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Sample records for multiple deck cases

  1. Application Side Casing on Open Deck RoRo to Improve Ship Stability

    Hasanudin; K. A. P Utama, I.; Chen, Jeng-Horng

    2018-03-01

    RoRo is a vessel that can transport passengers, cargo, container and cars. Open Car Deck is favourite RoRo Vessel in developing countries due to its small GT, small tax and spacious car deck, but it has poor survival of stability. Many accident involve Open Car Deck RoRo which cause fatalities and victim. In order to ensure the safety of the ship, IMO had applied intact stability criteria IS Code 2008 which adapted from Rahola’s Research, but since 2008 IMO improved criteria become probabilistic damage stability SOLAS 2009. The RoRo type Open Car Deck has wide Breadth (B), small Draft (D) and small freeboard. It has difficulties to satisfy the ship’s stability criteria. Side Casings which has been applied in some RoRo have be known reduce freeboard or improve ship’s safety. In this paper investigated the effect side casings to survival of intact dan damage ship’s stability. Calculation has been conducted for four ships without, existing and full side casings. The investigation results shows that defect stability of Open Deck RoRo can be reduce with fitting side casing.

  2. Comparison between major repair and replacement options for a bridge deck life cycle assessment: A case study

    Abu Dabous Saleh

    2017-01-01

    Full Text Available Material production, manufacturing, transportation, usage, and end of lifeprocessing are usually the main contributors defining the life cycle assessment (LCA. Bridge infrastructure is important to the economy and the society. Over their life cycle, highway bridges experience several stressors that can significantly affect their structural performance and therefore require rehabilitation. This paper discusses the life cycle analysis of bridge rehabilitation decisions and demonstrates the analysis with a case study of a bridge located in Ontario, Canada. The LCA of the bridge deck is analyzed for two rehabilitation strategies: major repair and replacement. The study focuses on evaluating the different life cycle phases of the bridge deck by assessing their carbon dioxide emission, energy consumption and cost. Also, the paper presents the impact of the different elements within each phase to identify the most contributing elements. The LCA of the bridge deck is analyzed and estimated with the aid of CES EduPack 2016 software that includes a database of more than 4000 different materials and more than 200 manufacturing processes. Analysis of the case study shows that material phase causes significant life cycle impact. The study concluded that the deck replacement yields higher environmental impact and life cycle cost compared to repairing and strengthening the deck.

  3. Multiple myeloma: 45 cases

    Yang, Hee Chul; Suh, Jin Suck; Park, Chang Yun

    1990-01-01

    We evaluated 45 cases of multiple myelomas retrospectively confirmed in Severance Hospital from the period of 1983-1989. In order to assess the radiologic features of the multiple myeloma and to assist in possible early diagnosis and treatment. The result were as follows: 1. IgG(41%) was the most common immunoglobulin type secreted followed by light chain(36%). IgA(19%) and IgD(2%). Two percent of the patients had non-secretory type. 89% of patients were in their stage III of the disease. 2. Among the 45 patients, 96% had abnormal plain radiographic findings with average number of 4.5 lesions. Common sites were the spine, rib, skull, pelvis, and humerus in descending orders. The findings were localized or diffuse osteolytic bone destruction(85%). osteoporosis(49%), pathologic fracture and endosteal scalloping(55%). Osteoporosis was more prominent in stage III than stage II. 3. Both plain X-ray and radioisotope study was available for comparison in 28 patients. Concordance between the two studies were 44%, lesions detected only on plain X-ray film were 51%, and lesions detected only on the radioisotope were 5%. The plain radiography was able to detect only 54% of bone lesions confirmed by bone marrow biopsy. With the above results, accurate evaluation of bone lesions in multiple myeloma may be difficult with radiologic studies only. But familiarity with these radiologic findings of the this disease entity is necessary for early suspicion of the disease, thus for early diagnosis and treatment

  4. A Usability and Learnability Case Study of Glass Flight Deck Interfaces and Pilot Interactions through Scenario-based Training

    De Cino, Thomas J., II

    In the aviation industry, digitally produced and presented flight, navigation, and aircraft information is commonly referred to as glass flight decks. Glass flight decks are driven by computer-based subsystems and have long been a part of military and commercial aviation sectors. Over the past 15 years, the General Aviation (GA) sector of the aviation industry has become a recent beneficiary of the rapid advancement of computer-based glass flight deck (GFD) systems. While providing the GA pilot considerable enhancements in the quality of information about the status and operations of the aircraft, training pilots on the use of glass flight decks is often delivered with traditional methods (e.g. textbooks, PowerPoint presentations, user manuals, and limited computer-based training modules). These training methods have been reported as less than desirable in learning to use the glass flight deck interface. Difficulties in achieving a complete understanding of functional and operational characteristics of the GFD systems, acquiring a full understanding of the interrelationships of the varied subsystems, and handling the wealth of flight information provided have been reported. Documented pilot concerns of poor user experience and satisfaction, and problems with the learning the complex and sophisticated interface of the GFD are additional issues with current pilot training approaches. A case study was executed to explore ways to improve training using GFD systems at a Midwestern aviation university. The researcher investigated if variations in instructional systems design and training methods for learning glass flight deck technology would affect the perceptions and attitudes of pilots of the learnability (an attribute of usability) of the glass flight deck interface. Specifically, this study investigated the effectiveness of scenario-based training (SBT) methods to potentially improve pilot knowledge and understanding of a GFD system, and overall pilot user

  5. Analysis, prediction, and case studies of early-age cracking in bridge decks

    ElSafty, Adel; Graeff, Matthew K.; El-Gharib, Georges; Abdel-Mohti, Ahmed; Mike Jackson, N.

    2016-06-01

    Early-age cracking can adversely affect strength, serviceability, and durability of concrete bridge decks. Early age is defined as the period after final setting, during which concrete properties change rapidly. Many factors can cause early-age bridge deck cracking including temperature change, hydration, plastic shrinkage, autogenous shrinkage, and drying shrinkage. The cracking may also increase the effect of freeze and thaw cycles and may lead to corrosion of reinforcement. This research paper presents an analysis of causes and factors affecting early-age cracking. It also provides a tool developed to predict the likelihood and initiation of early-age cracking of concrete bridge decks. Understanding the concrete properties is essential so that the developed tool can accurately model the mechanisms contributing to the cracking of concrete bridge decks. The user interface of the implemented computer Excel program enables the user to input the properties of the concrete being monitored. The research study and the developed spreadsheet were used to comprehensively investigate the issue of concrete deck cracking. The spreadsheet is designed to be a user-friendly calculation tool for concrete mixture proportioning, temperature prediction, thermal analysis, and tensile cracking prediction. The study also provides review and makes recommendations on the deck cracking based mainly on the Florida Department of Transportation specifications and Structures Design Guidelines, and Bridge Design Manuals of other states. The results were also compared with that of other commercially available software programs that predict early-age cracking in concrete slabs, concrete pavement, and reinforced concrete bridge decks. The outcome of this study can identify a set of recommendations to limit the deck cracking problem and maintain a longer service life of bridges.

  6. Moving dynamic loads caused by bridge deck joint unevenness - a case study

    Steyn, WJV

    2004-11-01

    Full Text Available This paper focus on the general guidelines regarding maximum unevenness from bridge deck joints for typical South African heavy vehicles, in order to minimize the generation of moving variable loads. In a recent investigation it was found that areas...

  7. Multiple meningiomas CASE SERIES

    masses in the right parietal and parasagittal region (Figs 1a and b). Case 2: A ... scan showed hyperdense parasagittal and left cerebellopontine angle meningiomas (Figs ... Meningiomas are the most common primary non-glial brain tumours.

  8. Case report 383: Multiple myeloma

    Kouwenberg, J.J.; Simons, A.J.

    1986-01-01

    A unique and obviously extremely rare example of multiple myeloma has been presented, affecting the peripheral appendicular skeleton and not the hematopoietic system of the axial skeleton, radiologically and probably pathologically. Only one other similar case has been described. The radiological features were confirmed by the pathological studies: a biopsy specimen obtained from a large osteolytic lesion in a patella showed the typical stigma of multiple myeloma; a biopsy from the iliac creast showed no abnormality. (orig./SHA)

  9. MULTIPLE PERSONALITY: CASE REPORT STUDY

    Miloš Židanik

    2004-07-01

    Full Text Available Background. Multiple personality disorder is characterised by splited individual ego-states and splited professional community arguing whether this disorder actually exists or not.Methods. In this case report study a supportive psychodynamic psychotherapy of a patient with multiple personality disorder is presented, that lasted for 4.5 years and resulted in ego-reintegration.Conclusions. The spliting between different ego-states is powered by unneutralised aggression with the possibility of hetero- and autoaggressive behaviour. Therefore the patient in the analytically oriented psychotherapeutic process is at high risk and a safe therapeutic (e. g. in-patient setting has to be provided.

  10. Using Correspondence Analysis in Multiple Case Studies

    Kienstra, Natascha; van der Heijden, Peter G.M.

    2015-01-01

    In qualitative research of multiple case studies, Miles and Huberman proposed to summarize the separate cases in a so-called meta-matrix that consists of cases by variables. Yin discusses cross-case synthesis to study this matrix. We propose correspondence analysis (CA) as a useful tool to study

  11. Using correspondence analysis in multiple case studies

    Kienstra, N.H.H.; van der Heijden, P.G.M.

    2015-01-01

    In qualitative research of multiple case studies, Miles and Huberman proposed to summarize the separate cases in a so-called meta-matrix that consists of cases by variables. Yin discusses cross-case synthesis to study this matrix. We propose correspondence analysis (CA) as a useful tool to study

  12. Noise from Aft Deck Exhaust Nozzles: Differences in Experimental Embodiments

    Bridges, James E.

    2014-01-01

    Two embodiments of a rectangular nozzle on an aft deck are compared. In one embodiment the lower lip of the nozzle was extended with the sidewalls becoming triangles. In a second embodiment a rectangular nozzle was fitted with a surface that fit flush to the lower lip and extended outward from the sides of the nozzle, approximating a semi-infinite plane. For the purpose of scale-model testing, making the aft deck an integral part of the nozzle is possible for relatively short deck lengths, but a separate plate model is more flexible, accounts for the expanse of deck to the sides of the nozzle, and allows the nozzle to stand off from the deck. Both embodiments were tested and acoustic far-field results were compared. In both embodiments the extended deck introduces a new noise source, but the amplitude of the new source was dependent upon the span (cross-stream dimension) of the aft deck. The noise increased with deck length (streamwise dimension), and in the case of the beveled nozzle it increased with increasing aspect ratio. In previous studies of slot jets in wings it was noted that the increased noise from the extended aft deck appears as a dipole at the aft deck trailing edge, an acoustic source type with different dependence on velocity than jet mixing noise. The extraneous noise produced by the aft deck in the present studies also shows this behavior both in directivity and in velocity scaling.

  13. [Special cases of multiple sclerosis].

    Mendibe Bilbao, Mar

    2014-12-01

    Multiple sclerosis is a chronic disease that usually occurs in young people and affects them for the rest of their lives. Patients and their families usually have a series of doubts and questions on everyday matters and all types of situations that occur during the distinct stages of life and which can influence the course of the disease. The aim of this review is to provide specific answers to these questions. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  14. Investigation of Aerodynamic Interference between Twin Deck Bridges

    Sitek, M. A. [Argonne National Lab. (ANL), Argonne, IL (United States). Energy Systems Division. Transportation Research and Analysis Computing Center (TRACC); Bojanowski, C. [Argonne National Lab. (ANL), Argonne, IL (United States). Energy Systems Division. Transportation Research and Analysis Computing Center (TRACC); Lottes, S. A. [Argonne National Lab. (ANL), Argonne, IL (United States). Energy Systems Division. Transportation Research and Analysis Computing Center (TRACC)

    2016-05-01

    Construction of a twin bridge can be a cost effective and minimally disruptive way to increase capacity when an existing bridge is not near the end of its service life. With ever growing vehicular traffic, when demand approaches the capacity of many existing roads and bridges. Remodeling a structure with an insufficient number of lanes can be a good solution in case of smaller and less busy bridges. Closing down or reducing traffic on crossings of greater importance for the construction period, however, can result in major delays and revenue loss for commerce and transportation as well as increasing the traffic load on alternate route bridges. Multiple-deck bridges may be the answer to this issue. A parallel deck can be built next to the existing one, without reducing the flow. Additionally, a new bridge can be designed as a twin or multi-deck structure. Several such structures have been built throughout the United States, among them: - The New NY Bridge Project - the Tappan Zee Hudson River Crossing, - SR-182 Columbia River Bridge, - The Thaddeus Kosciusko Bridge (I-87), - The Allegheny River Bridge, Pennsylvania, which carries I76, - Fred Hartman Bridge, TX, see Figure 1.2. With a growing number of double deck bridges, additional, more detailed, studies on the interaction of such bridge pairs in windy conditions appears appropriate. Aerodynamic interference effects should be examined to assure the aerodynamic stability of both bridges. There are many studies on aerodynamic response of single deck bridges, but the literature on double-deck structures is not extensive. The experimental results from wind tunnels are still limited in number, as a parametric study is required, they can be very time consuming. Literature review shows that some investigation of the effects of gap-width and angle of wind incidence has been done. Most of the CFD computational studies that have been done were limited to 2D simulations. Therefore, it is desirable to investigate twin decks

  15. Multiple orthokeratinized odontogenic cysts: a case report.

    Cheng, Yi-Shing Lisa; Liang, Hui; Wright, John; Teenier, Tom

    2015-03-01

    The purpose of this report is to document the clinical, radiographic, pathological and molecular findings of the first case of multiple orthokeratinized odontogenic cysts (OOCs). Multiple odontogenic keratocysts are one of the major features of nevoid basal cell carcinoma syndrome (NBCCS), and loss of heterozygosity in the PTCH gene, the culprit gene for NBCCS, has recently been found in sporadic OOC cases. Therefore, in this presenting case, we also investigated the possibility that this patient might also have NBCCS, by comparing the available clinical information and the molecular findings of this case to the diagnostic criteria for NBCCS (as proposed by the First International Colloquium on NBCCS in 2011). However, this patient with multiple OOCs showed no evidence of having NBCCS. This conclusion supports the findings from previous case series based on sporadic cases that OOC does not appear to be associated with NBCCS.

  16. Multiple cranial nerve palsies complicating tympanomastoiditis: case ...

    Otitis media either acute or chronic, is not uncommon in childhood. Multiple cranial nerve palsies occuring as a complication of either form of otitis media is unusual. A case of a nine year old boy with chronic suppurative otitis media with associated mastoiditis complicated with ipsilateral multiple cranial nerve palsies is ...

  17. Multiple Personality Disorder: Concepts and Cases.

    Lindsley, Hope L.

    1992-01-01

    Presents two case examples illustrating nature and etiology of multiple personality disorder in two clients and describing their entry into counseling and progress through treatment. Compares and contrasts cases in areas of diagnosis, symptoms, history, and treatment. Suggests that mental health counselors combine firmness with flexibility in…

  18. Multiple Hereditary Osteochondromatosis: A Case Report

    K???kesmen, ?i?dem; ?zen, Bu?ra; Ak?am, Mustafa

    2007-01-01

    Objectives Common carious lesions owing to vomiting are not widespread in children. In this case, we aimed to report an 11-years-old male patient with common carious lesions due to repeated vomitings, chewing and eating difficulty and retarded growth with Multiple Hereditary Osteochondromatosis (MHO). Case Report An 11-years-old boy was referred to Department of Pediatric Dentistry in Faculty of Dentistry because of eating difficulty owing to common carious lesions. It was seen that the patie...

  19. Free Material Design with Multiple Load Cases

    Pedersen, Pauli; Pedersen, Niels Leergaard

    2012-01-01

    Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together with a prac......Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together...... with a practical recursive design procedure is presented and illustrated with examples. The presented finite element analysis involve many elements as well as many load cases. Separating the local amount of material from a description with unit trace for the local anisotropy, gives the free materials formulation...... a more physical interpretation of the material constraint....

  20. Linear Cracking in Bridge Decks

    2018-03-01

    Concrete cracking in bridge decks remains an important issue relative to deck durability. Cracks can allow increased penetration of chlorides, which can result in premature corrosion of the reinforcing steel and subsequent spalling of the concrete de...

  1. Choice Experiment Analysis of Outdoor Decking Material Selection in E-Commerce Market in Finland

    Holopainen, Jani Markus; Toppinen, Anne Maarit Kristiina; Lähtinen, Katja Päivikki; Rekola, Mika Olavi

    2017-01-01

    Since the early 1990s, there has been hope that the uptake of certified forest products would ensure more sustainable forest management and also deliver business benefits along the value chain. Our study applies a Discrete Choice Experiment (DCE) to model an e-commerce purchase in the case of multiple products with various attribute and certification combinations in the Finnish retail outdoor decking material market. We received 2772 responses from 231 participants in an online survey. Applyi...

  2. Exodermic bridge deck performance evaluation.

    2010-07-01

    In 1998, the Wisconsin DOT completed a two"leaf bascule bridge in Green Bay with an exodermic deck system. The exodermic deck consisted of 4.5"in thick cast"in"place reinforced concrete supported by a 5.19"in tall unfilled steel grid. The concrete an...

  3. Stakeholders and Apart Hotels: Multiple Case Study

    Elizabeth Kyoko Wada

    2012-09-01

    Full Text Available Means of accommodation involve a wide range of social actors and agents, as well as different business models. Management strategies in this sector have been increasingly important for long-term sustainability and competitiveness of business organizations. This study aims to analyze the interactions between apart-hotels and their stakeholders to foster an improvement of services provided, aligning the interface of strategic management from the point of view of managers and their key stakeholders. It is an exploratory study, with qualitative chacter, along with multiple case studies of the following establishments: Travel Inn, Hotels Slaviero and Etoile george v. Brazilian enterprises, which manage lodging facilities with apart-hotel concepts, combining features that enable comparative analysis of the study. For conceptual understanding, this study was based on literature about stakeholders, taking the work of Freeman (1984 and Freeman et al (2010 as main references. The research was conducted through semi-structured interviews with managers of lodging facilities and their key stakeholders and through direct observation and documentation. We found that not all groups of influence are considered in the planning of service flats. However, the organizations surveyed indicated that the market has realized the importance of the groups that exert influence and are influenced by their goals, and are therefore increasingly alert for integration of such groups in their strategic planning.

  4. Familial multiple lipomatosis: a case report

    Veger, H. T. C.; Ravensbergen, N. J. C.; Ottenhof, A.; da Costa, S. A.

    2010-01-01

    Lipoma is the most common type of soft tissue tumour. Multiple lipomas localised in different areas of the body are rare and can occur in specific hereditary syndromes. Familial multiple lipomatosis is a rare benign hereditary syndrome with a proposed autosomal-dominant inheritance. We present the

  5. Skateboard deck materials selection

    Liu, Haoyu; Coote, Tasha; Aiolos; Charlie

    2018-03-01

    The goal of this project was to identify the ideal material for a skateboard deck under 200 in price, minimizing the weight. The material must have a fracture toughness of 5 MPa/m2, have a minimum lifetime of 10, 000 cycles and must not experience brittle fracture. Both single material and hybrid solutions were explored. When further selecting to minimize weight, woods were found to be the best material. Titanium alloy-wood composites were explored to determine the optimal percentage composition of each material.A sandwich panel hybrid of 50% titanium alloy and 50% wood (Ti-Wood) was found to be the optimum material, performing better than the currently used plywood.

  6. Case studies: Soil mapping using multiple methods

    Petersen, Hauke; Wunderlich, Tina; Hagrey, Said A. Al; Rabbel, Wolfgang; Stümpel, Harald

    2010-05-01

    Soil is a non-renewable resource with fundamental functions like filtering (e.g. water), storing (e.g. carbon), transforming (e.g. nutrients) and buffering (e.g. contamination). Degradation of soils is meanwhile not only to scientists a well known fact, also decision makers in politics have accepted this as a serious problem for several environmental aspects. National and international authorities have already worked out preservation and restoration strategies for soil degradation, though it is still work of active research how to put these strategies into real practice. But common to all strategies the description of soil state and dynamics is required as a base step. This includes collecting information from soils with methods ranging from direct soil sampling to remote applications. In an intermediate scale mobile geophysical methods are applied with the advantage of fast working progress but disadvantage of site specific calibration and interpretation issues. In the framework of the iSOIL project we present here some case studies for soil mapping performed using multiple geophysical methods. We will present examples of combined field measurements with EMI-, GPR-, magnetic and gammaspectrometric techniques carried out with the mobile multi-sensor-system of Kiel University (GER). Depending on soil type and actual environmental conditions, different methods show a different quality of information. With application of diverse methods we want to figure out, which methods or combination of methods will give the most reliable information concerning soil state and properties. To investigate the influence of varying material we performed mapping campaigns on field sites with sandy, loamy and loessy soils. Classification of measured or derived attributes show not only the lateral variability but also gives hints to a variation in the vertical distribution of soil material. For all soils of course soil water content can be a critical factor concerning a succesful

  7. Comorbidity of Bipolar Disorder and Multiple Sclerosis: A Case Report

    Necla Keskin

    2013-08-01

    Full Text Available Multiple sclerosis is a chronic demyelinating disease of a central nervous system. Neuropsychiatric symptoms are common in multiple sclerosis and bipolar disorder is one of the most common psychiatric disorders that coexist with multiple sclerosis. Manic episodes may be the first presenting symptom of multiple sclerosis as comorbid pathology or as an adverse effect of pharmacotherapies used in multiple sclerosis. The comorbidity of bipolar disorder and multiple sclerosis is well-proven but its etiology is not known and investigated accurately. Recent studies support a common genetic susceptibility. Management of bipolar disorder in multiple sclerosis is based on evidence provided by case reports and treatment should be individualized. In this report, the association between bipolar disorder and multiple sclerosis, epidemiology, ethiology and treatment is discussed through a case had diagnosed as multiple sclerosis and had a manic episode with psychotic features. [Cukurova Med J 2013; 38(4.000: 832-836

  8. Longer Lasting Bridge Deck Overlays

    2018-04-01

    The objective of this report is to determine the most effective method for bridge deck overlay construction and repair by assessing current practices; examining new products and technologies; and reviewing NCHRP (National Cooperative Highway Research...

  9. Fiber reinforced polymer bridge decks.

    2011-01-01

    The overarching goal of this study was to perform a comprehensive evaluation of various issues related to the strength and serviceability : of the FRP deck panels that are available in the industry. Specific objectives were to establish critical limi...

  10. A Case of Multiple Spontaneous Keloid Scars

    Abdulhadi Jfri

    2015-07-01

    Full Text Available Keloid scars result from an abnormal healing response to cutaneous injury or inflammation that extends beyond the borders of the original wound. Spontaneous keloid scars forming in the absence of any previous trauma or surgical procedure are rare. Certain syndromes have been associated with this phenomenon, and few reports have discussed the evidence of single spontaneous keloid scar, which raises the question whether they are really spontaneous. Here, we present a 27-year-old mentally retarded single female with orbital hypertelorism, broad nasal bridge, repaired cleft lip and high-arched palate who presented with progressive multiple spontaneous keloid scars in different parts of her body which were confirmed histologically by the presence of typical keloidal collagen. This report supports the fact that keloid scars can appear spontaneously and are possibly linked to a genetic factor. Furthermore, it describes a new presentation of spontaneous keloid scars in the form of multiple large lesions in different sites of the body.

  11. GARFEM input deck description

    Zdunek, A.; Soederberg, M. (Aeronautical Research Inst. of Sweden, Bromma (Sweden))

    1989-01-01

    The input card deck for the finite element program GARFEM version 3.2 is described in this manual. The program includes, but is not limited to, capabilities to handle the following problems: * Linear bar and beam element structures, * Geometrically non-linear problems (bar and beam), both static and transient dynamic analysis, * Transient response dynamics from a catalog of time varying external forcing function types or input function tables, * Eigenvalue solution (modes and frequencies), * Multi point constraints (MPC) for the modelling of mechanisms and e.g. rigid links. The MPC definition is used only in the geometrically linearized sense, * Beams with disjunct shear axis and neutral axis, * Beams with rigid offset. An interface exist that connects GARFEM with the program GAROS. GAROS is a program for aeroelastic analysis of rotating structures. Since this interface was developed GARFEM now serves as a preprocessor program in place of NASTRAN which was formerly used. Documentation of the methods applied in GARFEM exists but is so far limited to the capacities in existence before the GAROS interface was developed.

  12. Quantifying reinforced concrete bridge deck deterioration using ground penetrating radar

    Martino, Nicole Marie

    Bridge decks are deteriorating at an alarming rate due to corrosion of the reinforcing steel, requiring billions of dollars to repair and replace them. Furthermore, the techniques used to assess the decks don't provide enough quantitative information. In recent years, ground penetrating radar (GPR) has been used to quantify deterioration by comparing the rebar reflection amplitudes to technologies serving as ground truth, because there is not an available amplitude threshold to distinguish healthy from corroded areas using only GPR. The goal of this research is to understand the relationship between GPR and deck deterioration, and develop a model to determine deterioration quantities with GPR alone. The beginning of this research determines that not only is the relationship between GPR and rebar corrosion stronger than the relationship between GPR and delaminations, but that the two are exceptionally correlated (90.2% and 86.6%). Next, multiple bridge decks were assessed with GPR and half-cell potential (HCP). Statistical parameters like the mean and skewness were computed for the GPR amplitudes of each deck, and coupled with actual corrosion quantities based on the HCP measurements to form a future bridge deck model that can be used to assess any deck with GPR alone. Finally, in order to understand exactly which component of rebar corrosion (rust, cracking or chloride) attenuates the GPR data, computational modeling was carried out to isolate each variable. The results indicate that chloride is the major contributor to the rebar reflection attenuation, and that computational modeling can be used to accurately simulate GPR attenuation due to chloride.

  13. The effect of floating deck structures on underwater radiated noise

    Bosschaart, C.; Jansen, H.W.; Jong, C.A.F. de; Basten, T.

    2017-01-01

    A concept for underwater machinery noise mitigation of future civil and military ships is the application of a common deck structure, supporting multiple machines, which is installed on resilient mounts on the ship's foundation structure. TNO is addressing the availability and testing of tools to be

  14. "The Battery" designed with Super-Light (concrete) Decks

    Castberg, Niels Andreas; Hertz, Kristian Dahl

    This paper describes how Super-Light structures can be used as a structural principle for the buildings in the project ‘The Battery’ designed by Bjarke Ingels Group. The overall structural concept is described and the advantages of using super-light slabs for the project are explored. Especially...... the cantilevered internal corridors are investigated. Super-Light Structures is a newly patented structural concrete concept. Slabs based on the concept are the first structural element developed under the patent. The slabs called SL-decks have multiple advantages compared to traditional hollow core slabs....... The paper aims to describe the concept of how the deck can be used in these innovative buildings and how the special advantages of the SL-decks are applied....

  15. Case study: Malingering or multiple personality disorder?

    Alba García-Cortés

    2017-03-01

    Full Text Available The dissociative identity disorder (DID can be considered a rare disorder because of its seemingly low prevalence. However, in recent years it points to the possible underdiagnosis because its complexity and confusion at the time of differential diagnosis. On the other hand, the malingering of mental psychopathology can have a major socio-economic and legal impact, particularly important in this type of disorder, given the inability it generates and its complex diagnostic. This paper refers the case of a patient admitted to the short-term hospitalization unit of Dr. Rodríguez Lafora Hospital (Madrid with depressive symptoms. Then the patient seemed to become a TID case. The evaluation consisted of a psychological history and the application of the Structured Inventory of Malingered Symptoms (SIMS and the Millon Clinical Multiaxial Inventory (MCMI-II. The results showed an altered personality profile as well as likely malingered symptoms, what prevented us from a DID diagnosis. In view of the results, possible implications of this case for the clinical setting are discussed.

  16. Fiber reinforced polymer bridge decks : [technical summary].

    2011-01-01

    A number of researchers have addressed the use of Fiber Reinforced Polymer (FRP) deck as a replacement solution for deteriorated bridge decks made of traditional materials. The use of new, advanced materials such as FRP is advantageous when the bridg...

  17. Duality and the Deck effect

    Törnqvist, N A

    1972-01-01

    As shown by Deck, the double-peripheral model for three-particle final states gives a substantial low-mass enhancement over phase space in two-body subchannels. With the advent of duality it was conjectured that the Deck effect and a true resonance are just different manifestations of the same phenomena. Thus the presence of a Deck enhancement could be interpreted as evidence for the existence of the A/sub 1/ resonance. The conjecture has been subject to criticism of two different kinds. These two points are clarified by constructing a counter example to the conjecture of Chew and Pignotti, using the five-point amplitude (B/sub 5/) of the generalized Veneziano model. (8 refs).

  18. Childhood Mourning: Prospective Case Analysis of Multiple Losses

    Kaufman, Kenneth R.; Kaufman, Nathaniel D.

    2005-01-01

    Multiple losses within short time periods make one question life and can exponentially influence one's coping skills. But what are the effects on a child and what should be done when the next loss occurs? This case addresses the multiple losses suffered by a child while assessing coping skills of the child and coping strategies used by the parents…

  19. 46 CFR 108.486 - Helicopter decks.

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Helicopter decks. 108.486 Section 108.486 Shipping COAST... Fire Extinguishing Systems Fire Protection for Helicopter Facilities § 108.486 Helicopter decks. At least two of the accesses to the helicopter landing deck must each have a fire hydrant on the unit's...

  20. STUDY OF BRIDGE DECK A REVIEW

    MISS. KSHITIJA S. BALWAN , MR. V. G. KHURD , MR. S. S. CHOUGULE

    2018-01-01

    The objective of this study was to understand the meaning of bridge deck. To know the different forms of decks used in bridge design. To understand different methods used for analysis of deck and study of box girder and its evolution

  1. Steel plate reinforcement of orthotropic bridge decks

    Teixeira de Freitas, S.

    2012-01-01

    The PhD research is focused on the reinforcement of fatigue cracked orthotropic steel bridge decks (OBD) by adding a second steel plate to the existing deck. The main idea is to stiffen the existing deck plate, which will reduce the stresses at the fatigue sensitive details and extend the fatigue

  2. 75 FR 4584 - Wire Decking From China

    2010-01-28

    ... Decking From China AGENCY: United States International Trade Commission. ACTION: Scheduling of the final... subsidized and less-than-fair-value imports from China of wire decking, provided for in subheadings 9403.90... China of wire decking, and that such [[Page 4585

  3. Two Cases Of Multiple Sclerosis Accompanying Psychiatric Symptoms

    Ayşegül Şengel

    2007-10-01

    Full Text Available Scientific bacground: It has been reported that; Multiple Sclerosis (MS may be presented with many psychiatric symptoms such as anxiety, depression, mania and psychosis. MS cases, presented with psychiatric symptoms were also reported. Cases: Two MS cases, diagnosed as psychotic and bipolar disorder respectively, were reported in this paper. Both of the cases were responded to the steroid treatment, and neurological and psychiatric examinations were found to be normal after one month. CONCLUSION: MS cases might be presented with psychiatric complaints and symptoms except neurological ones. We conclude that; psychiatric evaluation as well as the neurological evaluation is important in the MS cases presented with psychiatric symptoms

  4. Multiple myeloma of the jaw: A case report

    Shubhasini A Raghavan

    2014-01-01

    Full Text Available Multiple myeloma is a systemic B-cell lymphoproliferative disease that causes osteolytic lesions in the vertebra, ribs, pelvic bone, skull and jaw. Rarely jaw lesions are seen as the first sign in multiple myeloma. This is a case report with follow up of a 57-year-old female patient, previously treated for osteoporosis, who presented with a swelling of the jaw. On radiographic examination, she was found to have osteolytic lesions in the mandible and skull bones. These conventional aids led to the diagnosis of multiple myeloma thereby proving that the osteoporotic lesions were a part of the spectrum of multiple myeloma. The patient underwent chemotherapy and is currently on follow-up. This case report emphasizes the importance of early diagnosis of multiple myeloma in the jaw using readily available technologies and illustrates the contribution that oral assessment can provide.

  5. [Association of Kaposi sarcoma--multiple myeloma. A new case].

    Cohen, J D; Thomas, E; Garnier, N; Hellier, I; Durand, L; Guilhou, J J; Baldet, P; Blotman, F

    2000-11-01

    Kaposi's disease is an angiogenic multifocal cancer process that has several forms, namely Mediterranean, African, HIV-associated, and secondary to a preexisting immunodepressive state (hematological disorder, corticosteroid therapy, immunodepressive treatment). Whatever its form, Kaposi's sarcoma is probably associated with a chronic viral human herpes type 8 infection (HHV8). This virus has been implicated in the pathogenesis of multiple myeloma (17 cases recorded to date). In the present study, a further case of Kaposi's sarcoma associated with multiple myeloma has been reported. However, Epstein-Barr virus, cytomegalovirus, hepatitis B and C, HIV and HHV8 serologies were negative. Radiotherapy on the lower limbs was initiated. It is concluded that HHV8 does not appear to play a pathogenic role in cases of multiple myeloma, given the rarity of the association between Kaposi's sarcoma/multiple myeloma/HHV8.

  6. Imaging Finding of Multiple Endocrine Neoplasia Type 1: Case Report

    Yum, Tae Jun; Cho, Hee Woo

    2012-01-01

    Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant inherited syndrome with characteristic clinical and radiological manifestations. Many reports on MEN1 have been published; however, no cases of radiologically diagnosed MEN1 have been reported. Therefore, we report on a radiologically diagnosed case of MEN1 with clinical symptoms of gastroduodenal ulcer.

  7. Multiple symmetrical lipomatosis (Madelung's disease) - a case report

    Vieira, Marcelo Vasconcelos; Abreu, Marcelo de; Furtado, Claudia Dietz; Silveira, Marcio Fleck da; Furtado, Alvaro Porto Alegre; Genro, Carlos Horacio; Grazziotin, Rossano Ughini

    2001-01-01

    Multiple symmetrical lipomatosis (Madelung's disease) is a rare disorder characterized by deep accumulation of fat tissue, involving mainly the neck, shoulders and chest. This disease is associated with heavy alcohol intake and it is more common in men of Mediterranean origin. This disease can cause severe aesthetic deformities and progressive respiratory dysfunction. We report a case of a patient with multiple symmetrical lipomatosis and describe the clinical and radiological features of this disorder. (author)

  8. The case of a multiple myeloma with hyperlipoproteinaemia

    Paluszewska, M.; Bobilewicz, D.; Gigier, A.; Zwolinski, J.; Kuratowska, Z.

    1994-01-01

    The case of a 52-year-old women with hyperlipoproteinaemia, xantomathosis and multiple myeloma was discussed. The lipid disorder was one of the first symptoms and the base for diagnosis. Hyperlipoproteinaemia was probably due to the monoclonal immunoglobulin and lipoprotein interaction or their impaired catabolism. Lipoprotein lipase activity was normal. Cytostatic therapy led to partial remission of multiple myeloma and lipoproteins concentration became normal. (author)

  9. Primary laryngeal localization of multiple myeloma: A case report

    Allegra, Eugenia; Marino, Nicol?; Modica, Domenico; Emmanuele, Carmela; Saita, Vincenzo

    2017-01-01

    Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Co...

  10. A case of multiple tuberculomas in brain presenting as hemiparesis

    Amit Gupta

    2011-03-01

    Full Text Available Tuberculosis of central nervous system can be present in many different clinical and radiological patterns with disseminated or miliary brain tuberculomas as a rare presentation. Multiple central nervous system tuberculoma is commonly associated with human immunodeficiency virus (HIV infection. Tuberculomas develop following haematogenous dissemination of bacilli from an infection elsewhere in the body, usually lung. Here we describe a case of immunocompetent host with a past history of pulmonary tuberculosis, presenting with headache and generalised weakness, and later was diagnosed as a case of multiple tuberculoma brain.

  11. Successful treatment of multiple bilateral impactions - a case report

    Schubert, Michael; Proff, Peter; Kirschneck, Christian

    2016-01-01

    Background Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. Case presentation In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of th...

  12. A case of multiple cardiac calcified amorphous tumours

    Amrit Chowdhary

    2017-05-01

    Full Text Available Cardiac calcified amorphous tumours of the heart are rare non-neoplastic cardiac masses that can present like a malignant mass or an intra-cardiac thrombus. We report an extremely unusual case of a 73 year old man who presented to hospital with dyspnoea and subsequent investigations revealed multiple cardiac CATs.

  13. MULTIPLE RETAINED TEETH IN MANDIBLE: A Case Report

    Cvetan Cvetanov

    2010-07-01

    Full Text Available Purpose: The aim of this science report is to show a rare case of multiple impacted teeth at adult patient and our propose clinical approach.Materials and methods: The clinical case is showed from adult man /64-year old/ with multiple impacted teeth (6 impacted teeth in the anterior place on the mandible were not suggestive of any syndrome or metabolic disorder. The extraction of the impacted teeth was made on two stage with piezosurgery unit under local anaesthesia. For prevention of postsurgical complications, as a swelling and prevention of postsurgical resorbtion were used coneshapes from pressure xeno colagen. To base on clinical and radiological examination we will discuss the differential diagnosis and we will offer a clinical approach about decided the case.Result and Conclusion: The incidence of multiple retained teeth by literature research range from 10.9% to 40.4%, most frequently is the retention of the third molars. In the literature most rarely have clinical reports about multiple retained teeth which differ from third molars at adult patients. The rare clinical case we showed is very demonstrative and the medicative approach which we used gave excellent result.

  14. Late diagnosis of multiple myeloma: a case report

    Syahreza, A.; Gatot, D.; Mardia, A. I.

    2018-03-01

    Multiple myeloma is a challenging hematologic case to handle. Sometimes the disease is diagnosed too late for the patient and doctor. Therefore, careful approaches are needed to manage the patient. A 66-year-old mansuffersfrom low back pain since one year before he came to the hospital. He was diagnosed multiple compression fractures by orthopedic and had undergone two surgeries in one year. Punched out lesions werein skull radiology and lumbar compression in lumbar MRI. After further investigation, plasmacytoma and M protein in urine electrophoresis were founded. Significant improvement found after bortezomib and dexamethasone were given.Diagnosis and management of multiple myeloma is a challenge for a doctor. Systematically approach is needed for a patient with a recurrent fracture. Even a novel therapies are not widely available in our country.We reported a late diagnosis of multiple myeloma and had a significant improvement after bortezomib and dexamethasone therapy.

  15. Multiple primary cancer in cases of atomic bomb survivors

    Tanaka, Tsuneo; Matsuda, Masahiro; Matsugu, Yasuhiro; Ishimoto, Tatsuro; Nakahara, Hideki; Kagawa, Naoki; Fukuda, Yasuhiko

    2006-01-01

    Multiple primary cancer was investigated in individual atomic bomb survivors more than 50 years after exposure. During the decade from 1995 to 2004, double cancer was detected in 275 individuals visiting our facility. These 275 patients with multiple primary cancer were divided into an atomic bomb-exposed group and a non-exposed group. In terms of age at the time of definite diagnosis of double cancer and age upon onset of the first cancer, there was no significant difference between the atomic bomb-exposed group and the non-exposed group. In both groups, the percentage of males was higher than that of females. However, the percentage of females was higher in the exposed group than in the non-exposed group. Synchronous double cancer (cases where a second cancer develops within one year after onset of the first cancer) was seen in 32 individuals from the exposed group. Triple cancer was seen in 3 cases. In the exposed group, the site affected by cancer was the stomach in 28% and the colon/rectum in 27% of cases. Thus, cancer affected the stomach or colon/rectum in the majority of cases. The most frequent combination of organs affected by double cancer was the stomach+colon/rectum (20 cases, 25%). In a study of multiple primary cancer patients, the percentage of females was higher in the atomic bomb exposed group compared to the non-exposed group. There was no other difference between the two groups. (author)

  16. Deltoid contracture: a case with multiple muscle contractures.

    Chen, Hsin-Chang; Huang, Tung-Fu; Chou, Po-Hsin; Chen, Tain-Hsiung

    2008-11-01

    Deltoid contracture is relatively uncommon. The literature consists primarily of case reports and few articles on large case series. The pathogenesis has been well studied. Muscle contractures can occur in the deltoid, biceps, triceps, gluteus and quadriceps muscles; however, cases of multiple muscle contractures are rare. We reported a patient with multiple contractures of the bilateral deltoid, bilateral gluteus, and bilateral quadriceps muscles, who had received repeated intramuscular injections during childhood and adulthood. The radiographic, including magnetic resonance imaging (MRI), features of the bone and joint abnormalities are presented. Some literatures reported that damage to the structures of the body due to intramuscular injection is related to the site of injection, age of the patient, and the volume, pH, chemical composition, and diffusional capacity of the injectate. Our patient had muscular contracture induced by needle injection regardless of her age, medication and injection site.

  17. [Intestinal perforation due to multiple magnet ingestion: a case report].

    Cevizci, Mehmet Nuri; Karadağ, Cetin Ali; Demir, Mesut; Dokucu, Ali Ihsan

    2012-03-01

    Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets may stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces. An eight-year-old girl presented with abdominal pain and vomiting. She had abdominal tenderness and defense on the physical examination. Abdominal X-ray showed air and fluid levels. Metallic images were not considered at first as important in the diagnosis. Abdominal ultrasonography was reported as acute appendicitis. During the abdominal exploration, the appendix was normal, but there were dense adherences around the ileum and cecum. After adhesiolysis, intestinal perforations were seen in the cecum and 15 and 45 cm proximal to the cecum. Magnet and metal pieces were present in the perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications, and she was discharged on the postoperative fifth day. Pediatric surgeons should be aware of the complications of multiple magnet ingestion. If the patient has a history of multiple magnet ingestion, follow-up with daily abdominal X-rays should be done, and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered.

  18. On the typography of flight-deck documentation

    Degani, Asaf

    1992-01-01

    Many types of paper documentation are employed on the flight-deck. They range from a simple checklist card to a bulky Aircraft Flight Manual (AFM). Some of these documentations have typographical and graphical deficiencies; yet, many cockpit tasks such as conducting checklists, way-point entry, limitations and performance calculations, and many more, require the use of these documents. Moreover, during emergency and abnormal situations, the flight crews' effectiveness in combating the situation is highly dependent on such documentation; accessing and reading procedures has a significant impact on flight safety. Although flight-deck documentation are an important (and sometimes critical) form of display in the modern cockpit, there is a dearth of information on how to effectively design these displays. The object of this report is to provide a summary of the available literature regarding the design and typographical aspects of printed matter. The report attempts 'to bridge' the gap between basic research about typography, and the kind of information needed by designers of flight-deck documentation. The report focuses on typographical factors such as type-faces, character height, use of lower- and upper-case characters, line length, and spacing. Some graphical aspects such as layout, color coding, fonts, and character contrast are also discussed. In addition, several aspects of cockpit reading conditions such as glare, angular alignment, and paper quality are addressed. Finally, a list of recommendations for the graphical design of flight-deck documentation is provided.

  19. A Case of Mediastinal Extramedullary Plasmacytoma Associated with Multiple Myeloma

    Min, Ji Hye; Kim, Tae Sung; Ko, Young Hyeh; Kim, Ki Hyun [Samsung Medical Center, Sungkyunkwan University, Seoul (Korea, Republic of)

    2010-08-15

    Extramedullary plasmacytoma is a rare manifestation of multiple myeloma, and involvement of the mediastinum by extramedullary plasmacytoma is very rare. We report here on a rare case of a large mediastinal extramedullary plasmacytoma and several pleural nodules with pleural effusions in a 45-year-old male patient with multiple myeloma that involved the thoracic spine and the calvarium. The mediastinal extramedullary plasmacytoma manifested on CT as an 11 x 4.5 cm-sized, relatively homogeneous, mildly enhancing, anterior mediastinal mass with several pleural nodules, and this simulated malignant lymphoma or malignant thymic epithelial tumor.

  20. Extranodal Rosai Dorfman disease in multiple sites: A case report

    Shim, Jong Joon; Kim, Ho Kyun; Shim, Jae Chan; Lee, Kyoung Eun; Lee, Ghi Jai; Suh, Jung Ho; Hong, Seong Woo; Lee, Hye Kyung [Seoul Paik Hospital/Inje Univ. College of Medicine, Seoul (Korea, Republic of)

    2012-07-15

    Rosai Dorfman disease involves an abnormal proliferation of histiocytes. This abnormal growth tends to occur within the lymph nodes, with occasional extranodal presentation. Rosai Dorfman disease is a rare disease, and the extranodal cases are even more uncommon. We report a rare case of extranodal Rosai Dorfman disease in multiple sites in a 56 year old male patient. Abdominopelvic CT revealed soft tissue attenuation masses, encasing both the renal pelvis and both ureters, as well as the thoracic vertebra. Following the neck sonography, both submandibular glands had an enlarged honey combed appearance. Although Rosai Dorfman disease is rare, it should be considered as a potential differential diagnosis when multiple sites involving soft tissue attenuation masses are observed with sonogram and CT.

  1. Two cases of multiple skeletal tuberculosis with spina ventosa

    Jeon, Byung Hee; Choi, Sung Wook; Kim, Byung Soo [Busan National University College of Medicine, Busan (Korea, Republic of)

    1974-10-15

    Two cases of multiple skeletal tuberculosis with spina ventosa proved by radiological and pathological methods, were reported. One of the cases was 3 years old boy who had multiple abscess formations in both lower legs, intermittent high fever and soft tissue swelling in both hands, and the other was 19 years old boy who had soft tissue swelling in both hands and feet. Radiologically, the former showed active hilar tuberculosis of the chest, and destructive changes with cortical expansion in the left humerus, left tibra, left calcaneus and both hands; the latter showed almost fibroconsolidated lesions of the chest, and the bony lesions in both radii, left calcaneus, and both hands and feet. Biopsy specimen showed tubercles composed of epithelial cells, small round cells and fibroblasts with caseous necrosis in part.

  2. Multiple intraoral neurofibromas: Case report and review of the literature

    C Krithika

    2009-01-01

    Full Text Available Neurofibromatosis type I (NF I is an autosomal dominant disease transmitted with a high degree of penetrance. The disease is expressed in different forms. NF I accounts for almost 90% of the cases although nine types have been described to date. We report one such case of a 40-year-old male who presented with multiple nodules on the body and multiple intraoral soft tissue swellings. He was diagnosed to have NF I, having satisfied the diagnostic criteria for the same. This paper highlights the clinical features and diagnostic criteria of NF, the prevalence and the significance of intraoral neurofibromas and the need for the general practitioner to be aware of this condition.

  3. [A case of multiple cavernous angioma with dementia].

    Kariya, S; Kawahara, M; Suzumura, A

    2000-10-01

    We reported a 65-year-old man who developed dementia since 50 years of age. His consciousness was clear but he was indifferent to his illness. Also, the luck of attention was recognized when we underwent examinations and the result of intellectual test varied every time we performed. His memory function was almost normal on the examination which was performed when he was cooperative. Magnetic resonance imaging (MRI) disclosed multiple tiny lesions (more than 130 in all) in cerebrum, brainstem, cerebellum and spinal cord. These lesions were compatible with multiple cavernous angioma. Most of lesions manifested high-density area on cranial CT. Though the multiplicity of foci indicated the possibility of familial occurrence, he was considered to be a sporadic case on his lineage investigation and the brain MRI of his only son. In this case, neither headache nor seizures which were known as the major clinical features of intracerebral cavernous angioma was observed. He was diagnosed as having white matter dementia characterized by attentional dysfunction, decrement of volition and less memory disturbance. We speculated that he developed symptomatic dementia by the sum of multiple minor degeneration, especially in frontal lobe white matter, caused by repeated minor bleeding from cavernous angiomas.

  4. A rare case of multiple meningiomas with different histology

    Toma I. Papacocea

    2017-11-01

    Full Text Available Meningiomas are generally benign tumors but sometimes they manifest tendency to progress towards malignancy. It is not yet clear if anaplastic meningiomas have an innate malignancy characteristic, or an initially beginning histological appearance that degenerates malignantly in time. According to literature data, the risk of a benign meningioma to progress towards malignant phenotype is about 0.16-2%, such malignant transformation occurring after a variable period of time (2-16 years. A still unanswered question is how many of the malignant meningiomas present this appearance as an innate feature and how many of them originate from benign meningiomas. Multiple meningiomas are defined as the presence of two or more distinct meningiomas. They occur in 6-10% of all patients that present meningiomas. Multiple meningiomas with a distinct histological appearance are rarely discovered. They support the theory of meningiomas that develop independently in the same patient. Different histology of multiple meningiomas is found in less than a third of the patients who suffer from this pathology. We are presenting the case of a patient with multiple meningiomas with distinct histology, one being benign and the other malignant. In connection with this case we are raising a question of therapeutic management in patients diagnosed with malignant meningiomas, namely if other possible small/ benign meningiomas should be also entirely resected.

  5. Case report 554: Osteonecrosis at multiple sites as noted

    Archer, A G; Nelson, M C [Georgetown Univ., Washington, DC (USA). Dept. of Radiology; Abbondanzo, S L [Georgetown Univ., Washington, DC (USA). Dept. of Pathology; Bogumill, G P [Georgetown Univ., Washington, DC (USA). Div. of Orthopaedics

    1989-08-01

    This is a case of a 31-year-old man who presented with persistent pain of the left knee and was found to have avascular necrosis at multiple sites. Plain film roentgenograms with tomography, bone scanning and magnetic resonance imaging were utilized in the diagnostic work-up. The history of treatment with steroids eight years previously was elicited only after the diagnosis was made radiographically and pathologically. (orig./GDG).

  6. Hydrodynamic forces on inundated bridge decks

    2009-05-01

    The hydrodynamic forces experienced by an inundated bridge deck have great importance in the design of bridges. Specifically, the drag force, lift force, and the moment acting on the bridge deck under various levels of inundation and a range of flow ...

  7. Clinical evaluation of multiple exostoses (17 cases) on bonescintigraphy

    Yamada, Takayuki; Nakamura, Mamoru; Sugita, Reiji; Satou, Akihiro; Sakamoto, Kiyohiko (Tohoku Univ., Sendai (Japan). School of Medicine)

    1991-03-01

    Seventeen patients with multiple exostoses were examined on bone scintigraphy. Inheritance was recognized on seven patients (41%). Onset age of 15 patients was under 20 years old and 10 patients were under 10. The number of lesions was 211 and they were usually recognized at metaphyses of long bones. The degree of accumulation was classified into four grades: 0 (non increased), 1 (slightly-mild), 2 (moderate), and 3 (strong). One hundred and fifty-three lesions (73%) did not show definite increased activity (Grade 0, 1). Grade 3 included 14 lesions and they tended to be strongly calcified on X-P. This disease was said to transform into chondrosarcoma in 10 to 20%. Transformation was said to occur preferably in adults at heavily calcified lesion or one which showed irregularly thick hyaline cartilage. Such lesions showed more increased accumulation than normal bones. In our cases three cases were resected for this reason but turned out to be benign histologically. One case showed malignant transformation. In this case, a large malignant tumor replaced the parent bone and bone scan showed the cold lesion. Bone scintigraphy was considered useful to evaluate the biological activity of multiple exostoses. (author).

  8. Multiple Symmetric Lipomatosis: A Review of 3 Cases

    Emilio Mevio

    2012-01-01

    Full Text Available Multiple symmetrical lipomatosis, or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and in the upper body. The neoformations grow slowly and their initial consequence is purely esthetic. They can, however, lead to compression of the laryngotacheal area and of the esophagus. This disease usually affects middle-aged males from the Mediterranean area with a history of alcohol abuse. Although most cases have been sporadic, a few authors have indicated that the disorder may be hereditary. It is thought that this pathology originates from an alteration in lipid metabolism. Since the patients were asymptomatic temperance and diet was proposed, surgical removal of the lipomatose mass is the treatment of choice in case of complications due to fat mass compression on upper aerodigestive tract. The authors present three cases of Madelung's disease with different and particular manifestations.

  9. Team effectiveness in academic medical libraries: a multiple case study.

    Martin, Elaine Russo

    2006-07-01

    The objective of this study is to apply J. Richard Hackman's framework on team effectiveness to academic medical library settings. The study uses a qualitative, multiple case study design, employing interviews and focus groups to examine team effectiveness in three academic medical libraries. Another site was selected as a pilot to validate the research design, field procedures, and methods to be used with the cases. In all, three interviews and twelve focus groups, with approximately seventy-five participants, were conducted at the case study libraries. Hackman identified five conditions leading to team effectiveness and three outcomes dimensions that defined effectiveness. The participants in this study identified additional characteristics of effectiveness that focused on enhanced communication, leadership personality and behavior, and relationship building. The study also revealed an additional outcome dimension related to the evolution of teams. Introducing teams into an organization is not a trivial matter. Hackman's model of effectiveness has implications for designing successful library teams.

  10. Case Report: Multiple Myeloma with Gangrene of Extremities

    N Gharahi

    2009-07-01

    Full Text Available Introduction: Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone and it results in bone pain or fracture, renal failure, susceptibility to infections, anemia and hypercalcemia. The hyper viscosity syndrome is rare. Cryoglobulins are immunoglubulins that precipitate at temperatures less than 37degrees Celsius. Monoclonal cryoglobulins are usually present along with a specific hematologic disorder and are often asymptomatic. We report a second case of multiple myeloma with gangrene of all four extremities. Case: The Patient was a 77 year–old farmer with a 2 weeks history of coldness, pain and discoloration of the fingers of both the extremities which had extended to the mid forearm and shin regions. It was accompanied by skin erosions of the lower extremities, dark spots on the ear auricles and discoloration of the tip of the nose. On physical examination, quadrigangrene associated with ischemia of the auricles and tip of nose was seen. Serum proteins electrophoresis demonstrated monoclonal gammopathy and serum was positive for cryoglobulin, Bone marrow study showed neoplastic plasma cells infiltration. The patient was diagnosed as cryoglobulinemia based on multiple myeloma and treated accordingly.

  11. A case of multiple brown tumors with primary hyperparathyroidism.

    Mori, Hiroko; Okada, Yosuke; Arao, Tadashi; Shimaziri, Shohei; Tanaka, Yoshiya

    2013-01-01

    We report a case of large multiple brown tumors in a patient with primary hyperparathyroidism. A 52-year-old woman suffered from pain in the ribs and developed left facial swelling and deformity. CT showed a large destructive osteolytic lesion in the left maxillary sinus. Biopsy showed a lesion with newly formed bone tissue, diffuse giant cells and deposits of hemosiderin. In addition, similar lesions were also observed in the ribs, iliac bones and pelvis. The laboratory data showed hypercalcemia and hyperparathyroidism. Cervical echo and (201)Tl-(99m)TcO(4-) scintigraphy demonstrated a right lower swollen parathyroid adenoma. The diagnosis was multiple brown tumors with primary hyperparathyroidism and parathyroidectomy was performed. Follow-up CT showed marked decreases in the size of osteolytic lesions with calcification in the brown tumors compared to pre-treatment findings. These changes were associated with marked improvement in pain and facial deformity. We described a rare case of multiple brown tumors appeared in the maxilla associated with primary hyperparathyroidism.

  12. A Highly Accurate and Efficient Analytical Approach to Bridge Deck Free Vibration Analysis

    D.J. Gorman

    2000-01-01

    Full Text Available The superposition method is employed to obtain an accurate analytical type solution for the free vibration frequencies and mode shapes of multi-span bridge decks. Free edge conditions are imposed on the long edges running in the direction of the deck. Inter-span support is of the simple (knife-edge type. The analysis is valid regardless of the number of spans or their individual lengths. Exact agreement is found when computed results are compared with known eigenvalues for bridge decks with all spans of equal length. Mode shapes and eigenvalues are presented for typical bridge decks of three and four span lengths. In each case torsional and non-torsional modes are studied.

  13. An unusual case of idiopathic multiple invasive cervical resorption

    Sathya Prakash Reddy Kesary

    2014-01-01

    Full Text Available Invasive cervical resorption is a rare form of root resorption, characterized by destruction of the cervical region of teeth resulting from the action of tooth resorbing cells. Being an asymptomatic condition, it is often discovered on routine radiographic examination. This multifactorial disease process can most commonly occur as a sequel to orthodontic treatment, dental trauma, bleaching procedures, and less commonly, as an outcome of segmental orthognathic surgery, periodontal root planning, tetracycline conditioning of the root canal, bruxism, transplantation of tooth, guided tissue regeneration, cementoenamel disjunction. In the absence of these predisposing factors, it can be labeled as ′idiopathic multiple cervical resorption′. This article describes the case of a medically fit Indian male, who displayed idiopathic invasive cervical resorption in multiple teeth.

  14. Extraosseous Multiple Myeloma with Retroperitoneal Manifestation: A Case Report

    Berdugo, Juan Oswaldo; Nieto, Sonia Janeth; Garzon, Julian Gonzalo

    2008-01-01

    This paper presents a case of a 57 years old man (patient of Hospital Militar Central of Bogota, Colombia) with weight loss and a mass in the right clavicle. Plain film radiography shows a lytic lesion in the sternum side of the clavicle. biopsy reports a plasmacytomas, radiotherapy was performed. Three years later lesions of similar characteristics within ribs and a focal lesion in left testicle were detected. The diagnosis was multiple myeloma, Chemotherapy and orquidectomy were performed. One year after, patient complained of diffuse abdominal pain and loss weight, contrast abdominal CT was performed. Computed tomography showed a left heterogeneous mass with irregular contours that involved the retroperitoneal space occupying its three compartments. Biopsy was performed and reported pleomorphicplasmocytic proliferation with nuclear enlargement and hyperchromic nuclei consistent with multiple myeloma with abdominal involvement.

  15. Anesthetic management of a patient with multiple sclerosis - case report

    Eduardo Barbin Zuccolotto

    Full Text Available Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

  16. Interference profiles with multiple spherical waves: general case

    Zerbino, L.M.; Torroba, R.; Rodriquez, N.; Garavaglia, M.

    1984-01-01

    Characteristics of multiple-beam interference fringes, as in a Fabry-Perot interferometer with monochromatic light, are analyzed. The optical path and the optical-path difference between interfering beams are calculated for the most general case. Different refractive indices in the inner and outer media, and arbitrary locations of the light source and the point of observation, are taken into account. An expression of the impulse response of the system is given. The results obtained from experimental tests confirm the theoretical predictions. 8 references

  17. Multiple bone metastasis of medulloblastoma; a case report

    Oh, Jae Cheon; Lee, Seoung Ro; Kim, Yong Soo; Park, Dong Woo; Joo, Kyung Bin; Hahm, Chang Kok

    1996-01-01

    Medulloblastoma is one of the most undifferentiated primitive neuroectodermal tumors and represents about 30% of all posterior fossa tumors in children. Disseminated medulloblastoma, mainly involving cerebral surfaces, ventricles and the subarachnoid space can, in 50% of patients, be identified on intial imaging studies. One third of these lesions metastasize to an extracranial sity, primarily to bone. Osseous metastases, which occur mainly after craniectomy are typically lytic, but osteoblastic lesions also may occur. We experienced the case of a 14 year-old female patient with multiple bone metastases of medulloblastoma after craniectomy. Bone metastatic lesions were present in the right femur and thoracic spine and were osteoblastic or osteolytic

  18. Missing data methods for dealing with missing items in quality of life questionnaires. A comparison by simulation of personal mean score, full information maximum likelihood, multiple imputation, and hot deck techniques applied to the SF-36 in the French 2003 decennial health survey.

    Peyre, Hugo; Leplège, Alain; Coste, Joël

    2011-03-01

    Missing items are common in quality of life (QoL) questionnaires and present a challenge for research in this field. It remains unclear which of the various methods proposed to deal with missing data performs best in this context. We compared personal mean score, full information maximum likelihood, multiple imputation, and hot deck techniques using various realistic simulation scenarios of item missingness in QoL questionnaires constructed within the framework of classical test theory. Samples of 300 and 1,000 subjects were randomly drawn from the 2003 INSEE Decennial Health Survey (of 23,018 subjects representative of the French population and having completed the SF-36) and various patterns of missing data were generated according to three different item non-response rates (3, 6, and 9%) and three types of missing data (Little and Rubin's "missing completely at random," "missing at random," and "missing not at random"). The missing data methods were evaluated in terms of accuracy and precision for the analysis of one descriptive and one association parameter for three different scales of the SF-36. For all item non-response rates and types of missing data, multiple imputation and full information maximum likelihood appeared superior to the personal mean score and especially to hot deck in terms of accuracy and precision; however, the use of personal mean score was associated with insignificant bias (relative bias personal mean score appears nonetheless appropriate for dealing with items missing from completed SF-36 questionnaires in most situations of routine use. These results can reasonably be extended to other questionnaires constructed according to classical test theory.

  19. Multiple sclerosis in the Faroe Islands. 7. Results of a case control questionnaire with multiple controls

    Kurtzke, J F; Hyllested, K; Arbuckle, J D

    1997-01-01

    Detailed questionnaires were completed in 1978-79 by 23 of the 28 then known resident Faroese multiple sclerosis (MS) patients and 127 controls. These controls were divided into 69 Group A (patient sibs and other relatives), 37 Group B (matched neighbor controls, their spouses and sibs, plus...... facilities, and nature of house construction or heating. Detailed dietary histories, available for half the subjects, revealed no differences, cases versus controls, for four age periods between age 0 and 30 years, and for 16 specified foodstuffs. Animal exposures showed overall no consistent differences...

  20. A Case of Multiple Sclerosis and Celiac Disease

    H. Z. Batur-Caglayan

    2013-01-01

    Full Text Available Objectives. Multiple sclerosis (MS is an inflammatory autoimmune disorder of the central nervous system (CNS. Since a correlation between gluten intake and incidence of MS had been reported, the relationship of antigliadin antibodies and MS was debated. Case Report. We report the case of a 45-year-old female MS patient who is under interferon treatment. After seven years of monitoring, during her routine gastroenterological assessment, she was diagnosed with celiac disease. Conclusion. Beside the neurological manifestations that have been demonstrated in about 10% of celiac disease (CD patients, white-matter abnormalities in brain MRI are uncommon and controversial. But in the literature, MS seems to be associated with CD as in our patient. We suggest that MS patients with gastroenterological complaints should undergo an assessment for CD.

  1. Multiple Levels of Lumbar Spondylolysis - A Case Report -

    Park, Kwang-Hwan; Ha, Joong-Won; Kim, Hak-Sun; Moon, Seong-Hwan; Lee, Hwan-Mo; Kim, Ho-Joong; Kim, Ju-Young

    2009-01-01

    We report here on an unusual case of multiple levels of asymmetric lumbar spondylolysis in a 19-year-old woman. The patient had severe low back pain of increasing intensity with lumbar instability, which was evident on the dynamic radiographs. MRI demonstrated the presence of abnormalities and the three dimensional CT scan revealed asymmetric complete spondylolysis at the left L2, L3 and L4 levels and the right L1, L2 and L3 levels. This case was treated surgically by posterior and posterolateral fusion at L2-3-4 with intersegmental fixation using pedicle screws and an auto iliac bone graft. The patient was relieved of her low back pain after the surgery. PMID:20404945

  2. Robotics and Automation for Flight Deck Aircraft Servicing

    Chesser, J.B.; Draper, J.V.; Pin, F.G.

    1999-03-01

    One of the missions of the Future Aircraft Carriers Program is to investigate methods that would improve aircraft turnaround servicing activities on carrier decks. The major objectives and criteria for evaluating alternative aircraft servicing methods are to reduce workload requirements, turnaround times (TAT), and life-cycle costs (LCC). Technologies in the field of Robotics and Automation (R and A) have the potential to significantly contribute to these objectives. The objective of this study was to investigate aircraft servicing functions on carrier decks which would offer the potentially most significant payoff if improved by various R and A technologies. Improvement in this case means reducing workload, time and LCC. This objective was accomplished using a ''bottom-up'' formalized approach as described in the following.

  3. Hereditary multiple exostosis with secondary malignization: case report

    Coutinho, A.M.N.; Pitella, F.A.; Coura Filho, G.B.; Costa, P.L.A.; Ono, C.R.; Watanabe, T.; Sapienza, M.T.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (USP), SP (Brazil). Inst. de Radiologia. Centro de Medicna Nuclear

    2008-07-01

    Full text: Introduction: Hereditary Multiple Exostosis (HME) or multiple osteochondromatosis is a skeletal development anomaly which is characterized by generalized exostoses in the bones, mainly in long bone metaphyses, appearing during childhood and adolescence. The transmission is autosomal dominant, its prevalence varies from 1/50,000 to 9/1,000,000 in Europe, and around 10% of cases show no family history. Case Report: Description of an HME case with two secondary malignization episodes. The data was taken from the patient's chart and from imaging exams from the hospital files. WASB, a 19-year-old male, hospitalized after being pre-diagnosed with HME and complaints of bone-consistent mass in the right gluteal region and a lump in the posterior region of the right leg, associated to multiple bone lumps all over the body. A magnetic resonance imaging (MRI) was performed along with a bone scintillography with {sup 99m}Tc-MDP which showed multiple osteogenic lesions in the thorax, pelvic bones and long bones with periarticular prevalence in the lower limbs. The suspicion of malignancy in the right iliac area was raised due to the MRI result and to the higher intensity captured in the scintillography, confirming chondrosarcoma grade I of malignancy in the biopsy. The patient suffered interileo abdominalis amputation of the right lower limb with good evolution and control scintillography performed after 1 and 1,5 years. In the second controlling procedure, the patient complained about pain in the left knee, and a MRI suggested a new secondary malignization. The hypothesis of a head of left fibula osteochondroma with signs of aggressiveness was confirmed following surgery. Discussion: In HME, the exostoses grow along with the individual, ceasing with the epiphyseal fusion. The growth of these formations after skeletal maturation suggests activity of exostoses and, in most times, it is a sign of malignant transformation, which turns almost every time into

  4. [A case of focal epilepsy manifesting multiple psychiatric auras].

    Ezura, Michinori; Kakisaka, Yosuke; Jin, Kazutaka; Kato, Kazuhiro; Iwasaki, Masaki; Fujikawa, Mayu; Aoki, Masashi; Nakasato, Nobukazu

    2015-01-01

    We present a case of epilepsy with multiple types of focal seizures that were misdiagnosed as psychiatric disorders. A 20-year-old female patient presented with a variety of episodes, including loss of consciousness, deja vu, fear, delusion of possession, violent movements, and generalized convulsions. Each of these symptoms appeared in a stereotypic manner. She was initially diagnosed with a psychiatric disorder and treated with psychoactive medications, which had no effect. Long-term video electroencephalography revealed that her episodes of violent movement with impaired consciousness and secondarily generalized seizure were epileptic events originating in the right hemisphere. High-field brain magnetic resonance imaging for detecting subtle lesions revealed bilateral lesions from periventricular nodular heterotopia. Her final diagnosis was right hemispheric focal epilepsy. Carbamazepine administration was started, which successfully controlled all seizures. The present case demonstrates the pitfall of diagnosing focal epilepsy when it presents with multiple types of psychiatric aura. Epilepsy should thus be included in differential diagnoses, considering the stereotypic nature of symptoms, to avoid misdiagnosis.

  5. Successful treatment of multiple bilateral impactions - a case report.

    Schubert, Michael; Proff, Peter; Kirschneck, Christian

    2016-07-25

    Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of the deciduous and surgical exposure of the impacted permanent teeth, the Easy-Way-Coil™ system was used in conjunction with a skeletal anchorage (maxilla, BENEfit™ system) to guide the eruption of all impacted teeth. After a total treatment time of only 22.8 months all impacted teeth could be aligned successfully and a stable and functional class I occlusion was achieved. In addition, there were no adverse treatment effects such as anchorage loss, root resorptions or periodontal problems and an esthetic result could be achieved. The presented treatment approach thus proved to be highly effective in cases with multiple bilateral impactions with minimal side effects and considerably reduced treatment time.

  6. Gigantism in sibling unrelated to multiple endocrine neoplasia: case report.

    Matsuno, A; Teramoto, A; Yamada, S; Kitanaka, S; Tanaka, T; Sanno, N; Osamura, R Y; Kirino, T

    1994-11-01

    The cases of gigantism sisters with somatotroph adenomas unrelated to multiple endocrine neoplasia (MEN) Type 1 are reported. The sisters grew rapidly since they were 5 or 6 years old and were diagnosed to have gigantism with pituitary adenoma by computed tomographic scan and magnetic resonance imaging. A serum endocrinological examination showed the elevated growth hormone values. After thyroxine-releasing hormone stimulation, growth hormone values exhibited a paradoxical rise. They were supposed to be unrelated to MEN Type 1, because analysis of the 11th chromosomes and the other endocrine functions were normal. They were operated on by the transphenoidal method. Immunohistochemical staining of both tumor specimens confirmed somatotroph adenomas. Pituitary adenoma associated with MEN Type 1 is a well-recognized entity. However, the sporadic occurrence of pituitary adenoma unrelated to MEN Type 1, especially in siblings, is extremely rare. Fifteen cases of pituitary adenomas in siblings were described in the literature. As for gigantism, only two brothers were reported. Our case of gigantism sisters is the second sporadic case. In our review of the isolated cases of pituitary adenoma in siblings described in the literature, 12 (70%) of 17 cases including ours are acromegaly or gigantism. This incidence is much higher than that of MEN Type 1 patients with pituitary adenomas. The cause of the familial occurrence of pituitary adenomas is still unclear, although autosomal recessive inheritance has been suggested. It has been stated that point mutations in codon 201 or 227 of the Gs alpha gene located in chromosome 20 were found in about 35 to 40% of somatotroph adenomas.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Optimizing rib width to height and rib spacing to deck plate thickness ratios in orthotropic decks

    Abdullah Fettahoglu

    2016-12-01

    Full Text Available Orthotropic decks are composed of deck plate, ribs, and cross-beams and are frequently used in industry to span long distances, due to their light structures and load carrying capacities. Trapezoidal ribs are broadly preferred as longitudinal stiffeners in design of orthotropic decks. They supply the required stiffness to the orthotropic deck in traffic direction. Trapezoidal ribs are chosen in industrial applications because of their high torsional and buckling rigidity, less material and welding needs. Rib width, height, spacing, thickness of deck plate are important parameters for designing of orthotropic decks. In the scope of this study, rib width to height and rib spacing to deck plate thickness ratios are assessed by means of the stresses developed under different ratios of these parameters. For this purpose a FE-model of orthotropic bridge is generated, which encompasses the entire bridge geometry and conforms to recommendations given in Eurocode 3 Part 2. Afterwards necessary FE-analyses are performed to reveal the stresses developed under different rib width to height and rib spacing to deck plate thickness ratios. Based on the results obtained in this study, recommendations regarding these ratios are provided for orthotropic steel decks occupying trapezoidal ribs.

  8. A Case of Turner Syndrome with Multiple Embolic Infarcts

    Cindy W. Yoon

    2016-09-01

    Full Text Available Only a few cases of Turner syndrome (TS with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

  9. Team effectiveness in academic medical libraries: a multiple case study*

    Russo Martin, Elaine

    2006-01-01

    Objectives: The objective of this study is to apply J. Richard Hackman's framework on team effectiveness to academic medical library settings. Methods: The study uses a qualitative, multiple case study design, employing interviews and focus groups to examine team effectiveness in three academic medical libraries. Another site was selected as a pilot to validate the research design, field procedures, and methods to be used with the cases. In all, three interviews and twelve focus groups, with approximately seventy-five participants, were conducted at the case study libraries. Findings: Hackman identified five conditions leading to team effectiveness and three outcomes dimensions that defined effectiveness. The participants in this study identified additional characteristics of effectiveness that focused on enhanced communication, leadership personality and behavior, and relationship building. The study also revealed an additional outcome dimension related to the evolution of teams. Conclusions: Introducing teams into an organization is not a trivial matter. Hackman's model of effectiveness has implications for designing successful library teams. PMID:16888659

  10. Multiple Study of Case Involving Implementation of Lean Manufacturing

    Delvio Venanzi

    2018-03-01

    Full Text Available This article aims to show some factors that can cause companies to succeed or fail in their attempts to use lean manufacturing, by performing a multiple case study which presents two successful cases and three conditions of failure, in a survey of five large companies, all belonging to the metal-mechanical sector, located in Campinas and Sorocaba, both in the state of São Paulo, Brazil. The data were collected using exploratory research between the periods of January 2013 and February 2015. The results show that successful cases of lean manufacturing implementation are the result of a more organized work environment, standardization of production and service areas, employee satisfaction, productivity results and quality of the final product. Unsuccessful deployments result from poor execution and faulty planning, that has no benefit and ultimately decrease the morale of its employees, creating more distrust and frustration directly influencing the results and productivity. In other words, lean manufacturing implementation requires hard and continuous work and these procedures should be aligned with the mission and goals of companies and mainly focus on the maintenance result by using tools to monitor and track the process systematically and also making investments to eliminate waste.

  11. Flight Deck I-Glasses, Phase I

    National Aeronautics and Space Administration — Flight Deck i-Glasses is a color, stereoscopic 3-D display mounted on consumer style eye glass frames that will enhance operator performance and multi-modal...

  12. Deck41 Surficial Seafloor Sediment Description Database

    National Oceanic and Atmospheric Administration, Department of Commerce — Deck41 is a digital summary of surficial sediment composition for 36,401 seafloor samples worldwide. Data include collecting source, ship, cruise, sample id,...

  13. Conjunctival Aspergilloma with Multiple Mulberry Nodules: A Case Report

    Jiunn-Liang Chen

    2005-06-01

    Full Text Available A 30-year-old healthy female presented with a 1-year history of chronic mucous discharge, tearing, and irritation in the left eye. Slit-lamp examination revealed severe papillary and follicular reaction surrounding a movable subconjunctival mass on the left upper tarsal conjunctiva. Incision and curettage were performed to establish the diagnosis. Multiple peculiar black mulberry nodules were obtained. The clumps of septate hyphae seen with periodic acid-Schiff stain were characteristic of fungus ball (aspergilloma. The patient's symptoms improved significantly after surgery without any antifungal therapy. Although rarely reported, aspergillus is a common fungus in the conjunctiva that may seed into the subconjunctiva. We present this case to remind ophthalmologists of such a rare cause of recalcitrant conjunctival inflammation in immunocompetent patients.

  14. Synchronous GISTs associated with multiple sporadic tumors: a case report

    Danila Comandini

    2017-08-01

    Full Text Available Gastrointestinal stromal tumors (GISTs are rare neoplasms, but they also represent the most common mesenchymal tumors of the gastrointestinal tract originating from the cell of Cajal. GIST incidence ranges around 1% of all gastrointestinal malignancies. Approximately 5% of all GISTs have a hereditary etiology. The remaining 95% of GISTs are considered sporadic events, with up to 75% of cases driven by a constitutional activation of the c-KIT proto-oncogene. GISTs are generally solitary lesions. Nonetheless, multiple sporadic GISTs can occur and present as synchronous or metachronous tumors, usually associated with familial GIST. Here, we report a case of primary prostate and lung tumors associated with gastric and small bowel GISTs, unrelated to any known hereditary syndrome. Also, in the case we describe, the prostatic tumor came before the GISTs, while the lung tumor occurred later in time and led to pulmonary lobectomy plus lymphoadenectomy, with a diagnosis of nonsmall cell lung cancer. With the exception of a slight difference in lymphoid infiltration, the abdominal and gastric GIST nodules shared the same proliferative MIB1 index and mitotic count. However, the genetic analysis revealed that the gastric GIST and abdominal tumors were characterized by two different c-KIT mutations. This molecular heterogeneity supported the hypothesis of two different synchronous GISTs arising from stomach and ileum. At present, the patient is disease free and has already completed the third year of adjuvant therapy with imatinib. This case supports the importance of the analysis of c-KIT mutational status to distinguish metastases from synchronous multicentric GISTs, with relevant implications in therapeutic decisions, as well as the importance of a dedicated multidisciplinary team and of a radiological follow-up after the diagnosis of a primary GIST, to discover a relapse of the GIST or, possibly, additional malignancies.

  15. Is deck B a disadvantageous deck in the Iowa Gambling Task?

    Chiu Yao-Chu

    2007-03-01

    Full Text Available Abstract Background The Iowa gambling task is a popular test for examining monetary decision behavior under uncertainty. According to Dunn et al. review article, the difficult-to-explain phenomenon of "prominent deck B" was revealed, namely that normal decision makers prefer bad final-outcome deck B to good final-outcome decks C or D. This phenomenon was demonstrated especially clearly by Wilder et al. and Toplak et al. The "prominent deck B" phenomenon is inconsistent with the basic assumption in the IGT; however, most IGT-related studies utilized the "summation" of bad decks A and B when presenting their data, thereby avoiding the problems associated with deck B. Methods To verify the "prominent deck B" phenomenon, this study launched a two-stage simple version IGT, namely, an AACC and BBDD version, which possesses a balanced gain-loss structure between advantageous and disadvantageous decks and facilitates monitoring of participant preferences after the first 100 trials. Results The experimental results suggested that the "prominent deck B" phenomenon exists in the IGT. Moreover, participants cannot suppress their preference for deck B under the uncertain condition, even during the second stage of the game. Although this result is incongruent with the basic assumption in IGT, an increasing number of studies are finding similar results. The results of the AACC and BBDD versions can be congruent with the decision literatures in terms of gain-loss frequency. Conclusion Based on the experimental findings, participants can apply the "gain-stay, loss-shift" strategy to overcome situations involving uncertainty. This investigation found that the largest loss in the IGT did not inspire decision makers to avoid choosing bad deck B.

  16. Surgical plate fixation of multiple rib fractures: a case report.

    Mitev, Konstantin; Neziri, Dashurie; Stoicovski, Emil; Mitrev, Zan

    2018-05-29

    The healthcare system in developing countries is limited; particularly, medical specialties such as emergency and trauma medicine are underdeveloped. Consequently, trauma injuries sustained in traffic accidents result in chronic morbidity more often than similar cases in developed countries. Multiple rib fractures induce significant patient morbidity. Current international guidelines recommend a multidisciplinary, surgery-based treatment approach to achieve optimal clinical benefit. We admitted a 41-year-old Albanian man to our emergency department following a pedestrian-vehicle accident 5 days earlier. He presented with severe upper thoracic pain, chest deformity, dyspnea, tachycardia, subcutaneous emphysema, and hematoma. Chest radiography pointed to hypoventilated lung fields and a minor pleural effusion. Computed tomographic scans indicated displaced fractures of right lateral ribs 5 -11, hyperdensity regions from bone fragments, and pulmonary contusion. The treatment consisted of surgical fixation of ribs 7-10 using titanium reconstruction plates and cortical locking screws. The patient's clinical condition rapidly improved postoperatively. Follow-up at 6 weeks confirmed a full return to preoperative daily activities and a high quality of life. In this case report, we present a novel and promising development in the field of trauma medicine in the Republic of Macedonia. Trauma injuries can be treated via advanced multidisciplinary medical care according to international standards, allowing optimal health recovery.

  17. Twelve cases of multiple myeloma in Nagasaki (especially seven atomic bombing casualty cases). [In Japanese

    Ichimaru, M; Yasuhi, S; Ouchuru, S

    1963-12-01

    Since 1958, there have been 12 cases of multiple myeloma in Nagasaki, and among them were 7 cases representing atomic bombing casualties, with 3 cases being with 2 km distance from the hypocenter. The age of onset was between 51 and 69 years, and the sex ratio was 8:4, it occurring mostly in males. Symptoms were predominantly low back pain and chest pain caused by the bone changes in 8 cases. Two cases complained of general malaise and palpitation which resulted from anemia. One developed persistent epistaris, and another complained of diplopia caused by the paralysis of the oculomotor nerve. Peripheral blood in all cases showed anemia, 9 with hyperchromic and 3 with normochromic or hypochromic anemia. Low platelet counts were seen in 3 cases. All showed leukopenia. All cases showed typical ..gamma..-globulin change with a myeloma peak, and in 4 cases showed an increase of ..beta..-globulin. Bence-Jones proteinuria was present in 5 cases. Average course was 1 year 4 months. Among complications, myeloma nephrosis, aplastic anemia, and pneumonia were the most important ones.

  18. Multiple thymoma in a patient with myasthenia gravis: case report

    Ko, Eun Sook; Jeon, Kyung Nyeo; Bae, Kyung Soo; Yoo, Jin Jong; Kang, Duk Sik

    2004-01-01

    A thymoma often occurs in patients with myasthenia gravis, but the development of multiple thymoma is very rare. The authors report the radiologic and pathologic findings of multiple invasive thymoma in a 59-year-old male with myasthenia gravis

  19. Multiple thymoma in a patient with myasthenia gravis: case report

    Ko, Eun Sook; Jeon, Kyung Nyeo; Bae, Kyung Soo; Yoo, Jin Jong [College of Medicine, Gyeongsang National Univ., Jinju (Korea, Republic of); Kang, Duk Sik [College of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2004-02-01

    A thymoma often occurs in patients with myasthenia gravis, but the development of multiple thymoma is very rare. The authors report the radiologic and pathologic findings of multiple invasive thymoma in a 59-year-old male with myasthenia gravis.

  20. Multiple cerebral aneurysms of middle cerebral artery. Case report

    D.A. Nica1, Tatiana Rosca1, A. Dinca2, M. Stroi3, Mirela Renta4, A.V. Ciurea5

    2010-11-01

    Full Text Available Multiple cerebral aneurysms present awide variation in incidence with averages of13% at angiographic studies and 22.7% atautopsy.High blood pressue, cigarette smoking,stress and possible also age and female sexseem to be risk factors for multipleintracranial aneurysms (MIAn in patientsof working age who have suffered asubarachnoid hemorrhage (SAH.Aneurysms were situated on the same sidein one-third of the patients with twoaneurysms and the most common site wasthe middle cerebral artery (MCA. Tomanage these challenging lesionsneurosurgeons must use all availableinnovations and advances, includingdiagnostic, technical and perioperativeadjuncts. The author presents a case ofmiddle age female, with two saccularaneurysms situated on the same side (rightMCA, who was operated in our clinic, 20days after first SAH episode, I grade onHunt/Hess scale. The angio MRI wasperformed before, and control DSangiography after operation. After pterionalapproach, the author used themagnification, microsurgical technics,temporal clip, and two permanent Yasargilcurved clips. A postoperative good recoveryenable the patient go to work and drive onemonth later.

  1. Multiple endocrine diseases in dogs: 35 cases (1996-2009).

    Blois, Shauna L; Dickie, Erica; Kruth, Stephen A; Allen, Dana G

    2011-06-15

    To characterize a population of dogs from a tertiary care center with 2 or more endocrine disorders, including the specific disorders and time intervals between diagnosis of each disorder. Retrospective case series. 35 dogs with 2 or more endocrine disorders. Medical records were reviewed, and the following was recorded: clinical signs, physical examination findings, and the results of CBC, serum biochemical analysis, urinalysis, aerobic bacterial culture of urine samples, endocrine testing, diagnostic imaging, and necropsy. 35 dogs with more than 1 endocrine disorder were identified. Seventy-seven percent (27/35) of the dogs were male, and the mean age at the time of diagnosis of the first endocrinopathy was 7.9 years. Miniature Schnauzer was the most common breed. Twenty-eight of 35 (80%) dogs had 2 disorders; 7 (20%) had 3 disorders. The most common combinations of disorders included diabetes mellitus and hyperadrenocorticism in 57.1 % (20/35) of dogs; hypoadrenocorticism and hypothyroidism in 22.9% (8/35) of dogs; and diabetes mellitus and hypothyroidism in 28.6% (10/35) of dogs. A mean of 14.5 months elapsed between diagnosis of the first and second endocrine disorders, whereas there was a mean of 31.1 months between diagnosis of the first and third endocrine disorders. Results suggested that the occurrence of multiple endocrine disorders was uncommon in dogs. The most common combinations of endocrine disorders in this population of dogs were diabetes mellitus and hyperadrenocorticism, followed by hypoadrenocorticism and hypothyroidism.

  2. Wave impact on a deck or baffle

    Md Noar, Nor Aida Zuraimi; Greenhow, Martin

    2015-02-01

    Some coastal or ocean structures have deck-like baffles or horizontal platforms that can be exposed to wave action in heavy seas. A similar situation may occur in partially-filled tanks with horizontal baffles that become engulfed by sloshing waves. This can result in dangerous wave impact loads (slamming) causing a rapid rise of pressures which may lead to local damaging by crack initiation and/or propagation. We consider the wave impact against the whole of underside of horizontal deck (or baffle) projecting from a seawall (or vertical tank wall), previously studied by Wood and Peregrine (1996) using a different method based on conformal mappings. The approach used is to simplify the highly time-dependent and very nonlinear problem by considering the time integral of the pressure over the duration of the impact pressure-impulse, P (x, y). Our method expresses this in terms of eigenfunctions that satisfy the boundary conditions apart from that on the impact region and the matching of the two regions (under the platform and under the free surface); this results in a matrix equation to be solved numerically. As in Wood and Peregrine, we found that the pressure impulse on the deck increases when the length of deck increases, there is a strong pressure gradient beneath the deck near the seaward edge and the maximum pressure impulse occurs at the landward end of the impact zone.

  3. Combined interpretation of multiple geophysical techniques: an archaeological case study

    Riedl, S.; Reichmann, S.; Tronicke, J.; Lück, E.

    2009-04-01

    subsurface structures and relevant geometries. From this data set, we interpret the depth and the extent of foundation and wall remains in the southern and central part of the site indicating the extent of the old orangery. This case study clearly illustrates the benefit of using multiple geophysical methods in archaeological studies. It further illustrates the advantage of 3-D GPR surveying at sites where anthropogenic disturbances (such as metallic pipes and other utilities) might limit the applicability of commonly applied mapping techniques such as magnetic gradiometry or EM38 conductivity mapping.

  4. Gust loading on streamlined bridge decks

    Larose, Guy; Mann, Jakob

    1998-01-01

    The current analytical description of the buffeting action of wind on long-span bridges is based on the strip assumption. However, recent experiments on closed-box girder bridge decks have shown that this assumption is not valid and is the source of an important part of the error margin...... of the analytical prediction methods. In this paper, an analytical model that departs from the strip assumption is used to describe the gust loading on a thin airfoil. A parallel is drawn between the analytical model and direct measurements of gust loading on motionless closed-box girder bridge decks. Empirical...

  5. 46 CFR 108.487 - Helicopter deck fueling operations.

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Helicopter deck fueling operations. 108.487 Section 108... DESIGN AND EQUIPMENT Fire Extinguishing Systems Fire Protection for Helicopter Facilities § 108.487 Helicopter deck fueling operations. (a) Each helicopter landing deck on which fueling operations are...

  6. 46 CFR 132.320 - Helicopter-landing decks.

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Helicopter-landing decks. 132.320 Section 132.320 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OFFSHORE SUPPLY VESSELS FIRE-PROTECTION EQUIPMENT Miscellaneous § 132.320 Helicopter-landing decks. Each vessel with a helicopter-landing deck must...

  7. 46 CFR 12.15-13 - Deck engine mechanic.

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Deck engine mechanic. 12.15-13 Section 12.15-13 Shipping... ENDORSEMENTS Qualified Member of the Engine Department § 12.15-13 Deck engine mechanic. (a) An applicant for an endorsement as deck engine mechanic shall be a person holding an MMC or MMD endorsed as junior engineer. The...

  8. 46 CFR 174.215 - Drainage of weather deck.

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Drainage of weather deck. 174.215 Section 174.215 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES... weather deck. The weather deck must have open rails to allow rapid clearing of water, or must have freeing...

  9. 46 CFR 173.062 - Drainage of weather deck.

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Drainage of weather deck. 173.062 Section 173.062 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSEL USE School Ships § 173.062 Drainage of weather deck. The weather deck of each sailing...

  10. Cone calorimeter tests of wood-based decking materials

    Robert H. White; Mark A. Dietenberger; Nicole M. Stark

    2007-01-01

    New technologies in building materials have resulted in the use of a wide variety of materials in decks. As part of our effort to address fire concerns in the wildland-urban interface, the Forest Products Laboratory has been examining the fire performance of decking products. In addition to preservative-treated wood, decking products include wood-plastic composites and...

  11. Renovation techniques for fatigue cracked orthotropic steel bridge decks

    de Jong, F.B.P.

    2007-01-01

    This dissertation presents the research into renovation techniques for orthotropic steel bridge decks. These techniques are needed to solve fatigue problems in the decks of these bridges, as several fatigue cracks have been detected in the deck structure of these bridges the last decade. A

  12. A case of multiple myeloma presenting as a bullous dermatosis

    Gul Ulker

    2008-01-01

    Full Text Available Multiple myeloma is a malignant plasma cell proliferative disorder that produces a monoclonal immunoglobulin protein. The skin involvement and the development of bullous disease are rarely seen features in multiple myeloma. We present a 55-year-old man with a longstanding, large, tense bullous eruption and hypertrophic scars over his body accompanied recently with weight loss and fatique. He had no response to the previous treatments, which included oral glucocorticoids and dapsone. Histologic examination of the lesions revealed subepidermal bullae, while no immunoflourescence staining was observed. In a further detailed labarotory examination, multiple myeloma was detected. After the treatment of multiple myeloma with chemotherapy, the lesions regressed. Patients with longstanding, recurrent, unusual bullous eruption should be investigated for the development of multiple myeloma.

  13. Life-cycle assessment of redwood decking in the United States with a comparison to three other decking materials

    R. Bergman; H. Sup-Han; E. Oneil; I. Eastin

    2013-01-01

    The goal of the study was to conduct a life-cycle inventory (LCI) of California redwood (Sequoia sempervirens) decking that would quantify the critical environmental impacts of decking from cradle to grave. Using that LCI data, a life-cycle assessment (LCA) was produced for redwood decking. The results were used to compare the environmental footprint...

  14. Administrative support of novice science teachers: A multiple case study

    Iacuone, Leann

    Novice science teachers leave the confines of colleges and universities to embark on a new adventure in education where they aim to influence young minds, make a difference in the world, and share their love for their content. They have learned their pedagogical skills with the support and assistance of fellow classmates, a supporting professor, and a cooperating teacher. These teachers enter their new place of employment and are met with many unexpected challenges, such as a lack of resources, no one to ask questions of, and a busy staff with already established relationships, causing them to feel an overall lack of support and resulting in many new teachers rethinking their career choice and leaving the field of education within 5 years of entering. This multiple-case study investigated the administrative support 4 novice science teachers received during an academic year and the novice teachers' perceptions of the support they received to answer the following research question: How do novice science teachers who have consistent interactions with administrators develop during their first year? To answer this question, semistructured interviews, reflection journals, observations, resumes, long-range plans, and student discipline referrals were collected. The findings from this study show novice science teachers who had incidents occur in the classroom requiring administrative assistance and guidance felt more confident in enforcing their classroom management policies and procedures as the year progressed to change student behavior. The novice science teachers perceived administrators who provided resources including technology, office supplies, science supplies, and the guidance of a mentor as supportive. Novice science teachers who engaged in dialogue after administrative observations, were provided the opportunity to attend professional development outside the district, and had a mentor who taught the same discipline made more changes to their instructional

  15. Animal attack: an unusual case of multiple trauma in childhood.

    O'Grady, E

    2014-11-01

    A 2½ year old girl attended our facility following attack by a tapir at a city zoo. She sustained multiple injuries including a forearm laceration and multiple perforating wounds to her abdominal wall. She had several procedures, including bowel resection, performed under the care of the General Paediatric Surgery and Plastic Surgery teams and was treated with a course of IV antibiotics. She recovered well and to date has suffered no long-term adverse outcome.

  16. Deck Yourself with Flu Protection Song

    2009-12-22

    This song (sung to the tune of Deck the Halls) describes actions you can take to protect yourself and others from the flu. Sing along!  Created: 12/22/2009 by National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID), Division of Global Migration and Quarantine (DGMQ).   Date Released: 12/22/2009.

  17. Analysis of Biaxially Stressed Bridge Deck Plates

    Jönsson, Jeppe; Bondum, Tommi Højer

    2012-01-01

    The ultimate state analysis of bridge deck plates at the intersection zone between main girders and transverse beams is complicated by biaxial membrane stresses, which may be in compression or tension in either direction depending on the bridge configuration and the specific location. This paper...

  18. An unusual case of multiple self-inflicted punctures to the precordium

    Borhan, F

    2017-06-01

    Sewing needles, albeit a rare case of penetrating cardiac injury, are potentially life-threatening. We report a case of successful intra-cardiac needle removal from a 32 year old who inserted multiple needles into the chest and abdomen.

  19. A case of multiple intracranial tuberculomas accompanied by tuberculous meningitis

    Fukabori, Takashi; Takamatsu, Hajime; Nakanishi, Yasuhiro

    1986-01-01

    A 63-year-old man was admitted for headache and progressive drowsiness. In spite of negative results from cerebrospinal fluid (CSF) stains and cultures of tuberculosis and other bacteria, CSF findings and tuberculosis-positive sputum culture led to a tentative diagnosis of tuberculous meningitis. Symptoms and neurological test results both improved remarkably during antituberculous chemotherapy. Although the brain CT scan taken on admission showed no abnormal findings, one taken two months later revealed multiple high-density areas after enhancement with a contrast medium, suggesting multiple intracranial tuberculomas accompanied by tuberculous meningitis. The size of the multiple high-density areas gradually decreased during antituberculous chemotherapy. The CT scan can clearly locate lesions, detect complications, and evaluate the effects of treatment in patients with intracranial tuberculosis. (author)

  20. Multiple eschars in scrub typhus: a case report.

    Koraluru, Munegowda; Nandigam, Manideep; Bairy, Indira; Vidyasagar, Sudha; Varma, Muralidhar

    2017-01-01

    Eschar in scrub typhus aids in early diagnosis and institution of appropriate therapy; however, the eschar positivity rates vary greatly in endemic regions. Multiple eschars in scrub typhus are a rare presentation. Our patient presented with fever and multiple eschars and was empirically started on doxycycline. Nested polymerase chain reaction from all the four eschars and from EDTA blood were positive for 56-kDa type-specific antigen which is specific for Orientia tsutsugamushi The patient recovered completely after 7 days of antibiotic treatment. He was from an area where scrub typhus was not observed previously. An eschar in an acute febrile patient from the "tsutsugamushi triangle" is a valuable sign in scrub typhus diagnosis. A search for multiple eschars in scrub typhus must be made by clinicians. © The Author(s) 2016.

  1. Multiple case study in seven European countries regarding culture-sensitive classroom quality assessment

    Slot, P.L.|info:eu-repo/dai/nl/328192694; Cadima, Joana; Salminen, Jenni; Pastori, Giulia; Lerkkanen, Marja-Kristiina

    This report presents the findings of a multiple case study, conducted in seven European countries to examine common and culturally differing aspects of curriculum, pedagogy, and quality of Early Childhood Education and Care (ECEC) provisions in Europe. This multiple case study involved intensive

  2. Supporting Affect Regulation in Children With Multiple Disabilities During Psychotherapy: A Multiple Case Design Study of Therapeutic Attachment. [Miscellaneous Article

    Schuengel, C; Sterkenburg, P S; Jeczynski, P; Janssen, C G C; Jongbloed, G

    2009-01-01

    : In a controlled multiple case design study, the development of a therapeutic relationship and its role in affect regulation were studied in 6 children with visual disabilities, severe intellectual disabilities, severe challenging behavior, and prolonged social deprivation. In the 1st phase,

  3. How Multiple Interventions Influenced Employee Turnover: A Case Study.

    Hatcher, Timothy

    1999-01-01

    A 3-year study of 46 textile industry workers identified causes of employee turnover (supervision, training, organizational communication) using performance analysis. A study of multiple interventions based on the analysis resulted in changes in orientation procedures, organizational leadership, and climate, reducing turnover by 24%. (SK)

  4. Multiple brain abscesses in an infant: a case report | Mathews ...

    An ex-preterm baby who was treated successfully for staphylococcus aureus septicaemia and skin abscess in the neonatal period represented at the age of 13 weeks (corrected gestation 41 weeks) with gradual enlargement of the head size. A diagnosis of multiple staphylococcus aureus brain abscesses was made.

  5. Magnetic resonance imaging correlates of bee sting induced multiple organ dysfunction syndrome: A case report.

    Das, Sushant K; Zeng, Li-Chuan; Li, Bing; Niu, Xiang-Ke; Wang, Jing-Liang; Bhetuwal, Anup; Yang, Han-Feng

    2014-09-28

    Occasionally systemic complications with high risk of death, such as multiple organ dysfunction syndrome (MODS), can occur following multiple bee stings. This case study reports a patient who presented with MODS, i.e., acute kidney injury, hepatic and cardiac dysfunction, after multiple bee stings. The standard clinical findings were then correlated with magnetic resonance imaging (MRI) findings, which demonstrates that MRI may be utilized as a simpler tool to use than other multiple diagnostics.

  6. Case Report: Multiple Unerupted Permanent Teeth Associated with ...

    The present report describes a case of Noonan's syndrome from a dental viewpoint. ... and malocclusions are some of the frequently observed clinical features. ... fixed orthodontic therapy for forced eruption of unerupted permanent teeth.

  7. Multiple endocrine diseases in cats: 15 cases (1997-2008).

    Blois, Shauna L; Dickie, Erica L; Kruth, Stephen A; Allen, Dana G

    2010-08-01

    The objective of this retrospective study was to characterize a population of cats from a tertiary care center diagnosed with multiple endocrine disorders, including the specific disorders and time intervals between diagnosis of each disorder. Medical records of 15 cats diagnosed with more than one endocrine disorder were reviewed. The majority of cats were domestic shorthairs, and the mean age at the time of diagnosis of the first disorder was 10.3 years. The most common combination of disorders was diabetes mellitus and hyperthyroidism. Two cats had concurrent diabetes mellitus and hyperadrenocorticism, one cat had concurrent central diabetes insipidus and diabetes mellitus. A mean of 25.7 months elapsed between diagnoses of the first and second endocrine disorder, but this was variable. This study suggests the occurrence of multiple endocrine disorders is uncommon in cats. Copyright 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

  8. Multiple calcifying hyperplastic dental follicles: A case report

    Aydin, Ulkem; Baykul, Timucin; Yildirim, Benay; Yildirim, Derya; Bozdemir, Esin; Karaduman, Ayse

    2013-01-01

    This report describes a 31-year-old female patient with six impacted teeth. The crowns of the impacted teeth were surrounded with cyst-like lesions with a mixed internal structure and well-defined cortical borders. Microscopic examination of the specimen obtained from the follicle of the left mandibular third molar tooth revealed loose to moderately dense collagenous connective tissue with abundant calcified material and sparse epithelial islands. A diagnosis of multiple calcifying hyperplastic dental follicles was made.

  9. Multiple calcifying hyperplastic dental follicles: A case report

    Aydin, Ulkem [Dept. of Dentomaxillofacial Radiology, Baskent University Faculty of Dentistry, Ankara (Turkey); Baykul, Timucin [Dept. of Oral and Maxillofacial Surgery, Suleyman Demirel University Faculty of Dentistry, Isparta (Turkey); Yildirim, Benay [Dept. of Oral Pathology, Gazi University Faculty of Dentistry, Ankara (Turkey); Yildirim, Derya; Bozdemir, Esin [Dept. of Dentomaxillofacial Radiology, Suleyman Demirel University Faculty of Dentistry, Isparta (Turkey); Karaduman, Ayse [Atlas Dent Dental Health Center, Aydin (Turkey)

    2013-12-15

    This report describes a 31-year-old female patient with six impacted teeth. The crowns of the impacted teeth were surrounded with cyst-like lesions with a mixed internal structure and well-defined cortical borders. Microscopic examination of the specimen obtained from the follicle of the left mandibular third molar tooth revealed loose to moderately dense collagenous connective tissue with abundant calcified material and sparse epithelial islands. A diagnosis of multiple calcifying hyperplastic dental follicles was made.

  10. Chronic periodontitis with multiple risk factor syndrome: a case report.

    Shimoe, Masayuki; Yamamoto, Tadashi; Iwamoto, Yoshihiro; Shiomi, Nobuyuki; Maeda, Hiroshi; Nishimura, Fusanori; Takashiba, Shogo

    2011-07-01

    Multiple risk factor syndrome is a clustering of cardiovascular risk factors, such as diabetes, dyslipidemia, hypertension, and obesity associated epidemiologically with insulin resistance. This report describes the clinical course of a patient suffering from severe periodontitis with multiple risk factor syndrome, and discusses the association between periodontal infection and systemic health. The patient had a history of type 2 diabetes, dyslipidemia, and hypertension for over 10 years. At baseline, her hemoglobin A1 c was 8.1%. However, she had no diabetic complications except periodontitis. The IgG antibody titers against Porphyromonas gingivalis FDC 381 and SU63 were elevated above the mean of healthy subjects +2 standard deviations. Intensive periodontal treatment, including periodontal surgery, was performed to reduce periodontal infection and bacteremia. Her systemic and periodontal conditions were evaluated longitudinally for 10 years. Following periodontal treatment, antibody titers against Porphyromonas gingivalis and hemoglobin A1c values were significantly improved. The other clinical data and medication for her systemic condition also remained stable during supportive periodontal therapy. However, she developed myocardial infarction, and showed continuous deterioration of hemoglobin A1 c level and periodontitis. The long-term clustering of risk factors, such as diabetes, dyslipidemia, hypertension, and periodontitis, are associated with the development of myocardial infarction. Treatment of systemic conditions in combination with comprehensive periodontal treatment is important in management of patients with multiple risk factor syndrome.

  11. Organic Functional Group Playing Card Deck

    Welsh, Michael J.

    2003-04-01

    The recognition and identification of organic functional groups, while essential for chemistry and biology majors, is also very useful for non-science majors in the study of molecules in art and life. In order to make this task more palatable for the non-science major (art and communications students), the images of a traditional playing deck of cards (heart, spade, diamond, and club) have been replaced with four representations of common organic functional groups. The hierarchy rules for naming two groups in a molecule is loosely incorporated to represent the sequence (King, Queen, Jack, ?, Ace) of the deck. Students practice recognizing and identifying organic groups by playing simple card games of "Old Maid" and "Go Fish". To play games like "Poker" or "Gin", a student must not only recognize the functional groups, but also master a naming hierarchy for the organic groups.

  12. Orthodontic exposure of multiple lmpactions: a case report.

    Munda-Lacson, Maridin C; Venugopal, Adith

    2014-01-01

    There are rare cases of impacted permanent central incisors with dilacerations, a dental deformity characterized by pronounced angulations of the longitudinal tooth axis. Impaction of maxillary canines is an orthodontic anomaly that causes facial and dentoalveolar system problems, both functional and esthetic. A combination of surgery and orthodontics is important in bringing impacted teeth to their ideal position in the dental arch. This is a case report of a 10-year-old patient with impacted and dilacerated right central incisor and impacted left maxillary canine, following surgical exposure and appropriate orthodontic traction, the impacted teeth were surgically exposed and aligned into the dental arch.

  13. Missed cases of multiple forms of child abuse and neglect.

    Koc, Feyza; Oral, Resmiye; Butteris, Regina

    2014-01-01

    Child abuse and neglect is a public health problem and usually associated with family dysfunction due to multiple psychosocial, individual, and environmental factors. The diagnosis of child abuse may be difficult and require a high index of suspicion on the part of the practitioners encountering the child and the family. System-related factors may also enable abuse or prevent the early recognition of abuse. Child abuse and neglect that goes undiagnosed may give rise to chronic abuse and increased morbidity-mortality. In this report, we present two siblings who missed early diagnosis and we emphasize the importance of systems issues to allow early recognition of child abuse and neglect.

  14. Improvement of fatigue properties of orthotropic decks

    Frýba, Ladislav; Urushadze, Shota

    2011-01-01

    Roč. 33, č. 4 (2011), s. 1166-1169 ISSN 0141-0296 R&D Projects: GA ČR GA103/08/1340; GA MŠk(CZ) 7E08098 Grant - others:BRIFAG -Bridge Fatigue Guidance(XE) RFSR_CT-2008-00033 Institutional research plan: CEZ:AV0Z20710524 Keywords : orthotropic deck * fatigue * prolonged life Subject RIV: JM - Building Engineering Impact factor: 1.351, year: 2011

  15. [A review of multiple sclerosis (1). Presentation of a case].

    Martinez-Altarriba, M C; Ramos-Campoy, O; Luna-Calcaño, I M; Arrieta-Antón, E

    2015-01-01

    Multiple sclerosis is a major demyelinating disease of the central nervous system. It has a significant economic and social impact. Its etiology is unclear, although there are several hypotheses, such as infections or genetics. In its pathophysiology, it seems that immune activation attacks the myelin sheath, causing a progressive and irreversible axonal degeneration. The disease produces a variety of symptoms, and diagnosis requires fulfilling a number of criteria and the exclusion of other possible causes. The role of neuroimaging, especially MRI, is very important. Despite the availability of disease-modifying drugs, none of them are able to halt its progress, and the most useful drugs are those designed to alleviate the symptoms of outbreaks. Overall, multiple sclerosis requires a significant effort in research to clarify not only why and how it occurs, but also to develop of new measures to improve the life of affected patients. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Optimization of wood plastic composite decks

    Ravivarman, S.; Venkatesh, G. S.; Karmarkar, A.; Shivkumar N., D.; Abhilash R., M.

    2018-04-01

    Wood Plastic Composite (WPC) is a new class of natural fibre based composite material that contains plastic matrix reinforced with wood fibres or wood flour. In the present work, Wood Plastic Composite was prepared with 70-wt% of wood flour reinforced in polypropylene matrix. Mechanical characterization of the composite was done by carrying out laboratory tests such as tensile test and flexural test as per the American Society for Testing and Materials (ASTM) standards. Computer Aided Design (CAD) model of the laboratory test specimen (tensile test) was created and explicit finite element analysis was carried out on the finite element model in non-linear Explicit FE code LS - DYNA. The piecewise linear plasticity (MAT 24) material model was identified as a suitable model in LS-DYNA material library, describing the material behavior of the developed composite. The composite structures for decking application in construction industry were then optimized for cross sectional area and distance between two successive supports (span length) by carrying out various numerical experiments in LS-DYNA. The optimized WPC deck (Elliptical channel-2 E10) has 45% reduced weight than the baseline model (solid cross-section) considered in this study with the load carrying capacity meeting acceptance criterion (allowable deflection & stress) for outdoor decking application.

  17. Strategic alternatives ranking methodology: Multiple RCRA incinerator evaluation test case

    Baker, G.; Thomson, R.D.; Reece, J.; Springer, L.; Main, D.

    1988-01-01

    This paper presents an important process approach to permit quantification and ranking of multiple alternatives being considered in remedial actions or hazardous waste strategies. This process is a methodology for evaluating programmatic options in support of site selection or environmental analyses. Political or other less tangible motivations for alternatives may be quantified by means of establishing the range of significant variables, weighting their importance, and by establishing specific criteria for scoring individual alternatives. An application of the process to a recent AFLC program permitted ranking incineration alternatives from a list of over 130 options. The process forced participation by the organizations to be effected, allowed a consensus of opinion to be achieved, allowed complete flexibility to evaluate factor sensitivity, and resulted in strong, quantifiable support for any subsequent site-selection action NEPA documents

  18. "Multiple Papillomas - a case report and review of literature"

    Gaurav Sharma

    2007-01-01

    Full Text Available We report a unique case of extensive papilIomatosis of the left buccal mucosa in an 80 year old female patient. We document and discuss the probable multifactorial etiology of the lesions and the possible involvement of a syndromic association. This report illustrates the need for careful clinical investigation and follow-up of individuals presenting with multifocal involvement of papillomas.

  19. 46 CFR 28.565 - Water on deck.

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Water on deck. 28.565 Section 28.565 Shipping COAST... VESSELS Stability § 28.565 Water on deck. (a) Each vessel with bulwarks must comply with the requirements... energy, “b” in Figure 28.565, must not be less than the water on deck heeling energy, “a” in Figure 28...

  20. Multiple fibromyxomas of the jaws: A case report

    Zayet, Mohamed Khalifa; Eiid, Salma Belal [Dept. of Oral Radiology, Faculty of Oral and Dental Medicine, Cairo University, Cairo (Egypt)

    2014-09-15

    Fibromyxoma of the jaw is a rare benign mesenchymal odontogenic tumor with locally aggressive behavior. In the present report, a 13-year-old female patient presented to our university hospital with delayed eruption of some of her teeth. A panoramic radiograph taken at the initial examination revealed four pericoronal radiolucencies related to the four third molars. Thereafter, a magnetic resonance imaging (MRI) examination was performed. After the surgical removal of these molars, the microscopic examination diagnosed the four lesions as fibromyxomas. Here, we have discussed the clinical, panoramic radiography, MRI, and histopathological findings of the case.

  1. Structural improvement of strengthened deck panels with externally bonded plates

    Sim, Jongsung; Oh, Hongseob

    2005-01-01

    Concrete bridge decks require eventual replacement and rehabilitation due to decreasing load-carrying capacity. This paper compares different strengthening design procedures that improve the usability and structural performance of bridge decks. The failure characteristics of bridge decks strengthened with various materials such as carbon fiber sheet, glass fiber sheet, steel plate, and grid CFRP and GFRP are analyzed, and the theoretical load-carrying capacities are evaluated using traditional beam and yield line theory, and punching shear analysis. The strengthening materials increase the punching shear strength of the deck and change the failure mode of the strengthened panel

  2. The intergenerational multiple deficit model and the case of dyslexia

    Elsje evan Bergen

    2014-06-01

    Full Text Available Which children go on to develop dyslexia? Since dyslexia has a multifactorial aetiology, this question can be restated as: What are the factors that put children at high risk for developing dyslexia? It is argued that a useful theoretical framework to address this question is Pennington’s (2006 multiple deficit model (MDM. This model replaces models that attribute dyslexia to a single underlying cause. Subsequently, the generalist genes hypothesis for learning (disabilities (Plomin & Kovas, 2005 is described and integrated with the MDM. Finally, findings are presented from a longitudinal study with children at family risk for dyslexia. Such studies can contribute to testing and specifying the MDM. In this study, risk factors at both the child and family level were investigated. This led to the proposed intergenerational MDM, in which both parents confer liability via intertwined genetic and environmental pathways. Future scientific directions are discussed to investigate parent-offspring resemblance and transmission patterns, which will shed new light on disorder aetiology.

  3. Systemic irradiation in multiple myeloma: a report on nineteen cases

    Rostom, A.Y.; O'Cathail, S.M.; Folkes, A.

    1984-01-01

    Nineteen patients with relapsed or resistant multiple myeloma were treated with sequential half-body irradiation (12) and half-body irradiation only (seven). Haematological toxicity was acceptable and recovery was complete in all but two of the 19 patients following half-body irradiation. However, only six of the 12 patients who subsequently had the remaining half irradiated completely recovered. Blood transfusions were required to correct anaemia in six patients, a platelet transfusion was given to one and one patient required both platelet and blood transfusions. No serious haematological complications were observed. Six of the 13 patients who received upper half-body irradiation of probable chest infection, while one patient of the six who received lower half-body irradiation died of this complication. Some of the seven deaths may have been due to radiation pneumonitis. Two patients developed brain secondaries, possibly indicating a change in the natural history of myeloma produced by this new treatment. Subjective improvement was observed in 17 patients and relief of pain usually occurred within the first 24 h. Objective responses were noted in six patients. The median survival for all patients was 6 months with five patients alive 11-28 months at the time of writing. (author)

  4. [A case of multiple sclerosis with hypothalamic amenorrhea].

    Miyamoto, T; Miyamoto, M; Yokota, N; Kubo, J; Hirata, K

    2000-03-01

    We present a 31-year-old woman of multiple sclerosis. At age 28, she was admitted with complaints of echolalia and a gradual onset of weakness affecting the right upper and bilateral lower limbs. Brain MRI showed high intensity areas in the bilateral frontal gyri, lobuli paracentralis, and left anterior thalamus. Although she had been in remission for 3 years, she developed dysesthesia of left upper and lower limbs. Cervical T2 weighted MRI showed a new high signal intensity lesion in the spinal cord from the C2 to C3 level. The combination of the cerebral, thalamic and spinal cord lesions with remission and excerbations allowed the diagnosis of clinically MS to be made. She suffered amenorrhea from the onset of her illness. Serum prolactin was within the normal range. The LH and FSH basal secretions were decreased and there were low delayed secretions of LH and FSH after intravenous injection of 100 micrograms LHRH. We consider that her amenorrhea was caused by the hypothalamic lesion, supported by MR findings of dilatation of the third ventricle.

  5. MULTIPLE PERSONALITY DISORDER FOLLOWING CONVERSION AND DISSOCIATIVE DISORDER NOS : A CASE REPORT

    Jhingan, Harsh Prem; Aggarwal, Neeruj; Saxena, Shekhar; Gupta, Dhanesh K.

    2000-01-01

    A case progressing from symptoms of conversion disorder to dissociative disorder and then to multiple personality disorder as per DSM-III-R criteria is being reported. The clinical implications are discussed.

  6. Abnormal radiological features in a multiple myeloma patient: a case report and radiological review of myelomas

    Ghosh, Sujoy; Wadhwa, P; A, Kumar

    2011-01-01

    and porotic changes. Primary sclerotic manifestations are rare and occur in only 3% of cases. Although exceptional, multiple myeloma must be borne in mind in the presence of bone sclerosis. This report presents a patient with multiple myeloma with a sunburst/hair-on-end pattern on the radiograph and sclerotic...

  7. Multiple case study in seven European countries regarding culture-sensitive classroom quality assessment

    Slot, P.L.; Cadima, Joana; Salminen, Jenni; Pastori, Giulia; Lerkkanen, Marja-Kristiina

    2016-01-01

    This report presents the findings of a multiple case study, conducted in seven European countries to examine common and culturally differing aspects of curriculum, pedagogy, and quality of Early Childhood Education and Care (ECEC) provisions in Europe. This multiple case study involved intensive data collection on structural characteristics, process quality, implemented curricula and pedagogical approaches in four ECEC centers in each of the seven countries that were considered examples of ‘g...

  8. Multiple Dentogerous Cysts With a Complex Odontoma: An Unusual Case Report

    Sheikhi

    2016-03-01

    Full Text Available Introduction Multiple dentigerous cysts are rare and mostly associated with syndromes. Case Presentation The present case report is unique, as the dentigerous cysts enclosed the lateral incisor, canine, first and second premolars of the mandible and were accompanied by a complex odontoma, instead of first mandibular molar. Conclusions Multiple unilateral nosyndromic dentigerous cysts with complex odontoma are found only rarely. The periapical inflammation of non-vital deciduous teeth and trauma may be considered ethiological factors.

  9. Networks in Argentine agriculture: a multiple-case study approach

    Sebastián Senesi

    2013-06-01

    Full Text Available Argentina is among the four largest producers of soybeans, sunflower, corn, and wheat, among other agricultural products. Institutional and policy changes during the 1990s fostered the development of Argentine agriculture and the introduction of innovative process and product technologies (no-till, agrochemicals, GMO, GPS and new investments in modern, large-scale sunflower and soybean processing plants. In addition to technological changes, a "quiet revolution" occurred in the way agricultural production was carried out and organized: from self-production or ownership agriculture to a contract-based agriculture. The objective of this paper is to explore and describe the emergence of networks in the Argentine crop production sector. The paper presents and describes four cases that currently represent about 50% of total grain and oilseed production in Argentina: "informal hybrid form", "agricultural trust fund", "investor-oriented corporate structure", and "network of networks". In all cases, hybrid forms involve a group of actors linked by common objectives, mainly to gain scale, share resources, and improve the profitability of the business. Informal contracts seem to be the most common way of organizing the agriculture process, but using short-term contracts and sequential interfirm collaboration. Networks of networks involve long-term relationships and social development, and reciprocal interfirm collaboration. Agricultural trust fund and investor-oriented corporate structures have combined interfirm collaboration and medium-term relationships. These organizational forms are highly flexible and show a great capacity to adapt to challenges; they are competitive because they enjoy aligned incentives, flexibility, and adaptability.

  10. Surgical management of symptomatic spinal cord and intracerebral cavernomas in a multiple cavernomas case

    Gorgan R.M.

    2016-03-01

    Full Text Available Multiple cavernous malformations are associated with familial cases and are present in 10-20% of all cavernoma cases. 5% of cavernomas are located intramedullary and of these only 10% present multiple cavernomas. With the availability of echo gradient MRI the cases of multiple cavernomas are diagnosed earlier and it is not rare that it uncovers multiple cavernomas in cases where only a single lesion can be identified on regular MRI sequences. We present the case of a 55 years old woman presented with a two years history of mild backache, followed by progressive lower legs motor deficit and urinary retention. The spine MRI showed an intramedullary T2/3 lesion and the cerebral MRI established the diagnosis of multiple cavernomas. One year after the intramedullary cavernoma was operated with success, she developed generalized seizures and a new cerebral MRI showed bleeding and volume growth of one right temporal pole cavernoma. The cerebral lesion was resected successfully and the patient was discharged free of seizures. This familial type multiple cavernomas cases should be screened and followed with repeated brain and spine MRI’s every year.

  11. An unusual case of non-syndromic occurrence of multiple dental anomalies

    Suprabha B

    2009-01-01

    Full Text Available Dental anomalies have been known to occur in humans due to a variety of genetic and environmental factors. Combinations of dental anomalies are known to be associated with specific syndromes. A few cases of multiple dental anomalies have been reported in patients with no generalized abnormalities. This case report describes an unusual occurrence of a combination of dental anomalies in an apparently normal healthy 12-year-old female patient. The dental anomalies in this patient were multiple dens invaginatus, generalized enamel hypoplasia, generalized microdontia, root resorption and multiple periapical lesions, shovel shaped incisors, cup shaped premolars, taurodontism, hypodontia and supernumerary teeth.

  12. CUTANEOUS INVOLVEMENT IN MULTIPLE MYELOMA AT AN UNUSUAL SITE: A RARE CASE REPORT

    Lohit Kumar

    2015-05-01

    Full Text Available Multiple myeloma is a rare cancer. According to the most recent data from the Surveillance, Epidemiology, and End Results (SEER program, multiple myeloma is the second most common haematological malignancy in the U.S. (after non - Hodgkin lymphoma, constitutes 1% of all cancers and constitutes 2% of all cancer deaths. Cutaneous involvement of multiple myeloma during treatment period is uncommon with fewer described in literature. Moreover, metastatic cutaneous involvement at the sole of the foot during treatment period of a IgA kappa type multiple myeloma patient followed by death has not encountered in literature. We have reported such a case

  13. Collaborative learning in local partnerships for public value : a multiple case study

    Bos, Eltje; de Zeeuw, Anna; van Vliet, Pieter; de Kreek, Mike

    2017-01-01

    In our recently started multiple case study - funded by the Netherlands Scientific Board (NWO) - on these processes of collaboration, we focused on the dynamics in growing partnerships between citizens, community social workers and civil servants. Three cases of social neighbourhood initiatives are

  14. Childhood Trauma and Multiple Personality Disorder: The Case of a 9-Year-Old Girl.

    LaPorta, Lauren D.

    1992-01-01

    This paper reports the case of a nine-year-old female victim of sexual abuse, evaluated and diagnosed with multiple personality disorder over a six-month period. Included is a description of the child's presentation with historical and developmental data. A discussion of the dynamic and predisposing features of the case follows, along with…

  15. Making Meaning with Multimedia in Secondary English Language Arts: A Multiple Case Study

    Mahoney, Kerrigan Rose

    2016-01-01

    The purpose of this multiple case study was to learn about how secondary English language arts (ELA) teachers help students to make meaning with multimedia. The study focused on how and why teachers plan and implement meaning-making learning experiences. The cases represent the experiences and perspectives of five ELA teachers who use digital and…

  16. Fatigue Assessment of Full-Scale Retrofitted Orthotropic Bridge Decks

    Teixeira De Freitas, S.; Kolstein, M.H.; Bijlaard, F.S.K.

    2017-01-01

    Full-scale fatigue tests were performed on two retrofitted orthotropic bridge decks (OBDs). The retrofitting systems consist of adding a second steel plate on the top of the existing deck. The aim is to reduce the stresses at the fatigue-sensitive details and therefore extend the fatigue life of

  17. Rapid replacement of bridge deck expansion joints study - phase I.

    2014-12-01

    Bridge deck expansion joints are used to allow for movement of the bridge deck due to thermal expansion, dynamics loading, and : other factors. More recently, expansion joints have also been utilized to prevent the passage of winter de-icing chemical...

  18. 46 CFR 45.143 - Hull openings above freeboard deck.

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Hull openings above freeboard deck. 45.143 Section 45.143 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) LOAD LINES GREAT LAKES LOAD LINES Conditions of Assignment § 45.143 Hull openings above freeboard deck. Closures for openings above...

  19. Forest Certification and Country of Origin: Choice Experiment Analysis of Outdoor Decking Material Selection in E-Commerce Market in Finland

    Jani Holopainen

    2017-11-01

    Full Text Available Since the early 1990s, there has been hope that the uptake of certified forest products would ensure more sustainable forest management and also deliver business benefits along the value chain. Our study applies a Discrete Choice Experiment (DCE to model an e-commerce purchase in the case of multiple products with various attribute and certification combinations in the Finnish retail outdoor decking material market. We received 2772 responses from 231 participants in an online survey. Applying conditional logit and latent class models, we were able to assess the relative importance of attributes, identify various consumer segments, and simulate various scenarios for communicating the certification and origin of forest products and competing materials. Our results show that the most important attribute for consumer decision-making was the outdoor decking material followed by price, origin, and certification. Some consumer segments showed a habit of only choosing certain materials or domestic products, while paying less attention to other product attributes. Simulations for an e-commerce purchase situation also implied that communications concerning intangible product attributes, such as domestic origin and environmental certifications, could be used in the brand building of the forest sector to gain competitive advantage and increased market shares over other sectors. The results suggest that the conventional and constantly developing e-commerce marketing tools should be harnessed also in forest product and more general environmental marketing.

  20. Stress Regression Analysis of Asphalt Concrete Deck Pavement Based on Orthogonal Experimental Design and Interlayer Contact

    Wang, Xuntao; Feng, Jianhu; Wang, Hu; Hong, Shidi; Zheng, Supei

    2018-03-01

    A three-dimensional finite element box girder bridge and its asphalt concrete deck pavement were established by ANSYS software, and the interlayer bonding condition of asphalt concrete deck pavement was assumed to be contact bonding condition. Orthogonal experimental design is used to arrange the testing plans of material parameters, and an evaluation of the effect of different material parameters in the mechanical response of asphalt concrete surface layer was conducted by multiple linear regression model and using the results from the finite element analysis. Results indicated that stress regression equations can well predict the stress of the asphalt concrete surface layer, and elastic modulus of waterproof layer has a significant influence on stress values of asphalt concrete surface layer.

  1. The multiple brain abscesses associated with congenital pulmonary arteriovenous malformations: a case report.

    Han, Seok; Lim, Dong-Jun; Chung, Yong-Gu; Cho, Tai-Hyoung; Lim, Seong-Jun; Kim, Woo-Jae; Park, Jung-Yul; Suh, Jung-Keun

    2002-01-01

    In this report, we describe a case of multiple brain abscesses associated with diffuse congenital pulmonary arteriovenous malformations (PAVM). Although the cases of brain abscesses associated with congenital PAVM are very rare, the brain abscess could be an initial clinical manifestation in asymptomatic PAVM as in the case presented in this report. PAVM may contribute to the development of a brain abscess by allowing easy bacterial access to systemic circulation through the right-to-left pul...

  2. Critique of the Reggeized deck model

    Berger, E.L.

    1975-01-01

    A detailed analysis is presented of the Reggeized pion exchange Deck model for processes of the type ap → A*N → (a*π)N, where a = π, K, or nucleon and a* = rho, K*, N or Δ. Predictions of the model for both production and decay properties of the low mass system A* → (a*π) are derived and contrasted with data. Diffractive as well as charge exchange reactions are treated. The role of pion exchange in generating (a*π) enhancements near threshold and their properties is examined from several points of view. Characteristic exchange effects and quantum number properties (e.g., cross-overs) of the pion exchange Deck graph are shown to be verified in the data, but this graph alone is inadequate. The failures all point to the need for a second graph, having a* exchange properties. The contribution of a* exchange is roughly equal to that of the π exchange graph. (U.S.)

  3. Rhabdomyolysis following interferon-beta treatment in a patient with multiple sclerosis - A case report.

    Dalbjerg, Sara Maria; Tsakiri, Anna; Frederiksen, Jette Lautrup

    2016-07-01

    Multiple sclerosis is an inflammatory disease of the central nervous system for which there is currently no cure. Interferon-beta-1-alpha is worldwide one of the most widely used treatments in multiple sclerosis. To our knowledge there is one previous reported case of rhabdomyolysis associated with Interferon-beta treatment. We describe a 30 year old man with relapsing remitting multiple sclerosis who developed rhabdomyolysis and increased creatine kinase following Interferon-beta-1-alpha therapy. After the medication was discontinued, the patient rapidly improved. Clinicians should be aware of the possibility of rhabdomyolysis occurring during Interferon-beta-1-alpha therapy. In cases where patients complain of severe myalgia, and in particular if weakness is reported, creatine kinase activity should be measured to prevent irreversible rhabdomyolysis during Interferon-beta-1-alpha therapy in patients with multiple sclerosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Jejunal Gastric Heterotopia causing Multiple Strictures and Perforation Peritonitis- A Case Report with Review of Literature.

    Vani, M; Nambiar, Ajit; Geetha, K; Kundil, Byju

    2017-03-01

    Gastric heterotopias beyond the ligament of Treitz though rare, should be thought of in the differential diagnosis of polypoid lesions presenting with gastrointestinal bleed or obstructive symptoms especially in children and in the young. Here is a 24-year-old male with multifocal jejunal gastric heterotopias causing multiple strictures and perforation peritonitis. Patient presented with acute abdomen pain and an emergency laparotomy was performed revealing jejunum with multiple strictures and perforation, followed by jejunal resection. On gross examination polypoid mucosa was noted at the stricture sites which showed heterotopic gastric mucosa on microscopy. Jejunal gastric heterotopias are extremely rare with less than ten reported cases and those presenting with multiple strictures are even rarer. To our knowledge this is the second case of jejunal gastric heterotopia presenting with multiple strictures.

  5. Multiple solid pilocytic astrocytomas in cerebleiium with neurofibromatosis type: A case report

    Choi, Seo Young; Kim, Myung Soon; Kim, Young Ju

    2014-01-01

    Pilocytic astrocytoma usually has a classic imaging manifestation of a solitary, cyst-like mass with a strong contrast-enhancing mural nodule. There is only one published report so far of multiple solid and cyst type pilocytic astrocytomas in the cerebellum in neurofibromatosis type 1 (NF1) patient from the United States in 2007. We report a case of pilocytic astrocytoma presenting with only solid, multiple pilocytic astrocytomas in the cerebellum in NF1 patient.

  6. Unusual CT findings of a benign metastasizing leiomyoma presenting with multiple cavitary nodules: a case report

    Ahn, Ji Eun; Do, Kyung Hyun; Chae, Eun Jin; Seo, Joon Beom; Lee, Jin Seong; Song, Koun Sik; Song, Jae Wo; Kim, Kyu Rae; Lim, Tae Hwan

    2007-01-01

    A benign metastasizing leiomyoma is a rare condition that affects women with a history of uterine leiomyoma, usually after a myomectomy or hysterectomy. Typical radiographic findings include well-circumscribed solitary or multiple pulmonary nodules ranging from a few millimeters to several centimeters in diameter and scattered among the normal interstitium. We report a case of a benign metastasizing leiomyoma that manifested with multiple cavitary nodules in a 46-year-old woman with no previous history of a myomectomy or hysterectomy

  7. Unusual CT findings of a benign metastasizing leiomyoma presenting with multiple cavitary nodules: a case report

    Ahn, Ji Eun; Do, Kyung Hyun; Chae, Eun Jin; Seo, Joon Beom; Lee, Jin Seong; Song, Koun Sik; Song, Jae Wo; Kim, Kyu Rae; Lim, Tae Hwan [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2007-09-15

    A benign metastasizing leiomyoma is a rare condition that affects women with a history of uterine leiomyoma, usually after a myomectomy or hysterectomy. Typical radiographic findings include well-circumscribed solitary or multiple pulmonary nodules ranging from a few millimeters to several centimeters in diameter and scattered among the normal interstitium. We report a case of a benign metastasizing leiomyoma that manifested with multiple cavitary nodules in a 46-year-old woman with no previous history of a myomectomy or hysterectomy.

  8. High-output cardiac failure secondary to multiple vascular malformations in the liver: case report

    Spaner, S.; Demeter, S.; Lien, D.; Shapiro, J.; McCarthy, M.; Raymond, G.

    2001-01-01

    High-output cardiac failure is associated with several systemic illnesses, including hyperthyroidism, thiamine deficiency, severe anemia, multiple myeloma, Paget's disease of bone and Osler-Weber-Rendu syndrome. We present an unusual case of a woman with high-output cardiac failure as a result of multiple arteriovenous fistulas in the liver, most likely representing an unusual variant of Osler-Weber-Rendu syndrome (i.e., no other telangiectasias or a family history of vascular malformations was demonstrated). (author)

  9. Rare case of multiple meningiomas in nonneurofibromatosis patient at unusual locations

    Setia Vikrant

    2017-06-01

    Full Text Available Multiple meningioma is a condition in which more than one intracranial lesion is seen in different location and these lesions may occur with or without signs of neurofibromatosis. Incidence of multiple meningioma range from 1 to 10% in different series. We report a case of multiple meningioma in a 33 years old female who had 14 intracranial lesions both supratentorially and infratentorially, and underwent surgery for large right lateral intraventricular meningioma. She had two meningiomas located in posterior fossa associated with supratentorial meningioma, which has been rarely reported.

  10. Design of Experimental Suspended Footbridge with Deck Made of UHPC

    Blank Marek

    2016-01-01

    Full Text Available This paper deals with the static and dynamic design of experimental footbridge for pedestrians and cyclists in the municipality Lužec nad Vltavou in Czech Republic, Europe. This work aims to familiarize the reader with calculations carried out and the results obtained, describing the static and dynamic properties of proposed footbridge. The construction of footbridge is designed as a suspended structure with prestressed bridge deck consisting of prefabricated UHPC panels and reversed “V” shaped steel pylon with height of approximately 40 meters. The deck is anchored using 24 steel hangers in one row in a steel pylon - 17 ropes in the main span and 7 cables on the other side. Range of the main span is 99.18 meters and the secondary span is 31.9 m. Deck width is 4.5 meters with 3.0 meters passing space. The bridge is designed for the possibility of passage of vehicles weighting up to 3.5 tons. Deck panels are made of UHPC with reinforcement. At the edge of the bridge on the side of the shorter span the bridge deck is firmly connected with abutment and on the other deck it is stored using a pair of sliding bearings. The utilization of the excellent properties of UHPC allows to design a very thin and lightweight construction of the deck, which could not be achieved with the use of normal concrete.

  11. Management of multiple intrusive luxative injuries: A case report with 7-year follow-up

    Seema Thakur

    2014-01-01

    Full Text Available This report presents a case of severe intrusive luxation of multiple anterior teeth in an 11-year-old girl. The teeth were repositioned successfully by endodontic and orthodontic management. The case was monitored for 7 years. Depending on the severity of the injury, different clinical approaches for treatment of intrusive luxation may be used. Despite the variety of treatment modalities, rehabilitation of intruded teeth is always a challenge and a multidisciplinary approach is important to achieve a successful result. In this case, intruded teeth were endodontically treated with multiple calcium hydroxide dressings and repositioned orthodontically. The follow-up of such cases is very important as the repair process after intrusion is complex. After 7 years, no clinical or radiographic pathology was detected.

  12. A decking for erecting an insulating connector

    Chuprikov, A Ye; Lagutin, V I; Sklyarov, A A; Sukhanov, G V

    1983-01-01

    The decking includes a parachute like dome, made of a material impenetrable to air, an air penetrable hood, attachment elements and a branch pipe for supplying the filler. To improve the sealing of the insulating connector upon contact with the walls and the roof of the drift being isolated and to reduce the labor intensity of operations, it is equipped with a housing made in the form of a cylinder from a material impenetrable to water, an advancible vertical upright and a spring loaded panel. The housing is installed between the parachute like dome and the air penetrable hood. The extendible vertical upright is installed on the side of the air penetrable hood and by means of a movable rack mechanism is kinematically linked with the spring loaded panel, installed with the capability of interacting with the air penetrable hood. The spring loaded plate is made in the form of perforated plates which have a telescopic disengagement in the horizontal plane.

  13. Does decision documentation help junior designers rationalize their decisions? A comparative multiple-case study

    Heesch, U. van; Avgeriou, P.; Tang, A.

    2013-01-01

    Software architecture design is challenging, especially for junior software designers. Lacking practice and experience, junior designers need process support in order to make rational architecture decisions. In this paper, we present the results of a comparative multiple-case study conducted to find out if decision viewpoints from van Heesch et al. (2012, in press) can provide such a support. The case study was conducted with four teams of software engineering students working in industrial s...

  14. Peripheral (Seventh Nerve Palsy and Multiple Sclerosis: A Diagnostic Dilemma - A Case Report

    Christian Saleh

    2016-01-01

    Full Text Available During the last decades, only a few cases on the association between peripheral demyelinating diseases and multiple sclerosis (MS have been reported. We describe the case of a young man who was initially diagnosed with Bell's palsy, and only after performing a brain MRI was the diagnosis of MS made. We review the literature and discuss some pitfalls which may lead to missing the diagnosis of MS.

  15. Experiments and theory on deck and girder crushing

    Simonsen, Bo Cerup; Ocakli, Hasan

    1999-01-01

    -deflection curves and modes of deformation for decks, stringer decks and deep thin-walled beams subjected to central or excentric point loads between transverse frames. Based on theory and experiments, various modelling aspects of the local/global failure of the beams are discussed. The agreement between......This paper is concerned with theoretical and experimental analysis of deep plastic collapse of a deck or deep girder subjected to an in-plane, concentrated load. A theory is derived which is valid until initition of fracture in the structure. The presented experimental results show load...

  16. Spontaneous tumour lysis syndrome in a case of multiple myeloma – A rare occurrence

    Kavitha Saravu

    2013-03-01

    Full Text Available We describe a case of a 40-year-old male patient who was found to have multiple myeloma with spontaneous tumour lysis syndrome (TLS, following a compression fracture of the L–2 vertebrae. Multiple myeloma was confirmed by bone marrow analysis and the M–band on serum protein electrophoresis. Hyperuricaemia (26.2 mg/dL, hyperkalaemia (> 7.0 mEq/L, hyperphosphatemia (16.2 mg of phosphorus/dL, normocalcemia and acute kidney injury, prior to anticancer treatment suggested spontaneous TLS. Inciting events for tumour lysis, such as chemotherapy, dehydration and exposure to steroids were absent. Patient received hydration, hypourecemic drugs and haemodialysis. This case report highlights the rare presentation of multiple myeloma with spontaneous TLS.

  17. A case of disseminated hydatid disease by surgery involving multiple organs

    Asli Tanrivermis Sayit

    2014-09-01

    Full Text Available Hydatid disease is the most common parasitic infection in the world, and is caused by the parasite Echinococcus granulosus. The most common site of this disease is the liver (75%, followed by the lungs, kidney, bones, and brain. Multiple abdominal organ and peritoneal involvement can also be seen in some cases. The dissemination of hydatid cyst disease can develop spontaneously or secondary to trauma or surgery. Here, we present the case of a 69-year-old man with multiple cyst hydatidosis, who underwent surgery for acute appendicitis approximately 20 years previously. Computed tomography of the abdomen shows the multiple active and inactive cystic lesions in the liver, spleen, right kidney, and mesentery. This patient required surgery several times, as well as medical treatment, after the rupture of a mesenteric hydatid cyst during the appendectomy. Combined anthelmintic treatment was recommended to the patient who refused further surgical treatment.

  18. Does decision documentation help junior designers rationalize their decisions? A comparative multiple-case study

    Heesch, U. van; Avgeriou, P.; Tang, A.

    Software architecture design is challenging, especially for junior software designers. Lacking practice and experience, junior designers need process support in order to make rational architecture decisions. In this paper, we present the results of a comparative multiple-case study conducted to find

  19. State Politics and Education: An Examination of Selected Multiple-State Case Studies.

    Burlingame, Martin; Geske, Terry G.

    1979-01-01

    Reviews the multiple-state case study literature, highlights some findings, discusses several methodological issues, and concludes with suggestions for possible research agendas. Urges students and researchers to be more actively critical of the assumptions and findings of these studies. (Author/IRT)

  20. Case Report: Multiple Sclerosis in a Pregnant Afro-Caribbean Woman

    Case Report: Multiple Sclerosis in a Pregnant Afro-Caribbean Woman. Abiola I Balogun. Abstract. No Abstract Available Archives of Ibadan Medicine Vol.1(1) 2000: 21-22. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/aim.v1i1.34534.

  1. Customer service strategy options : a multiple case study in a B2B setting

    Wouters, J.P.M.

    2004-01-01

    This study addresses the question whether customer service actually has order winning potential in B2B situations, which customer service strategies are deployed, and what determines customer service relevance. A literature review was followed by a multiple case study, using 12 organizations from

  2. Exploring Community College Peer Mentoring Practices within Central California: A Multiple Case Study

    Brown, Lenis Colton

    2017-01-01

    The purpose of this qualitative, multiple case study was to illuminate the prevalence and configurations of peer mentoring programs at Central California Community Colleges with emphasis on how the programs impacted student retention. The study's sample was drawn from ten campuses and five centers that operate within five California Community…

  3. The Best Practices for School Transformation: A Multiple-Case Study

    Waheed, Zarina; Hussin, Sufean; Bin Megat Daud, Megat Ahmad Kamaluddin

    2018-01-01

    Purpose: The purpose of this paper is to explore the best practices of school leaders, teachers, pupils, parents and the community in selected transformed schools in Selangor, Malaysia. Design/methodology/approach: This qualitative multiple-case study explores the best practices in two selected transformed schools through in-depth interviews,…

  4. Multiple Case Study of STEM in School-Based Agricultural Education

    Stubbs, Eric A.; Myers, Brian E.

    2015-01-01

    This multiple case study investigated the integration of science, technology, engineering, and mathematics (STEM) in three Florida high school agriculture programs. Observations, interviews, documents, and artifacts provided qualitative data that indicated the types of STEM knowledge taught. Variables of interest included student and teacher…

  5. The Initial Rise Method in the case of multiple trapping levels

    Furetta, C.; Guzman, S.; Cruz Z, E.

    2009-10-01

    The aim of the paper is to extent the well known Initial Rise Method (IR) to the case of multiple trapping levels. The IR method is applied to the minerals extracted from Nopal herb and Oregano spice because the thermoluminescent glow curves shape suggests a trap distribution instead of a single trapping level. (Author)

  6. The MORPG-Based Learning System for Multiple Courses: A Case Study on Computer Science Curriculum

    Liu, Kuo-Yu

    2015-01-01

    This study aimed at developing a Multiplayer Online Role Playing Game-based (MORPG) Learning system which enabled instructors to construct a game scenario and manage sharable and reusable learning content for multiple courses. It used the curriculum of "Introduction to Computer Science" as a study case to assess students' learning…

  7. The Initial Rise Method in the case of multiple trapping levels

    Furetta, C. [Centro de Investigacion en Ciencia Aplicada y Tecnologia Avanzada, IPN, Av. Legaria 694, Col. Irrigacion, 11500 Mexico D. F. (Mexico); Guzman, S.; Cruz Z, E. [Instituto de Ciencias Nucleares, UNAM, A. P. 70-543, 04510 Mexico D. F. (Mexico)

    2009-10-15

    The aim of the paper is to extent the well known Initial Rise Method (IR) to the case of multiple trapping levels. The IR method is applied to the minerals extracted from Nopal herb and Oregano spice because the thermoluminescent glow curves shape suggests a trap distribution instead of a single trapping level. (Author)

  8. Leaders' Experiences with High School-College Writing Center Collaborations: A Qualitative Multiple-Case Study

    Story, Julie A.

    2014-01-01

    The purpose of this qualitative multiple-case study was to explore academic leaders' experiences with the organizational elements of their own high school-college writing center collaborations. Conjoining theories framed this study: collaborative leadership theory, Kenneth Bruffee's notion of social constructionism and collaborative learning…

  9. Orthodontic Management with Traction and Asymmetric Extraction for Multiple Impacted Permanent Maxillary Teeth - A Case Report.

    Niu, Qiannan; Zhang, Liang; Dai, Juan; Li, Feifei; Feng, Xue

    2016-01-01

    Multiple impacted teeth are a rare eruption disturbance that increases the case complexity. In this article, we described a 13-year-old boy whose 5 permanent maxillary teeth were not erupted although their root formation was complete. The orthodontic treatment with traction and asymmetric extraction was performed to achieve a significantly improved functional and esthetic result.

  10. Tuberous sclerosis: Ultrasound, CT and MRI features of two cases with multiple organ involvement

    Arslan, A.; Ciftci, E.; Cetin, A.; Selcuk, H.; Demirci, A.

    1998-01-01

    The cases of two patients with tuberous sclerosis with multiple sites of involvement are presented. Both patients had characteristic cerebral lesions of tuberous sclerosis associated with bilateral renal angiomyolipomas and hepatic hamartomas. Additionally there were diffuse pulmonary cystic changes in one patient and cardiac rhabdomyoma in the other. Copyright (1998) Blackwell Science Pty Ltd

  11. Recurrent myelinoclastic diffuse sclerosis: a case report of a child with Schilder's variant of multiple sclerosis

    Fitzgerald, M.J.; Coleman, L.T.

    2000-01-01

    Myelinoclastic diffuse sclerosis (MDS, Schilder's disease) is a rare CNS demyelinating disorder affecting mainly children and usually presenting as an intracranial mass lesion. We report the first case of recurrent intracranial MDS where the third episode of demyelination involved the cervical spinal cord. This may represent a subset of the disease, which should be considered as Schilder's variant (childhood form) of multiple sclerosis. (orig.)

  12. Examining Education Leadership Communication Practices around Basic and Advanced Skill Sets: A Multiple Case Study

    Minger, Leslie

    2017-01-01

    The purpose of this multiple case study was to explore and describe the leadership communication practices of school principals in Southern California schools with demonstrated high levels of academic performance in order to identify practices that might be replicated in other schools. Communication practices were studied in relation to two…

  13. Negotiating jurisdiction in the workplace: a multiple-case study of nurse prescribing in hospital settings.

    Kroezen, M.; Mistiaen, P.; Dijk, L. van; Groenewegen, P.P.; Francke, A.L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  14. Negotiating jurisdiction in the workplace: A multiple-case study of nurse prescribing in hospital settings

    Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P.P.; Francke, A.L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  15. Where Adults Go: A Multiple Case Study of Adult Serving Undergraduate Colleges and Universities

    Dixon-Williams, Shelley B.

    2010-01-01

    This research is an exploratory multiple case study of adult serving undergraduate colleges and universities. Using the Council of Adult and Experiential Learning (CAEL) Principles of Effective Practice for Serving Adult Learners, this study examines the differences of adult serving undergraduate colleges across the three sectors of higher…

  16. An Exploration of Infant and Toddler Child Care Consultation: A Multiple Case Study

    John, Christine Marie

    2015-01-01

    This qualitative, multiple case study was an exploration of the professional development (PD) experience of consultation as it occurred within infant and toddler child care settings. Consultation is dependent upon the establishment of a relationship between the consultant and the consultee and offers opportunities for professional growth and…

  17. Key aspects in managing safety when working with multiple contractors: A case study

    Drupsteen, L.; Rasmussen, H.B.; Ustailieva, E.; Kampen, J. van

    2015-01-01

    Working with multiple contractors in a shared workplace can introduce and increase safety risks due to complexity. The aim of this study was to explore how safety issues are recognized in a specific case and to identify whether clients and contractors perceive problems similarly. The safety issues

  18. Existence and Multiplicity Results for Nonlinear Differential Equations Depending on a Parameter in Semipositone Case

    Hailong Zhu

    2012-01-01

    Full Text Available The existence and multiplicity of solutions for second-order differential equations with a parameter are discussed in this paper. We are mainly concerned with the semipositone case. The analysis relies on the nonlinear alternative principle of Leray-Schauder and Krasnosel'skii's fixed point theorem in cones.

  19. Negotiating jurisdiction in the workplace : A multiple-case study of nurse prescribing in hospital settings

    Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P. P.; Francke, A. L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  20. Non-syndromic multiple keratocyst odontogenic tumor: A rare case report

    Abhijeet Alok

    2015-01-01

    Full Text Available Keratocystic odontogenic tumors (KCOTs are one of the most frequent features of nevoid basal cell carcinoma syndrome (NBCCS. The condition is linked with mutation in the PTCH gene. Partial expression of the gene may result in occurrence of multiple recurring odontogenic keratocysts (OKCs. Although KCOTs are common in clinical practice, simultaneous occurrence of multiple cysts in both the maxilla and mandible of a patient is rare. These patients have early propensity to develop multiple neoplasms like basal cell carcinoma and medulloblastoma. Hence, early diagnosis and treatment is of utmost importance in reducing the severity of the long-term sequelae of NBCCS. We report a rare case of multiple KCOTs in a non-syndromic male patient, with emphasis on its diagnosis, radiographic features, and treatment.

  1. Accounting for multiple births in neonatal and perinatal trials: systematic review and case study.

    Hibbs, Anna Maria; Black, Dennis; Palermo, Lisa; Cnaan, Avital; Luan, Xianqun; Truog, William E; Walsh, Michele C; Ballard, Roberta A

    2010-02-01

    To determine the prevalence in the neonatal literature of statistical approaches accounting for the unique clustering patterns of multiple births and to explore the sensitivity of an actual trial to several analytic approaches to multiples. A systematic review of recent perinatal trials assessed the prevalence of studies accounting for clustering of multiples. The Nitric Oxide to Prevent Chronic Lung Disease (NO CLD) trial served as a case study of the sensitivity of the outcome to several statistical strategies. We calculated odds ratios using nonclustered (logistic regression) and clustered (generalized estimating equations, multiple outputation) analyses. In the systematic review, most studies did not describe the random assignment of twins and did not account for clustering. Of those studies that did, exclusion of multiples and generalized estimating equations were the most common strategies. The NO CLD study included 84 infants with a sibling enrolled in the study. Multiples were more likely than singletons to be white and were born to older mothers (P accounted for clustering were statistically significant; analyses assuming independence were not. The statistical approach to multiples can influence the odds ratio and width of confidence intervals, thereby affecting the interpretation of a study outcome. A minority of perinatal studies address this issue. Copyright 2010 Mosby, Inc. All rights reserved.

  2. Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review.

    Jácome Sánchez, Elisa Carolina; García Castillo, María Ariana; González, Victor Paredes; Guillén López, Fernando; Correa Díaz, Edgar Patricio

    2018-01-01

    Multiple sclerosis (MS) and systemic lupus erythematous (SLE) are autoimmune diseases, the coexistence of which is uncommon in patients. Owing to the rarity of this condition, the distinction between MS and SLE is a diagnostic challenge for neurologists. We present a case report in which MS and SLE were present in the same patient. There are few case reports in the world on the association between MS and SLE. The following case report is the first of its kind in which both MS and SLE are present in a patient from a country with low prevalence of MS such as Ecuador.

  3. Modified distal shoe appliance for premature loss of multiple deciduous molars: a case report.

    Bhat, Prasanna Kumar; K, Navin H; Idris, Mohammed; Christopher, Pradeep; Rai, Niharika

    2014-08-01

    Preservation of the primary dentition until the normal time of exfoliation is one of the most important factor involved in preventive and interceptive dentistry. The premature loss of second primary molar before the eruption of permanent first molar can create a significant arch space/tooth size discrepancy. Distal shoe space maintainer is a valuable part of the Paediatric Dentist's armamentarium in those cases where the second primary molar is prematurely lost and it helps to guide the first permanent molar into place. Conventional design poses various limitations in cases of premature loss of multiple deciduous molars. Thus, it is required to modify the conventional designs according to the needs of the patient. This case report describes an innovative modification of distal shoe appliance in cases of premature loss of multiple deciduous molars. In the present case, modification of distal shoe space maintainer was advocated because of inadequate abutments caused due to multiple loss of deciduous molars. Bilateral design of distal shoe was planned for unilateral loss of deciduous molars.

  4. A feasibility study of bridge deck deicing using geothermal energy.

    2015-04-01

    In this study, we investigated the feasibility of a ground-coupled system that utilizes heat energy harvested from the ground for : deicing of bridge decks. Heat exchange is performed using circulation loops integrated into the deep foundations suppo...

  5. Precision monitoring of bridge deck curvature change during replacement.

    2016-05-01

    This project was focused on development and deployment of a system for monitoring vertical : displacement in bridge decks and bridge spans. The system uses high precision wireless inclinometer : sensors to monitor inclinations at various points of a ...

  6. Bridge deck concrete volume change : final contract report.

    2010-02-01

    Concrete structures such as bridge decks, with large surface area relative to volume, shrink and crack, thus reducing service life performance and increasing operation costs. The project evaluated the early, first 24 hours, and long-term, 180 days, s...

  7. Evaluation of bridge deck with shrinkage-compensating concrete.

    2016-04-01

    Concrete bridge decks are susceptible to premature cracking and to corrosion of reinforcing steel. Low-permeability : concrete does not always ensure durability if the concrete has excessive cracks that facilitate the intrusion of aggressive solution...

  8. Multidisciplinary health monitoring of a steel bridge deck structure

    Pahlavan, P.L.; Pijpers, R.J.M.; Paulissen, J.H.; Hakkesteegt, H.C.; Jansen, T.H.

    2013-01-01

    Fatigue cracks in orthotropic bridge decks are an important cause for the necessary renovation of existing bridges. Parallel utilization of various technologies based on different physical sensing principles can potentially maximize the efficiency of structural health monitoring (SHM) systems for

  9. Structural Loading of Cross Deck Connections for Trimaran Vessels

    Rhoads, Jason

    2004-01-01

    ...: longitudinal bending, transverse bending, torsional bending, spreading and squeezing of hulls, inner and outer hull slam pressures, wet deck slam pressures, loading from ship's motions, and whipping of slender hulls...

  10. Experimental studies on multicellular GFRP bridge deck panels ...

    M P MUTHURAJ

    2017-11-20

    Nov 20, 2017 ... design of a new bridge deck panel made of GFRP. .... cient manufacturing processes with minimal wastage. But re-use of the remaining FRP elements during manufacture ... Energy consumption for production of different.

  11. Smart FRP Composite Sandwich Bridge Decks in Cold Regions

    2011-07-01

    In this study, new and integrated Smart honeycomb Fiber-Reinforced Polymer (S-FRP) : sandwich materials for various transportation construction applications, with particular emphasis : on highway bridge decks in cold regions, were developed and teste...

  12. Shrinkage and durability study of bridge deck concrete.

    2010-12-01

    The Mississippi Department of Transportation is incorporating changes to material : specifications and construction procedures for bridge decks in an effort to reduce shrinkage : cracking. These changes are currently being implemented into a limited ...

  13. On strength design using free material subjected to multiple load cases

    Pedersen, Pauli; Pedersen, Niels Leergaard

    2013-01-01

    Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together with a prac......Multiple load cases and the consideration of strength is a reality that most structural designs are exposed to. Improved possibility to produce specific materials, say by fiber lay-up, put focus on research on free material optimization. A formulation for such design problems together...... with a practical recursive design procedure is presented and illustrated with examples. The presented finite element analysis involve many elements as well as many load cases. Separating the local amount of material from a description with unit trace for the local anisotropy, gives the free materials formulation...

  14. Multiple Supernumerary Teeth in a Non-Syndromic Patient: A Case Report

    Majid Eshgh Pour

    2013-01-01

    Full Text Available Introduction: Multiple supernumerary teeth are a rare phenomenon. It occurs more often in patients with syndromes such as Gardner's syndrome, cleidocranial dysplasia and so on. This phenomenon in absence of such syndromes is rare. The purpose of this report was to introduce a case of non-syndromic multiple supernumerary impacted teeth.Case Report: A 29-year-old woman with no skeletal, metabolic, systemic and mental disorder was referred to oral and maxillofacial department of Mashhad dental school. In clinical evaluation, seven Permanent teeth were missing. In radiographic evaluation, there were a total of 15 impacted teeth which 7 of them were supernumerary.Conclusion: Missing or Excess of one or more teeth usually leads to occlusal and functional problems. In these cases, a complete clinical and radiographic examination accompanieal by a precise history should be performed to plan a suitable surgical-orthodontic-prosthetic treatment.

  15. Analysis of multiple primary cancer autopsy cases associated with breast cancer: 2002-2010.

    Shibahara, Yukiko; Sugawara, Yumi; Miki, Yasuhiro; Hata, Shuko; Takahashi, Hiroaki; Nakamura, Yasuhiro; Suzuki, Takashi; Ohuchi, Noriaki; Tsuji, Ichiro; Sasano, Hironobu

    2016-12-01

    Breast cancer patients have a generally increased risk of developing second cancers. The object of this study was to clarify the increased as well as decreased incidence of cancers in breast cancer patients using autopsy cases. 164 211 autopsy cases in the Annual of Pathological Autopsy Cases in Japan from 2002 to 2010 were analyzed for multiple primary cancer (MPC). Female MPC cases (4222 cases) were selected. We investigated the cancer incidence observed in breast cancer associated MPC. The Chi-squared test was used for analysis. All P-values were two-sided, and differences at P autopsy data on MPC which provide new evidence clinically and pathologically. © 2016 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

  16. The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study.

    Hoonakker, Peter L T; Carayon, Pascale; Cartmill, Randi S

    2017-04-01

    Secure messaging is a relatively new addition to health information technology (IT). Several studies have examined the impact of secure messaging on (clinical) outcomes but very few studies have examined the impact on workflow in primary care clinics. In this study we examined the impact of secure messaging on workflow of clinicians, staff and patients. We used a multiple case study design with multiple data collections methods (observation, interviews and survey). Results show that secure messaging has the potential to improve communication and information flow and the organization of work in primary care clinics, partly due to the possibility of asynchronous communication. However, secure messaging can also have a negative effect on communication and increase workload, especially if patients send messages that are not appropriate for the secure messaging medium (for example, messages that are too long, complex, ambiguous, or inappropriate). Results show that clinicians are ambivalent about secure messaging. Secure messaging can add to their workload, especially if there is high message volume, and currently they are not compensated for these activities. Staff is -especially compared to clinicians- relatively positive about secure messaging and patients are overall very satisfied with secure messaging. Finally, clinicians, staff and patients think that secure messaging can have a positive effect on quality of care and patient safety. Secure messaging is a tool that has the potential to improve communication and information flow. However, the potential of secure messaging to improve workflow is dependent on the way it is implemented and used. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Multiple keratocystic odontogenic tumors in a non-syndromic minor patient: Report of an unusual case

    Shalu Rai

    2013-01-01

    Full Text Available Keratocystic odontogenic tumor (KCOT is developmental odontogenic cysts of epithelial origin known for their potentially aggressive behavior and significant rate of recurrences. Single odontogenic cysts are very well documented in the literature. Multiple (KCOT are principle features of nevoid basal cell carcinoma syndrome (naevoid basal cell carcinoma syndrome; Gorlin-Goltz syndrome. We report an intriguing case of multiple KCOT in a non-syndromic patient simultaneously occurring in maxilla as well as in mandible with brief highlight on molecular data and the treatment modality.

  18. Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

    Kohno, Tadasu; Mun, Mingyon; Yoshiya, Tomoharu

    2014-01-01

    Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature of multiple bilateral thoracic myelolipomas that were resected simultaneously using bilateral VATS. We also present characteristic features of myelolipomas, which are helpful for diagnosis. PMID:24782978

  19. A CASE REPORT OF MULTIPLE PRIMARY SQUAMOUS CELL CARCINOMAS OF THE OVARY AND SIGMOID COLON

    A. B. Villert

    2016-01-01

    Full Text Available Squamous cell ovarian and sigmoid colon carcinomas are extremely rare malignancies. Because of their rarity, it is difficult to investigate the clinical characteristics and prognosis of patients with theses malignancies, and therefore, the increased interest in each clinical case report is highly relevant. Multiple primary squamous cell ovarian and sigmoid colon carcinomas are the subject of discussion and differential diagnosis of sigmoid colon cancer with secondary ovarian cancer. Histopathological and clinical characteristics of the tumors were present and evidences in favor of the multiple primary malignancies were given. The association of squamous cell ovarian and sigmoid colon carcinomas with human papilloma virus type 16 was shown.

  20. Multiple Mucous Retention Cysts (Mucocele of the Oral Mucosa: A Case Report

    Gholamreza Jahanshahi

    2007-01-01

    Full Text Available To our knowledge, the occurrence of multiple mucoceles is not very common. This case report presents a 62-year-old man with multiple nodules on the upper and lower labial mucosa as well as both buccal mucosae with unknown history. Histopathology evaluation showed minor salivary gland ducts dilated to the point of cyst formation. The cysts seemed to be formed either as a result of dilatation of salivary ducts due to altered secretion or because of an acquired or congenital weakness in the ductal structure. The physiopathology of these findings is discussed.

  1. Hypothermia in Multiple Sclerosis: Beyond the Hypothalamus? A Case Report and Review of the Literature

    Francesco Berti

    2018-01-01

    Full Text Available Hypothermia is a rare and poorly understood complication of Multiple Sclerosis (MS. We report on a 66-year-old patient currently with Secondary Progressive MS (SP-MS who developed unexplained hypothermia associated with multiple hospitalisations and we review the literature on this topic. In our case, magnetic resonance imaging (MRI of the brain failed to highlight hypothalamic disease, but spinal MRI identified a number of spinal cord lesions. Given the incidence and clinical significance of spinal involvement in MS and the hypothermic disturbances observed in high Spinal Cord Injury (SCI, we hypothesise that upper spinal cord pathology, along with hypothalamic and brainstem dysfunctions, can contribute to hypothermia.

  2. The 2002 Drigg post-closure safety case: implementation of a multiple factor safety case

    Lean, C.B.; Grimwood, P.D.; Watts, L.; Fowler, L.; Thomson, G.; Kelly, E.; Hodgkinson, D.

    2004-01-01

    British Nuclear Fuels plc (BNFL) owns and operates the Drigg disposal site, which is the UK's principal facility for the disposal of low level radioactive waste (LLW). Disposals are carried out under the terms of an authorization granted by the UK Environment Agency (the Agency). The Agency periodically reviews the authorization to take account of new information and any revisions to regulatory requirements. In September 2002 new Operational Environmental and Post-Closure Safety Cases (OESC and PCSC respectively) were submitted to the Agency to support the next authorization review. The OESC assesses radiological safety aspects up until closure of the site, including a post-operational management phase, whilst the PCSC considers the longer-term radiological safety. The Drigg disposal facility has been operational since 1959. For the first 3 decades of operations, disposals were solely by tumble tipping wastes into excavated trenches. This was phased out in favour of vault disposal and disposals to the trenches were completed in 1995. The first vault (Vault 8) commenced operations in 1988 and construction of future vaults is planned up to the estimated end of disposal operations in about 50 years time. This paper describes the main components of the 2002 Drigg PCSC and how they relate to each other. Central to the safety case is a systematic comprehensive post-closure radiological safety assessment (PCRSA). However, the importance of the more qualitative aspects of the safety case, including a demonstration of optimisation, is also highlighted. In addition, other confidence-building activities which are key to developing and presenting the safety case are discussed. (author)

  3. CT scan findings in three cases of multiple sclerosis with homonymous hemianopsia

    Arikado, Takuji; Ariga, Hiroko; Kase, Manabu; Nagata, Renpei; Tashiro, Kunio

    1983-01-01

    Three cases of clinically definite multiple sclerosis manifested homonymous hemianopsia. A 35-year-old female, in whom right optic neuritis developed as the initial symptom, manifested right homonymous hemianopsia 4 months later followed by cerebral symptoms another 4 months later. A 25-year-old male developed sudden brain stem and cerebellar symptoms associated with right abducens palsy and right homonymous hemianopsia. In a 26-year-old female developed right homonymous hemianopsia 13 years after the first attack of recurrent optic neuritis. CT-scan in these three cases revealed the presence of a ''plaque'' located in the white matter of the left occipital lobe in cases 1 and 2 and in the left peririgone white matter in case 3 as the causative lesion for the right homonymous hemianopsia. These findings indicate that the optic radiation may be involved in multiple sclerosis resulting in homonymous hemianopsia. CT scan is of value in determining the location of the affected intracranial lesion in multiple sclerosis. (author)

  4. Dedifferentiated chondrosarcoma in patients with multiple osteochondromatosis: report of a case and review of the literature

    Kilpatrick, S.E.; Pike, E.J.; Ward, W.G.; Pope, T.L.

    1997-01-01

    Multiple osteochondromatosis (MOS) is a familial disorder of autosomal dominant transmission characterized by the development of multiple exostoses and often derangements of epiphyseal cartilage, sometimes resulting in long bone growth retardation. Patients with the disorder appear to be at increased risk for developing secondary chondrosarcomas. Rarely, dedifferentiated chondrosarcomas may also occur. We report a single case of a 27-year-old man with multiple osteochondromatosis who developed a fatal dedifferentiated chondrosarcoma. Radiographically, the neoplasm arose from the pelvis completely destroying the left pubic ramus. Subsequently, the patient underwent preoperative chemotherapy followed by a left external hemipelvectomy. On pathologic examination, the tumor was characterized by high-grade pleomorphic sarcoma sharply juxtaposed to a low-grade chondrosarcoma. The patient ultimately died of widespread metastatic sarcoma. (orig.). With 7 figs

  5. Optimization of carrier multiplication for more effcient solar cells: the case of Sn quantum dots.

    Allan, Guy; Delerue, Christophe

    2011-09-27

    We present calculations of impact ionization rates, carrier multiplication yields, and solar-power conversion efficiencies in solar cells based on quantum dots (QDs) of a semimetal, α-Sn. Using these results and previous ones on PbSe and PbS QDs, we discuss a strategy to select QDs with the highest carrier multiplication rate for more efficient solar cells. We suggest using QDs of materials with a close to zero band gap and a high multiplicity of the bands in order to favor the relaxation of photoexcited carriers by impact ionization. Even in that case, the improvement of the maximum solar-power conversion efficiency appears to be a challenging task. © 2011 American Chemical Society

  6. Dedifferentiated chondrosarcoma in patients with multiple osteochondromatosis: report of a case and review of the literature

    Kilpatrick, S.E. [Department of Pathology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Pike, E.J. [Department of Radiology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Ward, W.G. [Department of Orthopaedics, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States); Pope, T.L. [Department of Radiology, North Carolina Baptist Hospitals, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (United States)

    1997-06-01

    Multiple osteochondromatosis (MOS) is a familial disorder of autosomal dominant transmission characterized by the development of multiple exostoses and often derangements of epiphyseal cartilage, sometimes resulting in long bone growth retardation. Patients with the disorder appear to be at increased risk for developing secondary chondrosarcomas. Rarely, dedifferentiated chondrosarcomas may also occur. We report a single case of a 27-year-old man with multiple osteochondromatosis who developed a fatal dedifferentiated chondrosarcoma. Radiographically, the neoplasm arose from the pelvis completely destroying the left pubic ramus. Subsequently, the patient underwent preoperative chemotherapy followed by a left external hemipelvectomy. On pathologic examination, the tumor was characterized by high-grade pleomorphic sarcoma sharply juxtaposed to a low-grade chondrosarcoma. The patient ultimately died of widespread metastatic sarcoma. (orig.). With 7 figs.

  7. Multiple Myeloma of the Central Nervous System: 13 Cases and Review of the Literature

    Gergely Varga

    2018-01-01

    Full Text Available Central nervous system involvement is a rare complication of multiple myeloma with extremely poor prognosis as it usually fails to respond to therapy. We present 13 cases diagnosed at two centers in Budapest and review the current literature. The majority of our cases presented with high-risk features initially; two had plasma cell leukemia. Repeated genetic tests showed clonal evolution in 3 cases. Treatments varied according to the era, and efficacy was poor as generally reported in the literature. Only one patient is currently alive, with 3-month follow-up, and the patient responded to daratumumab-based treatment. Recent case reports show promising effectivity of pomalidomide and marizomib.

  8. Exploring barriers to remaining physically active: a case report of a person with multiple sclerosis.

    Zalewski, Kathryn

    2007-03-01

    Physical therapy intervention for those with chronic disabling conditions typically follows an episode of care approach: therapists provide services when a decrement in functional performance occurs such that individuals require intervention to return to baseline performance. Attention to the psychosocial supports required for successful transition can be unintentionally minimized when the focus of an episode of care follows a change in physical function. The purpose of this case report is to present and discuss the challenges to successful community reintegration following physical therapy intervention with an emphasis on developing independent exercise habits in management of a person with multiple sclerosis. RW, presented in this case study, is a 52-year-old man diagnosed with progressive multiple sclerosis five years before self-referral to a pro bono physical therapy clinic.

  9. Integrated Markov-neural reliability computation method: A case for multiple automated guided vehicle system

    Fazlollahtabar, Hamed; Saidi-Mehrabad, Mohammad; Balakrishnan, Jaydeep

    2015-01-01

    This paper proposes an integrated Markovian and back propagation neural network approaches to compute reliability of a system. While states of failure occurrences are significant elements for accurate reliability computation, Markovian based reliability assessment method is designed. Due to drawbacks shown by Markovian model for steady state reliability computations and neural network for initial training pattern, integration being called Markov-neural is developed and evaluated. To show efficiency of the proposed approach comparative analyses are performed. Also, for managerial implication purpose an application case for multiple automated guided vehicles (AGVs) in manufacturing networks is conducted. - Highlights: • Integrated Markovian and back propagation neural network approach to compute reliability. • Markovian based reliability assessment method. • Managerial implication is shown in an application case for multiple automated guided vehicles (AGVs) in manufacturing networks

  10. Systemic amyloidosis due to unknown multiple myeloma in small bowel pseudo-obstruction: case report

    Giuseppe Caparrotti

    2016-03-01

    Full Text Available Amyloidosis is a pathologic diagnosis characterized by extracellular deposition of insoluble protein fibrils in various organs and tissues. There are two main forms of amyloidosis, primary amyloidosis, and secondary amyloidosis. Gastrointestinal involvement is common in both amyloidosis forms. We describe the case of a 78-year-old woman taken to the operating room for small bowel obstruction, found to have pseudo-obstruction and enteritis. Exploratory laparotomy revealed gastric mass and histological examen showed extensive amyloid deposition consistent with amyloidosis. Hematological evaluation revealed unknown multiple myeloma. This case report and literature data suggest to perform a hematological examination in patients with amyloidosis diagnosis to exclude a multiple myeloma or other plasma cell disorders

  11. Multiple Synchronous Central Giant Cell Granulomas of the Maxillofacial Region: A Case Report

    Kang, Min Seok; Kim, Hak Jin

    2010-01-01

    Multifocal central giant cell granulomas (CGCG) in the maxillofacial region are suggestive of systemic disease such as hyperparathyroidism or an inherited syndrome such as Noonan-like multiple giant cell lesion syndrome. Only 5 cases of multifocal CGCGs in the maxillofacial region without any concomitant systemic disease have currently been reported. We report here on an unusual case of 17-year-old man who presented with multifocal CGCGs of the bilateral posterior mandible and right maxilla and he was without any concomitant systemic disease

  12. Multiple Synchronous Central Giant Cell Granulomas of the Maxillofacial Region: A Case Report

    Kang, Min Seok; Kim, Hak Jin [Pusan National University Hospital, Busan (Korea, Republic of)

    2010-01-15

    Multifocal central giant cell granulomas (CGCG) in the maxillofacial region are suggestive of systemic disease such as hyperparathyroidism or an inherited syndrome such as Noonan-like multiple giant cell lesion syndrome. Only 5 cases of multifocal CGCGs in the maxillofacial region without any concomitant systemic disease have currently been reported. We report here on an unusual case of 17-year-old man who presented with multifocal CGCGs of the bilateral posterior mandible and right maxilla and he was without any concomitant systemic disease

  13. Urea cycle disorder misdiagnosed as multiple sclerosis: a case report and review of the literature.

    Algahtani, Hussein; Alameer, Seham; Marzouk, Yousef; Shirah, Bader

    2018-04-01

    Urea cycle disorders are a group of inborn errors of metabolism caused by dysfunction of any of the six enzymes or two transport proteins involved in urea biosynthesis. In this paper, we report a patient who presented with neurological dysfunction and coma in the immediate postpartum period. She was misdiagnosed for many years as a case of multiple sclerosis. The importance of reporting this case is to illustrate that the wrong diagnosis of patients as being affected with multiple sclerosis for many years due to magnetic resonance imaging abnormalities rather than the classic relapsing-remitting nature of the disease may lead to catastrophic consequences. The patient was treated with intravenous steroids several times, which is contraindicated in patients with urea cycle disorders as it may precipitate acute hyperammonemic attacks. In addition, the management of urea cycle disorder could have started earlier and avoided multiple admissions to the intensive care unit. We believe that the presence of symmetric hyperintense insular cortical changes are seen in multiple hyperammonemic processes, and in the context of the clinical presentation and high ammonia levels can be suggestive of a urea cycle disorder. For any patient presenting with atypical clinical features, images should be reviewed and discussed in detail with an experienced neuroradiologist. In addition, the ammonia levels should be checked if a urea cycle disorder is suspected.

  14. A 5-year follow-up case of multiple intrusive luxative injuries

    Seema Thakur

    2012-01-01

    Full Text Available Introduction: Traumatic intrusive luxation is one of the most severe forms of dental injuries, usually affecting the maxillary incisors. The consequence of such an occurrence is a high risk of healing complications such as pulp necrosis, external inflammatory resorption, and external replacement resorption (ankylosis. Case Report: This report presents a case of severe intrusive luxation of multiple anterior teeth in an 11-year-old girl. The teeth were repositioned successfully by endodontic and orthodontic management. The case was monitored for 5 years. Discussion: Depending on the severity of the injury, different clinical approaches for treatment of intrusive luxation may be used. Despite the variety of treatment modalities, rehabilitation of intruded teeth is always a challenge and a multidisciplinary approach is important to achieve a successful result. In this case, intruded teeth were endodontically treated with multiple calcium hydroxide dressings and repositioned orthodontically. The follow-up of such cases is very important as the repair process after intrusion is complex. After 5 years, no clinical or radiographic pathology was detected.

  15. A case of multiple sclerosis with multi-ring-like and butterfly-like enhancement on computerized tomography

    Morimoto, Takehiko; Nagao, Hideo; Sano, Nozomi; Habara, Shinji; Takahashi, Mitsugi; Matsuda, Hiroshi; Beppu, Keiko; Shoda, Takaaki

    1985-01-01

    We report a case of multiple sclerosis in which CT showed multiple ring-like enhancement and butterfly-like distribution of a low density area with marginal enhancement. The latter finding is found in other demyelinating disorders but is less common in tumors or abscesses. Therefore, it seems to have some diagnostic value in multiple sclerosis. (author)

  16. Multiple Atraumatic Osteoporotic Vertebral Fractures in an Adolescent with Suprasellar Germinoma: A Case Report

    CC Wong

    2012-07-01

    Full Text Available We present the case of a patient with multiple atraumatic osteoporotic vertebral fractures in an adolescent with suprasellar germinoma and also review of relevant literature. The patient suffered from a rare adolescent brain tumour with common complications which are often overlooked and give rise to significant morbidity. Suprasellar germinoma is an intracranial neoplasm, that in addition to its rarity, has variable clinical presentation. Despite appropriate treatment and good outcome, tumour related morbidity is still of concern for these patients.

  17. Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

    Nakagawa, Masatoshi; Kohno, Tadasu; Mun, Mingyon; Yoshiya, Tomoharu

    2014-01-01

    Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature ...

  18. Organizational Crises and Reactions from a Legitimacy Perspective - Results from Two Multiple-case Studies

    Heiko Breitsohl

    2009-01-01

    Organizational crises can be conceptualized as interactions between organizations and stake-holders around the breach and reestablishment of common norms and social codes, i.e. per-ceptions of legitimacy. This paper contributes to the understanding of organizational crises by exploring the roles of dimensions of legitimacy in organizational crises as well as the role of different reactions in the resolution of crises. Results of two qualitative multiple-case studies based on analyses of media...

  19. On a Diagnosed Case of Multiple Personality Disorder -A Supplementary Report with Special Reference to Psychotherapy-

    藤田, 裕司

    2000-01-01

    As a supplement of the study on a dignosed case of MPD (Multiple Personality Disorder), the effect of the psychotherapy was discussed. The patient was a twenty-four-year-old woman suspected of an attempted murder. In this article, continued from the previous one reporting the process of a series of ten psychotherapeutic interviews with her, the general comment on that was made, and the merits and demerits of the psychotherapy were clarified.

  20. Distant Migration of Multiple Siliconomas in Lower Extremities following Breast Implant Rupture: Case Report

    Oh, Joo Hyun; Song, Seung Yong; Lew, Dae Hyun; Lee, Dong Won

    2016-01-01

    Summary: Siliconoma from ruptured breast implants has been reported in multiple body sites, including but not limited to the breast parenchyma, axillary lymph nodes, upper arm, and even lower leg. In this regard, we report a rare case of distant silicone migration to the lower extremities after traumatic breast implant rupture. A 55-year-old Asian woman who received bilateral augmentation mammoplasty 20 years ago presented with ruptured breast implants from a car accident 2 years earlier. Mag...

  1. Integrative harm reduction psychotherapy: a case of substance use, multiple trauma, and suicidality.

    Tatarsky, Andrew; Kellogg, Scott

    2010-02-01

    Harm reduction is a new paradigm that seeks to reduce the harmful consequences of substance use and other risky behaviors without requiring abstinence. This article discusses integrative harm reduction psychotherapy, one application of harm reduction principles to psychotherapy. Seven therapeutic tasks are described with attention to clinical process, skills, and strategies. A case is presented that illustrates the application of this approach with life-threatening substance use that was related to multiple trauma and suicidal depression. (c) 2010 Wiley Periodicals, Inc.

  2. Multiple Bony Injuries on Bone Scan in a Case of Unsuspected Child Abuse

    Ya-Wen Chuang

    2017-01-01

    Full Text Available This case is described of an eleven-month-old infant with lower limbs swelling and the left elbow skeletal malformation following a fall. The radionuclide bone scan was performed to exclude bone infection or congenital skeletal anomaly. The images unexpectedly showed multiple increased radioactive foci throughout the whole body. It was a strong probability of child abuse. All lesions are readily apparent on the following plain film radiographs and MRI.

  3. Isolated Multiple Fragmented Cricoid Fracture Associated with External Blunt Neck Trauma: A Case Report

    Lee, Byung Hoon; Hwang, Yoon Joon; Kim, Yong Hoon; Seo, Jung Wook; Cho, Hyeon Je; Kim, Yeon Soo

    2010-01-01

    Blunt laryngeal trauma is a relatively uncommon but possibly life-threatening injury. An isolated cricoid fracture associated with blunt trauma is rare. We report a case of an isolated multiple fragmented cricoid cartilage fracture that developed in a 20-year-old man after a blunt neck trauma that occurred during a baseball game and was diagnosed by 64-slice multidetector computed tomography (MDCT)

  4. MULTIPLE MALIGNANT TUMORS IN 8-YEARS OLD BOY WITH XERODERMA PIGMENTOSUM: A CASE REPORT

    V. I. Al’banova

    2014-01-01

    Full Text Available This case report describes xeroderma pigmentosum in an 8-year old boy. At the age of 4 he was diagnosed with aggressive keratinizing squamous cell carcinoma. Surgical treatment, close-focus radiotherapy, isotretinoin and cyclosporine were ineffective. At the age of 8 he had multiple tumors on the face and concha of the ear, with destruction of adjacent bone and cartilage and regional nodal metastasing.

  5. Case of multiple hepatic abscesses detected by CT scan in the patient with acute lymphoblastic leukemia

    Saburi, Yoshio; Shuto, Ryusuke; Mizutani, Ryoko; Hosokawa, Takafumi; Itoga, Takashi (Medical Coll. of Oita (Japan))

    1983-12-01

    A 34 year old man admitted to a hospital on 21 Feb. 1983 was diagnosed acute lymphoblastic leukemia. A hematological complete remission was achieved by combination therapy of vincristine, prednisolone and L-asparaginase. However, he had been complaining of high fever and right hypochondralgia since early in Apr. 1983, and it was revealed that elevation of right diaphragm on chest X-ray. Therefore, he was also given several antibiotics (CPZ, TOB, LMOX, PIPC, LCM, AMK, MINO and GM) for complication of probable liver abscess. Remittent fever persisted in spite of as mentioned above various antibiotics. The multiple hepatic abscesses were found by CT scan of the mid-abdomen as the low density lesions, but bacterial cultures detected no pathogens. His complaining of remittent fever and right hypochondralgia were improved by treatment with Miconazole during about one month, and decreasing in size and number of multiple hepatic abscesses were found by CT scan. Though we could not determine clearly, but suspected that multiple hepatic abscesses were due to fungus infection, by reason of therapeutic result. Regarding the complication of hepatic abscesses with leukemia, 5 cases have been reported in Japan, and one case out of 5 cases were detected by CT scan. We thought that CT scans were useful procedures for early diagnosis of hepatic abscesses. Recently, the patient has continued complete remission hematologically.

  6. Multiple adenomatoid tumours in the Epididymis and Tunica vaginalis: Case report

    Ahmed Abroaf

    2014-03-01

    Full Text Available We describe the case of a 65 year-old male presenting with a tender right testicular mass, confirmed to be a tumour on ultrasound. The patient underwent a radical inguinal orchidectomy and histology revealed multiple adenomatoid tumours in epididymis and tunica vaginalis. This is an infrequent benign tumour of mesothelial origin that has rarely been reported as multiple lesions in the literature. Immunohistochemistry demonstrates that adenomatoid tumour and mesotheliomas share the expression of podoplanin (D2-40 which is helpful to differentiate them from carcinomas. On the other hand adenomatoid tumour is differentiated from mesothelioma on morphological grounds since the former does not exhibit cellular atypia, mitotic activity or bland focal tumour necrosis. Although testis preserving surgery can be an option for benign adenomatoid tumours, most patients (as in our case proceed to orchidectomy as diagnosing them confidently can be difficult.---------------------------Cite this article as: Abroaf A, Veeratterapillay R, Vasdev N, Majo J, Sherif AE, Paez E. Multiple adenomatoid tumours in the Epididymis and Tunica vaginalis : Case Report. Int J Cancer Ther Oncol 2014; 2(1:02021.DOI: http://dx.doi.org/10.14319/ijcto.0202.1

  7. Multiple cavernous malformations presenting in a patient with Poland syndrome: A case report

    De Salles Antonio AF

    2011-09-01

    Full Text Available Abstract Introduction Poland syndrome is a congenital disorder related to chest and hand anomalies on one side of the body. Its etiology remains unclear, with an ipsilateral vascular alteration (of unknown origin to the subclavian artery in early embryogenesis being the currently accepted theory. Cavernous malformations are vascular hamartomas, which have been linked to a genetic etiology, particularly in familial cases, which commonly present with multiple lesions. Our case report is the first to describe multiple cavernous malformations associated with Poland syndrome, further supporting the vascular etiology theory, but pointing to a genetic rather than a mechanistic factor disrupting blood flow in the corresponding vessels. Case presentation A 41-year-old Caucasian man with Poland syndrome on the right side of his body presented to our hospital with a secondary generalized seizure and was found to have multiple cavernous malformations distributed in his brain, cerebellum, and brain stem, with a predominance of lesions in the left hemisphere. Conclusion The distribution of cavernous malformations in the left hemisphere and the right-sided Poland syndrome in our patient could not be explained by a mechanistic disruption of one of the subclavian arteries. A genetic alteration, as in familial cavernous malformations, would be a more appropriate etiologic diagnosis of Poland syndrome in our patient. Further genetic and pathological studies of the involved blood vessels in patients with Poland syndrome could lead to a better understanding of the disease.

  8. WORM: A general-purpose input deck specification language

    Jones, T.

    1999-01-01

    Using computer codes to perform criticality safety calculations has become common practice in the industry. The vast majority of these codes use simple text-based input decks to represent the geometry, materials, and other parameters that describe the problem. However, the data specified in input files are usually processed results themselves. For example, input decks tend to require the geometry specification in linear dimensions and materials in atom or weight fractions, while the parameter of interest might be mass or concentration. The calculations needed to convert from the item of interest to the required parameter in the input deck are usually performed separately and then incorporated into the input deck. This process of calculating, editing, and renaming files to perform a simple parameter study is tedious at best. In addition, most computer codes require dimensions to be specified in centimeters, while drawings or other materials used to create the input decks might be in other units. This also requires additional calculation or conversion prior to composition of the input deck. These additional calculations, while extremely simple, introduce a source for error in both the calculations and transcriptions. To overcome these difficulties, WORM (Write One, Run Many) was created. It is an easy-to-use programming language to describe input decks and can be used with any computer code that uses standard text files for input. WORM is available, via the Internet, at worm.lanl.gov. A user's guide, tutorials, example models, and other WORM-related materials are also available at this Web site. Questions regarding WORM should be directed to wormatlanl.gov

  9. First-episode psychosis as the initial presentation of multiple sclerosis: a case report

    Enderami A

    2018-04-01

    Full Text Available Athena Enderami,1 Rose Fouladi,2 Seyed Hamzeh Hosseini3 1Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran; 2Sport Injuries and Corrective Exercise, University of Mazandaran, Mazandaran, Babolsar, Iran; 3Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran Background: Multiple sclerosis (MS is an inflammatory disease that affects the central nervous system (CNS. MS with episode of psychosis is a rare entity, and to the best of our knowledge, no case has been reported from Iran till date. Case presentation: We report a case of MS with first-episode psychosis in a 27-year-old single man with no history of psychiatric disorder or drug abuse. The patient developed neurological symptoms after 3 months and was finally diagnosed as a case of MS. His symptoms started with behavioral dysfunctions and progressively resulted in depression. Subsequently, treatment was performed with citalopram 20 mg daily, risperidone 2 mg three times a day, and biperiden 2 mg three times a day; however, no improvements in the symptoms were observed. T2-weighted magnetic resonance imaging has demonstrated periventricular and white matter multiple sclerotic plugs with lesions. Eventually, MS was diagnosed after the appearance of paresthesia, upper and lower limb muscle weakness, ataxia, and urinary incontinency as typical signs. Then, the medications were changed to methylprednisolone and interferon therapy, which resulted in improvements in the clinical conditions of the patient. Conclusion: Based on the fact that organic disorders such as MS may sometimes appear with initial pure psychiatric symptoms without any neurological signs and symptoms, examinations for symptoms linked to CNS dysfunction, cognitive changes, atypical symptoms, detailed neurological examination, and limited response to conventional antipsychotic drugs are highly

  10. Acute disseminated encephalomyelitis complicating dengue infection with neuroimaging mimicking multiple sclerosis: A report of two cases.

    Viswanathan, S; Botross, N; Rusli, B N; Riad, A

    2016-11-01

    Acute disseminated encephalomyelitis (ADEM) complicating dengue infection is still exceedingly rare even in endemic countries such as Malaysia. Here we report two such cases, the first in an elderly female patient and the second in a young man. Both presented with encephalopathy, brainstem involvement and worsening upper and lower limb weakness. Initial magnetic resonance imaging (MRI) of the brain was normal in the first case. Serum for dengue Ig M and NS-1 was positive in both cases. Cerebrospinal fluid (CSF) showed pleocytosis in both with Dengue IgM and NS-1 positive in the second case but not done in the first. MRI brain showed changes of perpendicular subcortical palisading white matter, callosal and brainstem disease mimicking multiple sclerosis (MS) in both patients though in the former case there was a lag between the onset of clinical symptoms and MRI changes which was only clarified on reimaging. The temporal evolution and duration of the clinical symptoms, CSF changes and neuroimaging were more suggestive of Dengue ADEM rather than an encephalitis though initially the first case began as dengue encephalitis. Furthermore in dengue encephalitis neuroimaging is usually normal or rarely edema, haemorrhage, brainstem, thalamic or focal lesions are seen. Therefore, early recognition of ADEM as a sequelae of dengue infection with neuroimaging mimicking MS and repeat imaging helped in identifying these two cases. Treatment with intravenous steroids followed by maintenance oral steroids produced good outcome in both patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Glossopharyngeal neuralgia secondary to vascular compression in a patient with multiple sclerosis: a case report

    Gaitour Emil

    2012-07-01

    Full Text Available Abstract Introduction Glossopharyngeal neuralgia is an uncommon, painful syndrome, characterized by paroxysms of pain in the sensory distribution of the 9th cranial nerve. Idiopathic glossopharyngeal neuralgia may be due to compression of the glossopharyngeal nerve by adjacent vessels, while secondary glossopharyngeal neuralgia is associated with identifiable lesions affecting the glossopharyngeal nerve at different levels of its neuroanatomic pathway. Glossopharyngeal neuralgia is rare in the general population, but is more common in patients with multiple sclerosis. Case presentation A 56-year-old Caucasian woman with multiple sclerosis and migraine presented to our facility with intermittent lancinating pain to the right of her throat, tongue, and the floor of her mouth that had been occurring for the past year. The pain was intense, sharp, and stabbing, which lasted two to six seconds with radiation to the right ear. Initially, the attacks were infrequent, however, they had become more intense and frequent over time. Our patient reported weight loss, headache, painful swallowing, and the inability to maintain sleep due to painful attacks. A neurological examination revealed a right-handed woman with trigger points in the back of the tongue and throat on the right side. She also had dysphagia, hoarseness, and pain in the distribution of the right glossopharyngeal nerve. Mild right hemiparesis, hyperreflexia, dysmetria, and an ataxic gait were present. A magnetic resonance imaging scan of the brain was consistent with multiple sclerosis and magnetic resonance angiography demonstrated a loop of the posterior inferior cerebellar artery compressing the right glossopharyngeal nerve. She responded satisfactorily to carbamazepine. Microvascular decompression and Gamma Knife® radiosurgery were discussed in case of failure of the medical treatment; however, she declined these options. Conclusions Glossopharyngeal neuralgia in multiple sclerosis may

  12. Horseshoe lung with multiple congenital anomalies. Case report and review of the literature

    Hawass, N.D.; Badawi, M.G.; Fatani, J.A.; Meshari, A.A.; Edrees, Y.B.

    A detailed radiologic and anatomic study of a 20-week old fetus is presented. In addition to conventional radiography, various contrast medium injection techniques were used. The findings were followed up at autopsy. The fetus showed multiple congenital abnormalities comprising phocomelia, horseshoe lung, horseshoe kidney, urethral stenosis with megacystis, bilateral hydronephrosis, hydroureters, imperforate anus, and a single tracheo-esophageal tube (persistent esophago-trachea). The association of horseshoe lung with persistent esophago-trachea, microurethra, megacystis, bilateral hydroureters, hydronephrosis and phocomelia is, we believe, the first ever to have been recorded in the literature. Twenty-one cases of horseshoe lung have been reported in the literature. These cases were reviewed and a comparison with the present case is presented. The embryologic basis for these anomalies is also briefly discussed.

  13. MULTIPLE MYELOMA PRESENTED AS AN ANTERIOR CHEST WALL MASS DIAGNOSED BY CYTOLOGICAL EXAMINATION : A CASE REPORT

    Parvathi

    2015-02-01

    Full Text Available Myeloma is a malignancy of terminally differentiated B cells (plasma cells that produce a complete and / or partial monoclonal immunoglobulin protein. Myeloma accounts for approximately 1% of all malignancies and 10% of haematological tumors. It becomes difficult to arrive at early diagnosis because myeloma manifests itself in different forms. The disease usually presents as bone pains, pathological fractures and anemia but can also present as swelling in jaw, orbit, rib, sternoclavicular area, scalp, paraspinal region and tonsil. We present a case of multiple myeloma in 63 year old male which presented as a soft tissue mass on anterior chest wall and diagnosed by FNAC . This case is presented because diagnosis was made on cytology and not many cases have been reported in literature where FNAC helped in making the diagnosis. This increases the hope of early diagnosis so that treatment can be advocated

  14. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

    Yeliz Guven

    2015-01-01

    Full Text Available The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.

  15. ANCA-Negative Churg-Strauss Syndrome Presenting as Acute Multiple Cerebral Infarcts: A Case Report.

    Psychogios, Klearchos; Evmorfiadis, Ilias; Dragomanovits, Spyros; Stavridis, Athanasios; Takis, Konstantinos; Kaklamanis, Loukas; Stathis, Pantelis

    2017-03-01

    Eosinophilic granulomatosis with polyangiitis (EGPA, previously named Churg-Strauss syndrome) is a form of necrotizing vasculitis occurring in patients with asthma and eosinophilia. Ischemic stroke is a relatively rare complication of the disease. We report a case of a 63-year-old woman with multiple embolic infarcts, hypereosinophilia (for >7 years), and skin rash. Elevated cardiac enzymes and cardiac magnetic resonance imaging were consistent with endomyocarditis. The simultaneous presence of history of asthma, sinusitis, hypereosinophilia, and vasculitis led to the diagnosis of EGPA. This case contributes to the recent debate of the 2 possible presentations of the disease according to the ANCA (antineutrophil cytoplasmic antibodies) status. We furthermore underscore the need for careful differential diagnosis of the "ANCA negative" cases with persistent hypereosinophilia from the idiopathic hypereosinophilic syndrome. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Study on the clinical usefulness of magnetic resonance imaging in cases of multiple cerebral infarction

    Miyashita, Kotaro

    1991-01-01

    The clinical significance of MRI in thrombotic multiple cerebral infarction was examined in 9 patients having recent lacunar stroke. Recent infarct was identified on Gd-enhanced MRI in 4 patients. For patients multiple small infarction, Gd-enhanced MRI made it possible to differentiate recent from other lesions. To clarify the significance of periventricular high intensity lesion (PVH) on T2-weighted MRI, hemodynamic and neuropsychologic examinations were carried out in 41 patients with multiple cerebral infarction. All the patients had PVH, which was classified into three grades as follows: grade I (n=16) showing only a thin high intensity band along the body of lateral ventricles; grade 2 (n=15) showing a definite high intensity area around the lateral ventricles; grade 3 (n=10) showing diffuse thick and irregular foci around the whole ventricle. In these patients, rCBF was measured by 133 Xe inhalation methods. Initial slope index was significantly higher in patients with grade 3 than those with grade I. Mini-mental state test score was significantly higher in patients with grade l than those with grade 2 and 3. Progression of PVH may be related with the reduction of the cerebral circulation and mental function in cases of multiple cerebral infarction. Ischemic and hemorrhagic lesions can be distinguished by MRI, because old intracerebral hemorrhage appear as hypointensity areas with or without hyperintensity area on T2w images. In 92 patients with multiple infarction, MRI was used to evaluate the incidence and distribution of coexisting old intracerebral hemorrhage. Old hemorrhage were found in 15 patients (16.3%). locating the site where hypertensive hemorrhage commonly occurred. High-field MRI is useful for assessing the coexistence of hemorrhage in hypertensive patients with multiple cerebral infarction. (N.K.)

  17. Clinical observation of the glaucoma trabeculectomy with tunnel knife making the double-deck scleral flap

    Min Fu

    2015-07-01

    Full Text Available AIM: To study the trabeculectomy clinical effect of use tunnel knife to make double-deck scleral flap and to cut off the layer scleral flap of glaucoma.METHODS:Using the random grouping method to divide 46 cases(60 eyesof glaucoma into the treatment group of 24 cases(32 eyesand control group of 22 cases(28 eyes. The treatment group, tunnel knife was used to make double-deck sclera flap and superficial scleral flap about the size of 5mm×5.5mm,1/3 scleral thickness, under the sclera flap made another one about the size of 3.5mm×4mm, 1/3 scleral thickness, resected the middle layer of the sclera flap, removed 2mm×2mm trabecular tissue, underwent routine peripheral iridectomy, could adjust suture the superficial scleral flap, sutured Ball fascia and bulbar conjunctiva. In control group, routine glaucoma trabeculectomy was undergone.RESULTS:Patients were followed up for 1a, the vision in treatment group was obviously better than that in the control group, with a statistically significant difference(PP>0.05. But after 6 and 12mo, the intraocular pressure of the treatment group were significantly lower than that of the control group, with statistically significant difference(PPCONCLUSION:The trabeculectomy have a good effect to lower the intraocular pressure by use tunnel knife to make double-deck scleral flap and to cut off the layer scleral flap. The scleral flap have uniform thickness, smooth surface, and the function of the filtering bleb maintained for a long time, less postoperative complications, suitable for various types of glaucoma, so it is worthy of clinical promotion.

  18. Gender-Based Violence Causing Severe Multiple Injuries; a Case Report

    Adalard Falschung

    2018-04-01

    Full Text Available Introduction: Gender-based violence (GBV against women has been identified as a global health and development issue. We reported a case of GBV causing sever, multiple injuries in a middle-aged female. Case report: A 47-year-old woman presented to emergency room with disturbed level of consciousness, shortness of breath and multiple patches of skin discoloration. On examination, the patient was semi-conscious, with multiple ecchymosis and bilateral decreased air entry. Computed tomography scan of the neck and chest showed six rib fractures on the left side, and eight rib fractures on the right side, sternal fracture, manubriosternal dislocation, bilateral hemothorax, fracture of body of eleventh thoracic vertebra, and fracture of cervical spine of fifth and seventh vertebrae. The patient was intubated and admitted to intensive care unit. She was discharged with good health condition after 23 days of hospital admission. Conclusion: GBV is still a cause of severe trauma that puts the patient’s life at risk.

  19. Treatment of multiple unresectable basal cell carcinomas from Gorlin-Goltz syndrome: a case report.

    Ojevwe, Fidelis O; Ojevwe, Cindy D; Zacny, James P; Dudek, Arkadiusz Z; Lin, Amy; Kohlitz, Patrick

    2015-03-01

    Nevoid basal cell carcinoma syndrome (NBCCS), which is also known by other names, including Gorlin-Goltz syndrome and multiple basal-cell carcinoma (BCC) syndrome, is a rare multi-systemic disease inherited in a dominant autosomal manner with complete penetrance and variable expressivity. The main clinical manifestations include multiple BCCs, odontogenic keratocysts of the jaw, hyperkeratosis of the palms and soles, skeletal abnormalities, intracranial calcifications and facial deformities. A 31-year-old male diagnosed with Gorlin-Goltz syndrome with multiple unresectable facial BCCs was treated with the Hedgehog inhibitor vismodegib. After one month of therapy on vismodegib, there were significant reductions in the size of multiple BCCs on the patient's face. The patient remains on this therapy. Hedgehog pathway inhibition is an effective strategy to treat unresectable BCCs from Gorlin-Goltz syndrome. Although vismodegib shows some promising clinical results in the early phase of its use, there are concerns of possible resistance developing within months. Duration of therapy, role of maintenance treatment and drug modification to reduce resistance need to be explored in future case studies. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  20. Hybrid FRP-concrete bridge deck system final report I : development and system performance validation.

    2009-10-01

    In this study, the concept of the hybrid FRP-concrete structural systems was applied to both bridge : superstructure and deck systems. Results from the both experimental and computational analysis for : both the hybrid bridge superstructure and deck ...

  1. Rapid replacement of Tangier Island bridges including lightweight and durable fiber-reinforced polymer deck systems.

    2009-01-01

    Fiber-reinforced polymer (FRP) composite cellular deck systems were used as new bridge decks on two replacement bridges on Tangier Island, Virginia. The most important characteristics of this application were reduced self-weight and increased durabil...

  2. Dynamic assessment of bridge deck performance considering realistic bridge-traffic interaction

    2017-09-01

    Concrete bridge decks are directly exposed to daily traffic loads and may experience some surface cracking caused by excessive stress or fatigue accumulation, which requires repair or replacement. Among typical bridges in North America, bridge decks ...

  3. Dynamic assessment of bridge deck performance considering realistic bridge-traffic interaction : research brief

    2017-09-01

    This study is to develop simulation methodology to conduct the dynamic assessment of bridge deck performance subjected to traffic. Concrete bridge decks are exposed to daily traffic loads and may experience some surface cracking caused by excessive s...

  4. Aircraft Carrier Flight and Hangar Deck Fire Protection: History and Current Status

    Darwin, Robert L; Bowman, Howard L; Hunstad, Mary; Leach, William B; Williams, Frederick W

    2005-01-01

    .... Next, a review of firefighting systems, including the firefighting agents currently in use, as well as the current tactics for fighting fires on the flight deck and the hangar deck, is provided...

  5. Multiple keratocysts of the mandible in association with Gorlin-Goltz syndrome: A rare case report.

    Kulkarni, Gayithri Harish; Khaji, Shahanavaj I; Metkari, Suryakant; Kulkarni, Harish S; Kulkarni, Reshma

    2014-07-01

    Nevoid basal cell carcinoma syndrome is a syndrome with wide variety of manifestations ranging from oral lesions to skeletal deformities. It calls for due responsibility of maxillofacial surgeon to diagnose the syndrome because very often they are the first health professionals to see the patient for the treatment of keratocystic odontogenic tumor. Keratocystic odontogenic tumor has been the topic of numerous investigators, is known for its potentially aggressive behavior, significant rate of recurrences. KCOT often occurs as a solitary lesion, in some instances multiple keratocysts may occur in association with a syndrome called Gorlin-Goltz syndrome (nevoid BCC, jaw cyst bifid rib basal cell nevus syndrome). Here, we present a case of multiple keratocysts in the mandible in association with skeletal, ocular, cutaneous anomalies in the given clinical scenario, which has profound relevance in the clinical dental practice.

  6. A case of multiple intracranial tuberculoma followed by serial computerized tomography

    Kummer, R. von; Storch, B.; Krause, K.H.; Rauch, H.

    1981-01-01

    This is the case report of an Indian living in Europe who suffered from multiple cerebral tuberculomes in connexion with extrapulmonal tuberculosis. The retrogression of the inflammatory granulomes and the surrounding cerebral edema by treatment with tuberculostatics and Dexamethasone was observed by means of computerized tomography (CT) over a period of 8 months. The value of CT in the diagnosis and treatment of cerebral tuberculomes is discussed. The diagnosis of cerebral tuberculomes is difficult as neither the clinical picture nor additional neuroradiological tests ensure safe delimitation against other intracranial growths. In how far this situation has changed by the introduction of CT into diagnostics is discussed by the example of serial computerized tomography on a patient with multiple cerebral tuberculomes. (orig.) [de

  7. [Choroidal neovascularization followed in a patient with "Multiple Evanescent White Dot Syndrome" (MEWDS) -- a case report].

    Löw, U; Palmowski, A M; Weich, C-M; Ruprecht, K W

    2004-12-01

    Since the description of the "multiple evanescent white dot syndrome" (MEWDS) by Jampol et al, choroiditis has been in the focus of interest. But the classical type of MEWDS was an exceptional case in clinical routine. A 48-year-old female presented to our hospital with a sudden unilateral visual acuity decrease and an extension of the blind spot. Ophthalmoscopy and fluorescein angiography revealed typical multiple grey-white chorioretinal patches of the same stage with lesion areas of about 100 - 200 microm compatible with the diagnose of MEWDS. Although visual acuity increased continuously the patient developed a classical choroidal neovascularization within 4 weeks. She was treated with PDT and visual acuity as well as the ophthalmoscopic diagnosis remained stable. In spite of visual improvement in MEWDS, regular control is recommended. In addition we propose to consider the diagnosis of MEWDS if an enlargement of the blind spot and CNV without lesions of the retinal pigment epithelium are diagnosed.

  8. [Application of Multiple Genetic Markers in a Case of Determination of Half Sibling].

    Yang, Xue; Shi, Mei-sen; Yuan, Li; Lu, Di

    2016-02-01

    A case of half sibling was determined with multiple genetic markers, which could be potentially applied for determination of half sibling relationship from same father. Half sibling relationship was detected by 39 autosomal STR genetic markers, 23 Y-chromosomal STR genetic markers and 12 X -chromosomal STR genetic markers among ZHAO -1, ZHAO -2, ZHAO -3, ZHAO -4, and ZHAO-5. According to autosomal STR, Y-STR and X-STR genotyping results, it was determined that ZHAO-4 (alleged half sibling) was unrelated with ZHAO-1 and ZHAO-2; however, ZHAO-3 (alleged half sibling), ZHAO-5 (alleged half sibling) shared same genetic profile with ZHAO-1, and ZHAO-2 from same father. It is reliable to use multiple genetic markers and family gene reconstruction to determine half sibling relationship from same father, but it is difficult to determination by calculating half sibling index with ITO and discriminant functions.

  9. Multiple keratocysts of the mandible in association with Gorlin-Goltz syndrome: A rare case report

    Gayithri Harish Kulkarni

    2014-01-01

    Full Text Available Nevoid basal cell carcinoma syndrome is a syndrome with wide variety of manifestations ranging from oral lesions to skeletal deformities. It calls for due responsibility of maxillofacial surgeon to diagnose the syndrome because very often they are the first health professionals to see the patient for the treatment of keratocystic odontogenic tumor. Keratocystic odontogenic tumor has been the topic of numerous investigators, is known for its potentially aggressive behavior, significant rate of recurrences. KCOT often occurs as a solitary lesion, in some instances multiple keratocysts may occur in association with a syndrome called Gorlin-Goltz syndrome (nevoid BCC, jaw cyst bifid rib basal cell nevus syndrome. Here, we present a case of multiple keratocysts in the mandible in association with skeletal, ocular, cutaneous anomalies in the given clinical scenario, which has profound relevance in the clinical dental practice.

  10. Intestinal volvulus and perforation caused by multiple magnet ingestion: report of a case.

    Ilçe, Zekeriya; Samsum, Hakan; Mammadov, Emil; Celayir, Sinan

    2007-01-01

    Ingested magnets can cause intestinal fistulas, perforation, and obstruction. There have been reports of magnet ingestion causing intestinal volvulus, but multiple magnet ingestion causing perforation and intestinal volvulus in a child is very unusual. We report the case of a 4-year-old girl, who ingested four magnets she acquired as toys, which caused intestinal volvulus and perforation as a result of pressure necrosis, several days after ingestion. At surgery we repaired two perforations, but additional bowel resection was not required. The patient was discharged on postoperative day 10. If multiple magnet ingestion is suspected in a child, the child must be monitored carefully. If there are signs of obstruction, emergency surgery is mandatory.

  11. First-episode psychosis as the initial presentation of multiple sclerosis: a case report.

    Enderami, Athena; Fouladi, Rose; Hosseini, Seyed Hamzeh

    2018-01-01

    Multiple sclerosis (MS) is an inflammatory disease that affects the central nervous system (CNS). MS with episode of psychosis is a rare entity, and to the best of our knowledge, no case has been reported from Iran till date. We report a case of MS with first-episode psychosis in a 27-year-old single man with no history of psychiatric disorder or drug abuse. The patient developed neurological symptoms after 3 months and was finally diagnosed as a case of MS. His symptoms started with behavioral dysfunctions and progressively resulted in depression. Subsequently, treatment was performed with citalopram 20 mg daily, risperidone 2 mg three times a day, and biperiden 2 mg three times a day; however, no improvements in the symptoms were observed. T2-weighted magnetic resonance imaging has demonstrated periventricular and white matter multiple sclerotic plugs with lesions. Eventually, MS was diagnosed after the appearance of paresthesia, upper and lower limb muscle weakness, ataxia, and urinary incontinency as typical signs. Then, the medications were changed to methylprednisolone and interferon therapy, which resulted in improvements in the clinical conditions of the patient. Based on the fact that organic disorders such as MS may sometimes appear with initial pure psychiatric symptoms without any neurological signs and symptoms, examinations for symptoms linked to CNS dysfunction, cognitive changes, atypical symptoms, detailed neurological examination, and limited response to conventional antipsychotic drugs are highly recommended to be carried out for patients with first-episode psychosis and even in the followup period.

  12. Issues in bridge deck damage evaluation using aerial photos

    Natarajan, M.; Chen, S. E.; Boyle, C.; Martin, E.; Hauser, E.

    2012-04-01

    Small format aerial photography (SFAP) with low flying technique is proposed for damage evaluation of bridge decks. High resolution images obtained using under-belly photography can be used to quantify the various bridge deck problems. The conventional truck-mount or vehicle-mount deck imaging technologies require a large number of image samples. Hence the physical scanning is time consuming and it is also challenging consider the size and location of a bridge. Aerial imaging overcomes these issues, but they face different kinds of challenges that are posed by obstacles such as shadow from trees, power lines and vehicles, signs and luminaries structures. The image resolution uncertainty, which is a function of the pilot skills and flying conditions, may also add additional challenges to aerial imaging technique. Hence different image processing tools have to be integrated into a single package to achieve the desired task. This paper summarizes the challenges faced and the preliminary results are presented and discussed.

  13. Coding response to a case-mix measurement system based on multiple diagnoses.

    Preyra, Colin

    2004-08-01

    To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

  14. Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

    Preyra, Colin

    2004-01-01

    Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

  15. PORTFOLIO MANAGEMENT IN NEW PRODUCTS DEVELOPMENT IN THE TELECOMMUNICATION SECTOR IN BRAZIL: A MULTIPLE CASES STUDY

    Roque Rabechini Jr.

    2017-06-01

    Full Text Available This study aimed to understand how the use of portfolio management practices influence the development of new products in the Brazilian telecommunications operators. The chosen alternative methodology was the multiple case study. The results showed that the processes of identification, selection and prioritization projects influence the development of new products. Specifically, we found that the optimization of resources and product launch projects in short periods of time, are indicators to reveal the possibilities of organizations to remain competitive in the market.

  16. Ischemic Stroke Following Multiple Traumas in a Child: A Case Report

    Pei-Jung Lin

    2006-04-01

    Full Text Available Stroke is an uncommon disorder in children but an increasingly recognized cause of disability. Acute stroke may be attributable to trauma, but this topic is seldom discussed. In limited reports, most ischemic strokes following trauma were detected after a considerable delay. Early recognition of stroke following trauma might reduce secondary neurologic complications. We report a case of posterior cerebral artery area infarct following multiple traumas in a child. A comprehensive etiologic survey was undertaken and discussed. Although the definite pathogenesis is still unclear, adequate, individualized, and uncomplicated management can significantly affect the outcome.

  17. Diffuse hepatic and splenic 99mTc MPD tracer uptake in case of multiple myeloma

    Sood, Ashwani; Seam, Rajeev Kumar; Sethi, Sandeep; Gupta, Manish

    2010-01-01

    99m Tc-methylene diphosphonate (MDP) bone scintigraphy has long been used for the evaluation of benign as well as malignant skeletal conditions. However, non-osseous tracer uptake on a bone scan is an unusual finding. There is a need to understand the pathophysiological basis of the non-osseous uptake, which may have a clinical relevance or deteriorating effect on the quality of the bone scan. We describe a case of multiple myeloma, where extraosseous uptake in the form of diffuse hepatic and splenic uptake, with almost normal skeletal tracer distribution, has been seen on the bone scan. (author)

  18. A Rare Case of Apical Root Resorption during Orthodontic Treatment of Patient with Multiple Aplasia.

    Agrawal, Chintan M; Mahida, Khyati; Agrawal, Charu C; Bothra, Jitendrakumar; Mashru, Ketan

    2015-07-01

    External apical root resorption is an adverse effect of orthodontic treatment. It reduces the length of root and breaks the integrity of teeth and dental arch. Orthodontics is the only dental specialty that clinically uses the inflammatory process to correct the mal-aligned teeth. Hence, it is necessary to know the risk factors of root resorption and do everything to reduce the rate of root resorption. Hence, all predisposing factors which are systemic as well as local should be considered before treatment begins. This case report describes the incidence of root resorption following orthodontic treatment and the teeth affected in the patient with multiple aplasia.

  19. A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

    Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je [KEPCO Medical foundation Hanil General Hospital, Seoul (Korea, Republic of); Lee, Hye Seung [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2007-06-15

    Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

  20. A Case of Multiple Splenic Lymph angiomas Diagnosed by Percutaneous Needle Biopsy

    Ki, Seung Seog; Jeong, Sook Hyang; Yoon, Chang Jin; Chang, Se Jung; Choi, Joon Hyuk; Ha, Ji Su; Kim, Soon Je; Lee, Hye Seung

    2007-01-01

    Lymphangioma of the spleen is an extremely rare disease in adults, and performing splenectomy has been considered necessary for its diagnosis and treatment, but the diagnosis of an isolated splenic mass lesion without performing splenectomy is a challenging problem. Herein, we report on a case of multiple splenic lymphangiomas that were found incidentally in a 56-year-old female; these lesions were diagnosed by percutaneous splenic biopsy without splenectomy. We suggest that this approach is a reasonable option for benign looking-appearing splenic tumors because splenectomy and its postsplenectomy complications can be avoided

  1. Merkel cell carcinoma with fingolimod treatment for multiple sclerosis: A case report.

    Mahajan, Kedar R; Ko, Jennifer S; Tetzlaff, Michael T; Hudgens, Courtney W; Billings, Steven D; Cohen, Jeffrey A

    2017-10-01

    Neoplasms and reactivation of latent viruses have been observed in individuals taking fingolimod. Merkel cell carcinoma (MCC), a rare neuroendocrine skin cancer, is associated with immunosuppression and can be triggered by the oncogenic Merkel cell polyoma virus (MCPyV). We report a case of a 61-year-old man with multiple sclerosis who developed MCPyV-positive MCC 4 years after starting fingolimod. This is the second report of MCC associated with MCPyV in an individual on fingolimod. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. PARAMETRIC STUDY OF SKEW ANGLE ON BOX GIRDER BRIDGE DECK

    Shrikant D. Bobade *, Dr. Valsson Varghese

    2016-01-01

    Box girder bridge deck, is the most common type of bridges in world and India, it consists of several Slab or girders. The span in the direction of the roadway and connected across their tops and bottoms by a thin continuous structural stab, the longitudinal box girders can be made of steel or concrete. The Simple supported single span concrete bridge deck is presented in present study. Skewed bridges are suitable in highway design when the geometry of straight bridges is not possible. The sk...

  3. Coexistence of multiple sclerosis and ankylosing spondylitis: Report of four cases from Russia and review of the literature.

    Fominykh, Vera; Shevtsova, Tatyana; Arzumanian, Narine; Brylev, Lev

    2017-10-01

    Multiple sclerosis is a chronic demyelinating disorder of the central nervous system. There are many cases of multiple sclerosis - like syndrome and demyelinating disorders in systemic lupus erythematosus, Sjogren disease, Behcet disease and other autoimmune conditions. Coexistence of ankylosing spondylitis and multiple sclerosis usually is rare but in this article we report 4 Russian patients with concomitant multiple sclerosis and ankylosing spondylitis diseases. None of these patients received anti-tumor necrosis factor alpha therapy prior to diagnosis of multiple sclerosis. Pathogenesis, diagnostic and treatment challenges are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. 46 CFR 109.575 - Accumulation of liquids on helicopter decks.

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Accumulation of liquids on helicopter decks. 109.575... DRILLING UNITS OPERATIONS Miscellaneous § 109.575 Accumulation of liquids on helicopter decks. The master or person in charge shall ensure that no liquids are allowed to accumulate on the helicopter decks. ...

  5. Family Owned Business Succession and Governance: a multiple case study in Brazil

    Leonardo Roth

    2017-08-01

    Full Text Available One of the main threats to the continuity of family owned business is the poor management of the succession process between generations of the family. This risk factor can be avoided when the process works properly and can also become a renewal and strengthening tool for organizations. The aim of this study is to evaluate the different factors that trigger the succession, as well as the various ways in which companies act and react to the process and the succession’s turbulence. The methodology used was a qualitative study of multiple cases in four representatives family owned organizations in south of Brazil. These families are going, either have passed or have chosen not to go through generational succession processes. The results show the process can be an opportunity to improve the company’s management. Moreover, it shows that there is no single model to follow, but good practices that can be applied to each case.

  6. Sjögren Syndrome Which Simulates Relapsing Remitting Multiple Sclerosis Clinical Features: Case Report

    Haluk Gümüş

    2013-12-01

    Full Text Available Sjögren syndrome (SS is a chronic, inflammatory, autoimmune disease. It emerges as a dry mouth and eyes (sicca symptoms because, it fundamentally affects exocrine glands, frequently, salivary gland and lachrymal gland. Neurological involvement in Sjögren syndrome is observed in the approximately 20-25% of cases. 87% of the neurological involvements are peripheral nervous system involvement and around 13% of the neurological involvements are central nervous system involvement. Cerebral involvement represents heterogeneous features in terms of both localization (focal or diffuse and progress of the statement (acute, progressive or reversible. Affected central nervous system can show clinical and radiological signs similar to Multiple sclerosis (MS. In this paper, the case, which has a complaint of difficulty in walking and instability and MS like lesions in brain magnetic resonance imaging (MRI and is diagnosed as Sjögren syndrome by further research, is discussed

  7. An access technology delivery protocol for children with severe and multiple disabilities: a case demonstration.

    Mumford, Leslie; Lam, Rachel; Wright, Virginia; Chau, Tom

    2014-08-01

    This study applied response efficiency theory to create the Access Technology Delivery Protocol (ATDP), a child and family-centred collaborative approach to the implementation of access technologies. We conducted a descriptive, mixed methods case study to demonstrate the ATDP method with a 12-year-old boy with no reliable means of access to an external device. Evaluations of response efficiency, satisfaction, goal attainment, technology use and participation were made after 8 and 16 weeks of training with a custom smile-based access technology. At the 16 week mark, the new access technology offered better response quality; teacher satisfaction was high; average technology usage was 3-4 times per week for up to 1 h each time; switch sensitivity and specificity reached 78% and 64%, respectively, and participation scores increased by 38%. This case supports further development and testing of the ATDP with additional children with multiple or severe disabilities.

  8. CT abnormality in multiple sclerosis analysis based on 28 probable cases and correlation with clinical manifestations

    Kakigi, Ryusuke; Shibasaki, Hiroshi; Tabira, Takeshi; Kuroiwa, Yoshigoro; Numaguchi, Yuji.

    1981-01-01

    In order to investigate the occurrence and nature of CT abnormality and its correlation with clinical manifestations in multiple sclerosis, 34 CT records obtained from 28 consecutive patients with probable multiple sclerosis were reviewed. Forty-six percent of all cases showed abnormal CT. Dilatation of cortical sulci was found in 39%; dilatation of the lateral ventricle in 36%; dilatation of prepontine or cerebello-pontine cistern and the fourth ventricle, suggesting brainstem atrophy, in 18%; dilatation of cerebellar sulci, superior cerebellar cistern and cisterna magna, suggesting cerebellar atrophy, in 11%. Low density area was found in the cerebral hemisphere in 11% of cases. Contrast enhancement, performed on 25 CT records, did not show any change. There was no correlation between CT abnormality and duration of the illness. Although abnormal CT tended to occur more frequently during exacerbations and chronic stable state than during remissions, the difference was not statistically significant. CT abnormalities suggesting brainstem atrophy, cerebellar atrophy or plaques were found exclusively during exacerbations and chronic stable state. The occurrence of CT abnormalities was not significantly different among various clinical forms which were classified based on clinically estimated sites of lesion, except that abnormal CT tended to occur less frequently in cases classified as the optic-spinal form. It is noteworthy that cerebral cortical atrophy and/or dilatation of the lateral ventricle were found in 31% of cases who did not show any clinical sign of cerebral involvement. There was a statistically significant correlation between CT abnormalities and levels of clinical disability. Eighty percent of the bedridden or severely disabled patients showed abnormal CT, in contrast with only 29% of those with moderate, slight or no disability. (author)

  9. CT abnormality in multiple sclerosis analysis based on 28 probable cases and correlation with clinical manifestations

    Kakigi, R.; Shibasaki, H.; Tabira, T.; Kuroiwa, Y. (Kyushu Univ., Fukuoka (Japan). Faculty of Medicine); Numaguchi, Y.

    1981-10-01

    In order to investigate the occurrence and nature of CT abnormality and its correlation with clinical manifestations in multiple sclerosis, 34 CT records obtained from 28 consecutive patients with probable multiple sclerosis were reviewed. Forty-six percent of all cases showed abnormal CT. Dilatation of cortical sulci was found in 39%; dilatation of the lateral ventricle in 36%; dilatation of prepontine or cerebello-pontine cistern and the fourth ventricle, suggesting brainstem atrophy, in 18%; dilatation of cerebellar sulci, superior cerebellar cistern and cisterna magna, suggesting cerebellar atrophy, in 11%. Low density area was found in the cerebral hemisphere in 11% of cases. Contrast enhancement, performed on 25 CT records, did not show any change. There was no correlation between CT abnormality and duration of the illness. Although abnormal CT tended to occur more frequently during exacerbations and chronic stable state than during remissions, the difference was not statistically significant. CT abnormalities suggesting brainstem atrophy, cerebellar atrophy or plaques were found exclusively during exacerbations and chronic stable state. The occurrence of CT abnormalities was not significantly different among various clinical forms which were classified based on clinically estimated sites of lesion, except that abnormal CT tended to occur less frequently in cases classified as the optic-spinal form. It is noteworthy that cerebral cortical atrophy and/or dilatation of the lateral ventricle were found in 31% of cases who did not show any clinical sign of cerebral involvement. There was a statistically significant correlation between CT abnormalities and levels of clinical disability. Eighty percent of the bedridden or severely disabled patients showed abnormal CT, in contrast with only 29% of those with moderate, slight or no disability.

  10. Cat-scratch disease presenting as multiple hepatic lesions: case report and literature review.

    Baptista, Mariana Andrade; Lo, Denise Swei; Hein, Noely; Hirose, Maki; Yoshioka, Cristina Ryoka Miyao; Ragazzi, Selma Lopes Betta; Gilio, Alfredo Elias; Ferronato, Angela Esposito

    2014-01-01

    Although infectious diseases are the most prevalent cause of fevers of unknown origin (FUO), this diagnosis remains challenging in some pediatric patients. Imaging exams, such as computed tomography (CT) are frequently required during the diagnostic processes. The presence of multiple hypoattenuating scattered images throughout the liver associated with the history of cohabitation with cats should raise the suspicion of the diagnosis of cat-scratch disease (CSD), although the main etiologic agent of liver abscesses in childhood is S taphylococcus aureus . Differential diagnosis by clinical and epidemiological data with Bartonella henselae is often advisable. The authors report the case of a boy aged 2 years and 9 months with 16-day history of daily fever accompanied by intermittent abdominal pain. Physical examination was unremarkable. Abdominal ultrasound performed in the initial work up was unrevealing, but an abdominal CT that was performed afterwards disclosed multiple hypoattenuating hepatic images compatible with the diagnosis of micro abscesses. Initial antibiotic regimen included cefotaxime, metronidazole, and oxacillin. Due to the epidemiology of close contact with kittens, diagnosis of CSD was considered and confirmed by serologic tests. Therefore, the initial antibiotics were replaced by clarithromycin orally for 14 days followed by fever defervescence and clinical improvement. The authors call attention to this uncommon diagnosis in a child presenting with FUO and multiple hepatic images suggestive of micro abscesses.

  11. Cat-scratch disease presenting as multiple hepatic lesions: case report and literature review

    Mariana Andrade Baptista

    2014-06-01

    Full Text Available Although infectious diseases are the most prevalent cause of fevers of unknown origin (FUO, this diagnosis remains challenging in some pediatric patients. Imaging exams, such as computed tomography (CT are frequently required during the diagnostic processes. The presence of multiple hypoattenuating scattered images throughout the liver associated with the history of cohabitation with cats should raise the suspicion of the diagnosis of cat-scratch disease (CSD, although the main etiologic agent of liver abscesses in childhood is Staphylococcus aureus. Differential diagnosis by clinical and epidemiological data with Bartonella henselae is often advisable. The authors report the case of a boy aged 2 years and 9 months with 16-day history of daily fever accompanied by intermittent abdominal pain. Physical examination was unremarkable. Abdominal ultrasound performed in the initial work up was unrevealing, but an abdominal CT that was performed afterwards disclosed multiple hypoattenuating hepatic images compatible with the diagnosis of micro abscesses. Initial antibiotic regimen included cefotaxime, metronidazole, and oxacillin. Due to the epidemiology of close contact with kittens, diagnosis of CSD was considered and confirmed by serologic tests. Therefore, the initial antibiotics were replaced by clarithromycin orally for 14 days followed by fever defervescence and clinical improvement. The authors call attention to this uncommon diagnosis in a child presenting with FUO and multiple hepatic images suggestive of micro abscesses.

  12. Acute gouty arthritis and rapidly progressive renal failure as manifestation of multiple myeloma: clinical case description

    O.V. Gudym

    2017-08-01

    Full Text Available The article describes a clinical case of multiple myeloma in 78-year-old man, its clinical onset was as an acute attack of gout. The patient was admitted to hospital due to the development of the first acute attack of gout. The attack was characterized by polyarthricular joint lesion of the upper and lower extremities, pronounced inflammatory reaction, insufficient response to the use of non-steroidal anti-inflammatory drugs, and a high level of hyperuricemia. The serum uric acid concentration ranged from 636 to 712 μmol/l. The study of the synovial fluid of the inflamed knee joint made it possible to reveal uric acid crystals and to confirm the diagnosis of acute gouty arthritis. Simultaneously, the patient had significant renal impairment: creatinine was 574 μmol/l, urea — 39.9 mmol/l, glomerular filtration rate according to CKD-EPI — 8 ml/min. The daily proteinuria was 1.8 g. A retrospective assessment of laboratory parameters allowed to reveal completely normal indicators of renal function 6 months ago. Considering the development of acute gouty arthritis, its polyarticular nature, persistent course, rapid involvement of new joints, high uric acid levels during an acute attack exceeding 600 μmol/l (10 mg/dL, rapid development of renal failure within 6 months until the terminal stage, it was suggested the secondary nature of gout on the background of kidney damage by another pathological process. Further clinical, laboratory and instrumental studies allowed verifying multiple myeloma with renal damage. Bence Jones protein in the urine was not detected, there was also no evidence of hyperproteinemia. However, pain in the spine, ribs and chest was the basis for carrying out an X-ray study of the bones of the skeleton. Changes in the skeleton typical for multiple myeloma have been identified. Myelogram showed a high content of plasma cells (21.1 %, electrophoresis of blood proteins showed a high M-gradient (30.42 %, and a cytochemical

  13. Full-Scale Evaluation of DuraDeck (registered trademark) and MegaDeck (trademark) Matting Systems

    2013-07-01

    plates studded with threaded bolts were placed ERDC/GSL TR-13-27 10 underneath two pre-drilled corners of the panel. The plates were positioned so...metal plates studded with threaded ERDC/GSL TR-13-27 4 Figure 1. DuraDeck® mat panel, top surface. Figure 2. DuraDeck® mat panel, bottom surface...ERDC/GSL TR-13-27 5 bolts , as shown in Figure 3, underneath the mat corners and then installing special connector nuts from the top surface

  14. The impact of science teachers' epistemological beliefs on authentic inquiry: A multiple-case study

    Jackson, Dionne Bennett

    The purpose of this study was to examine how science teachers' epistemological beliefs impacted their use of authentic inquiry in science instruction. Participants in this multiple-case study included a total of four teachers who represented the middle, secondary and post-secondary levels. Based on the results of the pilot study conducted with a secondary science teacher, adjustments were made to the interview questions and observation protocol. Data collection for the study included semi-structured interviews, direct observations of instructional techniques, and the collection of artifacts. The cross case analysis revealed that the cases epistemological beliefs were mostly Transitional and the method of instruction used most was Discussion. Two of the cases exhibited consistent beliefs and instructional practices, whereas the other two exhibited beliefs beyond their instruction. The findings of this study support the literature on the influence of contextual factors and professional development on teacher beliefs and practice. The findings support and contradict literature relevant to the consistency of teacher beliefs with instruction. This study's findings revealed that the use of reform-based instruction, or Authentic Inquiry, does not occur when science teachers do not have the beliefs and experiences necessary to implement this form of instruction.

  15. The Multiple Use of Tropical Forests by Indigenous Peoples in Mexico: a Case of Adaptive Management

    Víctor M. Toledo

    2003-12-01

    Full Text Available The quest for an appropriate system of management for tropical ecosystems necessitates that ecologists consider the accumulated experiences of indigenous peoples in their long-term management of local resources, a subject of current ethnoecology. This paper provides data and empirical evidence of an indigenous multiple-use strategy (MUS of tropical forest management existing in Mexico, that can be considered a case of adaptive management. This conclusion is based on the observation that some indigenous communities avoid common modernization routes toward specialized, unsustainable, and ecologically disruptive systems of production, and yet probably achieve the most successful tropical forest utilization design, in terms of biodiversity conservation, resilience, and sustainability. This analysis relies on an exhaustive review of the literature and the authors' field research. Apparently, this MUS represents an endogenous reaction of indigenous communities to the intensification of natural resource use, responding to technological, demographic, cultural, and economic changes in the contemporary world. This transforms traditional shifting cultivators into multiple-use strategists. Based on a case study, three main features (biodiversity, resilience, and permanence considered relevant to achieving adaptive and sustainable management of tropical ecosystems are discussed.

  16. A Case of Cushing's Syndrome with Multiple Adrenocortical Adenomas Composed of Compact Cells and Clear Cells.

    Asakawa, Masahiro; Yoshimoto, Takanobu; Ota, Mitsutane; Numasawa, Mitsuyuki; Sasahara, Yuriko; Takeuchi, Takato; Nakano, Yujiro; Oohara, Norihiko; Murakami, Masanori; Bouchi, Ryotaro; Minami, Isao; Tsuchiya, Kyoichiro; Hashimoto, Koshi; Izumiyama, Hajime; Kawamura, Naoko; Kihara, Kazunori; Negi, Mariko; Akashi, Takumi; Eishi, Yoshinobu; Sasano, Hironobu; Ogawa, Yoshihiro

    2016-06-01

    A 58-year-old woman was referred to our hospital for Cushingoid features and diagnosed as adrenal Cushing's syndrome due to a right adrenocortical mass (60 × 55 mm). The mass was composed of three different tumors; the first one was homogeneously lipid-poor neoplasm measuring 20 × 13 mm located at the most dorsal region, the second one was heterogeneous and lipid-rich tumor containing multiple foci of calcification measuring 50 × 32 mm located at the central region, and the last one was heterogeneous harboring dilated and tortuous vessels and lipid-poor one measuring 35 × 18 mm at the most ventral region of the adrenal gland. A right adrenalectomy was subsequently performed by open surgery. Macroscopic and microscopic analyses revealed that all three tumors were adrenocortical adenomas; the first one represents a pigmented adrenocortical adenoma, the second one adrenocortical adenoma associated with degeneration, and the third one adrenocortical adenoma harboring extensive degeneration. Immunohistochemical analysis of the steroidogenic enzymes also revealed that all of the tumors had the capacity of synthesizing cortisol. This is a very rare case of Cushing's syndrome caused by multiple adrenocortical adenomas including a pigmented adenoma. Immunohistochemical analysis of steroidogenic enzymes contributed to understanding of steroidogenesis in each of these three different adrenocortical adenomas in this case.

  17. Nonsyndromic Bilateral Multiple Impacted Supernumerary Mandibular Third Molars: A Rare and Unusual Case Report

    G. Siva Prasad Reddy

    2013-01-01

    Full Text Available A supernumerary tooth is that which is present additionally to the normal series and can be found in any region of the dental arch. An impacted tooth is defined as the one which is embedded in the alveolus, so that its eruption is prevented, or the tooth is locked in position by bone or the adjacent teeth. The occurrence of multiple supernumerary teeth in only one patient in the absence of an associated systemic condition or syndrome is considered as a rare phenomenon. The occurrence of supernumerary teeth in the lower molar region is rare. A prevalence of less than 2% of cases occurring in this region has been estimated. Their occurrence presents a clinical problem for orthodontists and oral surgeons. The cause, frequency, complications, and surgical operation of impacted teeth are always interesting subjects for study and research. An impacted tooth can result in caries, pulp disease, periapical and periodontal disease, temporomandibular joint disorder, infection of the fascial space, root resorption of the adjacent tooth, and even oral and maxillofacial tumours. The management of impacted wisdom teeth has changed over the past 20 years from removal of nonsymptomatic third molars to simple observation. The aim of this paper is to present a rare case of bilateral multiple impacted supernumerary mandibular third molars.

  18. Antithyroid drugs induced agranulocytosis and multiple myeloma: case report and general considerations.

    Dănciulescu Miulescu, R; Carşote, M; Trifănescu, R; Ferechide, D; Poiană, C

    2013-09-15

    Antithyroid drugs as thionamides are largely used in the treatment of the thyrotoxicosis. Side effects were reported in less than 10% of the cases, especially hematological, hepatic or skin allergies. One of the most severe manifestations is agranulocytosis, probably based on an immune mechanism that is exacerbated by the presence of the thyroid autoimmune disease itself. If the presence of the severe leucopenia is actually an epiphenomenon of a preexisting hematological disturbance as multiple myeloma is debated. The myeloma may also be correlated with an autoimmune predisposition. We present the case of a 56 years old female patient diagnosed with Graves' disease, who developed agranulocytosis after 8 months of therapy with thiamazole. Two months after antithyroid drug's withdrawal, the granulocytes number increased and she received therapy with radioiodine. Two years later she came back for diffuse bone pain that turned out to be caused by a multiple myeloma, confirmed by bone marrow biopsy. It might be a connection between the severe form of leucopenia that the patient developed and the medullar malignancy.

  19. Exploring Content Management Issues in Air Force On-Line Communities of Practice: A Multiple Case Study Approach

    Jaime

    2004-01-01

    .... Addressing existing or potential content management issues will help do so. This multiple-case study research observed and interviewed managers and members of eight active CoPs busted by AFMC/DRW...

  20. Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

    Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo [St. Mary' s Hospital, Catholic Medical College, Seoul (Korea, Republic of)

    1981-09-15

    Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left lobe

  1. Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

    Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo

    1981-01-01

    Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left lobe

  2. A Case Study of Tack Tiles[R] Literacy Instruction for a Student with Multiple Disabilities Including Congenital Blindness

    Klenk, Jessicia A.; Pufpaff, Lisa A.

    2011-01-01

    Research on literacy instruction for students with multiple disabilities is limited. Empirical research on braille instruction for students with multiple disabilities that include congenital blindness is virtually nonexistent. This case study offers initial insight into possible methods of early braille literacy instruction for a student with…

  3. Paper 5: Surveillance of multiple congenital anomalies: implementation of a computer algorithm in European registers for classification of cases

    Garne, Ester; Dolk, Helen; Loane, Maria

    2011-01-01

    Surveillance of multiple congenital anomalies is considered to be more sensitive for the detection of new teratogens than surveillance of all or isolated congenital anomalies. Current literature proposes the manual review of all cases for classification into isolated or multiple congenital anomal...

  4. An Unusual Radiologic Manifestation of Pulmonary Tuberculosis with Bilateral Multiple Lung Nodules and Diffuse Alveolar Hemorrhage: A Case Report

    Jeong, Seo In; Seon, Hyun Ju; Kim, Yun Hyeon [Dept. of Radiology, Chunnam National University Hospital, Gwangju (Korea, Republic of); Choi, Sung [Dept. of Radiology, Chunnam National University Hwasun Hospital, Hwasun(Korea, Republic of)

    2011-12-15

    Pulmonary tuberculosis presenting as bilateral multiple lung nodules or diffuse alveolar hemorrhage is very rare. Here, we report a case of pulmonary tuberculosis presenting as bilateral multiple lung nodules and diffuse alveolar hemorrhage mimicking granulomatous vasculitis, such as Wegener's granulomatosis.

  5. A FORM ANALYSIS OF JAPANESE PEDESTRIAN DECKS AND EUROPEAN PLAZAS

    ANDO Naomi

    2015-06-01

    Full Text Available This study compares Japanese pedestrian decks and European plazas as public pedestrian spaces. The characteristics of both types of spaces will be clarified through a schematic analysis. The connections of these spaces with their surroundings will also be analyzed. Further, the spatial image of these spaces are discussed. Pedestrian spaces in Romania will be discussed as well.

  6. Compressive Membrane Action in Prestressed Concrete Deck Slabs

    Amir, S.

    2014-01-01

    One of the most important questions that structural engineers all over the world are dealing with is the safety of the existing structures. In the Netherlands, there are a large number of transversely prestressed bridge decks that have been built in the last century and now need to be investigated

  7. Development of MIDAS/SMR Input Deck for SMART

    Cho, S. W.; Oh, H. K.; Lee, J. M.; Lee, J. H.; Yoo, K. J.; Kwun, S. K.; Hur, H.

    2010-01-01

    The objective of this study is to develop MIDAS/SMR code basic input deck for the severe accidents by simulating the steady state for the SMART plant. SMART plant is an integrated reactor developed by KAERI. For the assessment of reactor safety and severe accident management strategy, it is necessary to simulate severe accidents using the MIDAS/SMR code which is being developed by KAERI. The input deck of the MIDAS/SMR code for the SMART plant is prepared to simulate severe accident sequences for the users who are not familiar with the code. A steady state is obtained and the results are compared with design values. The input deck will be improved through the simulation of the DBAs and severe accidents. The base input deck of the MIDAS/SMR code can be used to simulate severe accident scenarios after improvement. Source terms and hydrogen generation can be analyzed through the simulation of the severe accident. The information gained from analyses of severe accidents is expected to be helpful to develop the severe accident management strategy

  8. a finite element model for the analysis of bridge decks

    Dr Obe

    A FINITE ELEMENT MODEL FOR THE ANALYSIS OF BRIDGE DECKS. NIGERIAN JOURNAL OF TECHNOLOGY, VOL. 27 NO.1, MARCH 2008. 59. (a) Beam-plate system. (b) T-beam structural model. Fig. 1 Beam-plate structure idealisations. The matrix displacement method of analysis is used. The continuum structure is.

  9. Life-Cycle Inventory Analysis of Manufacturing Redwood Decking

    Richard D. Bergman; Han-Sup Han; Elaine Oneil; Ivan L. Eastin

    2012-01-01

    Green building has become increasingly important. Therefore, consumers and builders often take into account the environmental attributes of a building material. This study determined the environmental attributes associated with manufacturing 38-mm × 138-mm (nominal 2 × 6) redwood decking in northern California using the life-cycle inventory method. Primary data...

  10. Fatigue Properties of Orthotropic Decks on Railway Bridges

    Frýba, Ladislav; Gajdoš, Lubomír

    1999-01-01

    Roč. 21, č. 7 (1999), s. 639-652 ISSN 0141-0296 Grant - others:XX(CZ) ERRI D 191 Keywords : railway bridges * orthotropic decks * fatigue Subject RIV: JM - Building Engineering Impact factor: 0.364, year: 1999

  11. Punching shear strength of transversely prestressed concrete decks

    Amir, S.; Van der Veen, C.; Walraven, J.C.

    2012-01-01

    In the Netherlands, there is a need to determine the capacity of bridge decks as a large number of them were built back in the 60’s and 70’s. Since then, not only a lot of additional safety requirements have been incorporated into the modern codes but the traffic flow has also increased drastically.

  12. SU-F-T-637: Single-Isocenter Versus Multiple-Isocenter VMAT SRS for Unusual Multiple Metastasis Case with Two Widely Separated Lesions

    Thomas, EM; Popple, RA; Fiveash, JB [The University of Alabama at Birmingham, Birmingham, AL (United States)

    2016-06-15

    Purpose: Single-isocenter (SI) volumetric modulated arc therapy has been shown to be an effective and efficient approach to multiple metastasis radiosurgery. However, certain extreme cases raise the question of whether multiple-isocenter (MI) approaches can still generate superior plans. In this study, we ask this question with respect to a clinical case with two very widely separated lesions. Methods: A patient with two widely separated (d = 12cm) tumors was treated with SI-VMAT SRS using 10MV flattening filter free (FFF) beam with high-definition multi-leaf collimator (HD-MLC, 2.5/5mm) in two non-coplanar arcs using concentric rings to enforce steep gradient. Because of lesion positioning with respect to collimator angle selection, lesions were treated by 5mm leaves. We re-planned the case with a congruent arc arrangement but separate isocenter for each lesion. In this manner, lesions were treated by 2.5mm leaves. Conformity index (CI), V50%, and mean brain dose were compared. Results: Neither conformity (CI-SI = 1.12, CI-MI = 1.08) nor V50% (V50%-SI =8.82cc, V50%-MI =8.81cc) were improved by utilizing a separate isocenter for each lesion. Mean brain dose was slightly reduced (dmean-SI = 118.4 cGy, dmean-MI = 88.7 cGy) by using multiple isocenters. Conclusion: For this case with a lesion at the apex of the brain and another distantly located at the base of skull, employing a separate isocenter for each target did not meaningfully improve plan quality. Single-isocenter VMAT has been shown feasible and equivalent to multiple-isocenter VMAT for multiple metastasis cases in general. In this extreme case, single- and multiple- isocenter VMAT were also equivalent. If rotational setup errors are appropriately corrected, the increased delivery efficiency of the single-isocenter approach renders it preferable to the multiple isocenter approach. Dr’s Thomas, Popple, and Fiveash have all received honoraria from Varian Medical Systems for discussing their experiences with

  13. Recurrent malignant otitis externa with multiple cranial nerve involvement: A case report

    Đerić Dragoslava

    2016-01-01

    Full Text Available Introduction. Necrotizing otitis externa is a rare but conditionally fatal infection of external auditory canal with extension to deep soft tissue and bones, resulting in necrosis and osteomyelitis of the temporal bone and scull base. This condition is also known as malignant otitis due to an aggressive behavior and poor treatment response. Early diagnosis of malignant otitis is a difficult challenge. We present an illustrative case of necrotizing otitis externa and suggest some strategies to avoid diagnostic and treatment pitfalls. Case Outline. A 70-year-old patient presented with signs of malignant otitis externa, complicated by peripheral facial palsy. Adequate diagnostic and treatment procedures were performed with clinical signs of resolution. The recurrence of malignant infection had presented three months after previous infection with multiple cranial nerve neuropathies and signs of jugular vein and lateral sinus thrombosis. An aggressive antibiotic treatment and surgery were carried out, followed by substantial recovery of the patient and complete restoration of cranial nerves’ functions. Conclusion. Necrotizing otitis externa is a serious condition with uncertain prognosis. The suspicion of malignant external otitis should be raised in cases of resistance to topical treatment, especially in patient with predisposing factors. Evidence-based guideline for necrotizing otitis externa still doesn’t exist and treatment protocol should be adjusted to individual presentation of each patient.

  14. Multiple small hemorrhagic infarcts in cerebral air embolism: a case report.

    Togo, Masaya; Hoshi, Taku; Matsuoka, Ryosuke; Imai, Yukihiro; Kohara, Nobuo

    2017-11-16

    Cerebral air embolism is a rare cause of cerebral infarction. In cerebral air embolism, T2 star-weighted imaging shows numerous spotty hypointense signals. Previous reports have suggested that these signals represent air in the brain and are gradually diminished and absorbed. We experienced two cases of cerebral air embolism, and in one of them, we conducted an autopsy. Case 1 was a 76-year-old Japanese man with lung cancer and emphysema. A spasmodic cough induced massive cerebral and cardiac air embolisms and the patient died because of cerebral herniation. T2 star-weighted imaging of brain magnetic resonance imaging showed multiple spotty low signals. Brain autopsy showed numerous spotty hemorrhagic infarcts in the area of T2 star-weighted imaging signals. Case 2 was an 85-year-old Japanese man with emphysema who suffered from acute stroke. Similar spotty T2 star-weighted imaging signals were observed and remained unchanged 2 months after the onset. These findings indicate that T2 star-weighted imaging in cerebral air embolism partially represents micro-hemorrhagic infarction caused by air bubbles that have migrated into the brain.

  15. Enhancement of Cognitive Processing by Multiple Sclerosis Patients Using Liquid Cooling Technology: A Case Study

    Montgomery, Leslie D.; Montgomery, Richard W.; Ku, Yu-Tsuan; Luna, Bernadette (Technical Monitor)

    1997-01-01

    Cognitive dysfunction is a common symptom in patients with multiple sclerosis (MS). This can have a significant impact on the quality of life of both the patient and of their primary care giver. This case study explores the possibility that liquid cooling therapy may be used to enhance the cognitive processing of MS patients in the same way that it provides temporary relief of some physical impairment. Two MS patients were presented a series of pattern discrimination tasks before and after being cooled with a liquid cooling garment for a one hour period. The subject whose ear temperature was reduced during cooling showed greater electroencephalographic (EEG) activity and scored much better on the task after cooling. The patient whose ear temperature was unaffected by cooling showed less EEG activity and degraded performance after the one hour cooling period.

  16. Oral Lesion as Unusual First Manifestation of Multiple Myeloma: Case Reports and Review of the Literature

    A. Romano

    2014-01-01

    Full Text Available Extramedullary plasmacytoma (EMP and solitary bone plasmacytoma (SBP represent a disease continuum through a multistage process of cell differentiation, survival, proliferation, and dissemination, strictly related to multiple myeloma (MM, the second most common hematological malignancy. Herein, we report two cases of recurrent oral plasmacytoma progressed to MM, in which the first clinical sign of a more widespread disease was limited to the mouth. Based on our experience, we recommend a strict workup for the differential diagnosis between EMP, SBP, and MM for patients with oral plasmacytoma, including radiological exam of the skeleton, magnetic resonance imaging (MRI of the bone, and positive emission tomography (FDG-PET. MRI and possibly PET can all be used to more sensitively detect EM plasmacytoma sites.

  17. Resilience Processes Supporting Adolescents With Intellectual Disability: A Multiple Case Study.

    Hall, Anna-Marié; Theron, Linda C

    2016-02-01

    Resilience, or the process of adjusting well to risk, relies on constructive collaboration between youths and their social ecologies. Although the literature details the risks of an intellectual disability (ID), there is little explanation of why some young people cope well despite these risks. Accordingly, we report a multiple case study that affords insight into the resilience of 24 adolescents with ID. Using a draw-and-talk methodology, these young people explained their resilience as enabled primarily by supportive social ecologies (which facilitated behavioral and emotional regulation, encouraged mastery, treated them as agentic beings, and offered safe spaces). Adolescents' positive orientation to their life-worlds co-facilitated their resilience. These insights advance effective ways to champion the resilience of young people with ID.

  18. Multiple Sclerosis and autoimmune diseases: clinical cases and review of the literature

    A. Protti

    2011-09-01

    Full Text Available Multiple sclerosis (MS, the most frequent demyelinating disease in adults, is thought to be an autoimmune disease. Symptoms and signs observed in MS reflect lesions present mainly in the white matter of the central nervous system (CNS. The diagnosis remains difficult, at least concerning presenting symptoms, because of their low specificity. Diagnosis criteria are usually based on dissemination of signs in time and space, evoked potentials, findings of magnetic resonance imaging, results of cerebrospinal fluid examination, and the exclusion of other diagnosis possibly explaining the clinical signs. However, no clinical and paraclinical investigation can distinguish with certainity MS from other conditions such as autoimmune or inflammatory diseases predominantly affecting the central nervous system. These other disorders include systemic lupus erythematosus, antiphospholipid syndrome, Behcet disease, Sjogren syndrome, sarcoidosis and vasculitides. We present four clinical cases showing the difficulty in reaching a proper diagnosis...

  19. Compton scatter correction in case of multiple crosstalks in SPECT imaging.

    Sychra, J J; Blend, M J; Jobe, T H

    1996-02-01

    A strategy for Compton scatter correction in brain SPECT images was proposed recently. It assumes that two radioisotopes are used and that a significant portion of photons of one radioisotope (for example, Tc99m) spills over into the low energy acquisition window of the other radioisotope (for example, Tl201). We are extending this approach to cases of several radioisotopes with mutual, multiple and significant photon spillover. In the example above, one may correct not only the Tl201 image but also the Tc99m image corrupted by the Compton scatter originating from the small component of high energy Tl201 photons. The proposed extension is applicable to other anatomical domains (cardiac imaging).

  20. Vogt Koyanagi Harada Syndrome mimicking multiple sclerosis: A case report and review of the literature.

    Algahtani, Hussein; Shirah, Bader; Algahtani, Raghad; Alkahtani, Abdulah; Alwadie, Saeed

    2017-02-01

    Vogt Koyanagi Harada (VKH) Syndrome, also called uveomeningioencephalitis, is a chronic disorder characterized by inflammation of the uvea, meninges, auditory system, and integumentary system. The association between VKH syndrome and multiple sclerosis (MS) has been reported only once in the literature in a patient who developed VKH syndrome after two years of the diagnosis of MS. In this article, we report a case who was misdiagnosed and treated as MS until she was proven to have VKH syndrome, and a diagnosis of MS was excluded. VKH syndrome is a systemic disorder that may present with clinical and/or radiological features mimicking MS. Applying diagnostic criteria is extremely important for confirming or excluding the diagnosis. Detailed history and physical examination are of paramount importance to score the final diagnosis. Rigorous search for red flags for both conditions is very helpful. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Neophyte experiences of football (soccer) match analysis: a multiple case study approach.

    McKenna, Mark; Cowan, Daryl Thomas; Stevenson, David; Baker, Julien Steven

    2018-03-05

    Performance analysis is extensively used in sport, but its pedagogical application is little understood. Given its expanding role across football, this study explored the experiences of neophyte performance analysts. Experiences of six analysis interns, across three professional football clubs, were investigated as multiple cases of new match analysis. Each intern was interviewed after their first season, with archival data providing background information. Four themes emerged from qualitative analysis: (1) "building of relationships" was important, along with trust and role clarity; (2) "establishing an analysis system" was difficult due to tacit coach knowledge, but analysis was established; (3) the quality of the "feedback process" hinged on coaching styles, with balance of feedback and athlete engagement considered essential; (4) "establishing effect" was complex with no statistical effects reported; yet enhanced relationships, role clarity, and improved performances were reported. Other emic accounts are required to further understand occupational culture within performance analysis.

  2. Stakeholders: Organizational Strategy and Relationship a Multiple Case Study in the Hotel Sector

    Rosemeire Rodrigues Junqueira

    2011-12-01

    Full Text Available Research into organizational management that focuses on relationships with stakeholders refers to the importance of the commitment of the various groups in the business development prioritizing the creation and distribution of values. For a better view and understanding of strategy-oriented management with stakeholders and the usage of this strategy in hotel chains, a qualitative approach to the methodology, focused on multiple case studies, was the most suitable for empirical investigation. Three hotel chains were selected, with features that allowed a comparative analysis of the study according to the method suggested by Yin (2010, with three sources of evidence: interviews, direct observations and documentation. Through this research, it was found that, through transparency, ethics, values and especially mutual respect clearly shown by the management, a strategy can be more collaborative and result in increasing the sustainability of organizations.

  3. Multidisciplinary management of multiple maxillary anterior supernumerary teeth: a case report.

    Kulkarni, Vinaya Kumar; Reddy, Sampath; Duddu, Mahesh; Reddy, Deepti

    2010-03-01

    Supernumerary teeth are a relatively frequent disorder of odontogenesis. They may occur alone or in multiple; be unilateral or bilateral; and appear in the maxilla, mandible, or both. Mesiodens is a supernumerary tooth in the anterior maxilla between the two central incisors. This case report describes the treatment of maxillary central incisors displaced and impacted because of the presence of four mesiodens in a 12-year-old boy. After clinical and radiographic examination, surgical removal of the mesiodens and exposure of the maxillary right central incisor was performed. This resulted in a 14-mm space between the displaced central incisors. Successively, fixed orthodontic treatment was planned with cephalometric analysis. The central incisors were brought to the occlusal plane and aligned, and the space between the incisors was redistributed. Remaining minor spaces between the incisors were closed with composite resin buildup.

  4. [A case of multiple liver abscesses associated with Streptococcus salivarius in a patient with chronic periodontitis].

    Kamachi, Saori; Otsuka, Taiga; Tsuji, Chika; Nakashita, Shunya; Ide, Yasushi; Mizuta, Toshihiko

    2014-08-01

    Streptococcus salivarius is an oral commensal bacterium that rarely causes disease in humans. Here, we report a case of liver abscess associated with S. salivarius in a 41-year-old woman who presented with continuous abdominal discomfort, fatigue, and fever. She was diagnosed with multiple liver abscesses; she underwent percutaneous transhepatic abscess drainage. Thereafter, S. salivarius was isolated in all bacterial cultures of the drained abscesses, and it was sensitive to penicillins. She made a good recovery after treatment. In the absence of an infective source other than chronic periodontitis, the cause of liver abscesses was attributed to oral S. salivarius. S. salivarius is a normal oral commensal, and oral commensals must be considered if the infective origin of liver abscess cannot be determined.

  5. Full-order optimal compensators for flow control: the multiple inputs case

    Semeraro, Onofrio; Pralits, Jan O.

    2018-03-01

    Flow control has been the subject of numerous experimental and theoretical works. We analyze full-order, optimal controllers for large dynamical systems in the presence of multiple actuators and sensors. The full-order controllers do not require any preliminary model reduction or low-order approximation: this feature allows us to assess the optimal performance of an actuated flow without relying on any estimation process or further hypothesis on the disturbances. We start from the original technique proposed by Bewley et al. (Meccanica 51(12):2997-3014, 2016. https://doi.org/10.1007/s11012-016-0547-3), the adjoint of the direct-adjoint (ADA) algorithm. The algorithm is iterative and allows bypassing the solution of the algebraic Riccati equation associated with the optimal control problem, typically infeasible for large systems. In this numerical work, we extend the ADA iteration into a more general framework that includes the design of controllers with multiple, coupled inputs and robust controllers (H_{∞} methods). First, we demonstrate our results by showing the analytical equivalence between the full Riccati solutions and the ADA approximations in the multiple inputs case. In the second part of the article, we analyze the performance of the algorithm in terms of convergence of the solution, by comparing it with analogous techniques. We find an excellent scalability with the number of inputs (actuators), making the method a viable way for full-order control design in complex settings. Finally, the applicability of the algorithm to fluid mechanics problems is shown using the linearized Kuramoto-Sivashinsky equation and the Kármán vortex street past a two-dimensional cylinder.

  6. Impression of multiple implants using photogrammetry: description of technique and case presentation.

    Peñarrocha-Oltra, David; Agustín-Panadero, Rubén; Bagán, Leticia; Giménez, Beatriz; Peñarrocha, María

    2014-07-01

    To describe a technique for registering the positions of multiple dental implants using a system based on photogrammetry. A case is presented in which a prosthetic treatment was performed using this technique. Three Euroteknika® dental implants were placed to rehabilitate a 55-year-old male patient with right posterior maxillary edentulism. Three months later, the positions of the implants were registered using a photogrammetry-based stereo-camera (PICcamera®). After processing patient and implant data, special abutments (PICabutment®) were screwed onto each implant. The PICcamera® was then used to capture images of the implant positions, automatically taking 150 images in less than 60 seconds. From this information a file was obtained describing the relative positions - angles and distances - of each implant in vector form. Information regarding the soft tissues was obtained from an alginate impression that was cast in plaster and scanned. A Cr-Co structure was obtained using CAD/CAM, and its passive fit was verified in the patient's mouth using the Sheffield test and the screw resistance test. Twelve months after loading, peri-implant tissues were healthy and no marginal bone loss was observed. The clinical application of this new system using photogrammetry to record the position of multiple dental implants facilitated the rehabilitation of a patient with posterior maxillary edentulism by means of a prosthesis with optimal fit. The prosthetic process was accurate, fast, simple to apply and comfortable for the patient.

  7. [A case of leptomeningeal melanomatosis with acute paraplegia and multiple cranial nerve palsies].

    Hattori, Kasumi; Matsuda, Nozomu; Murakami, Takenobu; Ito, Eiichi; Ugawa, Yoshikazu

    2017-12-27

    A 62-year-old man with acute paraplegia was transferred to our hospital. He had flaccid paraplegia and multiple cranial nerve palsies, such as mydriasis of the left pupil, abduction palsy of the left eye, hoarseness and dysphagia, but no meningeal irritation signs. MRI of the spinal canal showed swellings of the conus medullaris and the cauda equine, and also contrast enhancement of the spinal meninges. The cerebrospinal fluid (CSF) showed pleocytosis and protein increment. The lymph node was swollen in his right axilla. The biopsy specimen from the right axillary lymph node revealed metastasis of malignant melanoma histologically. Careful check-up of his whole body found a malignant melanoma in the subungual region of the right ring finger. Repeated cytological examination revealed melanoma cells in the CSF, confirming the diagnosis of leptomeningeal melanomatosis. His consciousness was gradually deteriorated. His family members chose supportive care instead of chemotherapy or surgical therapy after full information about his conditions. Finally, he died 60 days after transfer to our hospital. This is a rare case of leptomenigeal melanomatosis presenting with acute paraplegia and multiple cranial nerve palsies. Careful follow-up and repeated studies are vital for the early diagnosis of leptomenigeal melanomatosis in spite of atypical clinical presentation.

  8. A Case Study in Support of Multiple Post Mortem Assessments (Invited Paper

    Jill Pable

    2015-02-01

    Full Text Available Creative projects in various fields are often subjected to afterthe- fact 'post-mortem' assessments to better understand their successes and failures. Names for these include project retrospectives or post occupancy evaluations (POEs depending on their field of origin. This case study from the architecture field will show the utility of engaging in multiple rounds of post-mortem activities in order to assess the solution from multiple stakeholder perspectives and in doing so, more fully recognize its strengths and weaknesses. The design of a homeless shelter bedroom was subjected to two POE analyses: a 'demand side' focused study that analyzed user accommodation, and a 'supply side' study that addressed issues including budget and funding. The two POEs yielded both corroborative and contrasting findings that sometimes worked at cross purposes. Three evaluation tactics emerged that could be extended to other fields' post mortem assessment activities: 1 conduct two or more POEs; 2 vary the POE criteria so that one is deep and focused 'demand side' user analysis and the other is 'supply side' operational and installation issues; and 3 conduct the POEs over a broad time period.

  9. Multiple Ewing Sarcoma/Primitive Neuroectodermal Tumors in the Mediastinum: A Case Report and Literature Review.

    Bae, Sung Hwan; Hwang, Jung Hwa; Da Nam, Bo; Kim, Hyun Jo; Kim, Ki-Up; Kim, Dong Won; Choi, In Ho

    2016-02-01

    Ewing sarcoma/primitive neuroectodermal tumors (ES/PNET) are high-grade malignant neoplasms. These malignancies present very rare tumors of thoracopulmonary area and even rarer in the mediastinum. In our knowledge, ES/PNET presented with multiple mediastinal masses has not been reported previously. We experienced a case of a 42-year-old man presented with gradual onset of left-side pleuritic chest pain. A contrast-enhanced chest computed tomography (CT) scan showed separate 2 large heterogeneously enhancing masses in each anterior and middle mediastinum of the left hemithorax. Positron emission tomography-computed tomography (PET-CT) scan revealed high fluorodeoxyglucose (FDG) uptake in the mediastinal masses. After surgical excision for the mediastinal masses, both of the masses were diagnosed as the ES/PNET group of tumors on the histopathologic examination. The patient refused postoperative adjuvant chemotherapy and came back with local tumor recurrence and distant metastasis on 4-month follow-up after surgical resection. We report this uncommon form of ES/PNET. We are to raise awareness that this rare malignancy should be considered as a differential diagnosis of the malignant mediastinal tumors and which can be manifested as multiple masses in a patient. Understanding this rare entity of extra-skeletal ES/PNET and characteristic imaging findings can help radiologists and clinicians to approach proper diagnosis and better management for this highly malignant tumor.

  10. Nuclear magnetic resonance imaging in a case of facial myokymia with multiple sclerosis

    Kojima, Shigeyuki; Yagishita, Toshiyuki; Kita, Kohei; Hirayama, Keizo; Ikehira, Hiroo; Fukuda, Nobuo; Tateno, Yukio.

    1985-01-01

    A 59-year-old female of facial myokymia with multiple sclerosis was reported. In this case, facial myokymia appeared at the same time as the first attack of multiple sclerosis, in association with paroxysmal pain and desesthesia of the neck, painful tonic seizures of the right upper and lower extremities and cervical transverse myelopathy. The facial myokymia consisted of grossly visible, continuous, fine and worm-like movement, which often began in the area of the left orbicularis oculi and spread to the other facial muscles on one side. Electromyographic studies revealed grouping of motor units and continuous spontaneous rhythmic discharges in the left orbicularis oris suggesting facial myokymia, but there were no abnormalities on voluntary contraction. Sometimes doublet or multiplet patterns occurred while at other times the bursts were of single motor potential. The respective frequencies were 3-4/sec and 40-50/sec. There was no evidence of fibrillation. The facial myokymia disappeared after 4-8 weeks of administration of prednisolone and did not recur. In the remission stage after disappearance of the facial myokymia, nuclear magnetic resonance (NMR) imaging by the inversion recovery method demonstrated low intensity demyelinated plaque in the left lateral tegmentum of the inferior pons, which was responsible for the facial myokymia, but X-ray computed tomography revealed no pathological findings. The demyelinated plaque demonstrated by NMR imaging seemed to be located in the infranuclear area of the facial nerve nucleus and to involve the intramedurally root. (J.P.N.)

  11. Middle school science teachers' reaction and pedagogical response to high stakes accountability: A multiple case study

    Tse, Kenneth

    The purpose of this study was to understand how science teachers reacted to the high stakes accountability and standardized testing in California. In a multiple case study of middle and intermediate schools in Southern California, four research questions focused on the perceptions of secondary science teachers and how they responded to the changes in the accountability specifically geared towards science as a content area, the pedagogical skills teachers were using both outside and inside of the classroom that impact instruction, the pedagogical training received that related specifically to the content standards, the tools or impediments that existed for teachers to successfully utilize these pedagogical methods and types of support and assistance the school site administration and/or school district offered in learning about the California Science Standards and the STAR test. Interviews were conducted with multiple middle/intermediate school teachers, science department chairpersons and school site administrators to gather information about what the classroom teachers were doing pedagogically to improve student performance on the STAR tests. Moreover, the study described the issues that supported the professional development of the teacher and what schools and districts were doing to support them.

  12. Preimplantation genetic diagnosis for a patient with multiple endocrine neoplasia type 1: case report.

    Lima, Aline Dt; Alves, Vanessa R; Rocha, Andressa R; Martinhago, Ana C; Martinhago, Ciro; Donadio, Nilka; Dzik, Artur; Cavagna, Mario; Gebrim, Luiz H

    2018-03-01

    Preimplantation genetic diagnosis was carried out for embryonic analysis in a patient with multiple endocrine neoplasia type 1 (MEN1). This is a rare autosomal-dominant cancer syndrome and the patients with MEN1 are characterized by the occurrence of tumors in multiple endocrine tissues, associated with germline and somatic inactivating mutations in the MEN1 gene. This case report documents a successful preimplantation genetic diagnosis (PGD) involving a couple at-risk for MEN1 syndrome, with a birth of a healthy infant. The couple underwent a cycle of controlled ovarian stimulation and intracytoplasmic sperm injection (ICSI). Embryos were biopsied at the blastocyst stage and cryopreserved; we used PCR-based DNA analysis for PGD testing. Only one of the five embryos analyzed for MEN1 syndrome was unaffected. This embryo was thawed and transferred following endometrial preparation. After positive βHCG test; clinical pregnancy was confirmed by ultrasound, and a healthy infant was born. PGD for single gene disorders has been an emerging therapeutic tool for couples who are at risk of passing a genetic disease on to their offspring.

  13. Applying voting theory in natural resource management: a case of multiple-criteria group decision support.

    Laukkanen, Sanna; Kangas, Annika; Kangas, Jyrki

    2002-02-01

    Voting theory has a lot in common with utility theory, and especially with group decision-making. An expected-utility-maximising strategy exists in voting situations, as well as in decision-making situations. Therefore, it is natural to utilise the achievements of voting theory also in group decision-making. Most voting systems are based on a single criterion or holistic preference information on decision alternatives. However, a voting scheme called multicriteria approval is specially developed for decision-making situations with multiple criteria. This study considers the voting theory from the group decision support point of view and compares it with some other methods applied to similar purposes in natural resource management. A case study is presented, where the approval voting approach is introduced to natural resources planning and tested in a forestry group decision-making process. Applying multicriteria approval method was found to be a potential approach for handling some challenges typical for forestry group decision support. These challenges include (i) utilising ordinal information in the evaluation of decision alternatives, (ii) being readily understandable for and treating equally all the stakeholders in possession of different levels of knowledge on the subject considered, (iii) fast and cheap acquisition of preference information from several stakeholders, and (iv) dealing with multiple criteria.

  14. A case of multiple cancers in the pelvic organs after radiation for uterine cancer

    Miyake, Yasuhiro; Kurokawa, Eiji; Iijima, Shohei; Handa, Rio; Kato, Takeshi; Kikkawa, Nobuteru

    2005-01-01

    Patients who have undergone pelvic irradiation are reported to be at an increased risk of subsequently developing malignancies of the pelvic organs. We report a case of multiple cancers in the pelvic organs after radiation therapy for uterine cancer. The patient was a 76-year-old woman who had undergone a hysterectomy with radiation therapy for uterine cancer in 1960. Thereafter, she had undergone a total cystectomy for bladder cancer in 1989; an abdominoperineal resection for rectal cancer with radiation proctitis in February 1991; and a right hemicolectomy for cecum cancer in 1995. Then, in 2005, she was found to have early cancer of the sigmoid colon at the stoma, so that the colon was dissected from the periphery of the stoma, the sigmoid colon was removed, and an artificial anus was reconstructed again. The histopathological diagnosis was early well-differentiated adenocarcinoma. She had undergone three operations for multiple cancers of the large intestine in the pelvis at different times during 16 years since 1989 when the bladder cancer was detected and surgically treated. And she has been alive and well. Long-term follow-up would be mandatory for such patients undergone pelvic irradiation who might be able to survive for a long time with appropriate therapies like this patient. (author)

  15. Case Report of Multiple Tracheostomy Revisions due to Persistent, Recurrent Cuff Leak

    Jian P. Azimi-Bolourian

    2015-01-01

    Full Text Available This case is a patient with amyotrophic lateral sclerosis who was unable to be separated from mechanical ventilator support and required a tracheostomy. The patient underwent an initial open tracheostomy utilizing flexible fiberoptic tracheoscopy (FFT in the operating room (OR. Subsequently, he developed recurrent leaks in the tracheal tube cuff requiring multiple trips back to the operating room. The recurrent cuff leak occurred following each tube placement until the etiology of the leak was discovered during the fourth procedure. In the fourth procedure, the wound was explored more extensively, and it was found that there was a sharp, calcified, aberrant fragment of a tracheal cartilage ring protruding into the tracheal lumen, which was damaging the cuff of each tube. This fragment was not visible by multiple FFTs, nor was it visible in the wound by the surgeons until wider exploration of the wound occurred. The cartilage fragment was ultimately excised and the patient had no further cuff leaks. Aberrant tracheal cartilage should be on the differential diagnosis for cuff leaks subsequent to surgical tracheostomy (ST or percutaneous dilatational tracheostomy (PDT.

  16. Nuclear magnetic resonance imaging in a case of facial myokymia with multiple sclerosis

    Kojima, Shigeyuki; Yagishita, Toshiyuki; Kita, Kohei; Hirayama, Keizo; Ikehira, Hiroo; Fukuda, Nobuo; Tateno, Yukio

    1985-06-01

    A 59-year-old female of facial myokymia with multiple sclerosis was reported. In this case, facial myokymia appeared at the same time as the first attack of multiple sclerosis, in association with paroxysmal pain and desesthesia of the neck, painful tonic seizures of the right upper and lower extremities and cervical transverse myelopathy. The facial myokymia consisted of grossly visible, continuous, fine and worm-like movement, which often began in the area of the left orbicularis oculi and spread to the other facial muscles on one side. Electromyographic studies revealed grouping of motor units and continuous spontaneous rhythmic discharges in the left orbicularis oris suggesting facial myokymia, but there were no abnormalities on voluntary contraction. Sometimes doublet or multiplet patterns occurred while at other times the bursts were of single motor potential. The respective frequencies were 3-4/sec and 40-50/sec. There was no evidence of fibrillation. The facial myokymia disappeared after 4-8 weeks of administration of prednisolone and did not recur. In the remission stage after disappearance of the facial myokymia, nuclear magnetic resonance (NMR) imaging by the inversion recovery method demonstrated low intensity demyelinated plaque in the left lateral segmentum of the inferior pons, which was responsible for the facial myokymia, but X-ray computed tomography revealed no pathological findings. The demyelinated plaque demonstrated by NMR imaging seemed to be located in the infranuclear area of the facial nerve nucleus and to involve the intramedurally root.

  17. Optimising case detection within UK electronic health records : use of multiple linked databases for detecting liver injury

    Wing, Kevin; Bhaskaran, Krishnan; Smeeth, Liam; van Staa, Tjeerd P|info:eu-repo/dai/nl/304827762; Klungel, Olaf H|info:eu-repo/dai/nl/181447649; Reynolds, Robert F; Douglas, Ian

    2016-01-01

    OBJECTIVES: We aimed to create a 'multidatabase' algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition

  18. Radiological Findings in a Case of Multiple Focal Nodular Hyperplasia Associated with Portal Vein Atresia and Portopulmonary Hypertension

    Lee, In Joon; Jeong, Sook Hyang; Choi, Jin Woo; Park, Hee Sun; Lee, Kyoung Ho; Kim, Hae Ryoung [Seoul National University Bundang Hospital, Seoul (Korea, Republic of)

    2008-08-15

    We present here the radiological findings of a rare case of multiple focal nodular hyperplasia that was associated with portal vein atresia and portopulmonary hypertension in a young woman. This case illustrates and supports the pathophysiological hypotheses that were previously proposed for the coexistence of these three abnormalities

  19. Studying abroad: a multiple case study of nursing students' international experiences.

    Green, Barbara F; Johansson, Inez; Rosser, Megan; Tengnah, Cassam; Segrott, Jeremy

    2008-11-01

    This paper examines the experiences of nursing students undertaking an international placement during their pre-registration education. The study took place in two schools--one in the United Kingdom, and one in Sweden. The move of nursing education into higher education enabled students to participate in international exchange programmes. Previous research demonstrates that students participating in such programmes may gain enhanced cultural awareness and experience personal and professional growth. The study comprised a multiple case study, utilising semi-structured individual and group interviews and documentary analysis. Eighteen students from the UK and 14 from Sweden participated. Participants described an increase in confidence, self-reliance and professional knowledge and skills resulting from their international placement. There was an awareness of how healthcare roles differ between countries and a change in attitudes to others from different backgrounds and cultures. The differences between the two cases were marginal. Whilst there was support from both home and host universities this varied between the international placement providers. The international placements were beneficial; however, there is a need for change in the preparation, support and monitoring of students, greater engagement with the partner institutions, and more effective mentoring of staff.

  20. Vocabulary skills are well developed in university students with dyslexia: Evidence from multiple case studies.

    Cavalli, Eddy; Casalis, Séverine; El Ahmadi, Abdessadek; Zira, Mélody; Poracchia-George, Florence; Colé, Pascale

    2016-01-01

    Most studies in adults with developmental dyslexia have focused on identifying the deficits responsible for their persistent reading difficulties, but little is known on how these readers manage the intensive exposure to written language required to obtain a university degree. The main objective of this study was to identify certain skills, and specifically vocabulary skills, that French university students with dyslexia have developed and that may contribute to their literacy skills. We tested 20 university students with dyslexia and 20 normal readers (matched on chronological age, gender, nonverbal IQ, and level of education) in reading, phonological, vocabulary breadth (number of known words), and vocabulary depth (accuracy and precision) tasks. In comparing vocabulary measures, we used both Rasch model and single case study methodologies. Results on reading and phonological tasks confirmed the persistence of deficits in written word recognition and phonological skills. However, using the Rasch model we found that the two groups performed at the same level in the vocabulary breadth task, whereas dyslexics systematically outperformed their chronological age controls in the vocabulary depth task. These results are supplemented by multiple case studies. The vocabulary skills of French university students with dyslexia are well developed. Possible interpretations of these results are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Treatment of refractory epilepsy with natalizumab in a patient with multiple sclerosis. Case report

    Constantin Gabriela

    2010-09-01

    Full Text Available Abstract Background Multiple sclerosis (MS is considered an autoimmune disease of the central nervous system and therapeutic inhibition of leukocyte migration with natalizumab, an anti-alpha4 integrin antibody, is highly effective in patients with MS. Recent studies performed in experimental animal models with relevance to human disease suggested a key role for blood-brain barrier damage and leukocyte trafficking mechanisms also in the pathogenesis of epilepsy. In addition, vascular alterations and increased leukocyte accumulation into the brain were recently documented in patients with refractory epilepsy independently on the disease etiology. Case report Here we describe the clinical course of a 24-year-old patient with MS in whom abrupt tonic-clonic generalized seizures manifested at disease onset. Although MS had a more favorable course, treatment with glatiramer acetate and antiepileptic drugs for 7 years had no control on seizure generation and the patient developed severe refractory epilepsy. Interestingly, generalized seizures preceded new MS relapses suggesting that seizure activity may contribute to MS worsening creating a positive feedback loop between the two disease conditions. Notably, treatment with natalizumab for 12 months improved MS condition and led to a dramatic reduction of seizures. Conclusion Our case report suggests that inhibition of leukocyte adhesion may represent a new potential therapeutic approach in epilepsy and complement the traditional therapy with anti-epileptic drugs.

  2. The additive congruential random number generator--A special case of a multiple recursive generator

    Wikramaratna, Roy S.

    2008-07-01

    This paper considers an approach to generating uniformly distributed pseudo-random numbers which works well in serial applications but which also appears particularly well-suited for application on parallel processing systems. Additive Congruential Random Number (ACORN) generators are straightforward to implement for arbitrarily large order and modulus; if implemented using integer arithmetic, it becomes possible to generate identical sequences on any machine. Previously published theoretical analysis has demonstrated that a kth order ACORN sequence approximates to being uniformly distributed in up to k dimensions, for any given k. ACORN generators can be constructed to give period lengths exceeding any given number (for example, with period length in excess of 230p, for any given p). Results of empirical tests have demonstrated that, if p is greater than or equal to 2, then the ACORN generator can be used successfully for generating double precision uniform random variates. This paper demonstrates that an ACORN generator is a particular case of a multiple recursive generator (and, therefore, also a special case of a matrix generator). Both these latter approaches have been widely studied, and it is to be hoped that the results given in the present paper will lead to greater confidence in using the ACORN generators.

  3. A case-control study of risk factors for multiple sclerosis in Iran.

    Alonso, Alvaro; Cook, Stuart D; Maghzi, Amir-Hadi; Divani, Afshin A

    2011-05-01

    Numerous studies have assessed risk factors for multiple sclerosis (MS), although none have been conducted previously in Iran. The objective of this study was to study lifestyle and environmental risk factors of MS in the Iranian population. A case-control study, including 394 MS cases and 394 matched controls, was conducted in MS clinics in different Iranian cities. Information on lifestyles, environmental exposures, and past medical history was obtained from medical charts and phone interviews. In multivariable analysis, sunlight exposure was associated with a lower risk of MS: the odds ratio (OR) and 95% confidence interval (CI) of MS associated with a 1-h increment in daily sunlight was 0.62 (0.53-0.73). Smoking was associated with MS risk in women (OR: 6.48, 95% CI: 1.46-28.78), but not in men (OR: 0.72, 95% CI: 0.31-1.68) (p=0.002 for interaction). Finally, past history of common surgical procedures, infectious disorders, or exposure to pets and farm animals was not associated with MS risk. Different modifiable lifestyles, including sunlight exposure and smoking, were associated with lower MS risk in Iran. Interventions aimed at promoting smoking cessation and, more importantly, at increasing exposure to sunlight might contribute to the prevention of MS.

  4. Tumefactive multiple sclerosis requiring emergency craniotomy: case report and literature review.

    Munarriz, Pablo M; Castaño-Leon, Ana M; Martinez-Perez, Rafael; Hernandez-Lain, Aurelio; Ramos, Ana; Lagares, Alfonso

    2013-01-01

    Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by focal neurological dysfunction with a relapsing and remitting course. Tumor-like presentation of MS (or "tumefactive"/"pseudotumoral" presentation) has been described before with a certain frequency; it consists of a large single plaque (>2cm) with presence of edema and mass effect and it is hard to distinguish from a brain tumor. However, we present a very rare case of a 53-year-old woman with a right temporal mass that turned out to be a MS plaque, who deteriorated within hours (brain herniation with loss of consciousness and unilateral mydriasis) and required an emergency craniotomy. We also present a review of the literature. It appears that only 4 cases of emergency craniotomy/craniectomy required in a patient with a tumor-like MS plaque have been reported before. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  5. The Relation of Shadow Systems and ERP Systems—Insights from a Multiple-Case Study

    Melanie Huber

    2016-01-01

    Full Text Available ERP systems integrate a major part of all business processes and organizations include them in their IT service management. Besides these formal systems, there are additional systems that are rather stand-alone and not included in the IT management tasks. These so-called ‘shadow systems’ also support business processes but hinder a high enterprise integration. Shadow systems appear during their explicit detection or during software maintenance projects such as enhancements or release changes of enterprise systems. Organizations then have to decide if and to what extent they integrate the identified shadow systems into their ERP systems. For this decision, organizations have to compare the capabilities of each identified shadow system with their ERP systems. Based on multiple-case studies, we provide a dependency approach to enable their comparison. We derive categories for different stages of the dependency and base insights into integration possibilities on these stages. Our results show that 64% of the shadow systems in our case studies are related to ERP systems. This means that they share parts or all of their data and/or functionality with the ERP system. Our research contributes to the field of integration as well as to the discussion about shadow systems.

  6. Proteomic Analysis of Cerebrospinal Fluid in a Fulminant Case of Multiple Sclerosis

    Jonas Bergquist

    2012-06-01

    Full Text Available Multiple Sclerosis (MS is a chronic disease, but in rare fulminant cases rapid progression may lead to death shortly after diagnosis. Currently there is no diagnostic test to predict disease course. The aim of this study was to identify potential biomarkers/proteins related to rapid progression. We present the case history of a 15-year-old male MS patient. Cerebrospinal fluid (CSF was taken at diagnosis and at the time of rapid progression leading to the patient’s death. Using isobaric tag labeling and nanoflow liquid chromatography in conjunction with matrix assisted laser desorption/ionization time of flight tandem mass spectrometry we quantitatively analyzed the protein content of two CSF samples from the patient with fulminant MS as well as one relapsing-remitting (RR MS patient and one control headache patient, whose CSF analysis was normal. Seventy-eight proteins were identified and seven proteins were found to be more abundant in both fulminant MS samples but not in the RR MS sample compared to the control. These proteins are involved in the immune response, blood coagulation, cell proliferation and cell adhesion. In conclusion, in this pilot study we were able to show differences in the CSF proteome of a rapidly progressing MS patient compared to a more typical clinical form of MS and a control subject.

  7. Proteomic Analysis of Cerebrospinal Fluid in a Fulminant Case of Multiple Sclerosis

    Füvesi, Judit; Hanrieder, Jörg; Bencsik, Krisztina; Rajda, Cecilia; Kovács, S. Krisztián; Kaizer, László; Beniczky, Sándor; Vécsei, László; Bergquist, Jonas

    2012-01-01

    Multiple Sclerosis (MS) is a chronic disease, but in rare fulminant cases rapid progression may lead to death shortly after diagnosis. Currently there is no diagnostic test to predict disease course. The aim of this study was to identify potential biomarkers/proteins related to rapid progression. We present the case history of a 15-year-old male MS patient. Cerebrospinal fluid (CSF) was taken at diagnosis and at the time of rapid progression leading to the patient’s death. Using isobaric tag labeling and nanoflow liquid chromatography in conjunction with matrix assisted laser desorption/ionization time of flight tandem mass spectrometry we quantitatively analyzed the protein content of two CSF samples from the patient with fulminant MS as well as one relapsing-remitting (RR) MS patient and one control headache patient, whose CSF analysis was normal. Seventy-eight proteins were identified and seven proteins were found to be more abundant in both fulminant MS samples but not in the RR MS sample compared to the control. These proteins are involved in the immune response, blood coagulation, cell proliferation and cell adhesion. In conclusion, in this pilot study we were able to show differences in the CSF proteome of a rapidly progressing MS patient compared to a more typical clinical form of MS and a control subject. PMID:22837721

  8. An unusual presentation of brucellosis, involving multiple organ systems, with low agglutinating titers: a case report

    Khorvash Farzin

    2007-07-01

    Full Text Available Abstract Background Brucellosis is a multi-system disease that may present with a broad spectrum of clinical manifestations. While hepatic involvement in brucellosis is not rare, it may rarely involve the kidney or display with cardiac manifestations. Central nervous system involvement in brucellosis sometimes can cause demyelinating syndromes. Here we present a case of brucella hepatitis, myocarditis, acute disseminated encephalomyelitis, and renal failure. Case presentation A 26-year-old man presented with fever, ataxia, and dysarthria. He was a shepherd and gave a history of low grade fever, chilly sensation, cold sweating, loss of appetite, arthralgia and 10 Kg weight loss during the previous 3 months. He had a body temperature of 39°C at the time of admission. On laboratory tests he had elevated level of liver enzymes, blood urea nitrogen, Creatinine, Creatine phosphokinase (MB, and moderate proteinuria. He also had abnormal echocardiography and brain MRI. Enzyme-linked immunosorbent assay for IgG and IgM was negative. Standard tube agglutination test (STAT and 2-mercaptoethanol (2-ME titers were 1:80 and 1:40 respectively. Finally he was diagnosed with brucellosis by positive blood culture and the polymerase chain reaction for Brucella mellitensis. Conclusion In endemic areas clinicians should consider brucellosis in any unusual presentation involving multiple organ systems, even if serology is inconclusive. In endemic areas low STAT and 2-ME titers should be considered as an indication of brucellosis and in these cases additional testing is recommended to rule out brucellosis.

  9. Causes of Early Age Cracking on Concrete Bridge Deck Expansion Joint Repair Sections

    Jared R. Wright

    2014-01-01

    Full Text Available Cracking of newly placed binary Portland cement-slag concrete adjacent to bridge deck expansion dam replacements has been observed on several newly rehabilitated sections of bridge decks. This paper investigates the causes of cracking by assessing the concrete mixtures specified for bridge deck rehabilitation projects, as well as reviewing the structural design of decks and the construction and curing methods implemented by the contractors. The work consists of (1 a comprehensive literature review of the causes of cracking on bridge decks, (2 a review of previous bridge deck rehabilitation projects that experienced early-age cracking along with construction observations of active deck rehabilitation projects, and (3 an experimental evaluation of the two most commonly used bridge deck concrete mixtures. Based on the literature review, the causes of concrete bridge deck cracking can be classified into three categories: concrete material properties, construction practices, and structural design factors. The most likely causes of the observed early-age cracking were found to be inadequate curing and failure to properly eliminate the risk of plastic shrinkage cracking. These results underscore the significance of proper moist curing methods for concrete bridge decks, including repair sections. This document also provides a blueprint for future researchers to investigate early-age cracking of concrete structures.

  10. Hybrid FRP-concrete bridge deck system final report II : long term performance of hybrid FRP-concrete bridge deck system.

    2009-06-01

    This report describes the investigation of the long term structural performance of a : hybrid FRP-concrete (HFRPC) bridge deck on steel girders. The study aimed at : assessing three long term aspects pertaining to the HFRPC bridge deck: (1) creep : c...

  11. VGC analyzer: a software for statistical analysis of fully crossed multiple-reader multiple-case visual grading characteristics studies

    Baath, Magnus; Hansson, Jonny

    2016-01-01

    Visual grading characteristics (VGC) analysis is a non-parametric rank-invariant method for analysis of visual grading data. In VGC analysis, image quality ratings for two different conditions are compared by producing a VGC curve, similar to how the ratings for normal and abnormal cases in receiver operating characteristic (ROC) analysis are used to create an ROC curve. The use of established ROC software for the analysis of VGC data has therefore previously been proposed. However, the ROC analysis is based on the assumption of independence between normal and abnormal cases. In VGC analysis, this independence cannot always be assumed, e.g. if the ratings are based on the same patients imaged under both conditions. A dedicated software intended for analysis of VGC studies, which takes possible dependencies between ratings into account in the statistical analysis of a VGC study, has therefore been developed. The software-VGC Analyzer-determines the area under the VGC curve and its uncertainty using non-parametric re-sampling techniques. This article gives an introduction to VGC Analyzer, describes the types of analyses that can be performed and instructs the user about the input and output data. (authors)

  12. Multiple infestation of Dioctophyme renale in dogs with leishmaniasis in Uruguaiana, RS - Report of five cases

    Maria Lígia de Arruda Mistieri

    2014-06-01

    Full Text Available ABSTRACT. Mistieri M.L. de A., Pascon J.P. da E. & dos Santos F.P. [Multiple infestation of Dioctophyme renale in dogs with leishmaniasis in Uruguaiana, RS - Report of five cases.] Infestação múltipla de Dioctophyme renale em cães portadores de leishmaniose em Uruguaiana, RS - Relato de cinco casos. Revista Brasileira de Medicina Veterinária, 36(2:195-198, 2014. Universidade Federal do Pampa, BR 472, Km 592, Caixa Postal 118, Uruguaiana, RS 97500-970, Brasil. Email: mariamistieri@unipampa.edu.br Dioctophyme renale is a parasite of different animal species, including human beings. The parasite life cycle can be complex, involving intermediate hosts, definitive hosts and paratenic hosts, represented by different species of frog, rat and fish, specially. The domestic dogs are considered unusual and terminal hosts because they commonly present single parasite, enabling its reproduction and the cycle maintenance. This report presents a multiple infestation of D. renale (male and female specimens in five of nine dogs that underwent to euthanasia due to leishmaniasis. It was noticed two to eight parasites in each affected dog, summing 27 specimens, 12 males measuring between 9.0 and 21.5 cm in length and 15 females with 23.5 to 42.0 cm. In all dogs, the right kidney was completely destroyed. Actual epidemiological studies are necessary to check the real prevalence of the dioctophimosis in the region of Uruguaiana and the determination of the local parasite cycle. Deficient sanitary and hygiene conditions are commonly observed in the progression of D. renale and Leishmania sp. infections. It is possible that those conditions are the link between both disorders in the studied dogs.

  13. Syphilis: an atypical case of sepsis and multiple anogenital lesions in secondary syphilis

    Nichole Smith

    2016-10-01

    Full Text Available The incidence of syphilis has historically been cyclical in nature, often in relation to the rise and fall of public health initiatives directed toward eradication along with social attitudes toward sexual practices. The incidence of syphilis has increased by 15% in the last 6 years in the United States, with similar increases worldwide. Herein, we present an atypical case of syphilis presenting with severe septic shock and multiple anogenital lesions in an immunocompetent host. A 22-year-old male with no significant past medical history presented with fevers, chills, sore throat, diaphoresis, and diarrhea. He was febrile, tachycardic, hypotensive, and unresponsive to fluid resuscitation requiring short-term vasopressor support. Physical exam revealed diffuse lymphadenopathy; lower extremity macular rash involving the soles of the feet; papular non-pustular lesions on the scrotum; and a 0.5 cm non-tender irregular, healing lesion on the shaft of the penis. Laboratory analysis was significant for leukocytosis and elevated creatinine. Serum screening rapid plasma reagin was positive, and further testing revealed a titer of 1:32, with confirmation via fluorescent treponemal antibody absorption test. The patient was diagnosed with secondary syphilis, which was determined to be the underlying etiology of the sepsis as all other serological evaluations were negative. He was treated with penicillin G benzathine 2.4 million units intramuscular and supportive management, with improvement of symptoms. The patient engaged in high-risk sexual behaviors, including prior unprotected sexual contact with males. New research indicates that up to one-third of patients may present with atypical cutaneous manifestations, as demonstrated by this patient. It is important for physicians to familiarize themselves with the varied clinical presentations of syphilis, which include multiple anogenital lesions and tender primary lesions in primary or secondary syphilis.

  14. A retrospective likelihood approach for efficient integration of multiple omics factors in case-control association studies.

    Balliu, Brunilda; Tsonaka, Roula; Boehringer, Stefan; Houwing-Duistermaat, Jeanine

    2015-03-01

    Integrative omics, the joint analysis of outcome and multiple types of omics data, such as genomics, epigenomics, and transcriptomics data, constitute a promising approach for powerful and biologically relevant association studies. These studies often employ a case-control design, and often include nonomics covariates, such as age and gender, that may modify the underlying omics risk factors. An open question is how to best integrate multiple omics and nonomics information to maximize statistical power in case-control studies that ascertain individuals based on the phenotype. Recent work on integrative omics have used prospective approaches, modeling case-control status conditional on omics, and nonomics risk factors. Compared to univariate approaches, jointly analyzing multiple risk factors with a prospective approach increases power in nonascertained cohorts. However, these prospective approaches often lose power in case-control studies. In this article, we propose a novel statistical method for integrating multiple omics and nonomics factors in case-control association studies. Our method is based on a retrospective likelihood function that models the joint distribution of omics and nonomics factors conditional on case-control status. The new method provides accurate control of Type I error rate and has increased efficiency over prospective approaches in both simulated and real data. © 2015 Wiley Periodicals, Inc.

  15. Multiple familial trichoepithelioma with an adjacent basal cell carcinoma, transformation or collision - A case report and review of literature

    Ashok Sangwaiya

    2015-01-01

    Full Text Available Trichoepithelioma is a benign tumor of follicular origin that presents as small, skin-colored papules predominantly on the face. When more than one family member is affected, the disease is known as multiple familial trichoepithelioma (MFT. It is a rare autosomal dominant skin disease. Malignant transformation is very rare. We describe here a case that developed malignant neoplasm in a setting of multiple trichoepithelioma.

  16. Service Life and Maintenance Modelling of Reinforced Concrete Bridge Decks

    Thoft-Christensen, Palle

    Recent research in the area of assessment and maintenance of reinforced concrete bridge decks is presented in this paper. Three definitions of service lifetime are introduced and the difficult problem of assessing the service life is discussed. A stochastic modelling of corrosion and corrosion...... cracking is introduced and the site dependency of corrosion is stressed. Finally, a recently developed optimal repair strategy for bridges is briefly explained....

  17. Delamination Detection of Reinforced Concrete Decks Using Modal Identification

    Shutao Xing

    2012-01-01

    Full Text Available This study addressed delamination detection of concrete slabs by analyzing global dynamic responses of structures. Both numerical and experimental studies are presented. In the numerical examples, delaminations with different sizes and locations were introduced into a concrete slab; the effects of presence, sizes, and locations of delaminations on the modal frequencies and mode shapes of the concrete slab under various support conditions were studied. In the experimental study, four concrete deck specimens with different delamination sizes were constructed, and experimental tests were conducted. Traditional peak-picking, frequency domain decomposition, and stochastic subspace identification methods were applied to the modal identification from dynamic response measurements. The modal parameters identified by these three methods correlated well. The changes in modal frequencies, damping ratios, and mode shapes that were extracted from the dynamic measurements were investigated and correlated to the actual delaminations and can indicate presence and severity of delamination. Finite element (FE models of reinforced concrete decks with different delamination sizes and locations were established. The modal parameters computed from the FE models were compared to those obtained from the laboratory specimens, and the FE models were validated. The delamination detection approach was proved to be effective for concrete decks on beams.

  18. Sympathetic skin response in multiple sclerosis: a meta-analysis of case-control studies.

    Margaritella, Nicolò; Mendozzi, Laura; Garegnani, Massimo; Gilardi, Elisabetta; Nemni, Raffaello; Pugnetti, Luigi

    2018-01-01

    The usefulness of sympathetic skin responses (SSR) in multiple sclerosis (MS) has been advocated by several studies in the last 20 years; however, due to a great heterogeneity of findings, a comprehensive meta-analysis of case-control studies is in order to pinpoint consistencies and investigate the causes of discrepancies. We searched MEDLINE, EMBASE and Cochrane databases for case-control studies comparing SSR absence frequency and latency between patients with MS and healthy controls. Thirteen eligible studies including 415 MS patients and 331 healthy controls were identified. The pooled analysis showed that SSR can be always obtained in healthy controls while 34% of patients had absent SSRs in at least one limb (95% CI 22-47%; p studies (I 2  = 90.3%). Patients' age explained 22% of the overall variability and positive correlations were found with Expanded Disability Status Scale and disease duration. The pooled mean difference of SSR latency showed a significant increase in patients on both upper (193 ms; 95% CI 120-270 ms) and lower (350 ms; 95% CI 190-510 ms) extremities. We tested the discriminatory value of SSR latency thresholds defined as the 95% confidence interval (CI) upper bound of the healthy controls, and validated the results on a new dataset. The lower limb threshold of 1.964 s produces the best results in terms of sensitivity 0.86, specificity 0.67, positive predicted value 0.75 and negative predicted value 0.80. Despite a considerable heterogeneity of findings, there is evidence that SSR is a useful tool in MS.

  19. Glioma and multiple sclerosis: case report Glioma e esclerose múltipla: relato de caso

    Lineu Cesar Werneck

    2002-06-01

    Full Text Available We report a case of a 44-years-old woman with relapsing-remitting and secondarily progressive form of multiple sclerosis (MS since aged 24 years, who developed an anaplastic astrocytoma. The neurological manifestations of the tumor were misinterpreted as resulting from MS. Sequential MRI examination and seizures raised the possibility of another nature of her symptoms, besides MS. Her initial good response to high doses corticosteroids led to the initial assumption her symptoms were only exclusively due to the demyelinating process. She underwent craniotomy with radical excision of the lesion. Pathological examination disclosed anaplastic astrocytoma. Other cases of coincidental MS and primary CNS tumors are reviewed, as well as their possible relation.Relatamos o caso de uma paciente de 44 anos, portadora de esclerose múltipla forma surto-remissão e progressiva secundária, que na evolução desenvolveu um astrocitoma anaplásico. Os sintomas do tumor se confundiram com os da esclerose múltipla e com a repetição de ressonâncias magnéticas foi possível suspeitar do diagnóstico. Além dos sinais neurológicos, também apresentava crises convulsivas. A melhora com os cursos de pulsoterapia mascaravam os sintomas do tumor. Submetida a craniotomia e retirado tumor com características histológicas e histoquímicas de astrocitoma anaplásico, ao lado de áreas de desmielinização típicas de esclerose múltipla. São discutidos os aspectos radiológicos, incidência e mecanismos da concomitância das duas doenças.

  20. Environmental risk factors in the aetiology of multiple sclerosis in Kayseri: a case control study

    Servin Yeşil Günal

    2013-06-01

    Full Text Available Background: our purpose is to evaluate the possible relationship between multiple sclerosis (MS and environmental factors in Kayseri.Methods: this case control study was conducted on 100 patients with MS and 100 sex-aged and residential area matched control. Data was collected by using face to face interviews. Questionnaire consisted of two parts. The first part was comprised of items related with the participants’ sociodemographic features. The second part was related with factors thought to be involved in the occurrence or aggravation of the disease. The Chi-square test and logistic regression were used for analysis.Results: logistic regression analysis revealed the following as possible risk factors in MS cases: economic status (Odds Ratio (OR: 0.14 adjusted 7.19; Confidence Interval 95% (CI: 0.05-0.43, having a sensitive personality (OR:4.51; 95% CI: 1.10-18.45, familial history of MS (OR:3.28; 95% CI: 1.3-8.27, history of cranial and spinal injury (OR: 2.99; 95% CI: 1.11-8.08, cooking oil consumption (OR:0.07 adjusted 13.5; 95% CI: 0.03-0.20, consumption of legumes and grains (OR: 0.11 adjusted 8.9; 95% CI: 0.03-0.41, and living in dwellings within a distance of 500 meters from transformer basestations (OR: 6.5; 95% CI: 1.54-28.21.Conclusions: we believe that it is necessary to inform the individuals about the risk of MS and their relatives of the results of large-scale joint studies and to offer suggestions based on the data obtained.

  1. Cluster headache as a first manifestation of multiple sclerosis: case report and literature review

    Mijajlović MD

    2014-11-01

    Full Text Available Milija D Mijajlović,* Vuk M Aleksić,* Nadežda M Čovičković Šternić Department for Cerebrovascular Disorders and Headaches, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia *These authors contributed equally to this work Abstract: Cluster headache (CH is estimated to be the most common primary trigeminal autonomic headache, although it is a rare disabling medical condition. Dominant symptoms of CH include severe unilateral orbital, supraorbital, and/or temporal pain, lasting from 15 to 180 minutes if untreated, associated with at least one of various autonomic symptoms during the headache, such as conjunctival injection, lacrimation, nasal congestion and rhinorrhea, facial sweating, miosis, ptosis, and eyelid edema. Headache is not frequently a symptom of multiple sclerosis (MS. The most commonly reported primary headaches are migraine without aura and a tension-type headache. Several described cases involved complicated migraine, ophthalmoplegic migraine-like headache, and finally cluster-like headache. We present a case of a 45-year-old male patient who had typical CH attacks as the initial and only clinical manifestation of MS, which was diagnosed after cerebrospinal fluid (CSF isoelectric focusing and brain magnetic resonance imaging (MRI investigation. He presented as a typical cluster-like headache patient since in the background of the CH symptoms and signs, were MS demyelinating lesions. In a patient with CH symptoms one should always think about the possibility of cluster-like-headache, which presents the CH patient with different underlying diseases, so we proposed a protocol to evaluate such patients and exclude diseases that could be in the background of CH symptoms. Keywords: demyelinating disease, headache, trigeminal autonomic cephalalgia, diagnosis

  2. Full Scale Investigation of the Dynamic Heat Storage of Concrete Decks with PCM and Enhanced Heat Transfer Surface Area

    Pomianowski, Michal Zbigniew; Heiselberg, Per; Jensen, Rasmus Lund

    2013-01-01

    The paper presents the full-scale experimental investigation of the dynamic heat storage potential of the prefabricated hollow core deck elements with and without phase change material (PCM) and with and without increased bottom surface area of the decks. In the presented investigation five types...... of hollow core decks with different surfaces on the bottom are investigated: reference deck made of standard concrete and flat surface, deck with special mortar grooved tiles, deck with flat mortar tiles, deck with grooved mortar and phase change material tiles, deck with flat mortar and phase change...... material tiles. The experimental investigation presented in the paper is performed in the specially designed modified hot box apparatus that allows maintaining periodic steady-state tests with the full-scale concrete deck elements. The presented research investigates if the extended surface area and PCM...

  3. Numerical Analysis of Heat Storage and Heat Conductivity in the Concrete Hollow Core Deck Element

    Pomianowski, Michal Zbigniew; Heiselberg, Per; Jensen, Rasmus Lund

    2011-01-01

    extent these simplified models estimate the heat storage potential of precast hollow-core concrete decks correctly. This study investigates various approaches on how to model the heat transfer within the air void in the deck. Furthermore, it is analysed how different heat transfer models influence...... the overall heat transfer and heat storage in the hollow-core decks. The presented results allow comparison between detailed results from 2D-COMSOL simulations and simple 1D calculations from the whole building simulation tool such as BSim program and moreover, it is possible to validate the calculation...... method in BSim for the concrete deck element with air voids. Finally, this paper presents a comparison of the calculated heat conductivity of the hollow-core concrete deck and the measured heat conductivity for the same deck by using hot box apparatus....

  4. Benign metastasizing leiomyoma presenting as multiple cystic pulmonary nodules: a case report.

    Choe, Yeong Hun; Jeon, So Yeon; Lee, Yoon Chae; Chung, Myung Ja; Park, Seung Yong; Lee, Yong Chul; Kim, So Ri

    2017-09-12

    Benign metastatic leiomyoma (BML) is an extremely rare disease. Although uterine leiomyomas are benign histologically, they can metastasize to distant sites. While the incidence is very low, the lung is the organ most frequently affected by BML. Pulmonary BML usually presents as numerous well-defined nodules of various sizes, while the cavitary or cystic features in the nodules are rarely observed on radiologic images. A 52-year-old woman complained of cough and dyspnea for one month. She had been previously diagnosed with uterine leiomyoma and had undergone total hysterectomy about 14 years prior. High-resolution computed tomography (CT) images showed that there were multiple cystic nodules of various sizes in both lungs. Pathologic examination revealed that the pulmonary nodule had complex branching glandular structures lined by a single layer of simple cuboidal to columnar epithelium that was surrounded by abundant spindle cells. Additional immunohistochemistry data suggested that pulmonary nodule diagnosis was BML-associated uterine leiomyoma. In this report, we introduce an interesting case of pulmonary BML that presented as a combination of various kinds of nodules including simple round nodules, simple cysts, and cysts with a solid portion, which are very rare radiologic features of BML in lung. In addition, when the patient is a woman of reproductive age, physicians should meticulously review the gynecological history and suspect BML when there are various cystic pulmonary lesions.

  5. Imagery Rescripting for Body Dysmorphic Disorder: A Multiple-Baseline Single-Case Experimental Design.

    Willson, Rob; Veale, David; Freeston, Mark

    2016-03-01

    Individuals with body dysmorphic disorder (BDD) often experience negative distorted images of their appearance, and research suggests these may be linked to memories of adverse events such as bullying or teasing. This study evaluates imagery rescripting (ImR) as an intervention for BDD. In this article, we present a multiple-baseline single-case experimental design testing imagery rescripting as a brief, stand-alone intervention, with six individuals with BDD that related to aversive memories. The impact of the intervention was assessed by self-reported daily measures of symptom severity (preoccupation with appearance, appearance-related checking behaviors, appearance-related distress, and strength of belief that their main problem is their appearance) and standardized clinician ratings of BDD severity (Yale-Brown Obsessive Compulsive Scale modified for BDD). Four out of six of the participants responded positively to the intervention, with clinically meaningful improvement in symptomatology. Overall response was rapid; improvements began within the first week post-ImR intervention. From a small sample it is cautiously concluded that imagery rescripting may show promise as a module in cognitive-behavioral therapy for BDD, and is worthy of further investigation. Copyright © 2015. Published by Elsevier Ltd.

  6. A Preliminary Multiple Case Report of Neurocognitive Training for Children With AD/HD in China

    Han Jiang

    2015-06-01

    Full Text Available This preliminary multiple case study examined the behavioral outcomes of neurocognitive training on children with attention-deficit/hyperactivity disorder (AD/HD in China, as well as parent acceptance of the treatment. The training approach targeted working memory, impulse control, and attention/relaxation (via brain electrical activity. Outcome measures included overt behavior as rated by parents and teachers, AD/HD symptom frequency, and parent opinion/feedback. Training was completed by five individuals and delivered via a themed computer game with electroencephalogram (EEG input via a wireless, single-channel, dry-sensor, portable measurement device. The objective (i.e., training outcomes and EEG and subjective (i.e., parent ratings/feedback and teacher ratings data suggested that use of the neurocognitive training resulted in reduced AD/HD behaviors and improvement in socially meaningful outcomes. The parents expressed satisfaction with the training procedure and outcomes. It is concluded that the innovative neurocognitive training approach is effective for improving behavior and reducing symptoms of AD/HD for children in China.

  7. Professional practice of dietitians in the Brazilian School Feeding Program: A multiple case study

    Patrícia Fernanda Ferreira PIRES

    Full Text Available ABSTRACT Objective: To assess dietician’s numerical parameters for school feeding and discuss limitations and possibilities for professional practice in the municipalities of Vale do Ivaí, in Northern Paraná, Brazil. Methods: This is a multiple case study. A semi-structured interview was administered to dietitians working at the School Feeding Program in nine cities located in Vale do Ivaí, Paraná, Brazil. Resolution nº 465/2010, from the Brazilian Federal Board of Dietitians, was used to calculate the adequacy of working hours of dietitians. The legistation of the Brazilian School Feeding Program was applied to discuss professional practice. Results: All the cities had at least one dietitian responsible for the School Feeding Program. The percentage of adequate working hours was from 20 to 66%. Some dietitians were involved in management activities, administration, procurement, and accounting, in addition to dietitian assignments for the School Feeding Program. Most dietitians worked in other sectors of the municipalities such as the health system, social assistance, and at events. This practice could compromise compliance of technical activities that must be met by the dietitians of the School Feeding Program. Conclusion: The number of dietitians in most of cities working at School Feeding Program is not sufficient to meet the number of students. The insuficient workload and excessive activities could hinder the development of dietitian’s private activities. The hiring of nutrition and dietitian technicians and administrative assistants for bureaucratic activies is recommended.

  8. Simultaneous and sequential hemorrhage of multiple cerebral cavernous malformations: a case report.

    Louis, Nundia; Marsh, Robert

    2016-02-09

    The etiology of cerebral cavernous malformation hemorrhage is not well understood. Causative physiologic parameters preceding hemorrhagic cavernous malformation events are often not reported. We present a case of an individual with sequential simultaneous hemorrhages in multiple cerebral cavernous malformations with a new onset diagnosis of hypertension. A 42-year-old white man was admitted to our facility with worsening headache, left facial and tongue numbness, dizziness, diplopia, and elevated blood pressure. His past medical history was significant for new onset diagnosis of hypertension and chronic seasonal allergies. Serial imaging over the ensuing 8 days revealed sequential hemorrhagic lesions. He underwent suboccipital craniotomy for resection of the lesions located in the fourth ventricle and right cerebellum. One month after surgery, he had near complete resolution of his symptoms with mild residual vertigo but symptomatic chronic hypertension. Many studies have focused on genetic and inflammatory mechanisms contributing to cerebral cavernous malformation rupture, but few have reported on the potential of hemodynamic changes contributing to cerebral cavernous malformation rupture. Systemic blood pressure changes clearly have an effect on angioma pressures. When considering the histopathological features of cerebral cavernous malformation architecture, changes in arterial pressure could cause meaningful alterations in hemorrhage propensity and patterns.

  9. The Fashion Retail and the value creation with sustainable products: a multiple case study

    Eleonora Alves Baptista

    2016-06-01

    Full Text Available This study aims to understand how the development of sustainable products in Brazilian fashion retail businesses creates value for the companies themselves, society and the environment. A qualitative approach to multiple case study method investigates practices and processes at four companies from Rio de Janeiro State. The study collected primary information from direct observation and interviews with the firms’ directors, and secondary data from industry reports and other documents. Three overall dimensions of the study - environmental management, value creation and product development in fast fashion companies - encoded into seven categories, when considered in data crosssynthesis, elucidate the following conclusions: (1 the firms do not have economic, ethical and legal fields integrated view; (2 the companies do not believe that the fashion consumer market values environmental practices and thus not motivated to invest in practices and products; (3 a fragmented supply chain makes it difficult to control activities and appears as a major constraint to the development of sustainable products; (4 access to information on best environmental practices and tax incentives are important inductors’ mechanisms to leverage the development of sustainable products in the Brazilian fashion retail; (5 the development of strategic capabilities in pollution prevention area, management products and clean technology create value for the production chain.

  10. System-wide lean implementation in health care: A multiple case study.

    Centauri, Federica; Mazzocato, Pamela; Villa, Stefano; Marsilio, Marta

    2018-05-01

    Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

  11. Maternal and perinatal outcomes in pregnancies with multiple sclerosis: a case-control study.

    Yalcin, Serenat Eris; Yalcin, Yakup; Yavuz, And; Akkurt, Mehmet Ozgur; Sezik, Mekin

    2017-05-24

    To assess whether maternal multiple sclerosis (MS) is associated with adverse pregnancy outcomes by determining the clinical course of disease during pregnancy and postpartum throughout a 10-year-period in a single tertiary center. We conducted a case-control study that included pregnancies with a definitive diagnosis of MS (n=43), matched with 100 healthy pregnant women with similar characteristics. Maternal and perinatal data were retrieved from hospital files. Groups were compared with the Mann-Whitney and χ2 tests. Logistic regression models were constructed to determine independent effects. Maternal demographic and baseline laboratory data were similar across the groups. Rates of preterm delivery, fetal growth restriction, preeclampsia, gestational diabetes, stillbirth, cesarean delivery, congenital malformation, and 5-min Apgar score were comparable (P>0.05 for all). General anesthesia during cesarean delivery (96% vs. 39%, P=0.002), urinary tract infection (UTI) (12% vs. 3%, P=0.04), low 1-min Apgar score (21% vs. 9%, P=0.04), and nonbreastfeeding (33% vs. 2%, P=0.001) were more frequent in women with MS. The low 1-min Apgar score and breastfeeding rates were independent of general anesthesia and UTI in regression models. MS during pregnancy was not associated with adverse maternal and perinatal outcomes except UTI, low 1-min Apgar scores, and decreased breastfeeding rates.

  12. 320-row detector computed tomography angiography findings of a case with multiple

    Akay, S.; Bozlar, U.; Demirkol, S.; Tasar, M.

    2012-01-01

    Full text: Introduction: Computed tomography angiography (CTA) with three-dimensional imaging capability is a very reliable imaging modality for the evaluation of the coronary arteries. Objectives and tasks: To discuss the 320-row detector CTA findings of a case with multiple coronary artery course anomaly. Materials and methods: A 46-year-old man with palpitation, admitted to Cardiology department of our hospital. On electrocardiography, polymorphic ventricular early beats were observed. The patient was referred to Radiology department for CTA examination in terms of probable coronary artery anomaly. Results: On CTA, left main coronary artery was short. The bridging causes nearly 75% luminal stenosis was observed in the middle part of left descending artery. Circumflex artery was continuing as the first obtuse margin and this branch was separating to four branches in the middle part. They were coursing subepicardially in the middle and distal part. Right main coronary artery has also subepicardial course in its middle and distal part. Conclusion: Myocardial bridging is not a rare situation in routine clinical practice. But bridging in all of the three coronary arteries is very uncommon. Multidetector CTA is an effective and non-invasive imaging modality for understanding the normal anatomy and detecting the congenital anomalies of the coronary arteries

  13. Motivating factors in hospital environmental management programs: a multiple case study in four private Brazilian hospitals

    Jan Krüger

    Full Text Available Abstract Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private. The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research.

  14. Airport Managers' Perspectives on Security and Safety Management Systems in Aviation Operations: A Multiple Case Study

    Brown, Willie L., Jr.

    Global terrorism continues to persist despite the great efforts of various countries to protect and safely secure their citizens. As airports form the entry and exit ports of a country, they are one of the most vulnerable locations to terror attacks. Managers of international airports constantly face similar challenges in developing and implementing airport security protocols. Consequently, the technological advances of today have brought both positive and negative impacts on security and terrorism of airports, which are mostly managed by the airport managers. The roles of the managers have greatly increased over the years due to technological advances. The developments in technology have had different roles in security, both in countering terrorism and, at the same time, increasing the communication methods of the terrorists. The purpose of this qualitative multiple case study was to investigate the perspectives of airport managers with regard to societal security and social interactions in the socio-technical systems of the National Terrorism Advisory System (NTAS). Through the data gained regarding managers' perception and experiences, the researcher hoped to enable the development of security measures and policies that are appropriate for airports as socio-technical systems. The researcher conducted interviews with airport managers to gather relevant data to fulfill the rationale of the study. Ten to twelve airport managers based in three commercial aviation airports in Maryland, United States participated in the study. The researcher used a qualitative thematic analysis procedure to analyze the data responses of participants in the interview sessions.

  15. Developing and sustaining adolescent-friendly health services: A multiple case study from Ecuador and Peru.

    Goicolea, Isabel; Coe, Anna-Britt; San Sebastián, Miguel; Hurtig, Anna-Karin

    2017-08-01

    Adolescent-Friendly Health Services (AFHSs) are those that are accessible, acceptable, equitable, appropriate and effective for different youth sub-populations. This study investigated the process through which four clinics in two countries - Peru and Ecuador - introduced, developed and sustained AFHSs. A multiple case study design was chosen, and data from each clinic were collected through document review, observations and informant interviews. National level data were also collected. Data were analysed following thematic analysis. The findings showed that the process of introducing, developing and sustaining AFHSs was long term, and required a creative team effort and collaboration between donors, public institutions and health providers. The motivation and external support was crucial to initiating and sustaining the implementation of AFHSs. Health facilities' transformation into AFHSs was linked to the broader organisation of country health systems, and the evolution of national adolescent health policies. In Peru, the centralised approach to AFHSs introduction facilitated the dissemination of a comprehensive national model to health facilities, but dependency on national directives made it more difficult to systemise them when ideological and organisational changes occurred. In Ecuador, a less centralised approach to introducing AFHSs made for easier integration of the AFHSs model.

  16. Critical operations capabilities in a high cost environment: a multiple case study

    Sansone, C.; Hilletofth, P.; Eriksson, D.

    2018-04-01

    Operations capabilities have been a popular research area for many years and several frameworks have been proposed in the literature. The current frameworks do not take specific contexts into consideration, for instance a high cost environment. This research gap is of particular interest since a manufacturing relocation process has been ongoing the last decades, leading to a huge amount of manufacturing being moved from high to low cost environments. The purpose of this study is to identify critical operations capabilities in a high cost environment. The two research questions were: What are the critical operations capabilities dimensions in a high cost environment? What are the critical operations capabilities in a high cost environment? A multiple case study was conducted and three Swedish manufacturing firms were selected. The study was based on the investigation of an existing framework of operations capabilities. The main dimensions of operations capabilities included in the framework were: cost, quality, delivery, flexibility, service, innovation and environment. Each of the dimensions included two or more operations capabilities. The findings confirmed the validity of the framework and its usefulness in a high cost environment and a new operations capability was revealed (employee flexibility).

  17. Case Report: GcMAF Treatment in a Patient with Multiple Sclerosis.

    Inui, Toshio; Katsuura, Goro; Kubo, Kentaro; Kuchiike, Daisuke; Chenery, Leslye; Uto, Yoshihiro; Nishikata, Takahito; Mette, Martin

    2016-07-01

    Gc protein-derived macrophage-activating factor (GcMAF) has various functions as an immune modulator, such as macrophage activation, anti-angiogenic activity and anti-tumor activity. Clinical trials of second-generation GcMAF demonstrated remarkable clinical effects in several types of cancers. Thus, GcMAF-based immunotherapy has a wide application for use in the treatment of many diseases via macrophage activation that can be used as a supportive therapy. Multiple sclerosis (MS) is considered to be an autoimmune disorder that affects the myelinated axons in the central nervous system (CNS). This study was undertaken to examine the effects of second-generation GcMAF in a patient with MS. This case study demonstrated that treatments of GcMAF in a patient with MS have potent therapeutic actions with early beneficial responses, especially improvement of motor dysfunction. GcMAF shows therapeutic potency in the treatment of MS. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  18. A splenic artery aneurysm presenting with multiple episodes of upper gastrointestinal bleeding: a case report.

    De Silva, W S L; Gamlaksha, D S; Jayasekara, D P; Rajamanthri, S D

    2017-05-03

    Splenic artery aneurysm is rare and its diagnosis is challenging due to the nonspecific nature of the clinical presentation. We report a case of a splenic artery aneurysm in which the patient presented with chronic dyspepsia and multiple episodes of minor intragastric bleeding. A 60-year-old, previously healthy Sri Lankan man presented with four episodes of hematemesis and severe dyspeptic symptoms over a period of 6 months. The results of two initial upper gastrointestinal endoscopies and an abdominal ultrasound scan were unremarkable. A third upper gastrointestinal endoscopy detected a pulsatile bulge at the posterior wall of the gastric antrum. A contrast-enhanced computed tomogram of his abdomen detected a splenic artery aneurysm measuring 3 × 3 × 2.5 cm. While awaiting routine surgery, he developed a torrential upper gastrointestinal bleeding and shock, leading to emergency laparotomy. Splenectomy and en bloc resection of the aneurysm with the posterior stomach wall were performed. Histology revealed evidence for a true aneurysm without overt, acute, or chronic inflammation of the surrounding gastric mucosa. He became completely asymptomatic 2 weeks after the surgery. Splenic artery aneurysms can result in recurrent upper gastrointestinal bleeding. The possibility of impending catastrophic bleeding should be remembered when managing patients with splenic artery aneurysms after a minor bleeding. Negative endoscopy and ultrasonography should require contrast-enhanced computed tomography to look for the cause of recurrent upper gastrointestinal bleeding.

  19. Methodology for Selecting Best Management Practices Integrating Multiple Stakeholders and Criteria. Part 2: Case Study

    Mauricio Carvallo Aceves

    2016-02-01

    Full Text Available The selection of stormwater Best Management Practices (BMPs for mitigating the effects of urbanization on the hydrological cycle could be a complex process due to conflicting stakeholder views, and varying levels of performance of BMPs across a range of criteria (runoff reduction, erosion control, etc.. Part 1 of this article proposed a methodology based on the application of multi-criteria decision aid (MCDA methods, which was tested here on a residential stormwater network in the Montreal area. The case study considered green roofs, rain gardens, rain barrels and pervious pavement over a range of economic, social, and water quality and quantity criteria by applying 4 MCDA methods under three different stakeholder views. The results indicated Elimination et Choix Traduisant la Réalité (ELECTRE III to be the most appropriate method for the methodology, presenting flexibility concerning threshold values, criteria weights, and showing shared top choices across stakeholders (rain gardens, and rain gardens in combination with pervious pavement. The methodology shows potential for more formal applications and research opportunities. Future work may lie in the inclusion of multiple objective optimization, better stakeholder engagement, estimation of economic benefits, water quality modeling, long-term hydrological simulations, and estimating real BMP pollutant removal rates.

  20. Aerodynamic and aeroelastic characteristics of typical bridge decks equipped with wind barriers at the windward bridge-deck edge

    Buljac, Andrija; Kozmar, H.; Pospíšil, Stanislav; Macháček, Michael

    2017-01-01

    Roč. 137, April (2017), s. 310-322 ISSN 0141-0296 R&D Projects: GA ČR(CZ) GA15-01035S; GA MŠk(CZ) LO1219 Keywords : bridge decks * roadway wind barrier * aerodynamic forces and moments * galloping * flutter * wind-tunnel experiments Subject RIV: JM - Building Engineering OBOR OECD: Construction engineering , Municipal and structural engineering Impact factor: 2.258, year: 2016 http://www.sciencedirect.com/science/ article /pii/S014102961730278X

  1. Food and dietary patterns and multiple sclerosis: a case-control study in Belgrade (Serbia

    Tatjana D. Pekmezovic

    2009-03-01

    Full Text Available

    Background: The aetiology of multiple sclerosis (MS is unclear, but numerous studies suggest that different exogenous factors can lead to the development of the disease in genetically susceptible individuals. The objective of this case-control study was to determine the role of food and dietary patterns in patients with MS in the population of Belgrade (Serbia.

    Methods: In this matched case-control study, we included 110 cases with definite MS according to McDonald’s criteria, in whom the onset symptoms occurred up to 2 years prior to the interview, who were followed-up at the Institute of Neurology, Clinical Centre of Serbia, Belgrade. The identical number of controls from the same institution, individually matched by sex, age and area of residence, was recruited from patients with various non-autoimmune neurological disorders. Dietary information was obtained by using a frequency history approach.

    Results: According to univariate conditional logistic regression analysis the following factors were significantly related to MS: body mass index (BMI less than 25 (OR=2.2, p=0.009, frequent consumption of beef (OR=1.7, p=0.043, chicken (OR=2.0, p=0.045, meat of the lamb (OR=2.1, p=0.013, butter (OR=1.7, p=0.056 and ice-cream (OR=1.8, p=0.031, with dose-response relationship. Consumption of majority of various fruit was more frequently reported by controls. According to multivariate conditional logistic regression analysis, BMI less than 25 (OR=2.3, p=0.008, consumption (weekly of beef (OR=2.0, p=0.017 and butter (OR=1.9, p=0.027 was significantly related to MS, while regular consumption of cherry (OR=0.4, p=0.024 had protective role.

    Conclusions: This study might assist in potential defining of the dietary factors that could contribute to the risk of developing MS.

  2. Recommendations for Longitudinal Post-Tensioning in Full-Depth Precast Concrete Bridge Deck Panels

    Bowers, Susan Elizabeth

    2007-01-01

    Full-depth precast concrete panels offer an efficient alternative to traditional cast-in-place concrete for replacement or new construction of bridge decks. Research has shown that longitudinal post-tensioning helps keep the precast bridge deck in compression and avoid problems such as leaking, cracking, spalling, and subsequent rusting on the beams at the transverse panel joints. Current design recommendations suggest levels of initial compression for precast concrete decks in a very limit...

  3. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence.

    Dara, Ravi C; Tiwari, Aseem K; Pandey, Prashant; Arora, Dinesh

    2015-01-01

    Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  4. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence

    Ravi C Dara

    2015-01-01

    Full Text Available Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  5. Investigation of Flow Behavior around Corotating Blades in a Double-Spindle Lawn Mower Deck

    Chon W.; Amano R. S.

    2005-01-01

    When the airflow patterns inside a lawn mower deck are understood, the deck can be redesigned to be efficient and have an increased cutting ability. To learn more, a combination of computational and experimental studies was performed to investigate the effects of blade and housing designs on a flow pattern inside a 1.1m wide corotating double-spindle lawn mower deck with side discharge. For the experimental portion of the study, air velocities inside the deck were measured using a laser Do...

  6. Vertical impedance measurements on concrete bridge decks for assessing susceptibility of reinforcing steel to corrosion

    Bartholomew, Paul D.; Guthrie, W. Spencer; Mazzeo, Brian A.

    2012-08-01

    Corrosion is a pressing problem for aging concrete infrastructure, especially bridge decks. Because of its sensitivity to factors that affect corrosion of reinforcing steel in concrete, resistivity is an important structural health indicator for reinforced concrete structures. In this research, an instrument was developed to measure vertical impedance on concrete bridge decks. Measurements of vertical impedance on slabs prepared in the laboratory, on slabs removed from decommissioned bridge decks, and on an in-service bridge deck in the field demonstrate the utility of the new apparatus.

  7. Preparation of Input Deck to analyze the Nuclear Power Plant for the Use of Regulatory Verification

    Kang, Doo Hyuk; Kim, Hyung Seok; Suh, Jae Seung; Ahn, Seung Hoon

    2009-01-01

    The objectives of this paper are to make out the input deck that analyzes a nuclear power plant for the use of regulatory verification and to produce its calculation note. We have been maintained the input deck of T/H safety codes used in existing domestic reactors to ensure independent and accurate regulatory verification for the thermal-hydraulic safety analysis in domestic NPPs. This paper is mainly divided into two steps: first step is to compare existing input deck to the calculation note in order to verify the consistency. Next step is to model 3-dimensional reactor pressure vessel using MULTID component instead of the 1D existing input deck

  8. Ultrasonographic evaluation of cerebral arterial and venous haemodynamics in multiple sclerosis: a case-control study.

    Pasquale Marchione

    Full Text Available OBJECTIVE: Although recent studies excluded an association between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (MS, controversial results account for some cerebrovascular haemodynamic impairment suggesting a dysfunction of cerebral autoregulation mechanisms. The aim of this cross-sectional, case-control study is to evaluate cerebral arterial inflow and venous outflow by means of a non-invasive ultrasound procedure in Relapsing Remitting (RR, Primary Progressive (PP Multiple Sclerosis and age and sex-matched controls subjects. MATERIAL AND METHODS: All subjects underwent a complete extra-intracranial arterial and venous ultrasound assessment with a color-coded duplex sonography scanner and a transcranial doppler equipment, in both supine and sitting position by means of a tilting chair. Basal arterial and venous morphology and flow velocities, postural changes in mean flow velocities (MFV of middle cerebral arteries (MCA, differences between cerebral venous outflow (CVF in clinostatism and in the seated position (ΔCVF and non-invasive cerebral perfusion pressure (CPP were evaluated. RESULTS: 85 RR-MS, 83 PP-MS and 82 healthy controls were included. ΔCVF was negative in 45/85 (52.9% RR-MS, 63/83 (75.9% PP-MS (p = 0.01 and 11/82 (13.4% controls (p<0.001, while MFVs on both MCAs in sitting position were significantly reduced in RR-MS and PP-MS patients than in control, particularly in EDSS ≥ 5 subgroup (respectively, 42/50, 84% vs. 66/131, 50.3%, p<0.01 and 48.3 ± 2 cm/s vs. 54.6 ± 3 cm/s, p = 0.01. No significant differences in CPP were observed within and between groups. CONCLUSIONS: The quantitative evaluation of cerebral blood flow (CBF and CVF and their postural dependency may be related to a dysfunction of autonomic nervous system that seems to characterize more disabled MS patients. It's not clear whether the altered postural control of arterial inflow and venous outflow is a specific MS condition or simply an

  9. Numerical Simulation of Early Age Cracking of Reinforced Concrete Bridge Decks with a Full-3D Multiscale and Multi-Chemo-Physical Integrated Analysis

    Tetsuya Ishida

    2018-03-01

    Full Text Available In November 2011, the Japanese government resolved to build “Revival Roads” in the Tohoku region to accelerate the recovery from the Great East Japan Earthquake of March 2011. Because the Tohoku region experiences such cold and snowy weather in winter, complex degradation from a combination of frost damage, chloride attack from de-icing agents, alkali–silica reaction, cracking and fatigue is anticipated. Thus, to enhance the durability performance of road structures, particularly reinforced concrete (RC bridge decks, multiple countermeasures are proposed: a low water-to-cement ratio in the mix, mineral admixtures such as ground granulated blast furnace slag and/or fly ash to mitigate the risks of chloride attack and alkali–silica reaction, anticorrosion rebar and 6% entrained air for frost damage. It should be noted here that such high durability specifications may conversely increase the risk of early age cracking caused by temperature and shrinkage due to the large amounts of cement and the use of mineral admixtures. Against this background, this paper presents a numerical simulation of early age deformation and cracking of RC bridge decks with full 3D multiscale and multi-chemo-physical integrated analysis. First, a multiscale constitutive model of solidifying cementitious materials is briefly introduced based on systematic knowledge coupling microscopic thermodynamic phenomena and microscopic structural mechanics. With the aim to assess the early age thermal and shrinkage-induced cracks on real bridge deck, the study began with extensive model validations by applying the multiscale and multi-physical integrated analysis system to small specimens and mock-up RC bridge deck specimens. Then, through the application of the current computational system, factors that affect the generation and propagation of early age thermal and shrinkage-induced cracks are identified via experimental validation and full-scale numerical simulation on real

  10. Mantle cell lymphoma of the gastrointestinal tract presenting with multiple intussusceptions – case report and review of literature

    Abo Stephen M

    2009-07-01

    Full Text Available Abstract Background Mantle cell lymphoma (MCL is an aggressive type of B-cell non-Hodgkin's lymphoma that originates from small to medium sized lymphocytes located in the mantle zone of the lymph node. Extra nodal involvement is present in the majority of cases, with a peculiar tendency to invade the gastro-intestinal tract in the form of multiple lymphomatous polyposis. MCL can be accurately diagnosed with the use of the highly specific marker Cyclin D1. Few cases of mantle cell lymphoma presenting with intussuception have been reported. Here we present a rare case of multiple intussusceptions caused by mantle cell lymphoma and review the literature of this disease. Case presentation A 68-year-old male presented with pain, tenderness in the right lower abdomen, associated with nausea and non-bilious vomiting. CT scan of abdomen revealed ileo-colic intussusception. Laparoscopy confirmed multiple intussusceptions involving ileo-colic and ileo-ileal segments of gastrointestinal tract. A laparoscopically assisted right hemicolectomy and extended ileal resection was performed. Postoperative recovery was uneventful. The histology and immuno-histochemistry of the excised small and large bowel revealed mantle cell lymphoma with multiple lymphomatous polyposis and positivity to Cyclin D1 marker. The patient was successfully treated with Rituximab-CHOP chemotherapy and remains in complete remission at one-year follow-up. Conclusion This is a rare case of intestinal lymphomatous polyposis due to mantle cell lymphoma presenting with multiple small bowel intussusceptions. Our case highlights laparoscopic-assisted bowel resection as a potential and feasible option in the multi-disciplinary treatment of mantle cell lymphoma.

  11. Non-syndromic multiple odontogenic keratocysts associated with dental anomalies: A report of unusual case and its management

    Sulabha A Narsapur

    2015-01-01

    Full Text Available Odontogenic keratocyst (OKC, now known as keratocystic odontogenic tumor (KCOT, is the most common cystic lesion occurring in the maxillofacial region. Multiple occurrence of these cysts is less frequent and is usually associated with syndromes, the most common being the Gorlin Goltz syndrome or the nevoid basal cell carcinoma syndrome (NBCCS. We hereby report an unusual case of multiple OKCs in a healthy adult, associated with other dental anomalies. Management approach consisted of enucleation with curettage of the smaller lesions and decortication of buccal cortex in the large lesion. The condition in the present case may be because of the multifocal nature of OKC rather than its association with any syndrome. Concomitant occurrence of multiple OKCs with other dental anomalies may be coincidental. Impacted teeth or missing teeth must be radiographed to rule out the lesions associated with them.

  12. Familial atypical multiple mole melanoma syndrome in an adult Indian male-case report and literature review

    Radhika C G Raj

    2015-01-01

    Full Text Available Familial atypical multiple mole melanoma syndrome (FAMMMS is an autosomal dominant genodermatosis characterized by multiple melanocytic nevi, usually more than 50, and a family history of melanoma. It is known to be associated with carcinoma of pancreas and other malignancies involving gastrointestinal tract, breast, lung, larynx, and skin in the kindred. There is no published report of FAMMMS in dark-skinned individuals. We report a case of FAMMMS in a dark-skinned adult Indian male, who had multiple extensive nevi all over the body and oral mucosa; associated with malignant melanoma, squamous cell carcinoma (Marjolin′s ulcer, and carcinoma of pancreas. His father had died of carcinoma of lung and his sister had a partial phenotypic expression. The clinical presentation of the case is discussed with review of literature.

  13. A Qualitative Exploration of Multiple Case Studies of the Perception of School Social Workers Concerning Their Roles in Public Schools

    Morrison, Alesha Nicole

    2016-01-01

    This qualitative exploration in the form of multiple case studies interviewed a group of seven social workers from the St. Louis Metropolitan area to gain their perception as school social workers concerning their roles in public schools. The literature on school social workers indicated that school social workers brought unique knowledge and…

  14. Toward a Multiple Perspective in Family Theory and Practice: The Case of Social Exchange Theory, Symbolic Interactionism, and Conflict Theory.

    Rank, Mark R.; LeCroy, Craig W.

    1983-01-01

    Examines the complementarity of three often-used theories in family research: social exchange theory, symbolic interactionism, and conflict theory. Provides a case example in which a multiple perspective is applied to a problem of marital discord. Discusses implications for the clinician. (Author/WAS)

  15. Fatal case of Herbaspirillum seropedicae bacteremia secondary to pneumonia in an end-stage renal disease patient with multiple myeloma.

    Suwantarat, Nuntra; Adams, La'Tonzia L; Romagnoli, Mark; Carroll, Karen C

    2015-08-01

    Herbaspirillum spp. are rare causes of human infections associated primarily with bacteremia in cancer patients. We report the first fatal case of bacteremia secondary to pneumonia caused by Herbaspirillum seropedicae in a 65-year-old man with end-stage renal disease and multiple myeloma. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Addressing Gender-Based Violence at Schools for Learners with Intellectual Disability in Gauteng, South Africa: A Multiple Case Study

    Phasha, T. N.; Nyokangi, D.

    2012-01-01

    This paper reports part of the findings of the study which investigated sexual violence at two schools catering specifically for learners with mild intellectual disability in Gauteng Province. It looks particularly on participants' suggestions for addressing sexual violence in such school. A multiple case study within the qualitative research…

  17. Togetherness of the Multiple Diverticulosis of the First Part of the Duodenum with Neurofibromatosis Type I: A Case Report

    Ozgur Turk

    2014-04-01

    Full Text Available Duedonal diverticulosis is common in clinical practice. Most of duedonal diverticulosis is located at the second part of duodenum; incidence is reported as 67%, incidence of third and forth part is %20. Multiple diverticulosis of the first part of the duodenum is a rare case. There is not any knowledge togetherness of neurofibromatosis type 1 and duedonal diverticulosis. Here we reported incidentally diagnosed multiple diverticulosis of duodenum that is located in the first part in a neurofibromatosis type 1 patient with multiple neurofibromatosis nodules. Neurofibromatosis could affect various organs. Along the digestive system carcinoid tumors and neuroendocrine tumors are more encountered diseases. Endoscopic examinations and abdominal imaging may be useful for the diagnosis of gastrointestinal coexisting disease in neurofibromatosis type 1 . In conclusion neurofibromatosis type 1 could affect multiple systems and it should evaluate carefully.

  18. Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report.

    Pallangyo, Pedro; Lyimo, Frederick; Bhalia, Smita; Makungu, Hilda; Nyangasa, Bashir; Lwakatare, Flora; Suranyi, Pal; Janabi, Mohamed

    2017-07-19

    Pulmonary artery aneurysms constitute 50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial. A 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S 2 ) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization. The presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality.

  19. The integration of occupational therapy into primary care: a multiple case study design

    2013-01-01

    Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group

  20. PSEUDOTUMORAL FORM OF MULTIPLE SCLEROSIS WITH SYMPTOMATIC CONVULSIVE SEIZURES (A CLINICAL CASE

    Yu. A. Belova

    2015-01-01

    Full Text Available Multiple sclerosis (MS is prominent among central nervous system diseases. It affects chiefly young people and almost inevitably results in disability. In the past decade, there has been an upward trend for the prevalence of MS worldwide; in particular, the higher prevalence of this disease has been registered in the Moscow Region, which is associated with both an objective increase in its morbidity and improvement of specialized care to the population in the region. MS is characterized by a variety of clinical manifestations. However, paroxysmal disturbances are referred to as the rare symptoms of MS: the incidence of epileptic seizures in this condition is 0.89 to 7.5% according to the literature data. In addition to the clinical form of MS, there are its rare malignant atypical forms that also include its pseudotumoral form characterized by intrinsic neuroimaging and clinical signs that are different from the classical form of MS and another abnormality of the central nervous system. The pseudotumoral form of MS is characterized by the development of acute focal demyelination that appears as a large focus of an increased magnetic resonance signal with perifocal edema as evidenced by magnetic resonance imaging. A pseudotumoral focus of demyelination can occur both at the onset of MS and during its recurrent course. The atypical onset of MS is a special challenge because of diagnostic problems, which may lead to erroneous therapeutic policy and have a negative impact on the late prognosis of the disease. The authors provide a clinical case of the pseudotumoral form of MS with convulsive seizures at the onset of demyelinating disease. The problems of diagnosis and therapeutic approaches are discussed.

  1. [The life as a caregiver of a person affected by Chorea Huntington: multiple case study].

    Winkler, Evi; Ausserhofer, Dietmar; Mantovan, Franco

    2012-10-01

    Chorea Huntington is an autosomal dominantly inherited, neurodegenerative brain disorder that leads to involuntary hyperkinesia, psychotic symptoms and dementia. The illness not only changes the life of the person itself but also the world of the caregivers. The challenges in the care of a person which is affected by Chorea Huntington have an effect on the daily living as an assemblage of natural and social conditions. a multiple case study was conducted. It included semi-structured interviews with three caregivers of people with Chorea Huntington in South Tyrol. The qualitative data was analyzed using the qualitative structured analysis of Mayring (2007). The objective of this study was to describe the phenomenon of change of life from family members that care people affected by Chorea Huntington in a specific cultural setting (South Tyrol, Italy). The caregivers reported that the diagnosis of Chorea Huntington leads to negative changes in "relationship and family". Particularly, frustration, aggression, impatience and apathy were perceived as stressful. At the same time they highlight the positive changes through home care. They report that the relationship became more intimate and integral and it was characterized by more cohesion. Family caregivers get valuable support from the home care service, however, they complain that there is no facility in South Tyrol, which is specialized to care people with Chorea Huntington. Therefore, the caregivers have to "give up a lot" and don't have any personal desires, dreams and expectations for the future. The caregivers have learned independently to deal with their changed life step by step, and to see also the positive effects of the caring role. The life of family caregivers of a person which is affected by Chorea Huntington is characterized by abandonment. A continuous and professional care would be important for the affected and his caregiver. A continuous and professional care is important for both, addressing the

  2. Distant Migration of Multiple Siliconomas in Lower Extremities following Breast Implant Rupture: Case Report.

    Oh, Joo Hyun; Song, Seung Yong; Lew, Dae Hyun; Lee, Dong Won

    2016-10-01

    Siliconoma from ruptured breast implants has been reported in multiple body sites, including but not limited to the breast parenchyma, axillary lymph nodes, upper arm, and even lower leg. In this regard, we report a rare case of distant silicone migration to the lower extremities after traumatic breast implant rupture. A 55-year-old Asian woman who received bilateral augmentation mammoplasty 20 years ago presented with ruptured breast implants from a car accident 2 years earlier. Magnetic resonance imaging confirmed intracapsular and extracapsular rupture of the right breast implant, showing "linguine sign." We removed the bilateral breast implants and performed capsulectomy and bilateral reduction mammoplasty using inverted-T incisions. The implant was confirmed as a smooth, silicone gel-filled mammary implant of 125 cm 3 by a Japanese manufacturer, Koken. During her regular follow-up outpatient visits, physical examination revealed 2.5- × 1.5-cm ill-defined, tender, subcutaneous nodules on both knees and 8.5- × 3.0-cm inflammatory changes in the inguinal area with persistent pain. Computed tomography showed no definite mass, but rather infiltrative, nonenhancing soft-tissue densities in the subcutaneous layers of the bilateral inguinal and knee areas. Surgical excision was performed, and pathologic findings confirmed variable vacuoles with foreign body reaction and fibrosis, consistent with siliconoma. It is important to acknowledge that siliconomas can be encountered in patients with ruptured breast implants, especially those manufactured decades ago. Our patient with masses as remote as the inguinal and knee areas is a prime example of how far siliconomas can migrate.

  3. Exploring the use of storytelling in quantitative research fields using a multiple case study method

    Matthews, Lori N. Hamlet

    The purpose of this study was to explore the emerging use of storytelling in quantitative research fields. The focus was not on examining storytelling in research, but rather how stories are used in various ways within the social context of quantitative research environments. In-depth interviews were conducted with seven professionals who had experience using storytelling in their work and my personal experience with the subject matter was also used as a source of data according to the notion of researcher-as-instrument. This study is qualitative in nature and is guided by two supporting theoretical frameworks, the sociological perspective and narrative inquiry. A multiple case study methodology was used to gain insight about why participants decided to use stories or storytelling in a quantitative research environment that may not be traditionally open to such methods. This study also attempted to identify how storytelling can strengthen or supplement existing research, as well as what value stories can provide to the practice of research in general. Five thematic findings emerged from the data and were grouped under two headings, "Experiencing Research" and "Story Work." The themes were found to be consistent with four main theoretical functions of storytelling identified in existing scholarly literature: (a) sense-making; (b) meaning-making; (c) culture; and (d) communal function. The five thematic themes that emerged from this study and were consistent with the existing literature include: (a) social context; (b) quantitative versus qualitative; (c) we think and learn in terms of stories; (d) stories tie experiences together; and (e) making sense and meaning. Recommendations are offered in the form of implications for various social contexts and topics for further research are presented as well.

  4. Flight Deck Weather Avoidance Decision Support: Implementation and Evaluation

    Wu, Shu-Chieh; Luna, Rocio; Johnson, Walter W.

    2013-01-01

    Weather related disruptions account for seventy percent of the delays in the National Airspace System (NAS). A key component in the weather plan of the Next Generation of Air Transportation System (NextGen) is to assimilate observed weather information and probabilistic forecasts into the decision process of flight crews and air traffic controllers. In this research we explore supporting flight crew weather decision making through the development of a flight deck predicted weather display system that utilizes weather predictions generated by ground-based radar. This system integrates and presents this weather information, together with in-flight trajectory modification tools, within a cockpit display of traffic information (CDTI) prototype. that the CDTI features 2D and perspective 3D visualization models of weather. The weather forecast products that we implemented were the Corridor Integrated Weather System (CIWS) and the Convective Weather Avoidance Model (CWAM), both developed by MIT Lincoln Lab. We evaluated the use of CIWS and CWAM for flight deck weather avoidance in two part-task experiments. Experiment 1 compared pilots' en route weather avoidance performance in four weather information conditions that differed in the type and amount of predicted forecast (CIWS current weather only, CIWS current and historical weather, CIWS current and forecast weather, CIWS current and forecast weather and CWAM predictions). Experiment 2 compared the use of perspective 3D and 21/2D presentations of weather for flight deck weather avoidance. Results showed that pilots could take advantage of longer range predicted weather forecasts in performing en route weather avoidance but more research will be needed to determine what combinations of information are optimal and how best to present them.

  5. The multiple imputation method: a case study involving secondary data analysis.

    Walani, Salimah R; Cleland, Charles M

    2015-05-01

    To illustrate with the example of a secondary data analysis study the use of the multiple imputation method to replace missing data. Most large public datasets have missing data, which need to be handled by researchers conducting secondary data analysis studies. Multiple imputation is a technique widely used to replace missing values while preserving the sample size and sampling variability of the data. The 2004 National Sample Survey of Registered Nurses. The authors created a model to impute missing values using the chained equation method. They used imputation diagnostics procedures and conducted regression analysis of imputed data to determine the differences between the log hourly wages of internationally educated and US-educated registered nurses. The authors used multiple imputation procedures to replace missing values in a large dataset with 29,059 observations. Five multiple imputed datasets were created. Imputation diagnostics using time series and density plots showed that imputation was successful. The authors also present an example of the use of multiple imputed datasets to conduct regression analysis to answer a substantive research question. Multiple imputation is a powerful technique for imputing missing values in large datasets while preserving the sample size and variance of the data. Even though the chained equation method involves complex statistical computations, recent innovations in software and computation have made it possible for researchers to conduct this technique on large datasets. The authors recommend nurse researchers use multiple imputation methods for handling missing data to improve the statistical power and external validity of their studies.

  6. A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study.

    Van Durme, Thérèse; Schmitz, Olivier; Cès, Sophie; Anthierens, Sibyl; Maggi, Patrick; Delye, Sam; De Almeida Mello, Johanna; Declercq, Anja; Macq, Jean; Remmen, Roy; Aujoulat, Isabelle

    2015-06-18

    Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.

  7. Images from Galileo of the Venus cloud deck

    Belton, M.J.S.; Gierasch, P.J.; Smith, M.D.; Helfenstein, P.; Schinder, P.J.; Pollack, James B.; Rages, K.A.; Ingersoll, A.P.; Klaasen, K.P.; Veverka, J.; Anger, C.D.; Carr, M.H.; Chapman, C.R.; Davies, M.E.; Fanale, F.P.; Greeley, R.; Greenberg, R.; Head, J. W.; Morrison, D.; Neukum, G.; Pilcher, C.B.

    1991-01-01

    Images of Venus taken at 418 (violet) and 986 [near-infrared (NIR)] nanometers show that the morphology and motions of large-scale features change with depth in the cloud deck. Poleward meridional velocities, seen in both spectral regions, are much reduced in the NIR. In the south polar region the markings in the two wavelength bands are strongly anticorrelated. The images follow the changing state of the upper cloud layer downwind of the subsolar point, and the zonal flow field shows a longitudinal periodicity that may be coupled to the formation of large-scale planetary waves. No optical lightning was detected.

  8. Super-light concrete decks for building floor slabs

    Hertz, Kristian Dahl; Castberg, Niels Andreas; Christensen, Jacob

    2014-01-01

    to flexibility, sound insulation and fire resistance compared with present-day prefabricated structures. Full-scale tests and theoretical investigations show that the deck structure performs as intended. Also, that it is possible to assess by calculation the loadbearing capacity in bending and shear, and assess...... the pull-out strength of prestressing wires, the fire resistance and the acoustic insulation. Based on the results of the investigations, recommendations are given for further development of the structure before fully automated mass production is established....

  9. Advanced flight deck/crew station simulator functional requirements

    Wall, R. L.; Tate, J. L.; Moss, M. J.

    1980-01-01

    This report documents a study of flight deck/crew system research facility requirements for investigating issues involved with developing systems, and procedures for interfacing transport aircraft with air traffic control systems planned for 1985 to 2000. Crew system needs of NASA, the U.S. Air Force, and industry were investigated and reported. A matrix of these is included, as are recommended functional requirements and design criteria for simulation facilities in which to conduct this research. Methods of exploiting the commonality and similarity in facilities are identified, and plans for exploiting this in order to reduce implementation costs and allow efficient transfer of experiments from one facility to another are presented.

  10. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.

    Broggi, G; Ferroli, P; Franzini, A; Servello, D; Dones, I

    2000-01-01

    To examine surgical findings and results of microvascular decompression (MVD) for trigeminal neuralgia (TN), including patients with multiple sclerosis, to bring new insight about the role of microvascular compression in the pathogenesis of the disorder and the role of MVD in its treatment. Between 1990 and 1998, 250 patients affected by trigeminal neuralgia underwent MVD in the Department of Neurosurgery of the "Istituto Nazionale Neurologico C Besta" in Milan. Limiting the review to the period 1991-6, to exclude the "learning period" (the first 50 cases) and patients with less than 1 year follow up, surgical findings and results were critically analysed in 148 consecutive cases, including 10 patients with multiple sclerosis. Vascular compression of the trigeminal nerve was found in all cases. The recurrence rate was 15.3% (follow up 1-7 years, mean 38 months). In five of 10 patients with multiple sclerosis an excellent result was achieved (follow up 12-39 months, mean 24 months). Patients with TN for more than 84 months did significantly worse than those with a shorter history (p<0.05). There was no mortality and most complications occurred in the learning period. Surgical complications were not related to age of the patients. Aetiopathogenesis of trigeminal neuralgia remains a mystery. These findings suggest a common neuromodulatory role of microvascular compression in both patients with or without multiple sclerosis rather than a direct causal role. MVD was found to be a safe and effective procedure to relieve typical TN in patients of all ages. It should be proposed as first choice surgery to all patients affected by TN, even in selected cases with multiple sclerosis, to give them the opportunity of pain relief without sensory deficits.

  11. Left-Sided Congenital Diaphragmatic Hernia with Multiple Congenital Cardiac Anomalies, Hernia Sac, and Microscopic Hepatic Heterotopia: A Case Report

    Maria Arafah

    2011-01-01

    Full Text Available Congenital diaphragmatic hernia is a common congenital anomaly of uncertain etiology. Its association with multiple congenital anomalies in various organs is well recognized and antenatal radiological evidence of congenital diaphragmatic hernia warrants thorough evaluation to detect other anomalies, some of which can be life threatening. Rarely, heterotopic hepatic tissue is identified in the hernia, a rare pathological finding, exhibiting more than one macroscopic and microscopic characteristics, and always associated with cardiac congenital anomalies. Herein, we report a case of left-sided microscopic heterotopic hepatic tissue in a congenital diaphragmatic hernia in an infant with multiple cardiac congenital anomalies, but with preserved pericardium.

  12. Enhancement of Cognitive Processing by Multiple Sclerosis Patients Using Liquid Cooling Technology: A Case Study

    Montgomery, Leslie D.; Ku, Yu-Tsuan E.; Montgomery, Richard W.; Kliss, Mark (Technical Monitor)

    1997-01-01

    Recent neuropsychological studies demonstrate that cognitive dysfunction is a common symptom in patients with multiple sclerosis. In many cases the presence of cognitive impairment affects the patient's daily activities to a greater extent than would be found due to their physical disability alone. Cognitive dysfunction can have a significant impact on the quality of life of both the patient and that of their primary caregiver. Two cognitively impaired male MS patients were given a visual discrimination task before and after a one hour cooling period. The subjects were presented a series of either red or blue circles or triangles. One of these combinations, or one fourth of the stimuli, was designated as the "target" presentation. EEG was recorded from 20 scalp electrodes using a Tracor Northern 7500 EEG/ERP system. Oral and ear temperatures were obtained and recorded manually every five minutes during the one hour cooling period. The EEG ERP signatures from each series of stimuli were analyzed in the energy density domain to determine the locus of neural activity at each EEG sampling time. The first subject's ear temperature did not decrease during the cooling period. It was actually elevated approximately 0.05 C by the end of the cooling period compared to his mean of control period value. In turn, Subject One's discrimination performance and cortical energy remained essentially the same after body cooling. In contrast, Subject Two's ear temperature decreased approx. 0.8 C during his cooling period. Subject Two's ERROR score decreased from 12 during the precooling control period to 2 after cooling. His ENERGY value increased approximately 300%, from a precooling value of approximately 200 to a postcooling value of nearly 600. These findings might be interpreted by the following three-part hypothesis: (1) the general cognitive impairment of MS patients may be a result of low or unfocused metabolic energy conversion in the cortex; (2) such differences show up most

  13. Citation searching: a systematic review case study of multiple risk behaviour interventions.

    Wright, Kath; Golder, Su; Rodriguez-Lopez, Rocio

    2014-06-03

    The value of citation searches as part of the systematic review process is currently unknown. While the major guides to conducting systematic reviews state that citation searching should be carried out in addition to searching bibliographic databases there are still few studies in the literature that support this view. Rather than using a predefined search strategy to retrieve studies, citation searching uses known relevant papers to identify further papers. We describe a case study about the effectiveness of using the citation sources Google Scholar, Scopus, Web of Science and OVIDSP MEDLINE to identify records for inclusion in a systematic review.We used the 40 included studies identified by traditional database searches from one systematic review of interventions for multiple risk behaviours. We searched for each of the included studies in the four citation sources to retrieve the details of all papers that have cited these studies.We carried out two analyses; the first was to examine the overlap between the four citation sources to identify which citation tool was the most useful; the second was to investigate whether the citation searches identified any relevant records in addition to those retrieved by the original database searches. The highest number of citations was retrieved from Google Scholar (1680), followed by Scopus (1173), then Web of Science (1095) and lastly OVIDSP (213). To retrieve all the records identified by the citation tracking searching all four resources was required. Google Scholar identified the highest number of unique citations.The citation tracking identified 9 studies that met the review's inclusion criteria. Eight of these had already been identified by the traditional databases searches and identified in the screening process while the ninth was not available in any of the databases when the original searches were carried out. It would, however, have been identified by two of the database search strategies if searches had been

  14. Nature and Specificity of Gestural Disorder in Children with Developmental Coordination Disorder: A Multiple Case Study

    Orianne Costini

    2017-07-01

    Full Text Available Aim: Praxis assessment in children with developmental coordination disorder (DCD is usually based on tests of adult apraxia, by comparing across types of gestures and input modalities. However, the cognitive models of adult praxis processing are rarely used in a comprehensive and critical interpretation. These models generally involve two systems: a conceptual system and a production system. Heterogeneity of deficits is consistently reported in DCD, involving other cognitive skills such as executive or visual-perceptual and visuospatial functions. Surprisingly, few researches examined the impact of these functions in gestural production. Our study aimed at discussing the nature and specificity of the gestural deficit in DCD using a multiple case study approach.Method: Tasks were selected and adapted from protocols proposed in adult apraxia, in order to enable a comprehensive assessment of gestures. This included conceptual tasks (knowledge about tool functions and actions; recognition of gestures, representational (transitive, intransitive, and non-representational gestures (imitation of meaningless postures. We realized an additional assessment of constructional abilities and other cognitive domains (executive functions, visual-perceptual and visuospatial functions. Data from 27 patients diagnosed with DCD were collected. Neuropsychological profiles were classified using an inferential clinical analysis based on the modified t-test, by comparison with 100 typically developing children divided into five age groups (from 7 to 13 years old.Results: Among the 27 DCD patients, we first classified profiles that are characterized by impairment in tasks assessing perceptual visual or visuospatial skills (n = 8. Patients with a weakness in executive functions (n = 6 were then identified, followed by those with an impaired performance in conceptual knowledge tasks (n = 4. Among the nine remaining patients, six could be classified as having a visual

  15. Development and layout of a protocol for the field performance of concrete deck and crack sealers.

    2009-09-01

    The main objective of this project was to develop and layout a protocol for the long-term monitoring and assessment of the performance of concrete deck and crack sealants in the field. To accomplish this goal, a total of six bridge decks were chosen ...

  16. 46 CFR 45.135 - Hull openings at or below freeboard deck.

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Hull openings at or below freeboard deck. 45.135 Section 45.135 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) LOAD LINES GREAT LAKES LOAD LINES Conditions of Assignment § 45.135 Hull openings at or below freeboard deck. Closures for hull...

  17. 46 CFR 108.133 - Hull superstructure, structural bulkheads, decks, and deckhouses.

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Hull superstructure, structural bulkheads, decks, and deckhouses. 108.133 Section 108.133 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A... Protection § 108.133 Hull superstructure, structural bulkheads, decks, and deckhouses. Each hull...

  18. STS-37 Commander Nagel in commanders seat on OV-104's flight deck

    1991-01-01

    STS-37 Commander Steven R. Nagel, wearing launch and entry suit (LES), sits at commanders station on the forward flight deck of Atlantis, Orbiter Vehicle (OV) 104. Surrounding Nagel are the seat headrest, control panels, checklists, forward flight deck windows, and three drinking water containers with straws attached to forward panel F2.

  19. Super-Light Prefabricated Deck Element Integrated in Traditional Concrete Prefabricated Element Construction

    Christensen, Jacob Ellehauge; Hertz, Kristian Dahl

    Super-light structures in form of deck elements have been used for the first time in a building to construct indoor pedestrian bridges. Examples of connections to external structures and other super-light deck elements are given along with other details. Other examples on the great versatility...

  20. decké osobnosti a vedení ve vědě

    Wiedermann, Jiří

    č. 3 (2005), s. 14-17 ISSN 1210-9525 Institutional research plan: CEZ:AV0Z10300504 Keywords : vědecké osobnosti * talent * grantový systém * vědecká excelence Subject RIV: AM - Education http://abicko.avcr.cz/archiv/2005/3/obsah/vedecke-osobnosti-a-vedeni-ve-vede.html

  1. 29 CFR 1915.73 - Guarding of deck openings and edges.

    2010-07-01

    ... 29 Labor 7 2010-07-01 2010-07-01 false Guarding of deck openings and edges. 1915.73 Section 1915.73 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION..., Ladders and Other Working Surfaces § 1915.73 Guarding of deck openings and edges. (a) The provisions of...

  2. Multiple case study analysis of young women's experiences in high school engineering

    Pollock, Meagan C.

    richly describe the diversity of experiences. A multiple case study analysis, this study answers the question: How do gender, class, race, and other components of intersectionality, influence high school females' experiences in engineering? Nine young women taking a high school engineering course in a suburban high school in Central Texas during the school year 2011-2012 volunteered to participate. The students were observed in their engineering classes for half of the spring 2012 semester, with bi-weekly interviews with the students, monthly interviews with the teacher, and a single interview with a parent of each volunteer. The nine rich case studies provide us with new stories that help prevent us from narrowing the experiences of women to a single incomplete stereotype, because these young women vary across race, socioeconomic backgrounds, and sexual orientation. Although each story is unique, there are commonalities among their experiences, including family, influence, classroom environment, biases, and beliefs. By drawing from their collective experiences in high school engineering, the findings direct us toward recommendations for educators, parents, engineering curriculum developers, designers of teacher professional development, and future research to improve equity and access for every student in engineering.

  3. Multiple Sclerosis in a Nigerian Alcoholic Male: A Case Report from ...

    Uche

    Background: Multiple sclerosis is a rare neurological disorder in black Africans. In Nigeria it had been ... and intracerebral white matter hyper-intensities on magnetic resonance imaging. ... life in Eha-Alumona, a rural community in Enugu state.

  4. Achondroplasia with multiple-suture craniosynostosis: a report of a new case of this rare association

    Bessenyei, Beáta; Nagy, Andrea; Balogh, Erzsébet; Novák, László; Bognár, László; Knegt, Alida C.; Oláh, Eva

    2013-01-01

    We report on a female patient with an exceedingly rare combination of achondroplasia and multiple-suture craniosynostosis. Besides the specific features of achondroplasia, synostosis of the metopic, coronal, lambdoid, and squamosal sutures was found. Series of neurosurgical interventions were

  5. Sexual habits before multiple sclerosis: a national case-control study

    Lidegaard, O.; Svendsen, Anne Louise; Lidegaard, Øjvind

    2008-01-01

    The trigging off agent for multiple sclerosis (MS) is despite intensive epidemiological and biomedical research still unknown. The disease is typically diagnosed in reproductive age and recent findings have suggested that MS could be a sexually transmitted disease.......The trigging off agent for multiple sclerosis (MS) is despite intensive epidemiological and biomedical research still unknown. The disease is typically diagnosed in reproductive age and recent findings have suggested that MS could be a sexually transmitted disease....

  6. Investigation of Flow Behavior around Corotating Blades in a Double-Spindle Lawn Mower Deck

    Chon W.

    2005-01-01

    Full Text Available When the airflow patterns inside a lawn mower deck are understood, the deck can be redesigned to be efficient and have an increased cutting ability. To learn more, a combination of computational and experimental studies was performed to investigate the effects of blade and housing designs on a flow pattern inside a 1.1m wide corotating double-spindle lawn mower deck with side discharge. For the experimental portion of the study, air velocities inside the deck were measured using a laser Doppler velocimetry (LDV system. A high-speed video camera was used to observe the flow pattern. Furthermore, noise levels were measured using a sound level meter. For the computational fluid dynamics (CFD work, several arbitrary radial sections of a two-dimensional blade were selected to study flow computations. A three-dimensional, full deck model was also developed for realistic flow analysis. The computational results were then compared with the experimental results.

  7. Analysis of an Orthotropic Deck Stiffened with a Cement-Based Overlay

    Walter, Rasmus; Olesen, John Forbes; Stang, Henrik

    2007-01-01

    decks. A solution might be to enhance the stiffness of the traditional orthotropic bridge deck by using a cement-based overlay. In this paper, an orthotropic steel bridge deck stiffened with a cement-based overlay is analyzed. The analysis is based on nonlinear fracture mechanics, and utilizes......Over the past years, with increasing traffic volumes and higher wheel loads, fatigue damage in steel parts of typical orthotropic steel bridge decks has been experienced on heavily trafficked routes. A demand exists to find a durable system to increase the fatigue safety of orthotropic steel bridge...... the finite-element method. The stiffness of the steel deck reinforced with an overlay depends highly on the composite action. The composite action is closely related to cracking of the overlay and interfacial cracking between the overlay and underlying steel plate (debonding). As an example, a real size...

  8. Dynamic Heat Storage and Cooling Capacity of a Concrete Deck with PCM and Thermally Activated Building System

    Pomianowski, Michal Zbigniew; Heiselberg, Per; Jensen, Rasmus Lund

    2012-01-01

    This paper presents a heat storage and cooling concept that utilizes a phase change material (PCM) and a thermally activated building system (TABS) implemented in a hollow core concrete deck. Numerical calculations of the dynamic heat storage capacity of the hollow core concrete deck element...... in the article highlight the potential of using TABS and PCM in a prefabricated concrete deck element....

  9. Heat Storage Performance of the Prefabricated Hollow Core Concrete Deck Element with Integrated Microencapsulated Phase Change Material

    Pomianowski, Michal Zbigniew; Heiselberg, Per; Jensen, Rasmus Lund

    2012-01-01

    The paper presents the numerically calculated dynamic heat storage capacity of the prefabricated hollow core concrete deck element with and without microencapsulated phase change material (PCM). The reference deck is the ordinary deck made of standard concrete material and that is broadly used...

  10. Evaluation of bridge decks using non-destructive evaluation (NDE) at near highway speeds for effective asset management.

    2015-06-01

    Remote sensing technologies allow for the condition evaluation of bridge decks at near highway speed. : Data collection at near highway speed for assessment of the top of the concrete deck and proof of : concept testing for the underside of the deck ...

  11. Nontesticular cancers in relatives of testicular germ cell tumor (TGCT) patients from multiple-case TGCT families

    McMaster, Mary L; Heimdal, Ketil R; Loud, Jennifer T; Bracci, Janet S; Rosenberg, Philip S; Greene, Mark H

    2015-01-01

    Testicular germ cell tumors (TGCT) exhibit striking familial aggregation that remains incompletely explained. To improve the phenotypic definition of familial TGCT (FTGCT), we studied an international cohort of multiple-case TGCT families to determine whether first-degree relatives of FTGCT cases are at increased risk of other types of cancer. We identified 1041 first-degree relatives of TGCT cases in 66 multiple-case TGCT families from Norway and 64 from the United States (combined follow-up of 31,556 person-years). We collected data on all cancers (except nonmelanoma skin cancers) reported by the family informant in these relatives, and we attempted to verify all reported cancer diagnoses through medical or cancer registry records. We calculated observed-to-expected (O/E) standardized incidence ratios, together with 95% confidence intervals (CI), for invasive cancers other than TGCT. We found no increase in risk of cancer overall (Norway O/E = 0.8; 95% CI: 0.6–1.1 and United States O/E = 0.9; 95% CI: 0.7–1.3). Site-specific analyses pooled across the two countries revealed a leukemia excess (O/E = 6.5; 95% CI: 3.0–12.3), deficit of female breast cancer (O/E = 0.0; 95% CI: 0.0–0.6) and increased risk of soft tissue sarcoma (O/E = 7.2; 95% CI: 2.0–18.4); in all instances, these results were based on small case numbers and statistically significant only in Norway. While limited by sample size and potential issues relating to completeness of cancer reporting, this study in multiple-case TGCT families does not support the hypothesis that cancers other than testis cancer contribute to the FTGCT phenotype. PMID:25882629

  12. Static and fatigue investigation of second generation steel free bridge decks

    Klowak, C.; Memon, Amjad H.; Mufti, Aftab A.

    2006-01-01

    This paper outlines the static and fatigue behavior of two different cast-in-place second generation steel-free bridge decks, which are: hybrid carbon fiber reinforced polymer (CFRP); and glass fiber reinforced polymer (GFRP) and steel strap design. Although cast monolithically, the first deck slab was divided into three segments with different reinforcement configurations. All three segments were tested under a 222kN cyclic loading to investigate fatigue behavior. The second bridge deck comprised an internal panel and two cantilevers and was equipped with a civionics system. The internal panel static test that this paper deals with is useful in the development of fatigue theory derived from fatigue testing of the first bridge deck. Test results form the cyclic loading of the first bridge deck indicated that the cross-sectional area of the reinforcement used in the test bridge deck can be reduced by 40% based on the reinforcement provided in the deck under service loads. The hybrid system also reduced the development of longitudinal crack widths to approximately 0.4 mm under service conditions, compared to the cracks that occurred approximately halfway between adjacent bridge girders that were determined to be roughly 1 mm in several first generation steel-free bridge decks constructed in Canada. Civionics, also discussed in the paper, is a new term coined from Civil-Electronics, which is the application of electronics to civil structures. The Civionics Specifications (2004) developed by ISIS Canada researchers are a helpful design tool for engineers and contractors to develop civionics and structural health monitoring systems for civil infrastructure that will last the lifetime of a structure. The use of civionics for the second test bridge deck ensured the survival of 100% of the 63 internal sensors throughout the rigors of the construction and casting of the deck. (author)

  13. Management of a rare case of idiopathic multiple unerupted impacted permanent teeth in an adult female patient

    Karunakar Shetty

    2016-01-01

    Full Text Available This clinical case report describes the multi-disciplinary approach in the management of an unusual presentation of idiopathic multiple unerupted impacted permanent teeth in a 20-year-old female patient. The case was unique in that, not only were there multiple missing permanent teeth, but also over retained deciduous teeth and attrited existing permanent teeth with loss of vertical dimension of occlusion. Since the patient was young, it was decided to retain all the erupted permanent teeth and extract the infected deciduous teeth with the objective of fabricating overlay complete dentures. This is a simple, reversible and an economical treatment modality, which satisfies both the esthetic and functional demands where the extraction of teeth is not generally indicated and, in addition, provides a stable occlusion.

  14. The Interplay of Virtual Communities: A Multiple Case Study of E-Retailers in Yahoo E-Auctions

    Julia Zhi-Xian Zhao

    2012-06-01

    Full Text Available This study investigated how businesses operate e-shops in a transaction-oriented virtual community. This research employed a multiple case study approach by observing three cases of e-retailers, as being new e-commerce initiates, operating their businesses on the Yahoo! e-auction website. The results showed that e-shops displaying amusing stories can attract site visitors and “spick and span” e-shop design format can be helpful for converting visitors into buyers.

  15. Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds from a Shotgun: A Case Report and Literature Review

    Jaramillo, Paula M.; Montoya, Jaime A.; Mejia, David A.; Pereira Warr, Salin

    2018-01-01

    Introduction. Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case. A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea,...

  16. Understanding Information Technology Investment Decision-Making in the Context of Hotel Global Distribution Systems: a Multiple-Case Study

    Connolly, Daniel J.

    1999-01-01

    UNDERSTANDING INFORMATION TECHNOLOGY INVESTMENT DECISION-MAKING IN THE CONTEXT OF HOTEL GLOBAL DISTRIBUTION SYSTEMS: A MULTIPLE-CASE STUDY by Daniel J. Connolly Dr. Michael D. Olsen, Chair Department of Hospitality and Tourism Management ABSTRACT This study investigates what three large, multinational hospitality companies do in practice when evaluating and making IT investment decisions. This study was launched in an attempt to 1) learn more about ...

  17. Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature

    Vigo, Federica; Ciammella, Patrizia; Valli, Riccardo; Cagni, Elisabetta; Iotti, Cinzia

    2012-01-01

    Abstract Introduction Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery w...

  18. A case report of a Wada test after dominant hemisphere multiple hippocampal transections: Pathophysiology of confusion after amobarbital injection

    Patrick Landazuri

    2014-01-01

    Full Text Available Dialepsis is defined as a predominant alteration of consciousness with preservation of motor tone and the ability to perform movements. While dialepsis is a common feature of both focal and generalized epilepsies, its precise symptomatogenic zone and pathogenesis remain undefined. This case report describes a patient who underwent intracarotid amobarbital procedures before and after dominant hemisphere multiple hippocampal transections. From our observations, we propose a possible pathogenesis for the generation of dialeptic seizures.

  19. Configuration of supply chains in emerging industries: a multiple-case study in the wave-and-tidal energy industry

    Bjørgum, Øyvind; Netland, Torbjørn H.

    2017-01-01

    Companies in emerging industries face particular challenges in configuring effective supply chains. In this paper, we build on transaction cost economics to explore how supply chains can be configured in emerging industries. We focus on two key aspects of supply chain configuration: the make-or-buy decision and the strength of the ties between a focal firm and its suppliers. We utilise a multiple-case study methodology, including seven start-up companies in the emerging wave-and-tidal energy ...

  20. Multiple Pulp Stones in Primary and Developing Permanent Dentition: A Report of 4 Cases

    Mohita Marwaha

    2012-01-01

    Full Text Available Pulp stones are foci of calcification or discrete calcifications in the dental pulp. They are frequently found on bitewing and periapical radiographs, but their occurrence in entire dentition is unusual. We are reporting four cases in which the occurrence of pulp stones ranged from their presence in just primary teeth (Cases 1 and 2 to involvement of young permanent teeth also (Case 3 and even unerupted permanent teeth (Case 4. In all the cases, dental, medical, and family histories as well as the findings from the clinical examination of the patient were not contributory. Histopathological report revealed true denticle. Metabolic evaluation of patients through liver function test, kidney function test, and blood investigation did not show any metabolic disorders. Patients were also evaluated for any systemic, syndromic, or genetic involvement, but this was also noncontributing. Therefore, it is suggested that these unusual cases may be of idiopathic origin.

  1. A rare case of giant urethral calculus and multiple urethral diverticulum

    A Agarwal

    2012-09-01

    Full Text Available Urethral stones in adults are rare and usually encountered with urethral stricture or diverticulum. We report a 54 years old gentleman who presented with urinary retention due to a large urethral calculus impacted in bulbar urethra with multiple stones in anterior and posterior urethral diverticulum. On examination a mass of size 5.5cmx4cmx3cm was palpable at anterior perineum with a fistulous tract from which pus was oozing out. On retrograde urethrogram a large urethral calculus with bulbar diverticulum and multiple radio opacity in prostatic area were revealed. Patient was managed by suprapubic cystostomy initially and later on by external urethrotomy, diverticulectomy, urethroscopic removal of multiple stones in prostatic urethral diverticulum and urethroplasty. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 46-48 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6838

  2. A case of multiple hepatic abscesses detected by CT scan in the patient with acute lymphoblastic leukemia

    Saburi, Yoshio; Shuto, Ryusuke; Mizutani, Ryoko; Hosokawa, Takafumi; Itoga, Takashi

    1983-01-01

    A 34 years old man admitted to a hospital on 21 Feb. 1983 and was diagnosed acute lymphoblastic leukemia. A hematological complete remission was achieved by combination therapy of vincristine, prednisolone and L-asparaginase. However, he had complaining of high fever and right hypochondralgia since early in Apr. 1983, and it was revealed that elevation of right diaphragm on chest X-ray. Therefore, he was also given several antibiotics (CPZ, TOB, LMOX, PIPC, LCM, AMK, MINO and GM) for complication of probable liver abscess. Remittent fever was persisted in spite of as mentioned above various antibiotics. The multiple hepatic abscesses were found by CT scan of the mid-abdomen as the low density lesions, but bacterial cultures detected no any pathogens. His complaining of remittent fever and right hypochondralgia were improved by treated with Miconazole during about one month, and decreasing in size and number of multiple hepatic abscesses were found by CT scan. Though we could not determined clearly, but suspected that, multiple hepatic abscesses were due to fungus infection, by reason of therapeutic result. Regarding the complication of hepatic abscesses with leukemia, 5 cases have been reported in Japan, and one case out of 5 cases were detected by CT scan. We thought that CT scan were useful procedure for a early diagnosis of hepatic abscesses. In recently, the patient has continued of complete remission hematologically. (author)

  3. Multiple congenital PSS in a dog: case report and literature review.

    Leeman, Jessica J; Kim, Stanley E; Reese, David J; Risselada, Marije; Ellison, Gary W

    2013-01-01

    A 4 yr old spayed female mixed-breed dog presented with a 2 yr history of recurring increases in liver enzymes. Two congenital portosystemic shunts (PSSs) were identified using computed tomography (CT) angiography, which included a portoazygous and portorenal extrahepatic shunt. Double right renal veins were also identified. The shunts were successfully identified and attenuated with cellophane banding. Multiple congenital PSS is a rare phenomenon, but should be considered during exploratory laparotomy for PSS and in dogs with poor response to surgical attenuation of a single PSS. CT proved to be a crucial part of accurate diagnosis and surgical planning for this dog with multiple congenital PSS.

  4. Hepatobiliary fascioliasis with multiple aneurysms and active bleeding: A case report

    Choi, Soo Young; Kim Jae Woon; Jang, Jae Cheon

    2015-01-01

    A 52-year-old woman visited our institution with upper abdominal pain which had lasted for the past two days. Laboratory tests revealed mild leukocytosis, decreased serum hemoglobin, and peripheral blood eosinophilia. CT scans showed multiple ill-defined, hypodense lesions in the peripheral areas of both hepatic lobes and active bleeding with a subcapsular hematoma in the right hepatic lobe. Angiography also showed active bleeding in the right hepatic lobe with multiple aneurysms, so a transarterial coil embolization was performed to stop the bleeding. The endoscopic retrograde cholangiopancreatography revealed several moving flat flukes in the common bile duct, which were pathologically confirmed as Fasciola hepatica.

  5. Hepatobiliary fascioliasis with multiple aneurysms and active bleeding: A case report

    Choi, Soo Young; Kim Jae Woon; Jang, Jae Cheon [Dept. of Radiology, College of Medicine, Yeungnam University, Daegu (Korea, Republic of)

    2015-04-15

    A 52-year-old woman visited our institution with upper abdominal pain which had lasted for the past two days. Laboratory tests revealed mild leukocytosis, decreased serum hemoglobin, and peripheral blood eosinophilia. CT scans showed multiple ill-defined, hypodense lesions in the peripheral areas of both hepatic lobes and active bleeding with a subcapsular hematoma in the right hepatic lobe. Angiography also showed active bleeding in the right hepatic lobe with multiple aneurysms, so a transarterial coil embolization was performed to stop the bleeding. The endoscopic retrograde cholangiopancreatography revealed several moving flat flukes in the common bile duct, which were pathologically confirmed as Fasciola hepatica.

  6. Risk factors for colorectal cancer in patients with multiple serrated polyps: a cross-sectional case series from genetics clinics.

    Daniel D Buchanan

    2010-07-01

    Full Text Available Patients with multiple serrated polyps are at an increased risk for developing colorectal cancer (CRC. Recent reports have linked cigarette smoking with the subset of CRC that develops from serrated polyps. The aim of this work therefore was to investigate the association between smoking and the risk of CRC in high-risk genetics clinic patients presenting with multiple serrated polyps.We identified 151 Caucasian individuals with multiple serrated polyps including at least 5 outside the rectum, and classified patients into non-smokers, current or former smokers at the time of initial diagnosis of polyposis. Cases were individuals with multiple serrated polyps who presented with CRC. Controls were individuals with multiple serrated polyps and no CRC. Multivariate logistic regression was performed to estimate associations between smoking and CRC with adjustment for age at first presentation, sex and co-existing traditional adenomas, a feature that has been consistently linked with CRC risk in patients with multiple serrated polyps. CRC was present in 56 (37% individuals at presentation. Patients with at least one adenoma were 4 times more likely to present with CRC compared with patients without adenomas (OR = 4.09; 95%CI 1.27 to 13.14; P = 0.02. For females, the odds of CRC decreased by 90% in current smokers as compared to never smokers (OR = 0.10; 95%CI 0.02 to 0.47; P = 0.004 after adjusting for age and adenomas. For males, there was no relationship between current smoking and CRC. There was no statistical evidence of an association between former smoking and CRC for both sexes.A decreased odds for CRC was identified in females with multiple serrated polyps who currently smoke, independent of age and the presence of a traditional adenoma. Investigations into the biological basis for these observations could lead to non-smoking-related therapies being developed to decrease the risk of CRC and colectomy in these patients.

  7. Case-Based Instructional Practices: A Multiple-Case Study from Torts, Marketing, and Online Instructional Design Classes

    Jung, Ji yoon

    2017-01-01

    The purpose of this study is to provide a comprehensive account on case-based instructional practices. Semester-long participant observation records in torts, marketing, and online instructional design classes, instructor interviews, course syllabi and teaching materials were used to describe the within-class complexity of the practices in terms…

  8. A Case Study of Resources Management Planning with Multiple Objectives and Projects

    David L. Peterson; David G. Silsbee; Daniel L. Schmoldt

    1995-01-01

    Each National Park Service unit in the United States produces a resources management plan (RMP) every four years or less. The plans commit budgets and personnel to specific projects for four years, but they are prepared with little quantitative and analytical rigor and without formal decisionmaking tools. We have previously described a multiple objective planning...

  9. Creating Multiple Pathways in the Arts: A New York City Case Study

    Maguire, Cindy; Mishook, Jacob; Garcia, Ivonne; de Gaillande, Genevieve

    2013-01-01

    Increasingly, education policy makers understand the importance of students and families having access to a range of high quality educational opportunities inside and outside of school, 365 days a year. This paper explores the concept of multiple pathways in arts education to further conceptualize and build upon such opportunities, inside and…

  10. Multiple Intelligence Distribution of Prospective Teachers: The Case at Yildiz Technical University

    Çeliköz, Mine

    2017-01-01

    The aim of this study is to find out whether intelligence distributions differ or not according to gender and departmental variables by determining the dominant intelligence (Multiple Intelligence) distributions of prospective teachers studying at Yildiz Technical University Education Faculty. The population of the research constitutes the…

  11. Therapeutic Riding for a Student with Multiple Disabilities and Visual Impairment: A Case Study.

    Lehrman, Jennifer; Ross, David B.

    2001-01-01

    A 9-year-old with multiple disabilities and visual impairments was the focus of a 10-week developmental therapeutic riding program incorporating hippotherapy. The program has led to increased mobility, an increase in visual attention span and fixation time, signs of greater verbal communication, and the acquisition of new functional signs.…

  12. Case Report: Multiple anatomical variations in the arm in an Indian ...

    Additionally, a small slip of accessory fibers of biceps brachii was found arising from the main bulk of the muscle and inserted on to the deep fascia of the lateral cubital region. We present multiple variations in the same limb some of which have not been reported yet. Awareness of these rare variations is therefore necessary ...

  13. Modeling transport pricing with multiple stakeholders. Working paper : Methodology and a case study

    Smits, E.

    2012-01-01

    Pricing measures (e.g., a kilometre charge or cordon toll) are used to improve the external effects of transportation (e.g., congestion or emissions). This working paper presents a planning model for pricing while taking the preferences and interactions of multiple stakeholders (e.g., governments or

  14. Multiple Site Action Research Case Studies: Practical and Theoretical Benefits and Challenges

    Pereira, Mary Delfin; Vallance, Roger

    2006-01-01

    A curriculum initiative project was implemented in four schools in Singapore over a span of five to six weeks during 2004. The project employed a number of different schools: girls only, boys only and co-educational schools; different levels of performance in a graded situation; multiple teachers and classes within each site; and control and…

  15. Multiple pathways to sustainability in the city: the case of San Juan, Puerto Rico

    Tischa A. Munoz

    2014-01-01

    I examined the multiple visions of the future of the city that can emerge when city actors and organizations reconfigure themselves to address sustainability. In various cities worldwide, novel ideas, initiatives, and networks are emerging in governance to address social and ecological conditions in urban areas. However, cities can be contested spaces, bringing a...

  16. The Use of Management and Marketing Textbook Multiple-Choice Questions: A Case Study.

    Hampton, David R.; And Others

    1993-01-01

    Four management and four marketing professors classified multiple-choice questions in four widely adopted introductory textbooks according to the two levels of Bloom's taxonomy of educational objectives: knowledge and intellectual ability and skill. Inaccuracies may cause instructors to select questions that require less thinking than they intend.…

  17. Tolerance to multiple climate stressors: a case study of Douglas-fir drought and cold hardiness

    Sheel Bansal; Connie Harrington; Brad St. Clair

    2016-01-01

    1. Drought and freeze events are two of the most common forms of climate extremes which result in tree damage or death, and the frequency and intensity of both stressors may increase with climate change. Few studies have examined natural covariation in stress tolerance traits to cope with multiple stressors among wild plant populations. 2. We assessed the...

  18. A case of lung adenocarcinoma with multiple intracranial hemorrhages of brain metastases after whole-brain radiation therapy

    Nakamichi, Shinji; Hirano, Satoshi; Asao, Tetsuhiko; Takeda, Yuichiro; Sugiyama, Haruhito; Kobayashi, Nobuyuki

    2011-01-01

    Whole-brain radiation therapy (WBRT) is widely applied in cases of brain metastases of non-small cell lung cancer (NSCLC). However, there are few case reports on hemorrhages of brain metastases occurring after WBRT. A 63-year-old woman was given a diagnosis of stage IV (T4N0M1b) lung adenocarcinoma about 4 years previously, and received chemotherapy regimens and gamma knife radiosurgery. However, her brain metastases exacerbated and she received WBRT in November 2010 and docetaxel monotherapy in December 2010. Two weeks after completing WBRT, she experienced dysarthria and an MRI showed multiple hemorrhages within brain metastases. Over a period of careful observation, these hemorrhages repeatedly alternated between improvement and exacerbation. Radiotherapy for metastatic brain tumors is considered to suppress hemorrhagic events of brain metastases. However, multiple intracranial hemorrhages of brain metastases occurred after WBRT in the present case. The accumulation of further studies of similar cases is necessary to identify the exact mechanism of these hemorrhages. (author)

  19. Satellite observed impacts of wildfires on regional atmosphere composition and shortwave radiative forcing: multiple cases study

    Fu, Y.; Li, R.; Huang, J.; Bergeron, Y.; Fu, Y.

    2017-12-01

    Emissions of aerosols and trace gases from wildfires and the direct shortwave radiative forcing were studied using multi-satellite/sensor observations from Aqua Moderate-Resolution Imaging Spectroradiometer (MODIS), Aqua Atmospheric Infrared Sounder (AIRS), Aura Ozone Monitoring Instrument (OMI), and Aqua Cloud's and the Earth's Radiant Energy System (CERES). The selected cases occurred in Northeast of China (NEC), Siberia of Russia, California of America have dominant fuel types of cropland, mixed forest and needleleaf forest, respectively. The Fire radiative power (FRP) based emission coefficients (Ce) of aerosol, NOx (NO2+NO), formaldehyde (HCHO), and carbon monoxide (CO) showed significant differences from case to case. 1) the FRP of the cropland case in NEC is strongest, however, the Ce of aerosol is the lowest (20.51 ± 2.55 g MJ-1). The highest Ce of aerosol is 71.34 ± 13.24 g MJ-1 in the needleleaf fire case in California. 2) For NOx, the highest Ce existed in the cropland case in NEC (2.76 ± 0.25 g MJ-1), which is more than three times of those in the forest fires in Siberia and California. 3) The Ce of CO is 70.21±10.97 and 88.38±46.16 g MJ-1 in the forest fires in Western Siberia and California, which are about four times of that in cropland fire. 4) The variation of Ce of HCHO are relatively small among cases. Strong spatial correlations are found among aerosol optical depth (AOD), NOx, HCHO, and CO. The ratios of NOx to AOD, HCHO, and CO in the cropland case in NEC show much higher values than those in other cases. Although huge differences of emissions and composition ratios exist among cases, the direct shortwave (SW) radiative forcing efficiency (SWARFE) of smoke at the top of the atmosphere (TOA) are in good agreement, with the shortwave radiative forcing efficiencies values of 20.09 to 22.93 per unit AOD. Results in this study reveal noteworthy variations of the FRP-based emissions coefficient and relative chemical composition in the smoke

  20. Unmanned Ground Vehicle for Autonomous Non-Destructive Testing of FRP Bridge Decks

    Klinkhachorn, P.; Mercer, A. Scott; Halabe, Udaya B.; GangaRao, Hota V. S.

    2007-03-01

    Current non-destructive techniques for defect analysis of FRP bridge decks have a narrow scope. These techniques are very good at detecting certain types of defects but are not robust enough to detect all defects by themselves. For example, infrared thermography (IRT) can detect air filled defects and Ground Penetrating Radar (GPR) is good at detecting water filled ones. These technologies can be combined to create a more robust defect detection scheme. To accomplish this, an Unmanned Ground Vehicle (UGV) has been designed that incorporates both IR and GPR analysis to create a comprehensive defect map of a bridge deck. The UGV autonomously surveys the deck surface and acquires data. The UGV has two 1.5 GHz ground coupled GPR antennas that are mounted on the front of the UGV to collect GPR data. It also incorporates an active heating source and a radiometric IR camera to capture IR images of the deck, even in less than ideal weather scenarios such as cold cloudy days. The UGV is designed so that it can collect data in an assembly line fashion. It moves in 1 foot increments. When moving, it collects GPR data from the two antennas. When it stops it heats a section of the deck. The next time it stops to heat a section, the IR camera is analyzing the preheated deck section while preparing for the next section. Because the data is being continually collected using this method, the UGV can survey the entire deck in an efficient and timely manner.

  1. Accumulation of Tc99m-DMSA-3 in the spleen in a case of multiple myeloma with associated amyloidosis

    Barai Sukanta

    2005-01-01

    Full Text Available We describe a case of a 58-year-old male with longstanding hypertension and Type 2 diabetes mellitus who developed sudden onset renal impairment. The first clue to the possible presence of amyloidosis in this case was provided by the radionuclide renal cortical scan performed with trivalent dimercapto succinic acid (Tc99m-DMSA-3, which revealed intense tracer uptake in the spleen suggesting amyloid deposit. Further workup to ascertain the cause of amyloidosis led to the diagnosis of multiple myeloma. We conclude that in cases of extra-renal or splenic accumulation of Tc99m-DMSA-3, a diagnosis of amyloidosis should be considered, in an appropriate clinical setting.

  2. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report

    Lindholt, Jes Sanddal; Sandermann, Jes; Bruun-Petersen, J

    1998-01-01

    The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits....

  3. ePRISM: A case study in multiple proxy and mixed temporal resolution integration

    Robinson, Marci M.; Dowsett, Harry J.

    2010-01-01

    As part of the Pliocene Research, Interpretation and Synoptic Mapping (PRISM) Project, we present the ePRISM experiment designed I) to provide climate modelers with a reconstruction of an early Pliocene warm period that was warmer than the PRISM interval (similar to 3.3 to 3.0 Ma), yet still similar in many ways to modern conditions and 2) to provide an example of how best to integrate multiple-proxy sea surface temperature (SST) data from time series with varying degrees of temporal resolution and age control as we begin to build the next generation of PRISM, the PRISM4 reconstruction, spanning a constricted time interval. While it is possible to tie individual SST estimates to a single light (warm) oxygen isotope event, we find that the warm peak average of SST estimates over a narrowed time interval is preferential for paleoclimate reconstruction as it allows for the inclusion of more records of multiple paleotemperature proxies.

  4. [A case of MEWDS. "The multiple evanescent white-dot syndrome"].

    Lefrançois, A; Hamard, H; Corbe, C; Schmitt, A; Badelon, I; Vidal, A

    1989-01-01

    A young white man developed acute bilateral visual loss with no previous general illness. Ophthalmoscopic examination showed multiple small yellow-white lesions scattered throughout the posterior poles and mild periphery fundus. There was also fine granularity of two foveal areas and one optic disc margin was blurred. Fluorescein angiography showed early hyperfluorescence of the lesions and late staining of the retinal pigment epithelium. Electrophysiologic abnormalities were transient, asymmetric, more marked in photopic than in scotopic. The origin could be in retinal bipolar cells. These lesions regressed, with return of normal visual function within several weeks. These clinical findings are different from others acute inflammatory diseases primarily involving retinal pigment epithelium and photoreceptors. This aspect is usually described as "multiple evanescent white dot syndrome". The etiology of this syndrome remains unknown with no evidence of systemic disease. A history of flulike illness is rare.

  5. [Cornelia de Lange Syndrome and multiple hormonal deficiency, an unusual association. Clinical case].

    Mora-Bautista, Víctor M; Mendoza-Rojas, Víctor; Contreras-García, Gustavo A

    2017-06-01

    Cornelia de Lange syndrome is a genetic disease characterized by distinctive facial features, failure to thrive, microcephaly and several malformations associated. Its main endocrinological features are anomalies of the genitalia. We present a 13-year-old boy, who suffered from complicated aspiration pneumonia and showed Cornelia de Lange syndrome phenotype, with global developmental delay, suction-swallowing abnormalities, short stature and abnormal genitalia associated. His bone age was delayed, so he underwent full endocrinological panel. Central hypothyroidism, growth hormone deficiency and low luteinizing hormone-follicle-stimulating hormone levels were observed and multiple pituitary hormone deficiencies diagnosis was made. Basal cortisol, adrenocorticotropic hormone and prolactin levels were normal. He received thyroid hormonal substitution. Multiple pituitary hormone deficiencies are an unusual feature of De Lange syndrome. We suggest evaluating all different endocrine axes in these patients. Sociedad Argentina de Pediatría.

  6. Multiple abdominal cysts in a patient with Gorlin-Goltz syndrome: a case report.

    Haenen, F; Hubens, G; Creytens, D; Vaneerdeweg, W

    2013-01-01

    A rare case of symptomatic mesenteric cysts in a patient with Gorlin-Goltz syndrome, associated with various neoplasms, is presented. The patient, known with Gorlin-Goltz syndrome, consulted with increasingly severe abdominal pain and large abdominal cysts. At surgery, the cysts were excised and the postoperative course was uneventful. In conclusion, this case reminds clinicians to always maintain a wide differential diagnosis when dealing with patients known with Gorlin-Goltz syndrome.

  7. Using Multiple Senses in Tourism Marketing: The Helsinki Expert, Eckero Line and Linnanmaki Amusement Park Cases

    Isacsson, Annica; Alakoski, Leena; Bäck, Asta

    2009-01-01

    In order to create awareness & motivation among future travellers, tourism communication, should, according to our understanding, not only appeal to the visuals, but to all user senses in an inter medial mix. Hence, smell, sound, touch, taste and sight must be touched, in order for communication to be perceived valuable and interesting, as we argue that the activation of multiple senses enhances the feeling of authenticity and experience. If combined with ration and need, in addition to the i...

  8. Demonstration of multiple neurofibromas in gadolinium-DTPA enhanced MRI - a case report

    Kaminsky, S.; Schulz, B.

    1988-01-01

    Although magnetic resonance imaging has a high sensitivity for cerebral and spinal tumors, demonstration of small lesions can be difficult. In a patient with multiple extra- and intraspinal tumors due to neurofibromatosis generalisata, the use of the MRI contrast agent gadolinium-DTPA resulted in a better differentiation especially of small lesions. High tumor contrast facilitated a safe localisation of the widespread disease using a fast imaging sequence (FLASH). (orig.) [de

  9. Integrating Multiple Social Statuses in Health Disparities Research: The Case of Lung Cancer

    Williams, David R; Kontos, Emily Z; Viswanath, K; Haas, Jennifer S; Lathan, Christopher S; MacConaill, Laura E; Chen, Jarvis; Ayanian, John Z

    2012-01-01

    Objective To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. Principal Findings SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Conclusions Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities. PMID:22568674

  10. Ketamine Therapy for Treatment-resistant Depression in a Patient with Multiple Sclerosis: A Case Report.

    Messer, Michael M; Haller, Irina V

    2017-01-01

    Objective: Depression is a common condition among patients with multiple sclerosis and often becomes resistant to oral antidepressants. We report a patient with multiple sclerosis who developed severe treatment-resistant depression and who was successfully treated with intravenous ketamine over the period of two years. Methods: Ketamine treatment protocol included an initial series of six treatments administered every other day, followed by a maintenance schedule. Ketamine was administered intravenously at 0.5mg/kg of ideal body weight over 40 minutes. Depression symptoms were measured using Beck Depression Index. Results: The patient's Beck Depression Index score prior to initiating ketamine treatment was 38, corresponding to severe depression. Response to treatment, defined as 50-percent reduction in Beck Depression Index score, was observed after five treatments. For this patient, the maintenance schedule ranged from a weekly treatment to one treatment every three weeks. During the two-year observation period, this patient was able to maintain a stable non-depressed mood and had no worsening of her MS symptoms. Conclusion: Ketamine may be an alternative treatment for resistant depression and may have a special use in patients with multiple sclerosis.

  11. Clinico-MRI study of hemispheric disorder in long-term follow-up cases of multiple system atrophy

    Konagaya, Masaaki; Miwa, Shigeru; Matsuoka, Yukihiko; Konagaya, Yoko

    1998-01-01

    Twelve cases of multiple system atrophy (MSA) were studied for clinical and MRI findings of the cerebral hemispheric involvement. The subjects consisted of five olivopontocerebellar atrophy (OPCA) type and seven striatonigral degeneration (SND) type. The age at onset was 56.7±8.0 (M±SD) years, duration of illness at the first MRI study 3.2±1.1 years, duration of illness at the last study 8.1±2.2 years, and the following up duration 4.9±2.0 years. The grasping phenomenon was observed in 70% of the cases examined, snout reflex in 80%, slowness of verbal response in 88%, and decrease of spontaneous speech in 100%. Three cases finally fell into the state of mutism. Three out of ten cases were categorized as dementia by HDS-R (Hasegawa Dementia Scale-Revised) test. Besides the progression of the pontocerebellar atrophy and putaminal changes, MRI study revealed progressive frontal lobe atrophy in most cases. At six years after the onset, SND type showed significantly higher incidence of conspicuous frontal lobe atrophy and dilatation of the Sylvian fissure than OPCA type. Cerebral ventricular dilatation was common feature, and atrophy of the temporal and occipital lobes were observed in several cases. We indicated the possible involvement of the cerebral hemisphere, especially the frontal lobe, and higher nervous function in MSA. (author)

  12. Clinico-MRI study of hemispheric disorder in long-term follow-up cases of multiple system atrophy

    Konagaya, Masaaki; Miwa, Shigeru; Matsuoka, Yukihiko [Suzuka National Hospital, Mie (Japan); Konagaya, Yoko

    1998-12-01

    Twelve cases of multiple system atrophy (MSA) were studied for clinical and MRI findings of the cerebral hemispheric involvement. The subjects consisted of five olivopontocerebellar atrophy (OPCA) type and seven striatonigral degeneration (SND) type. The age at onset was 56.7{+-}8.0 (M{+-}SD) years, duration of illness at the first MRI study 3.2{+-}1.1 years, duration of illness at the last study 8.1{+-}2.2 years, and the following up duration 4.9{+-}2.0 years. The grasping phenomenon was observed in 70% of the cases examined, snout reflex in 80%, slowness of verbal response in 88%, and decrease of spontaneous speech in 100%. Three cases finally fell into the state of mutism. Three out of ten cases were categorized as dementia by HDS-R (Hasegawa Dementia Scale-Revised) test. Besides the progression of the pontocerebellar atrophy and putaminal changes, MRI study revealed progressive frontal lobe atrophy in most cases. At six years after the onset, SND type showed significantly higher incidence of conspicuous frontal lobe atrophy and dilatation of the Sylvian fissure than OPCA type. Cerebral ventricular dilatation was common feature, and atrophy of the temporal and occipital lobes were observed in several cases. We indicated the possible involvement of the cerebral hemisphere, especially the frontal lobe, and higher nervous function in MSA. (author)

  13. Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature

    Vigo Federica

    2012-08-01

    Full Text Available Abstract Introduction Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. Conclusion The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient. This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma.

  14. Air MEDEVAC in case of multiple casualties – The experience of civilian-military cooperation in RoAF

    Dragoș C. Tudose

    2016-07-01

    Full Text Available Introduction: Starting September 2010 in Romania was created the Military Emergency Medical Service (SMMU by the Ministry of National Defense, which has as main mission to provide first aid and save the lives of military personnel during military operations using special equipped MEDEAVC aircraft. Nationwide exist the national emergency system which operates thru 112- SMURD acting in support of the civilian population. In case of accidents with multiple victims the experience has shown the need for collaboration between the two systems, in order to save lives. In the last 5 years there has been an increasing Airlift missions (MEDEVAC with multiple victims executed by joint civil-military medical teams using military aircraft. Material and methods. This paper provides a review of the most important aspects of particularities, advantages and disadvantages of this type of medical transport using the MEDEVAC missions based study carried out by the Air Force in recent years. Results and conclusions. Performing these tasks presents challenges to mission planning, use of medical equipment and procedures, command-control system, exercise programs jointly joint medical teams and, of course, managing a large number of patients in flight. The large number of patients transported safely and in the shortest time, regardless of weather conditions recommends this type of medical intervention. Given the Romanian military presence in various theaters and that NATO strategic medical evacuation is a national responsibility, the capacity of air transport in case multiple casualties is a priority.

  15. The application of microcatheter superselective catheterization in interventional chemoembolization for multiple hepatocarcinomas: an initial experience in 34 cases

    Xu Xiaolu; Chen Yongqiang; Wang Qing

    2012-01-01

    Objective: To assess the clinical value of superselective catheterization by using microcatheter in interventional chemoembolization for multiple hepatocarcinomas. Methods: A total of 68 patients with multiple hepatocarcinomas were enrolled in this study. The clinical data were retrospectively analyzed. Superselective catheterization by using a microcatheter was carried out in 34 cases (study group) and superselective catheterization by using a 4-5 F common catheter was performed in 34 cases (control group). The hepatic dysfunctions and the survival rate at 0.5, 1, 2 years were compared between the two groups. Results: The liver function of the patients in study group was much better than that of the patients in control group (P<0.05), and the survival time of the patients in study group was much longer than that of the patients in control group (P<0.05). Conclusion: For the treatment of multiple hepatocarcinomas, interventional chemoembolization by using microcatheter superselective catheterization technique is technically simple and clinically effective with high success rate and fewer complications. (authors)

  16. Profiled Deck Composite Slab Strength Verification: A Review

    K. Mohammed

    2017-12-01

    Full Text Available The purpose of this article is to present an overview on alternate profiled deck composite slab (PDCS strength verification devoid of the expensive and complex laboratory procedures in establishing its longitudinal shear capacity. Despite the several deterministic research findings leading to the development of proposals and modifications on the complex shear characteristics of PDCS that defines its strength behaviour, the laboratory performance testing stands to be the only accurate means for the PDCS strength assessment. The issue is critical and warrants much further thoughts from different perspective other than the deterministic approach that are rather expensive and time consuming. Hence, the development of a rational-based numerical test load function from longitudinal shear capacity consideration is a necessity in augmenting the previous futile attempts for strength determination of PDCS devoid of the costlier and expensive laboratory procedure.

  17. Eye Tracking Metrics for Workload Estimation in Flight Deck Operation

    Ellis, Kyle; Schnell, Thomas

    2010-01-01

    Flight decks of the future are being enhanced through improved avionics that adapt to both aircraft and operator state. Eye tracking allows for non-invasive analysis of pilot eye movements, from which a set of metrics can be derived to effectively and reliably characterize workload. This research identifies eye tracking metrics that correlate to aircraft automation conditions, and identifies the correlation of pilot workload to the same automation conditions. Saccade length was used as an indirect index of pilot workload: Pilots in the fully automated condition were observed to have on average, larger saccadic movements in contrast to the guidance and manual flight conditions. The data set itself also provides a general model of human eye movement behavior and so ostensibly visual attention distribution in the cockpit for approach to land tasks with various levels of automation, by means of the same metrics used for workload algorithm development.

  18. Experimental Test for Benchmark 1--Deck Lid Inner Panel

    Xu Siguang; Lanker, Terry; Zhang, Jimmy; Wang Chuantao

    2005-01-01

    The Benchmark 1 deck lid inner is designed for both aluminum and steel based on a General Motor Corporation's current vehicle product. The die is constructed with a soft tool material. The die successfully produced aluminum and steel panels without splits and wrinkles. Detailed surface strains and thickness measurement were made at selected sections to include a wide range of deformation patterns from uniaxial tension mode to bi-axial tension mode. The springback measurements were done by using CMM machine along the part's hem edge which is critical to correct dimensional accuracy. It is expected that the data obtained will provide a useful source for forming and springback study on future automotive panels

  19. Coexisting multiple myeloma, lymphoma, and non-small cell lung cancer: a case report and review of the literature

    Khade P

    2017-11-01

    Full Text Available Parth Khade, Srinivas Devarakonda Department of Internal Medicine, Louisiana State University Health, Shreveport, LA, USA Abstract: Multiple myeloma is a plasma cell dyscrasia characterized by neoplastic proliferation of plasma cells, producing a monoclonal immunoglobulin. Small lymphocytic lymphoma (SLL is a neoplasm consisting of monoclonal B-cell lymphocyte proliferation. We present an extremely rare case of coexisting multiple myeloma, SLL, and squamous cell carcinoma of the lung in a 74-year-old female patient. She initially presented with a midline mass with pain in the lumbar area. Debulking surgery was performed, and pathology showed plasmacytoma. Further evaluation revealed coexistent IgG kappa myeloma. Imaging revealed extensive abdominal lymphadenopathy, and mesenteric lymph node biopsy confirmed the presence of SLL. The patient was also found to have a mass in the left lower lobe of the lung; biopsy showed squamous cell carcinoma. This patient was treated with lenalidomide and dexamethasone for multiple myeloma, and stereotactic body radiotherapy for limited stage lung cancer. Due to the more indolent course of SLL, watchful waiting was applied. Keywords: coexisting, multiple myeloma, lung cancer, non-Hodgkin’s lymphoma

  20. Multiple large solar lentigos on the upper back as clinical markers of past severe sunburn: a case-control study.

    Derancourt, C; Bourdon-Lanoy, E; Grob, J-J; Guillaume, J-C; Bernard, P; Bastuji-Garin, S

    2007-01-01

    Multiple solar lentigos commonly seen on the upper back and shoulders of adults are classically considered as a sign of photodamage, although epidemiological studies are scarce. To assess whether these lesions are clinical markers of past severe sunburn. A case-control study in two outpatient dermatology clinics in French university hospitals. Past episodes of moderate and severe sunburn were compared between 145 adult patients with multiple solar lentigos on the upper back and 145 matched controls. In multivariate analysis adjusted for potential confounders, recalled episodes of sunburn during childhood, adolescence and adulthood were independently associated with the presence of multiple solar lentigos (adjusted odds ratios, 95% confidence intervals: 2.3 (1.1-5.2) and 28.1 (10.4-75.6) for moderate and severe sunburn, respectively). Multiple solar lentigos on the upper back and shoulders of adults are potential clinical markers of past severe sunburn which may thus be used to identify a population at higher risk of developing cutaneous malignant melanoma.

  1. An Examination of Fluoxetine for the Treatment of Selective Mutism Using a Nonconcurrent Multiple-Baseline Single-Case Design Across 5 Cases.

    Barterian, Justin A; Sanchez, Joel M; Magen, Jed; Siroky, Allison K; Mash, Brittany L; Carlson, John S

    2018-01-01

    This study examined the utility of fluoxetine in the treatment of 5 children, aged 5 to 14 years, diagnosed with selective mutism who also demonstrated symptoms of social anxiety. A nonconcurrent, randomized, multiple-baseline, single-case design with a single-blind placebo-controlled procedure was used. Parents and the study psychiatrist completed multiple methods of assessment including Direct Behavior Ratings and questionnaires. Treatment outcomes were evaluated by calculating effect sizes for each participant as an individual and for the participants as a group. Information regarding adverse effects with an emphasis on behavioral disinhibition and ratings of parental acceptance of the intervention was gathered. All 5 children experienced improvement in social anxiety, responsive speech, and spontaneous speech with medium to large effect sizes; however, children still met criteria for selective mutism at the end of the study. Adverse events were minimal, with only 2 children experiencing brief occurrences of minor behavioral disinhibition. Parents found the treatment highly acceptable.

  2. Peer Support in Full-Service Partnerships: A Multiple Case Study Analysis.

    Siantz, Elizabeth; Henwood, Benjamin; Gilmer, Todd

    2017-07-01

    Peer providers are integral to Full Service Partnerships (FSPs), which are team-based mental health service models. Peer providers use principles of recovery to engage clients, but FSPs can vary in their recovery orientation. Whether and how peer recovery orientation reflects the organizational environments of FSPs is unclear. This qualitative study explored peer provider attitudes towards recovery within the organizational contexts of FSPs where they are employed. Case study analysis was conducted on eight purposively sampled FSPs using qualitative interviews with peer providers and program directors. In two cases, peer recovery attitudes diverged from those of their organizational context. In these cases, peer providers were champions for recovery, and used practice-based strategies to promote client autonomy despite working in settings with lower recovery orientation. Peer providers could be uniquely positioned to promote client autonomy in settings where organizational factors limit consumer choice.

  3. Case Report of Urethritis in a Male Patient Infected with Two Different Isolates of Multiple Drug-Resistant Neisseria gonorrhoeae

    Lamiaa Al-Madboly

    2017-11-01

    Full Text Available We report a brief description of a case suffering from bacterial urethritis, conjunctivitis, and arthritis, caused by two different isolates of multiple drug-resistant Neisseria gonorrhoeae. Initial diagnosis was dependent on the patient history, clinical findings, symptoms, and the bacteriological data. Polymerase chain reaction confirmed the identification of the pathogens. Random amplified polymorphic DNA revealed two different patterns. Susceptibility testing was performed using Kirby–Bauer disk diffusion method and the minimum inhibitory concentration was also determined. It revealed multiple drug resistance associated with β-lactamase production. Only gentamicin, rifampicin, and azithromycin were active against the test pathogens. A dual therapy was initiated using gentamicin as well as azithromycin to treat the possible co-infection with Chlamydia trachomatis. Complete recovery of the patient achieved with resolved symptoms a week later.

  4. Case Report of Urethritis in a Male Patient Infected with Two Different Isolates of Multiple Drug-Resistant Neisseria gonorrhoeae.

    Al-Madboly, Lamiaa; Gheida, Shereen

    2017-01-01

    We report a brief description of a case suffering from bacterial urethritis, conjunctivitis, and arthritis, caused by two different isolates of multiple drug-resistant Neisseria gonorrhoeae . Initial diagnosis was dependent on the patient history, clinical findings, symptoms, and the bacteriological data. Polymerase chain reaction confirmed the identification of the pathogens. Random amplified polymorphic DNA revealed two different patterns. Susceptibility testing was performed using Kirby-Bauer disk diffusion method and the minimum inhibitory concentration was also determined. It revealed multiple drug resistance associated with β-lactamase production. Only gentamicin, rifampicin, and azithromycin were active against the test pathogens. A dual therapy was initiated using gentamicin as well as azithromycin to treat the possible co-infection with Chlamydia trachomatis . Complete recovery of the patient achieved with resolved symptoms a week later.

  5. An autopsy case of multiple myeloma with veno-occlusive disease of the liver induced by ionizing radiation

    Ueno, Hironori; Inagaki, Yasutaka; Yonei, Yoshikazu; Ozawa, Yukako; Atsukawa, Kazuhiro; Tsukada, Nobuhiro; Miyamoto, Kei; Suzuki, Osamu; Kiryu, Yasuyoshi

    1995-01-01

    An autopsy case of multiple myeloma which accompanied radiation-induced veno-occlusion of the liver is presented. A 62-year-old woman with a chief complaint of low back pain was diagnosed as having multiple myeloma. Approximately one year later, the patient was treated with chemotherapy, consisting of VCR, MCNU, ADR, PSL, and CPA, and X-irradiation of 30 Gy to the bilateral trunk for medically intractable rib pain. The irradiation field included the entire liver. Six months later, she was admitted to the hospital due to abdominal distention and massive amounts of ascites. Various examinations failed to make a qualitative diagnosis. Postmortem examination revealed fibrotic occlusion of the central vein which is typical for veno-occlusion disease of the liver. This finding was restricted to the area that was not shielded, irrespective of anatomical structure, strongly suggesting radiation-induced veno-occlusion of the liver. (N.K.)

  6. Using Multiple Big Datasets and Machine Learning to Produce a New Global Particulate Dataset: A Technology Challenge Case Study

    Lary, D. J.

    2013-12-01

    A BigData case study is described where multiple datasets from several satellites, high-resolution global meteorological data, social media and in-situ observations are combined using machine learning on a distributed cluster using an automated workflow. The global particulate dataset is relevant to global public health studies and would not be possible to produce without the use of the multiple big datasets, in-situ data and machine learning.To greatly reduce the development time and enhance the functionality a high level language capable of parallel processing has been used (Matlab). A key consideration for the system is high speed access due to the large data volume, persistence of the large data volumes and a precise process time scheduling capability.

  7. [A case of severe asthma exacerbation complicated with cerebral edema and diffuse multiple cerebral micro-bleeds].

    Ohkura, Noriyuki; Fujimura, Masaki; Sakai, Asao; Fujita, Kentaro; Katayama, Nobuyuki

    2009-08-01

    A 36-year-old woman was admitted to the Intensive Care Unit for the treatment of severe asthma exacerbation. Her condition of asthma improved with systemic glucocorticosteroids, inhaled beta2-agonist, intravenous theophylline and inhaled anesthesia (isoflurane) under mechanical ventilation. Her consciousness was disturbed even after terminating isoflurane. Brain CT and MRI scan showed cerebral edema and diffuse multiple cerebral micro-bleeds. Glyceol, a hyperosmotic diuretic solution consisting of 10% glycerol and 5% fructose in saline, was administered to decrease cerebral edema. Her consciousness disturbance gradually recovered. Cerebral edema and hemorrhage improved. On the 69th hospital day, she was discharged from hospital without sequelae. This case is a rare one in which severe asthma exacerbation was complicated with cerebral edema and diffuse multiple cerebral hemorrhage. Inhaled anesthesia for asthma exacerbation should be used carefully to avoid delay of diagnosis of central nervous system complications.

  8. Bisphosphonate-related osteonecrosis of the jaw in a multiple myeloma patient: A case report with characteristic radiographic features.

    Lee, Byung-Do; Park, Moo-Rim; Kwon, Kyung-Hwan

    2015-09-01

    A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature.

  9. Bisphosphonate-related osteonecrosis of the jaw in a multiple myeloma patient: A case report with characteristic radiographic features

    Lee, Byung Do; Kwon, Kyung Hwan; Park, Moo Rim

    2015-01-01

    A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature

  10. The albedo problem in the case of multiple synthetic scattering taking place in a plane-symmetric slab

    Shafiq, A.; Meyer, H.E. de; Grosjean, C.C.

    1985-01-01

    An approximate model based on an improved diffusion-type theory is established for treating multiple synthetic scattering in a homogeneous slab of finite thickness. As in the case of the exact treatment given in the preceding paper (Part I), it appears possible to transform the considered transport problem into an equivalent fictitious one involving multiple isotropic scattering, therefore permitting the application of an established corrected diffusion theory for treating isotropic scattering taking place in a convex homogeneous medium bounded by a vacuum in the presence of various types of sources. The approximate values of the reflection and transmission coefficients are compared with the rigorous values listed in Part I. In this way, the high accuracy of the approximation is clearly demonstrated. (author)

  11. A case of Fanconi syndrome accompanied by crystal depositions in tubular cells in a patient with multiple myeloma

    Do Hee Kim

    2014-06-01

    Full Text Available Fanconi syndrome (FS is a rare condition that is characterized by defects in the proximal tubular function. A 48-year-old woman was admitted for evaluation of proteinuria. The patient showed normal anion gap acidosis, normoglycemic glycosuria, hypophosphatemia, and hypouricemia. Thus, her condition was compatible with FS. The M peak was found behind the beta globulin region in urine protein electrophoresis. Upon bone marrow examination, we found that 24% of cells were CD138+ plasma cells with kappa restriction. From a kidney biopsy, we found crystalline inclusions within proximal tubular epithelial cells. Thereafter, she was diagnosed with FS accompanied by multiple myeloma. The patient received chemotherapy and autologous stem cell transplantation, and obtained very good partial hematologic response. However, proximal tubular dysfunction was persistent until 1 year after autologous stem cell transplantation. In short, we report a case of FS accompanied by multiple myeloma, demonstrating crystalline inclusion in proximal tubular cells on kidney biopsy.

  12. Automatic feedback to promote safe walking and speech loudness control in persons with multiple disabilities: two single-case studies.

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Alberti, Gloria; Boccasini, Adele; Smaldone, Angela; Oliva, Doretta; Bosco, Andrea

    2014-08-01

    Assessing automatic feedback technologies to promote safe travel and speech loudness control in two men with multiple disabilities, respectively. The men were involved in two single-case studies. In Study I, the technology involved a microprocessor, two photocells, and a verbal feedback device. The man received verbal alerting/feedback when the photocells spotted an obstacle in front of him. In Study II, the technology involved a sound-detecting unit connected to a throat and an airborne microphone, and to a vibration device. Vibration occurred when the man's speech loudness exceeded a preset level. The man included in Study I succeeded in using the automatic feedback in substitution of caregivers' alerting/feedback for safe travel. The man of Study II used the automatic feedback to successfully reduce his speech loudness. Automatic feedback can be highly effective in helping persons with multiple disabilities improve their travel and speech performance.

  13. Multiple self-inserted pins and nails in pericardium in a patient of schizophrenia: Case report and review

    S Soren

    2015-01-01

    Full Text Available This report is the case of multiple self-inserted pins and nails in chest and pericardial cavity in a young male suffering from schizophrenia. This act of self-mutilation was done to get relief from burning sensation in chest and palpitations. Review of the relevant literature revealed that self-inflicted intra-cardiac needle injuries occur mainly in young and middle-aged adults suffering from psychiatric disorders, commonly depression, schizophrenia, and substance use disorders. In one-fourth of the patients, it is due to deliberate self-harm. About 70% use a single needle but 30% may use multiple needles. Second attempts are rare. Majority of the patients (85% are managed by surgery and recover from the injury. The condition has a low mortality rate of 5%.

  14. Bisphosphonate-related osteonecrosis of the jaw in a multiple myeloma patient: A case report with characteristic radiographic features

    Lee, Byung Do; Kwon, Kyung Hwan [College of Dentistry, Wonkwang University, Iksan (Korea, Republic of); Park, Moo Rim [Dept. of Internal Medicine, School of Medicine, Wonkwang University, Iksan (Korea, Republic of)

    2015-09-15

    A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature.

  15. A case of severe congenital kyphoscoliosis secondary to multiple bilateral thoracic pedicle aplasia

    Geoffray, Anne; Leloutre, Beatrice; Albertario, Marco; Bechard-Sevette, Nancy; Clement, Jean-Luc

    2008-01-01

    A 9-month-old boy with congenital kyphoscoliosis secondary to multiple bilateral thoracic pedicle aplasias is presented. This anomaly has rarely been described in the literature. Plain films showed absence of thoracic pedicles bilaterally from T2 to T9, which was better demonstrated on CT multiplanar and 3-D reformatted images. There were no neurological symptoms even though the deformity progressed rapidly. Congenital kyphosis or kyphoscoliosis is often related to spinal anomalies that are located on the anterior aspect of the vertebrae. However, posterior anomalies may also be responsible and should be recognized before neurological complications occur. (orig.)

  16. Multiple supernumerary teeth and odontoma in the maxilla: A case report

    P B Sood

    2010-01-01

    Full Text Available Most supernumerary impacted teeth are located in the anterior maxillary region. They are classified according to their form and location. Their presence may give rise to a variety of clinical problems. The detection of supernumerary teeth is best achieved by thorough clinical and radiographic examination. Their management should form part of a comprehensive treatment plan. This article presents an overview of the diagnostic problems associated with multiple supernumerary impacted teeth and includes a discussion of the classification, diagnosis, and management of this difficult clinical entity.

  17. [Case of suspected multiple sclerosis with transcallosal lesions involving the upper surface of the corpus callosum].

    Shirafuji, Toshihiko; Oya, Yasushi; Nakamura, Harumasa; Ogata, Katsuhisa; Ogawa, Masafumi; Kawai, Mitsuru

    2008-05-01

    A 26-year-old woman noticed gradually progressive, right lower leg weakness over a 1.5-month period. Neurological examination revealed right hemiparesis with slightly increased deep tendon reflexes, Babinski's sign on the right side, loss of position sense in the right leg, and slight loss of superficial sensation in the right toes. MR FLAIR images showed a high intensity area measuring 5 x 2 x 3 cm in the left frontal lobe, extending to the outer surface of the body of the corpus callosum and the adjacent right cingulate gyrus. Gadolinium enhancement was seen along the cortex and the outer surface of the body of the corpus callosum. CSF findings showed no pleocytosis, a protein content of 32 mg/dl, a sugar level of 85 mg/dl, and an IgG index of 0.46. The biopsy specimen obtained from the superior frontal gyrus showed perivascular cuffing of T-lymphocytes and some B-lymphocytes, as well as multiple small foci of demyelination. Starting on the second day of admission, the patient was treated with methylprednisolone pulse therapy (1,000 mg/day for 3 days); she was then switched to oral prednisolone (20 mg/day). Thereafter, the patient had two clinical relapses: one was due to a lesion in the dorsal part of the medulla oblongata associated with a disturbance of deep sensation in both hands, and the other was due to a lesion involving the right internal capsule, the globus pallidus, and the caudate nucleus associated with left facial nerve palsy. Visual evoked potentials suggested a demyelinating lesion in the right optic nerve. We suspected a diagnosis of multiple sclerosis based on the presence of more than two clinical episodes of neurological deficits with identifiable lesions on MRI. Multiple sclerosis should be considered in the differential diagnosis of lesions located in the outer part of the corpus callosum and transcallosal bilateral hemispheres on MRI, even though inner callosal lesions are common in multiple sclerosis.

  18. UV imaging of Multiple Unit Pellet System (MUPS) tablets: A case study of acetylsalicylic acid stability

    Novikova, Anna; Carstensen, Jens Michael; Rades, Thomas

    2017-01-01

    for estimation of the salicylic acid (SA) concentration as degradation product of ASA in the tablets were compared to the SA concentration measured by high performance liquid chromatography with a partial least squares regression resulting in an RMSEP of 4.86% and an R2 of 0.9812. The estimation of the SA......The applicability of multispectral ultraviolet (UV) imaging in combination with multivariate image analysis was investigated to monitor API degradation within multiple unit pellet system (MUPS) tablets during storage. For this purpose, acetylsalicylic acid (ASA) layered pellets were coated...

  19. How teams use indicators for quality improvement - a multiple-case study on the use of multiple indicators in multidisciplinary breast cancer teams.

    Gort, Marjan; Broekhuis, Manda; Regts, Gerdien

    2013-11-01

    A crucial issue in healthcare is how multidisciplinary teams can use indicators for quality improvement. Such teams have increasingly become the core component in both care delivery and in many quality improvement methods. This study aims to investigate the relationships between (1) team factors and the way multidisciplinary teams use indicators for quality improvement, and (2) both team and process factors and the intended results. An in-depth, multiple-case study was conducted in the Netherlands in 2008 involving four breast cancer teams using six structure, process and outcome indicators. The results indicated that the process of using indicators involves several stages and activities. Two teams applied a more intensive, active and interactive approach as they passed through these stages. These teams were perceived to have achieved good results through indicator use compared to the other two teams who applied a simple control approach. All teams experienced some difficulty in integrating the new formal control structure, i.e. measuring and managing performance, in their operational task, and in using their 'new' managerial task to decide as a team what and how to improve. Our findings indicate the presence of a network of relationships between team factors, the controllability and actionability of indicators, the indicator-use process, and the intended results. Copyright © 2013. Published by Elsevier Ltd.

  20. College Student Perceptions and Learning Points from the Formal University Judicial Process: A Multiple Case Study

    Lucas, Christopher M.

    2009-01-01

    For educators in the field of higher education and judicial affairs, issues are growing. Campus adjudicators must somehow maximize every opportunity for student education and development in the context of declining resources and increasing expectations of public accountability. Numbers of student misconduct cases, including matters of violence and…