe both special theory and general theory of relativity in regimes that have been never tested so far. We may see a glimpse into the reach of relativity or even its breakdown in some extreme regimes. We will learn Einstein and may even go beyond Einstein, if our journey is led. Laser-driven acceleration both by the laser field itself and by the wakefield that is triggered in a plasma is huge. Energies, if not luminosity, we can access, may be unprecedented going far beyond TeV. The nice thing about ELI is that it has relatively high repetition rate and average fluence as compared with other extreme lasers. This high fluence can be a key element that leads to applications to high energy physics, such as gamma-gamma collider driver experiment, and some gamma ray experiments that may be relevant in the frontier of photo-nuclear physics, and atomic energy applications. Needless to say, high fluence is one of most important features that industrial and medical applications may need. If we are lucky, we may see a door opens at the frontier of novel physics that may not be available by any other means. (authors)

  1. Knapsack problems

    CERN Document Server

    Kellerer, Hans; Pisinger, David

    2004-01-01

    Thirteen years have passed since the seminal book on knapsack problems by Martello and Toth appeared. On this occasion a former colleague exclaimed back in 1990: "How can you write 250 pages on the knapsack problem?" Indeed, the definition of the knapsack problem is easily understood even by a non-expert who will not suspect the presence of challenging research topics in this area at the first glance. However, in the last decade a large number of research publications contributed new results for the knapsack problem in all areas of interest such as exact algorithms, heuristics and approximation schemes. Moreover, the extension of the knapsack problem to higher dimensions both in the number of constraints and in the num­ ber of knapsacks, as well as the modification of the problem structure concerning the available item set and the objective function, leads to a number of interesting variations of practical relevance which were the subject of intensive research during the last few years. Hence, two years ago ...

  2. Digital dice computational solutions to practical probability problems

    CERN Document Server

    Nahin, Paul J

    2013-01-01

    Some probability problems are so difficult that they stump the smartest mathematicians. But even the hardest of these problems can often be solved with a computer and a Monte Carlo simulation, in which a random-number generator simulates a physical process, such as a million rolls of a pair of dice. This is what Digital Dice is all about: how to get numerical answers to difficult probability problems without having to solve complicated mathematical equations. Popular-math writer Paul Nahin challenges readers to solve twenty-one difficult but fun problems, from determining the

  3. Non-Stationary Dependence Structures for Spatial Extremes

    KAUST Repository

    Huser, Raphaël

    2016-03-03

    Max-stable processes are natural models for spatial extremes because they provide suitable asymptotic approximations to the distribution of maxima of random fields. In the recent past, several parametric families of stationary max-stable models have been developed, and fitted to various types of data. However, a recurrent problem is the modeling of non-stationarity. In this paper, we develop non-stationary max-stable dependence structures in which covariates can be easily incorporated. Inference is performed using pairwise likelihoods, and its performance is assessed by an extensive simulation study based on a non-stationary locally isotropic extremal t model. Evidence that unknown parameters are well estimated is provided, and estimation of spatial return level curves is discussed. The methodology is demonstrated with temperature maxima recorded over a complex topography. Models are shown to satisfactorily capture extremal dependence.

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

    Science.gov (United States)

    Ummenhofer, Caroline C; Meehl, Gerald A

    2017-06-19

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

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

    Science.gov (United States)

    Wolke, Dieter; St. James-Roberts, Ian

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

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

    Directory of Open Access Journals (Sweden)

    Fabíola Maria Sabino Meireles

    2013-03-01

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

  7. How to Handle Difficult Parents: Proven Solutions for Teachers. Second Edition

    Science.gov (United States)

    Tingley, Suzanne Capek

    2012-01-01

    "How to Handle Difficult Parents" is a funny, but practical, guide to working effectively with parents and avoiding unnecessary conflict. Whether you're a teacher (regular or special education) or a coach, this book will give you practical suggestions regarding what to say and how to say it to parents who question your lesson plans, challenge your…

  8. Prehospital prognosis is difficult in patients with acute exacerbation of chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Lindvig, Katrine P.; Brøchner, Anne C.; Lassen, Annmarie T.

    2017-01-01

    in the form of intubation. The emergency physician faces difficult treatment decisions, however, and prognostic tools that could assist in determining which patients would benefit from intubation and ventilator support would be helpful. The aim of the current study was to identify prehospital clinical...

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

    Science.gov (United States)

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

    2016-01-01

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

  10. Long-Term Memory for Pictures under Conditions of Difficult Foil Discriminability.

    Science.gov (United States)

    Homa, Donald; Viera, Cynthia

    Research has demonstrated that subjects are sensitive to both thematic and non-thematic information in pictorial stimuli. Three experiments were conducted to investigate memory for pictures under conditions of difficult foil discriminability and lengthy retention intervals. The foils differed from the studied persons in the number and quality of…

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

    Directory of Open Access Journals (Sweden)

    Walid Kerkeni

    2015-06-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2018-04-01

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

  14. Has it become more difficult for young households in rental housing to become homeowners?

    DEFF Research Database (Denmark)

    Skak, Morten; Bloze, Gintautas

    2013-01-01

    by increased income inequality. In this paper we present calculations of the number of month it takes for an average young wage earner family that is presently in a tenant position to save 10 per cent of the average dwelling value. Our calculations show that it has become more difficult for young families...

  15. Difficult Dialogues, Rewarding Solutions: Strategies to Expand Postsecondary Opportunities While Controlling Costs

    Science.gov (United States)

    Immerwahr, John

    2009-01-01

    This report from Public Agenda is a summary of the process and outcomes of the "Difficult Dialogues" that took place in November 2008 at the 4th annual policy summit of the Midwestern Higher Education Compact (MHEC). Nearly 200 state legislators, institutional and system-level leaders and governing board members, faculty, executive…

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-05-15

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

  17. Intraabdominal actinomycosis resulting in a difficult to diagnose intraperitoneal mass: A case report.

    Science.gov (United States)

    Tsujimura, Naoto; Takemoto, Hiroyoshi; Nakahara, Yujiro; Wakasugi, Masaki; Matsumoto, Takashi; Nishioka, Kiyonori; Takachi, Kou; Oshima, Satoshi; Yoshida, Kyotaro

    2018-01-01

    Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces israelii. Preoperative confirmed diagnosis is very difficult, so most cases are diagnosed preoperatively as malignant tumors. We report a case of intraabdominal actinomycosis which was difficult to diagnose preoperatively. A woman, 60 years old, experienced discomfort in her lower right abdomen. She complained of nausea and anorexia and visited our hospital. Laboratory blood tests, abdominal CT, and abdominal MRI led to a diagnosis of a uterine sarcoma or primary intestinal mass, and she underwent surgery. Her histopathological diagnosis was intraabdominal actinomycosis. Actinomycosis is a chronic purulent granulomatous inflammation caused by Actinomyces israelii. No clinical symptoms or laboratory findings are characteristic of abdominal actinomycosis, so this disorder is very difficult to diagnose preoperatively. Therefore, many cases are diagnosed as malignant tumors and undergo surgery. After surgery, long-term antibiotic treatment (penicillin) is usually administered. We reported a case of intraabdominal actinomycosis that resulted in a difficult to diagnose intraperitoneal mass. When a large intraperitoneal mass is found, actinomycosis needs to be included as one of differential diagnoses. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

    Science.gov (United States)

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

    2010-01-01

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

  19. "Everything Is about Balance": Graduate Education Faculty and the Navigation of Difficult Discourses on Race

    Science.gov (United States)

    Murray-Johnson, Kayon; Ross-Gordon, Jovita M.

    2018-01-01

    The purpose of this multiple case study was to describe the experiences of graduate education faculty of varying racial/ethnic backgrounds, learning to navigate difficult discourses on race effectively over time. The study employed positionality as a theoretical framework. Findings indicate that faculty balance what we refer to as "strategies…

  20. Difficult airways: a reliable “Plan B” | Bishop | Southern African ...

    African Journals Online (AJOL)

    Percutaneous transtracheal jet ventilation (PTJV) is an accepted method of rescue ventilation following unsuccessful attempts to secure the airway through conventional methods. Pre-emptive use of PTJV in the difficult airway has also been described as using either a specifically designed jet ventilation catheter, or other ...

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

    Science.gov (United States)

    Segall, Avner

    2014-01-01

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

  2. Successful difficult airway management of a child with Coffin-siris syndrome.

    Science.gov (United States)

    Ozkan, Ahmet Selim; Akbas, Sedat; Yalin, Mehmet Ridvan; Ozdemir, Emine; Koylu, Zeynep

    2017-08-01

    Management of airway in patients who have Coffin-Siris syndrome (CSS) is often problematic because most of these patients have difficult airway. NTI via C-MAC VL is an useful alternative to direct laryngoscope for orotracheal intubation in airway and anesthetic management in a case of CSS. Alternative airway devices should be readily available.

  3. Successful difficult airway management of a child with Coffin?siris syndrome

    OpenAIRE

    Ozkan, Ahmet Selim; Akbas, Sedat; Yalin, Mehmet Ridvan; Ozdemir, Emine; Koylu, Zeynep

    2017-01-01

    Key Clinical Message Management of airway in patients who have Coffin?Siris syndrome (CSS) is often problematic because most of these patients have difficult airway. NTI via C?MAC VL is an useful alternative to direct laryngoscope for orotracheal intubation in airway and anesthetic management in a case of CSS. Alternative airway devices should be readily available.

  4. Vulnerability as a Key Concept in Museum Pedagogy on Difficult Matters

    Science.gov (United States)

    Tinning, Katrine

    2018-01-01

    In recent years there has been an increasing interest in museum studies in exhibitions on what is termed Difficult Matters (Silvén and Björklund 2006)--such as rape and mass murder--and how such exhibitions may evoke ethical change. This raises the question about the conditions on which such exhibitions can lead to an ethical change. By developing…

  5. Assessment of risk factors responsible for difficult weaning from mechanical ventilation in adults

    Directory of Open Access Journals (Sweden)

    Yehia Khalil

    2012-07-01

    Conclusion: All potential causes of ventilator dependency should be identified when a patient is difficult-to-wean. Then, a plan should be developed that uses a multidisciplinary team approach to correct the reversible causes of weaning failure and facilitates weaning thereafter.

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

    Directory of Open Access Journals (Sweden)

    Mehmet Turan Inal

    2014-12-01

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

  7. Do Early Difficult Temperament and Harsh Parenting Differentially Predict Reactive and Proactive Aggression?

    Science.gov (United States)

    Vitaro, Frank; Barker, Edward Dylan; Boivin, Michel; Brendgen, Mara; Tremblay, Richard E.

    2006-01-01

    The goal of this study was to examine the links between difficult temperament (i.e., negative emotionality) and harsh parental discipline during toddlerhood, and reactive and proactive aggression in kindergarten. These links were assessed on a longitudinal population-based study of 1516 boys and girls followed longitudinally from the age of 17…

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

    Science.gov (United States)

    Mintz, Avi I.

    2010-01-01

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

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

    Science.gov (United States)

    Keller, Eric

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Huang AS

    2016-11-01

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

  11. Combination therapy versus monotherapy for gastroesophageal reflux in children with difficult-to-treat bronchial asthma

    Directory of Open Access Journals (Sweden)

    Adel Salah Bediwy

    2014-01-01

    Conclusions: Combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test (C-ACT and FEV1 (% of predicted and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma.

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

    Science.gov (United States)

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

    2015-01-01

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

  13. Robust Matching Pursuit Extreme Learning Machines

    Directory of Open Access Journals (Sweden)

    Zejian Yuan

    2018-01-01

    Full Text Available Extreme learning machine (ELM is a popular learning algorithm for single hidden layer feedforward networks (SLFNs. It was originally proposed with the inspiration from biological learning and has attracted massive attentions due to its adaptability to various tasks with a fast learning ability and efficient computation cost. As an effective sparse representation method, orthogonal matching pursuit (OMP method can be embedded into ELM to overcome the singularity problem and improve the stability. Usually OMP recovers a sparse vector by minimizing a least squares (LS loss, which is efficient for Gaussian distributed data, but may suffer performance deterioration in presence of non-Gaussian data. To address this problem, a robust matching pursuit method based on a novel kernel risk-sensitive loss (in short KRSLMP is first proposed in this paper. The KRSLMP is then applied to ELM to solve the sparse output weight vector, and the new method named the KRSLMP-ELM is developed for SLFN learning. Experimental results on synthetic and real-world data sets confirm the effectiveness and superiority of the proposed method.

  14. Some types of difficulty encountered during the simulation of heat exchangers (1961); Quelques types de difficultes rencontrees lors de la simulation des echangeurs (1961)

    Energy Technology Data Exchange (ETDEWEB)

    Bettembourg, D [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

    1961-07-01

    After recalling that the simulation of exchangers poses problems which are often difficult to solve, the author points out that these problems appear first of all when the physical phenomena are described in terms of equations. They appear also during the solving of the equations since expressions which are more and more complex can give rise to unstable electronic structures. These difficulties are developed during the analysis of various types of exchangers and in each case the solutions chosen are given. (author) [French] On rappelle que la simulation des echangeurs pose un certain nombre de problemes souvent difficiles a resoudre. Les difficultes apparaissent d'abord lors de la mise en equations des phenomenes physiques; elles apparaissent ensuite au moment de la resolution, car des formulations de plus en plus complexes peuvent donner lieu a des structures electroniques instables. On developpe ces difficultes en faisant l'analyse de quelques types varies d'echangeurs et l'on indique dans chacun des cas les solutions qui ont ete retenues. (auteur)

  15. Extreme Politics: on Some Approaches to the Definition of the Category and Boundaries of the Phenomenon

    Directory of Open Access Journals (Sweden)

    Михаил Григорьевич Анохин

    2010-06-01

    Full Text Available The article is dedicated to the actual and underdeveloped problem of defining «extreme politics». The authors suppose that «extreme politics» is a special kind of human activities. Extreme politics is defined by the authors as an activity conducted for power in extreme conditions (situations tied with insufficiency of different resources, lack of time for analysis and long-term prognosis of political situation and political decision-making, deficit of actual information and its free circulation, dominance of authoritative leaders-competitors.

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

    Science.gov (United States)

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

    2013-12-01

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

  17. Automatic residue removal for high-NA extreme illumination

    Science.gov (United States)

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

    2007-10-01

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

  18. Gravity and Extreme Magnetism SMEX

    Science.gov (United States)

    2012-01-01

    The Gravity and Extreme Magnetism SMEX mission will be the first mission to catalogue the X-ray polarisation of many astrophysical objects including black-holes and pulsars. This first of its kind mission is enabled by the novel use of a time projection chamber as an X-ray polarimeter. The detector has been developed over the last 5 years, with the current effort charged toward a demonstration of it's technical readiness to be at level 6 prior to the preliminary design review. This talk will describe the design GEMS polarimeter and the results to date from the engineering test unit.

  19. Calculus problems

    CERN Document Server

    Baronti, Marco; van der Putten, Robertus; Venturi, Irene

    2016-01-01

    This book, intended as a practical working guide for students in Engineering, Mathematics, Physics, or any other field where rigorous calculus is needed, includes 450 exercises. Each chapter starts with a summary of the main definitions and results, which is followed by a selection of solved exercises accompanied by brief, illustrative comments. A selection of problems with indicated solutions rounds out each chapter. A final chapter explores problems that are not designed with a single issue in mind but instead call for the combination of a variety of techniques, rounding out the book’s coverage. Though the book’s primary focus is on functions of one real variable, basic ordinary differential equations (separation of variables, linear first order and constant coefficients ODEs) are also discussed. The material is taken from actual written tests that have been delivered at the Engineering School of the University of Genoa. Literally thousands of students have worked on these problems, ensuring their real-...

  20. Climate change & extreme weather vulnerability assessment framework.

    Science.gov (United States)

    2012-12-01

    The Federal Highway Administrations (FHWAs) Climate Change and Extreme Weather Vulnerability : Assessment Framework is a guide for transportation agencies interested in assessing their vulnerability : to climate change and extreme weather event...

  1. Frequently Asked Questions (FAQ) about Extreme Heat

    Science.gov (United States)

    ... Extreme Heat Older Adults (Aged 65+) Infants and Children Chronic Medical Conditions Low Income Athletes Outdoor Workers Pets Hot Weather Tips Warning Signs and Symptoms FAQs Social Media How to Stay Cool Missouri Cooling Centers Extreme ...

  2. Physiotherapy in the postpartum problems

    Directory of Open Access Journals (Sweden)

    Witold Słomko

    2017-04-01

    Full Text Available Female after childbirth recovering at different rates, in theory, it is assumed that the confinement takes from 6 to 8 weeks. At this time maternal should return of the condition before pregnancy and childbirth. Sometimes that the return to full fitness is difficult, because of the problems typical for the postpartum. This article presents physiotherapeutic methods are effective in treating: diastasis of the rectus muscle of abdomen, stretch marks, difficult  healing scars after a cesarean section, lactating problems, incontinence. Appropriate treatment results prevention of these symptoms, although if they appear, it helps to fight them down. Kinesitherapy and physical therapy are used in the treatment. Also can be used massage and kinesiotaping.

  3. Benefits of visualization in the mammography problem

    DEFF Research Database (Denmark)

    Khan, Azam; Breslav, Simon; Glueck, Michael

    2015-01-01

    Abstract Trying to make a decision between two outcomes, when there is some level of uncertainty, is inherently difficult because it involves probabilistic reasoning. Previous studies have shown that most people do not correctly apply Bayesian inference to solve probabilistic problems for decision...... making under uncertainty. In an effort to improve decision making with Bayesian problems, previous work has studied supplementing the textual description of problems with visualizations, such as graphs and charts. However, results have been varied and generally indicate that visualization...

  4. Extreme Maximum Land Surface Temperatures.

    Science.gov (United States)

    Garratt, J. R.

    1992-09-01

    There are numerous reports in the literature of observations of land surface temperatures. Some of these, almost all made in situ, reveal maximum values in the 50°-70°C range, with a few, made in desert regions, near 80°C. Consideration of a simplified form of the surface energy balance equation, utilizing likely upper values of absorbed shortwave flux (1000 W m2) and screen air temperature (55°C), that surface temperatures in the vicinity of 90°-100°C may occur for dry, darkish soils of low thermal conductivity (0.1-0.2 W m1 K1). Numerical simulations confirm this and suggest that temperature gradients in the first few centimeters of soil may reach 0.5°-1°C mm1 under these extreme conditions. The study bears upon the intrinsic interest of identifying extreme maximum temperatures and yields interesting information regarding the comfort zone of animals (including man).

  5. Problems in diagnosing and forecasting power equipment reliability

    Energy Technology Data Exchange (ETDEWEB)

    Popkov, V I; Demirchyan, K S

    1979-11-01

    This general survey deals with approaches to the resolution of such problems as the gathering, analysis and systematization of data on component defects in power equipment and setting up feedback with the manufacturing plants and planning organizations to improve equipment reliability. Such efforts on the part of designers, manufacturers and operating and repair organizations in analyzing faults in 300 MW turbogenerators during 1974-1977 reduced the specific fault rate by 20 to 25% and the downtime per failure by 35 to 40%. Since power equipment should operate for several hundreds of thousands of hours (20 to 30 years) and the majority of power components have guaranteed service lives of no more than 10/sup 5/ hours, an extremely difficult problem is the determination of the reliability of equipment past the 10/sup 5/ point. The present trend in the USSR Unified Power System towards increasing the number of shutdowns and startups, which in the case of turbogenerators of up 1200 MW power can reach 7500 to 10,000 cycles is noted. Other areas briefly treated are: MHD generator reliability and economy; nuclear power plant reliability and safety; the reliability of high-power high-voltage thyristor converters; the difficulties involved in scale modeling of power system reliability and the high cost of the requisite full-scale studies; the poor understanding of long term corrosion and erosion processes. The review concludes with arguments in favor of greater computerization of all aspects of power system management.

  6. Thyroid Problems

    Science.gov (United States)

    ... Home › Aging & Health A to Z › Thyroid Problems Font size A A A Print Share Glossary Basic ... enough thyroid hormone, usually of the thyroxine (T4) type of hormone. Your T4 levels can drop temporarily ...

  7. Balance Problems

    Science.gov (United States)

    ... fully trust your sense of balance. Loss of balance also raises the risk of falls. This is a serious and even life-threatening ... 65. Balance disorders are serious because of the risk of falls. But occasionally balance problems may warn of another health condition, such ...

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

    DEFF Research Database (Denmark)

    Halttunen, Jorma; Meisner, Søren; Aabakken, Lars

    2014-01-01

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

  9. Exascale Co-design for Modeling Materials in Extreme Environments

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-07-08

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

  10. Observed increase in extreme daily rainfall in the French Mediterranean

    Science.gov (United States)

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

    2018-04-01

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

  11. An overview on extremity dosimetry in medical applications

    International Nuclear Information System (INIS)

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

    2008-01-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

  13. Spatial planning via extremal optimization enhanced by cell-based local search

    International Nuclear Information System (INIS)

    Sidiropoulos, Epaminondas

    2014-01-01

    A new treatment is presented for land use planning problems by means of extremal optimization in conjunction to cell-based neighborhood local search. Extremal optimization, inspired by self-organized critical models of evolution has been applied mainly to the solution of classical combinatorial optimization problems. Cell-based local search has been employed by the author elsewhere in problems of spatial resource allocation in combination with genetic algorithms and simulated annealing. In this paper it complements extremal optimization in order to enhance its capacity for a spatial optimization problem. The hybrid method thus formed is compared to methods of the literature on a specific characteristic problem. It yields better results both in terms of objective function values and in terms of compactness. The latter is an important quantity for spatial planning. The present treatment yields significant compactness values as emergent results

  14. Simulating variable source problems via post processing of individual particle tallies

    International Nuclear Information System (INIS)

    Bleuel, D.L.; Donahue, R.J.; Ludewigt, B.A.; Vujic, J.

    2000-01-01

    Monte Carlo is an extremely powerful method of simulating complex, three dimensional environments without excessive problem simplification. However, it is often time consuming to simulate models in which the source can be highly varied. Similarly difficult are optimization studies involving sources in which many input parameters are variable, such as particle energy, angle, and spatial distribution. Such studies are often approached using brute force methods or intelligent guesswork. One field in which these problems are often encountered is accelerator-driven Boron Neutron Capture Therapy (BNCT) for the treatment of cancers. Solving the reverse problem of determining the best neutron source for optimal BNCT treatment can be accomplished by separating the time-consuming particle-tracking process of a full Monte Carlo simulation from the calculation of the source weighting factors which is typically performed at the beginning of a Monte Carlo simulation. By post-processing these weighting factors on a recorded file of individual particle tally information, the effect of changing source variables can be realized in a matter of seconds, instead of requiring hours or days for additional complete simulations. By intelligent source biasing, any number of different source distributions can be calculated quickly from a single Monte Carlo simulation. The source description can be treated as variable and the effect of changing multiple interdependent source variables on the problem's solution can be determined. Though the focus of this study is on BNCT applications, this procedure may be applicable to any problem that involves a variable source

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

    Science.gov (United States)

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

    2018-01-01

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

  16. Anaesthetic management in a case of large plunging ranula with difficult airway: A case report

    Directory of Open Access Journals (Sweden)

    Surendra Kumar Sethi

    2017-04-01

    Full Text Available Plunging ranula is a mucous retention cyst found on the floor of mouth which arises from the submandibular and sublingual salivary glands extending to lateral aspect of neck, which may often cause potential airway obstruction leading to difficulty in airway management. A forty year old female patient was admitted to our hospital with large, painless swelling in the floor of mouth extending to the lateral part of body of mandible and neck. This intraoral swelling distorted the normal airway anatomy thus making airway management difficult as the patient was planned for excision of swelling under general anaesthesia. So we present a case of successful management of a difficult airway by using awake fibre optic intubation in a patient posted for excision of a large plunging ranula under general anaesthesia.

  17. Infrared Red Intubation System (IRRIS) guided flexile videoscope assisted difficult airway management

    DEFF Research Database (Denmark)

    Kristensen, M S; Fried, E; Biro, P

    2018-01-01

    BACKGROUND: Tracheal intubation with a flexible scope is a cornerstone technique in patients with severely difficult airways, but may fail. We report on a technique, Infrared Red Intubation System (IRRIS), that seems to facilitate the identification of the glottis. METHODS: The IRRIS is placed over...... the patient's cricothyroid membrane and emits blinking infrared light through the patient's skin into the subglottic space. When a flexible videoscope (one that does not filter infrared light) is introduced into the airway, it will display this as a blinking white light emerging from the glottis, retrograde...... transillumination, showing the pathway to the trachea. We have introduced this as an adjunct when managing our patients with difficult airways. We describe the technique and retrospectively report on the first ten patients where it was used. RESULTS: All ten patients had significant pathology in the airway...

  18. Fast, Simple and Accurate Handwritten Digit Classification by Training Shallow Neural Network Classifiers with the 'Extreme Learning Machine' Algorithm.

    Directory of Open Access Journals (Sweden)

    Mark D McDonnell

    Full Text Available Recent advances in training deep (multi-layer architectures have inspired a renaissance in neural network use. For example, deep convolutional networks are becoming the default option for difficult tasks on large datasets, such as image and speech recognition. However, here we show that error rates below 1% on the MNIST handwritten digit benchmark can be replicated with shallow non-convolutional neural networks. This is achieved by training such networks using the 'Extreme Learning Machine' (ELM approach, which also enables a very rapid training time (∼ 10 minutes. Adding distortions, as is common practise for MNIST, reduces error rates even further. Our methods are also shown to be capable of achieving less than 5.5% error rates on the NORB image database. To achieve these results, we introduce several enhancements to the standard ELM algorithm, which individually and in combination can significantly improve performance. The main innovation is to ensure each hidden-unit operates only on a randomly sized and positioned patch of each image. This form of random 'receptive field' sampling of the input ensures the input weight matrix is sparse, with about 90% of weights equal to zero. Furthermore, combining our methods with a small number of iterations of a single-batch backpropagation method can significantly reduce the number of hidden-units required to achieve a particular performance. Our close to state-of-the-art results for MNIST and NORB suggest that the ease of use and accuracy of the ELM algorithm for designing a single-hidden-layer neural network classifier should cause it to be given greater consideration either as a standalone method for simpler problems, or as the final classification stage in deep neural networks applied to more difficult problems.

  19. Terminological and Definitional Problems of Deficit and Debt in the Polish and EU Law of Public Finance

    Directory of Open Access Journals (Sweden)

    Ewa Lotko

    2016-06-01

    Full Text Available In the Polish and the EU public finances law there are serious terminological difficulties concerning the deficit and the debt. They arise first from the terminological chaos in this field and second from the parallel application of the EU and the Polish methodology of calculating of deficit and debt. Thus, the paper aims to explain the terminological and definitional problems of deficit and debt in the public finances law using unobtrusive research consisting of the detailed analysis of the Polish and EU legislation. Although there is no doubt that it would be desirable to order the applied terms, in the current legal situation, it would be extremely difficult, as it would require the changes to the Constitution, laws, and modification of translations of UE acts. The solution to the problem, presenting additional advantages, could consist of full transition to the EU methodology by the renouncement from the Polish methodology.

  20. An Electrostatics Approach to the Determination of Extremal Measures

    Energy Technology Data Exchange (ETDEWEB)

    Meinguet, Jean [Universite Catholique de Louvain, Institut Mathematique, Chemin du Cyclotron 2 (Belgium)], E-mail: meinguet@anma.ucl.ac.be

    2000-12-15

    One of the most important aspects of the minimal energy (or induced equilibrium) problem in the presence of an external field - sometimes referred to as the Gauss variation problem - is the determination of the support of its solution (the so-called extremal measure associated with the field). A simple electrostatic interpretation is presented here, which is apparently new and anyway suggests a novel, rather systematic approach to the solution. By way of illustration, the classical results for Jacobi, Laguerre and Freud weights are explicitly recovered by this alternative method.