WorldWideScience

Sample records for previously intractable questions

  1. Peace Education in Societies Involved in Intractable Conflicts: Direct and Indirect Models

    Science.gov (United States)

    Bar-Tal, Daniel; Rosen, Yigal

    2009-01-01

    The present article deals with the crucial question: Can peace education facilitate change in the sociopsychological infrastructure that feeds continued intractable conflict and then how the change can be carried? Intractable conflicts still rage in various parts of the globe, and they not only cause local misery and suffering but also threaten…

  2. Political Socialization of Young Children in Intractable Conflicts: Conception and Evidence

    Science.gov (United States)

    Bar-Tal, Daniel; Diamond, Aurel Harrison; Nasie, Meytal

    2017-01-01

    This article examines the political socialization of young children who live under conditions of intractable conflict. We present four premises: First, we argue that, within the context of intractable conflict, political socialization begins earlier and faster than previously suspected, and is evident among young children. Second, we propose that…

  3. Intractable vomiting caused by vertebral artery compressing the medulla: A case report

    Directory of Open Access Journals (Sweden)

    Lauren Gorton

    2015-01-01

    Full Text Available Vertebral artery compressing the medulla and causing intractable vomiting has only been reported once previously. We report a case of a 69-year-old woman with intractable nausea and vomiting causing a 50 pound weight loss and who failed medical management and whose symptoms were completely reversed following microvascular decompression (MVD.

  4. An unusual cause of intractable heel pain.

    Science.gov (United States)

    Ghani, Samuel; Fazal, Muhammad Ali

    2011-01-01

    We report a case of severe heel pain that did not respond to noninvasive measures. Magnetic resonance imaging scans revealed a soft tissue mass that after complete surgical excision was found to be an epidermal cyst. The patient experienced full resolution of the symptoms after excision of the epidermal cyst. To our knowledge, intractable heel pain due to an epidermal cyst is rare. We were unable to identify a previous publication describing the presence of an epidermal cyst localized to the heel without a history of previous trauma. From our experience with the present case, we believe that clinicians should consider the possibility of an epidermal inclusion cyst and should have a low threshold for obtaining magnetic resonance imaging scans, in particular, before the initiation of invasive treatment, in the case of intractable heel pain. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Predictors of intractable childhood epilepsy

    International Nuclear Information System (INIS)

    Malik, M.A.; Ahmed, T.M.

    2008-01-01

    To determine the prognosis of seizures in epileptic children and identify early predictors of intractable childhood epilepsy. All children (aged 1 month to 16 years) with idiopathic or cryptogenic epilepsy who were treated and followed at the centre during the study period were included. The patients who had marked seizures even after two years of adequate treatment were labeled as intractable epileptics (cases). Children who had no seizure for more than one year at last follow-up visit were the controls. Adequate treatment was described as using at least three anti-epileptic agents either alone or in combination with proper compliance and dosage. Records of these patients were reviewed to identify the variables that may be associated with seizure intractability. Of 442 epileptic children, 325 (74%) intractable and 117 (26%) control epileptics were included in the study. Male gender (OR=3.92), seizures onset in infancy >10 seizures before starting treatment (OR=3.76), myoclonic seizures (OR=1.37), neonatal seizures (OR=3.69), abnormal EEG (OR=7.28) and cryptogenic epilepsy (OR=9.69) and head trauma (OR=4.07) were the factors associated with intractable epilepsy. Seizure onset between 5-7 years of age, idiopathic epilepsy, and absence seizures were associated with favourable prognosis in childhood epilepsy. Intractable childhood epilepsy is expected if certain risk factors such as type, age of onset, gender and cause of epilepsy are found. Early referral of such patients to the specialized centres is recommended for prompt and optimal management. (author)

  6. Intractable Seizures and Rehabilitation in Ciguatera Poisoning.

    Science.gov (United States)

    Derian, Armen; Khurana, Seema; Rothenberg, Joshua; Plumlee, Charles

    2017-05-01

    Ciguatera fish poisoning is the most frequently reported seafood toxin illness associated with the ingestion of contaminated tropical fish. Diagnosis relies on a history of recent tropical fish ingestion and subsequent development of gastrointestinal, cardiovascular, and neurological symptoms. Ciguatera poisoning usually has a self-limited time course, and its management involves symptomatic control and supportive care. This case report presents an uncommon case of ciguatera poisoning with prolonged intractable seizures refractory to standard antiseizure medications. The patient also had significant functional decline that responded to rigorous inpatient rehabilitation not previously described in literature.

  7. Assessment of the Density of Suppression to Identify Risk of Intractable Diplopia in the United Kingdom.

    Science.gov (United States)

    Newsham, David; O'Connor, Anna R

    2016-06-01

    Occlusion used to treat amblyopia towards the end of the developmental component of the critical period gives a risk of inducing intractable diplopia. In the United Kingdom, the density of suppression is assessed via the Sbisa/Bagolini filter bar, but there is very little research evidence to guide clinical practice or interpretation of the tests used. The aims of this study were to determine current practice and estimate the incidence of intractable diplopia following amblyopia treatment. Current practice and incidence of intractable diplopia following amblyopia were determined via a questionnaire distributed to head orthoptists in every eye department in the United Kingdom. The questionnaire explored testing and test conditions, interpretation of the test results, and cases of intractable diplopia over the last 5 years. There was considerable variation in clinical practice of the measurement of the density of suppression and interpretation of the results to guide the treatment of amblyopia. The minimum age of patients taking the test ranged from 2 to 8 years and the minimum filter considered still safe to continue treatment ranged from 4 to 17. It is estimated there were 24 cases of intractable diplopia over the last 5 years. The issue of intractable diplopia and amblyopia treatment is likely to become increasingly important as there appears to be greater plasticity and scope to treat amblyopia in teenagers and adults than was previously thought. Lack of knowledge of how to evaluate the risk may lead to more cases of intractable diplopia or alternatively treatment being withheld unnecessarily.

  8. Increased self-transcendence in patients with intractable diseases.

    Science.gov (United States)

    Iwamoto, Rie; Yamawaki, Niwako; Sato, Takeshi

    2011-12-01

    Patients with intractable disease require long-term treatment and experience repeated bouts of progressive symptoms and resolutions, which cause them severe suffering. The aim of this study was to elucidate the concepts of self-transcendence and subjective well-being in patients with intractable disease. Forty-four patients with intractable disease (men/women: 22/22) participated. The diseases of the participants were classified into five systems: (i) neural/muscle system; (ii) digestive system; (iii) immunity/blood system; (iv) visual system; and (v) bone/joint system. The controls were 1854 healthy individuals (men/women: 935/869). Participants completed the Self-Transcendence Scale (STS) and the Japanese version of the World Health Organization-Subjective Inventory. The Japanese version of the Mini-International Neuropsychiatric Interview was also used for the intractable disease group. Analysis of covariance found a significant increase in STS score among the intractable disease group (P self-transcendence. The results also showed that there was a strong correlation between self-transcendence and respondents' subjective well-being. Our results suggest that patients with life-changing intractable disease can have a high level of self-transcendence, which may lead them to regain mental well-being, and increase their psychological health even in situations that cause physical and mental suffering. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

  9. Trans-thoracic peri-oesophageal adjustable band for intractable reflux

    OpenAIRE

    Mark Simon X. Kusel; Jeremy T.H. Tan

    2015-01-01

    Introduction: Gastric bands for obesity have the beneficial side-effect of improving reflux symptoms in patients; however placement of these on patients with multiple prior abdominal surgeries can be challenging. Presentation of case: We present two cases where gastric bands were placed in a peri-oesophageal position via a left thoracotomy due to multiple previous abdominal surgeries in an attempt to treat their intractable reflux. Discussion: At three month follow up, both patients hav...

  10. Diagnosis and treatment procedure for intractable liver ascites

    Directory of Open Access Journals (Sweden)

    FAN Zhidong

    2015-03-01

    Full Text Available Ascites is a common complication of liver cirrhosis. Liver ascites may occur repeatedly, which increases the therapeutic difficulty. This paper reviews the definition of intractable liver ascites, general treatment measures, and current treatment of common complications such as spontaneous bacterial peritonitis and hepatorenal syndrome, as well as the advances in conventional, unconventional, and surgical treatment of intractable liver ascites. It is pointed out that abdominocentesis for excessive drainage and active preparation for liver transplantation are the preferred approach to the treatment of intractable liver ascites.

  11. Intractable hiccup as the presenting symptom of cavernous hemangioma in the medulla oblongata: a case report and literature review.

    Science.gov (United States)

    Lee, Kyung-Hwa; Moon, Kyung-Sub; Jung, Min-Young; Jung, Shin

    2014-06-01

    A case of intractable hiccup developed by cavernous hemangioma in the medulla oblongata is reported. There have been only five previously reported cases of medullary cavernoma that triggered intractable hiccup. The patient was a 28-year-old man who was presented with intractable hiccup for 15 days. It developed suddenly, then aggravated progressively and did not respond to any types of medication. On magnetic resonance images, a well-demarcated and non-enhancing mass with hemorrhagic changes was noted in the left medulla oblongata. Intraoperative findings showed that the lesion was fully embedded within the brain stem and pathology confirmed the diagnosis of cavernous hemangioma. The hiccup resolved completely after the operation. Based on the presumption that the medullary cavernoma may trigger intractable hiccup by displacing or compression the hiccup arc of the dorsolateral medulla, surgical excision can eliminate the symptoms, even in the case totally buried in brainstem.

  12. Rethinking Intractable Conflict: The Perspective of Dynamical Systems

    Science.gov (United States)

    Vallacher, Robin R.; Coleman, Peter T.; Nowak, Andrzej; Bui-Wrzosinska, Lan

    2010-01-01

    Intractable conflicts are demoralizing. Beyond destabilizing the families, communities, or international regions in which they occur, they tend to perpetuate the very conditions of misery and hate that contributed to them in the first place. Although the common factors and processes associated with intractable conflicts have been identified…

  13. Sequencing intractable DNA to close microbial genomes.

    Directory of Open Access Journals (Sweden)

    Richard A Hurt

    Full Text Available Advancement in high throughput DNA sequencing technologies has supported a rapid proliferation of microbial genome sequencing projects, providing the genetic blueprint for in-depth studies. Oftentimes, difficult to sequence regions in microbial genomes are ruled "intractable" resulting in a growing number of genomes with sequence gaps deposited in databases. A procedure was developed to sequence such problematic regions in the "non-contiguous finished" Desulfovibrio desulfuricans ND132 genome (6 intractable gaps and the Desulfovibrio africanus genome (1 intractable gap. The polynucleotides surrounding each gap formed GC rich secondary structures making the regions refractory to amplification and sequencing. Strand-displacing DNA polymerases used in concert with a novel ramped PCR extension cycle supported amplification and closure of all gap regions in both genomes. The developed procedures support accurate gene annotation, and provide a step-wise method that reduces the effort required for genome finishing.

  14. Sequencing Intractable DNA to Close Microbial Genomes

    Energy Technology Data Exchange (ETDEWEB)

    Hurt, Jr., Richard Ashley [ORNL; Brown, Steven D [ORNL; Podar, Mircea [ORNL; Palumbo, Anthony Vito [ORNL; Elias, Dwayne A [ORNL

    2012-01-01

    Advancement in high throughput DNA sequencing technologies has supported a rapid proliferation of microbial genome sequencing projects, providing the genetic blueprint for for in-depth studies. Oftentimes, difficult to sequence regions in microbial genomes are ruled intractable resulting in a growing number of genomes with sequence gaps deposited in databases. A procedure was developed to sequence such difficult regions in the non-contiguous finished Desulfovibrio desulfuricans ND132 genome (6 intractable gaps) and the Desulfovibrio africanus genome (1 intractable gap). The polynucleotides surrounding each gap formed GC rich secondary structures making the regions refractory to amplification and sequencing. Strand-displacing DNA polymerases used in concert with a novel ramped PCR extension cycle supported amplification and closure of all gap regions in both genomes. These developed procedures support accurate gene annotation, and provide a step-wise method that reduces the effort required for genome finishing.

  15. A randomized, double-blind, placebo-controlled clinical trial of the efficacy of treatment with zinc in children with intractable epilepsy

    Science.gov (United States)

    Saad, Khaled; El-Houfey, Amira A.; Abd El-Hamed, Mohamed A.; El-Asheer, Osama M.; Al-Atram, Abdulrahman A.; Tawfeek, Mostafa S. K.

    2015-01-01

    Summary This study was conducted to assess the efficacy of oral zinc supplementation in children with intractable epilepsy. Forty-five children aged between three and 12 years and diagnosed with idiopathic intractable epilepsy at Assiut University Hospital, Assiut, Egypt were recruited. The patients were randomly allocated to two groups: the intervention group received oral zinc supplementation (1 mg/kg/day) while the placebo group received placebo, each for six months. The parents of each child filled in a detailed questionnaire that covered demographic characteristics, type of seizures, frequency, duration of seizures, previous hospital admissions, postictal phenomena and the occurrence of status epilepticus. The primary outcome (frequency of seizures) was compared between the two groups. Zinc supplementation resulted in a significant reduction of seizure frequency in 31% of the treated children. Zinc is an important trace element. Our results suggest that it has mildly beneficial effects in children with intractable epilepsy. We recommend further investigation of oral zinc supplementation as an adjunctive therapy for managing intractable epilepsy in children. Zinc therapy may be an option in treatment protocols for intractable epilepsy in the near future. PMID:26415035

  16. Age decreases quality of life in adolescents with intractable epilepsy

    Directory of Open Access Journals (Sweden)

    Prastiya Indra Gunawan

    2015-12-01

    Intractable epileptic adolescents have higher scores for physical functioning and health perception, but lower scores for social stigmatization. Social support has extremely low scores. Increasing age decreases quality of life in adolescents with intractable epilepsy.

  17. Prospective study of POLG mutations presenting in children with intractable epilepsy: prevalence and clinical features.

    Science.gov (United States)

    Uusimaa, Johanna; Gowda, Vasantha; McShane, Anthony; Smith, Conrad; Evans, Julie; Shrier, Annie; Narasimhan, Manisha; O'Rourke, Anthony; Rajabally, Yusuf; Hedderly, Tammy; Cowan, Frances; Fratter, Carl; Poulton, Joanna

    2013-06-01

    To assess the frequency and clinical features of childhood-onset intractable epilepsy caused by the most common mutations in the POLG gene, which encodes the catalytic subunit of mitochondrial DNA polymerase gamma. Children presenting with nonsyndromic intractable epilepsy of unknown etiology but without documented liver dysfunction at presentation were eligible for this prospective, population-based study. Blood samples were analyzed for the three most common POLG mutations. If any of the three tested mutations were found, all the exons and the exon-intron boundaries of the POLG gene were sequenced. In addition, we retrospectively reviewed the notes of patients presenting with intractable epilepsy in which we had found POLG mutations. All available clinical data were collected by questionnaire and by reviewing the medical records. We analyzed 213 blood DNA samples from patients fulfilling the inclusion criteria of the prospective study. Among these, five patients (2.3%) were found with one of the three common POLG mutations as homozygous or compound heterozygous states. In addition, three patients were retrospectively identified. Seven of the eight patients had either raised cerebrospinal fluid (CSF) lactate (n = 3) or brain magnetic resonance imaging (MRI) changes (n = 4) at presentation with intractable epilepsy. Three patients later developed liver dysfunction, progressing to fatal liver failure in two without previous treatment with sodium valproate (VPA). Furthermore, it is worth mentioning that one patient presented first with an autism spectrum disorder before seizures emerged. Mutations in POLG are an important cause of early and juvenile onset nonsyndromic intractable epilepsy with highly variable associated manifestations including autistic features. This study emphasizes that genetic testing for POLG mutations in patients with nonsyndromic intractable epilepsies is very important for clinical diagnostics, genetic counseling, and treatment decisions

  18. Application of transcatheter arterial embolization in the intractable epistaxis

    International Nuclear Information System (INIS)

    Huang Zhaodong; Li Mingjun; Zhang Chuanwen

    2005-01-01

    Objective: To evaluate the value of transcatheter arterial embolization (TAE) in the treatment of intractable epistaxis. Methods: TAE using gel form or polyvinyl alcohol (PVA) particles of forty-one patients with intractable epistaxis were undertaken by the femoral artery approach, through selective catheterization of involved maxillary artery or the bleeding arteries for the stoppage of bleeding. Results: Of the forty-one patient, 39 cases were cured by once TAE and the other 2 with recurrent bleeding on the next day after the TAE, to whom a second interventional treatment full filled the requirement. Conclusions: Transcatheter arterial embolization is a simple, safe and effective treatment for the intractable epistaxis. (authors)

  19. Therapeutic efficacy of uterine arterial embolization for intractable uterine hemorrhage

    International Nuclear Information System (INIS)

    Liu Lang; Lu Lianwei; Ke Mengjia; Zhao Ru'en; Zeng Shaolan

    2010-01-01

    Objective: To evaluate the therapeutic efficacy of uterine arterial embolization (UAE) for intractable uterine hemorrhage. Methods: 16 patients with intractable uterine hemorrhage underwent bilateral UAE after failed conventional conservative treatment. Results: Uterine hemorrhage ceased within 12 hours in 15 patients (93.8%) after bilateral super-selective UAE. Internal iliac artery embolization was performed on one patient (6.2%) and hysterectomy was eventually carried out because of recurrent hemorrhage. Conclusion: UAE is a rapid and effective treatment method obviating hysterectomy for intractable uterine hemorrhage. (authors)

  20. Intractable seizures after a lengthy remission in childhood-onset epilepsy.

    Science.gov (United States)

    Camfield, Peter R; Camfield, Carol S

    2017-12-01

    To establish the risk of subsequent intractable epilepsy after ≥2, ≥5, and ≥10 years of remission in childhood-onset epilepsy. From the Nova Scotia childhood-onset epilepsy population-based cohort patients with all types of epilepsy were selected with ≥20 years follow-up from seizure onset (incidence cases). Children with childhood absence epilepsy were excluded. The rate of subsequent intractable epilepsy was then studied for patients with ≥5 years remission on or off AED treatment and compared with the rate for those with ≥2 and ≥10 years of remission. Three hundred eighty-eight eligible patients had ≥20 years follow-up (average 27.7 ± (standard deviation) 4 years) until they were an average of 34 ± 6.5 years of age. Overall, 297 (77%) had a period of ≥5 years of seizure freedom (average 21.2 ± 8 years), with 90% of these remissions continuing to the end of follow-up. Seizures recurred in 31 (10%) and were intractable in 7 (2%). For the 332 with a remission of ≥2 years seizure-free, 6.9% subsequently developed intractable epilepsy (p = 0.001). For the 260 with ≥10 years remission, 0.78% subsequently developed intractable epilepsy (p = 0.25 compared with ≥5 years remission). Even after ≥5 or ≥10 years of seizure freedom, childhood-onset epilepsy may reappear and be intractable. The risk is fortunately small, but for most patients it is not possible to guarantee a permanent remission. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  1. Management of intractable spontaneous epistaxis

    Science.gov (United States)

    Rudmik, Luke

    2012-01-01

    Background: Epistaxis is a common otolaryngology emergency and is often controlled with first-line interventions such as cautery, hemostatic agents, or anterior nasal packing. A subset of patients will continue to bleed and require more aggressive therapy. Methods: Intractable spontaneous epistaxis was traditionally managed with posterior nasal packing and prolonged hospital admission. In an effort to reduce patient morbidity and shorten hospital stay, surgical and endovascular techniques have gained popularity. A literature review was conducted. Results: Transnasal endoscopic sphenopalatine artery ligation and arterial embolization provide excellent control rates but the decision to choose one over the other can be challenging. The role of transnasal endoscopic anterior ethmoid artery ligation is unclear but may be considered in certain cases when bleeding localizes to the ethmoid region. Conclusion: This article will focus on the management of intractable spontaneous epistaxis and discuss the role of endoscopic arterial ligation and embolization as it pertains to this challenging clinical scenario. PMID:22391084

  2. Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy

    Science.gov (United States)

    Boling, Warren W.

    2018-01-01

    Surgery of temporal lobe epilepsy is the best opportunity for seizure freedom in medically intractable patients. The surgical approach has evolved to recognize the paramount importance of the mesial temporal structures in the majority of patients with temporal lobe epilepsy who have a seizure origin in the mesial temporal structures. For those individuals with medically intractable mesial temporal lobe epilepsy, a selective amygdalohippocampectomy surgery can be done that provides an excellent opportunity for seizure freedom and limits the resection to temporal lobe structures primarily involved in seizure genesis. PMID:29461485

  3. Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy

    Directory of Open Access Journals (Sweden)

    Warren W. Boling

    2018-02-01

    Full Text Available Surgery of temporal lobe epilepsy is the best opportunity for seizure freedom in medically intractable patients. The surgical approach has evolved to recognize the paramount importance of the mesial temporal structures in the majority of patients with temporal lobe epilepsy who have a seizure origin in the mesial temporal structures. For those individuals with medically intractable mesial temporal lobe epilepsy, a selective amygdalohippocampectomy surgery can be done that provides an excellent opportunity for seizure freedom and limits the resection to temporal lobe structures primarily involved in seizure genesis.

  4. Renal Embolization and Urothelial Sclerotherapy for Recurrent Obstructive Urosepsis and Intractable Haematuria from Upper Tract Urothelial Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Nicholas, E-mail: nibrown@cantab.net [St Vincent’s Hospital, Department of Interventional Radiology (Australia); Olayos, Elizabeth; Elmer, Sandra; Wong, Lih-Ming [St Vincent’s Hospital, Department of Urology (Australia); Brooks, Duncan M; Jhamb, Ashu [St Vincent’s Hospital, Department of Interventional Radiology (Australia)

    2016-03-15

    Management of intractable haematuria and obstructive urosepsis from upper tract urothelial carcinoma can be problematic in patients not suitable for surgery, chemotherapy or radiotherapy. Interventional radiology techniques provide alternative approaches in this setting, such as complete kidney embolization to cease urine output, percutaneous nephrostomy, antegrade injection of sclerotherapy agents and sterilisation of the upper collecting system. Related approaches have been successfully employed to sclerose renal cysts, lymphoceles, chyluria and intractable lower tract haemorrhage. No reports of percutaneous, antegrade sclerotherapy in the upper urinary tract have previously been published. We present a case of recurrent haematuria and obstructive urosepsis caused by invasive upper tract urothelial carcinoma in a non-operative patient, which was treated with renal embolisation and percutaneous upper tract urothelial sclerotherapy.

  5. Growth hormone used to control intractable bleeding caused by radiation-induced gastritis.

    Science.gov (United States)

    Zhang, Liang; Xia, Wen-Jie; Zhang, Zheng-Sen; Lu, Xin-Liang

    2015-08-21

    Intractable bleeding caused by radiation-induced gastritis is rare. We describe a 69-year-old man with intractable hemorrhagic gastritis induced by postoperative radiotherapy for the treatment of esophageal carcinoma. Although anti-secretory therapy with or without octreotide was initiated for hemostasis over three months, melena still occurred off and on, and the patient required blood transfusions to maintain stable hemoglobin. Finally growth hormone was used in the treatment of hemorrhage for two weeks, and hemostasis was successfully achieved. This is the first report that growth hormone has been used to control intractable bleeding caused by radiation-induced gastritis.

  6. Noninvasive treatment alternative for intractable startle epilepsy

    Directory of Open Access Journals (Sweden)

    Sylvia Klinkenberg

    2014-01-01

    Full Text Available We describe a treatment alternative for intractable, startle-provoked, epileptic seizures in four children aged between 8 and 14. Three of the four children had symptomatic localization-related epilepsy. They all suffered from intractable epilepsy precipitated by sudden sounds. The fact that seizures tended to occur with high frequency – more than one seizure a day – had a clear impact on daily life. Clinical seizure pattern demonstrated asymmetric tonic posturing in all four children. Three children experienced several seizure types including focal seizure onset. All children had focal neurological signs or learning disabilities or a combination of both. Our noninvasive treatment method using psychoeducational counseling and sound generators was applied in four children, resulting in a seizure frequency reduction of ≥50% in two of them.

  7. Motive attribution asymmetry for love vs. hate drives intractable conflict.

    Science.gov (United States)

    Waytz, Adam; Young, Liane L; Ginges, Jeremy

    2014-11-04

    Five studies across cultures involving 661 American Democrats and Republicans, 995 Israelis, and 1,266 Palestinians provide previously unidentified evidence of a fundamental bias, what we term the "motive attribution asymmetry," driving seemingly intractable human conflict. These studies show that in political and ethnoreligious intergroup conflict, adversaries tend to attribute their own group's aggression to ingroup love more than outgroup hate and to attribute their outgroup's aggression to outgroup hate more than ingroup love. Study 1 demonstrates that American Democrats and Republicans attribute their own party's involvement in conflict to ingroup love more than outgroup hate but attribute the opposing party's involvement to outgroup hate more than ingroup love. Studies 2 and 3 demonstrate this biased attributional pattern for Israelis and Palestinians evaluating their own group and the opposing group's involvement in the current regional conflict. Study 4 demonstrates in an Israeli population that this bias increases beliefs and intentions associated with conflict intractability toward Palestinians. Finally, study 5 demonstrates, in the context of American political conflict, that offering Democrats and Republicans financial incentives for accuracy in evaluating the opposing party can mitigate this bias and its consequences. Although people find it difficult to explain their adversaries' actions in terms of love and affiliation, we suggest that recognizing this attributional bias and how to reduce it can contribute to reducing human conflict on a global scale.

  8. Evaluation of emergency transcatheter arterial embolization in intractable postpartum hemorrhage

    International Nuclear Information System (INIS)

    Qi Weihong; Wang Song; Zhan Ying

    2008-01-01

    Objective: To assess the efficacy and safety of emergency transcatheter arterial embolization in the management of intractable postpartum hemorrhage. Methods: Twenty-five patients with intractable postpartum hemorrhage were undertaken superselective catheterization into the bilateral internal iliac arteries or uterial arteries to find the causes and sites of bleeding through DSA and then followed by arterial embolization with gelfoam particles. Result: All of the 25 patients with obstetrical bleeding were successfully controlled by TAE, the procedure lasted for 25-60 min, (mean 42.5 ± 4.6 min); with both catheterization and bleeding halt successful rates of 100%. Comparison of hemoglobin and heartbeat before and after the procedure showed significance (t=29.49, P<0.01; t=16.51, P<0.01). The uterus showed reintegration on time and menstruation resumed in all patients. Conclusions: Emergency arterial embolization is a safe and effective means for control of intractable postpartum hemorrhage, providing less trauma and no severe complications, especially as an unique management for fetal postpartum hemorrhage. (authors)

  9. Motive attribution asymmetry for love vs. hate drives intractable conflict

    Science.gov (United States)

    Waytz, Adam; Young, Liane L.; Ginges, Jeremy

    2014-01-01

    Five studies across cultures involving 661 American Democrats and Republicans, 995 Israelis, and 1,266 Palestinians provide previously unidentified evidence of a fundamental bias, what we term the “motive attribution asymmetry,” driving seemingly intractable human conflict. These studies show that in political and ethnoreligious intergroup conflict, adversaries tend to attribute their own group’s aggression to ingroup love more than outgroup hate and to attribute their outgroup’s aggression to outgroup hate more than ingroup love. Study 1 demonstrates that American Democrats and Republicans attribute their own party’s involvement in conflict to ingroup love more than outgroup hate but attribute the opposing party’s involvement to outgroup hate more than ingroup love. Studies 2 and 3 demonstrate this biased attributional pattern for Israelis and Palestinians evaluating their own group and the opposing group’s involvement in the current regional conflict. Study 4 demonstrates in an Israeli population that this bias increases beliefs and intentions associated with conflict intractability toward Palestinians. Finally, study 5 demonstrates, in the context of American political conflict, that offering Democrats and Republicans financial incentives for accuracy in evaluating the opposing party can mitigate this bias and its consequences. Although people find it difficult to explain their adversaries’ actions in terms of love and affiliation, we suggest that recognizing this attributional bias and how to reduce it can contribute to reducing human conflict on a global scale. PMID:25331879

  10. New population-based exome data question the pathogenicity of some genetic variants previously associated with Marfan syndrome

    DEFF Research Database (Denmark)

    Yang, Ren-Qiang; Jabbari, Javad; Cheng, Xiao-Shu

    2014-01-01

    BACKGROUND: Marfan syndrome (MFS) is a rare autosomal dominantly inherited connective tissue disorder with an estimated prevalence of 1:5,000. More than 1000 variants have been previously reported to be associated with MFS. However, the disease-causing effect of these variants may be questionable...

  11. Recurrent intractable hiccups treated by cervical phrenic nerve block under electromyography: report of a case.

    Science.gov (United States)

    Sa, Young Jo; Song, Dae Heon; Kim, Jae Jun; Kim, Young Du; Kim, Chi Kyung; Moon, Seok Whan

    2015-11-01

    Intractable or persistent hiccups require intensive or invasive treatments. The use of a phrenic nerve block or destructive treatment for intractable hiccups has been reported to be a useful and discrete method that might be valuable to patients with this distressing problem and for whom diverse management efforts have failed. We herein report a successful treatment using a removable and adjustable ligature for the phrenic nerve in a patient with recurrent and intractable hiccups, which was employed under the guidance of electromyography.

  12. Peripheral neurostimulation for control of intractable occipital neuralgia.

    Science.gov (United States)

    Weiner, R L; Reed, K L

    1999-07-01

    Objective. To present a novel approach for treatment of intractable occipital neuralgia using percutaneous peripheral nerve electrostimulation techniques. Methods. Thirteen patients underwent 17 implant procedures for medically refractory occipital neuralgia. A subcutaneous electrode placed transversely at the level of C1 across the base of the occipital nerve trunk produced paresthesias and pain relief covering the regions of occipital nerve pain Results. With follow-up ranging from 1-½ to 6 years, 12 patients continue to report good to excellent response with greater than 50% pain control and requiring little or no additional medications. The 13th patient (first in the series) was subsequently explanted following symptom resolution. Conclusions. In patients with medically intractable occipital neuralgia, peripheral nerve electrostimulation subcutaneously at the level of C1 appears to be a reasonable alternative to more invasive surgical procedures following failure of more conservative therapies.

  13. Secondary Voice Restoration After Laryngotracheal Separation (LTS) for Dysphagia with Intractable Aspiration.

    Science.gov (United States)

    Bonte, Katrien; Huvenne, Wouter; De Loof, Marie; Deron, Philippe; Viaene, Annick; Duprez, Fréderic; Vermeersch, Hubert

    2015-12-01

    Intractable aspiration is a serious, often life-threatening condition due to its potential impact on pulmonary function. Aspiration requires therapeutic measures, starting with conservative management but often necessitating surgical treatment. The basic surgical principle is to separate the alimentary and respiratory tracts through a variety of procedures which, unfortunately, nearly all result in the loss of phonation, with the exception of total laryngectomy (TL) which includes the placement of an indwelling voice prosthesis. In this study, we present a modified laryngotracheal separation (LTS) technique that, we believe, offers multiple advantages compared to standard TL. After reviewing the medical records of 35 patients with intractable aspiration who have undergone LTS, we describe the surgical technique and present the postoperative result. In a second surgical procedure about two months following LTS, we aimed to achieve voice restoration by placement of an indwelling voice prosthesis. Intractable aspiration was successfully treated in all patients. Placement of an indwelling voice prosthesis during a second operation was successful in 15 patients, representing the largest reported cohort thus far. LTS is a reliable surgical technique to treat intractable aspiration, with restoration of oral intake, thereby improving the general condition and quality of life of these unfortunate patients. Furthermore, voice restoration can be achieved in selected patients, by placement of a voice prosthesis.

  14. [Disseminated metastatic tumor at dorsal surface of medulla oblongata presenting intractable hiccups. A case report].

    Science.gov (United States)

    Arishima, Hidetaka; Kikuta, Ken-ichirou

    2011-04-01

    We report the case of disseminated metastatic tumor at dorsal surface of medulla oblongata presenting intractable hiccups. A 73-year-old man has a history of for metastatic lung tumor of the left tempral lobe. Although 3 surgeries and 4 radiotherapies were performed in the last 8 years, residual tumor grew slowly. He presented with intractable hiccups. His hiccups continued for 30 minutes, sometimes for 3 hours with obstruction of eating. Contrast-enhanced Magnetic resonance (MR) imaging demonstrated the dissemination of metastatic lung tumor at dorsal surface of medulla oblongata and ventral surface of midbrain. Some literatures reported the patients with intractable hiccups caused by dorsal medullary lesions. Therefore, we thought that the small disseminated tumor at dorsal surface of medulla oblongata caused the hiccups. Evaluation of dorsal medullay area by MR imaging is important to reveal the cause of intractable hiccups.

  15. "To Obey or Disobey? This Is the Question" NDE: Nonviolent Disobedience Education in Israeli and US Civics Textbooks (1980-2012)

    Science.gov (United States)

    Firer, Ruth

    2013-01-01

    "To Obey or Disobey" should be a life question for all free people, but for the Israelis, who are in intractable war with their neighbors while facing constant rifts among themselves, it is a concrete problem they have to face every day. Therefore, the research question posed by this article is: How is obedience of laws or military…

  16. Surgery for Intractable Temporal Lobe Epilepsy in Young Children

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2008-01-01

    Full Text Available The results of temporal resection for medically intractable epilepsy in 20 children less than age 5 years with at least 2 years follow-up are reported from Miami Children's Hospital, Florida.

  17. Unique and shared areas of cognitive function in children with intractable frontal or temporal lobe epilepsy.

    Science.gov (United States)

    Law, Nicole; Widjaja, Elysa; Smith, Mary Lou

    2018-03-01

    Previous findings have been mixed in terms of identifying a distinct pattern of neuropsychological deficits in children with frontal lobe epilepsy (FLE) and in those with temporal lobe epilepsy (TLE). The current study investigated the neuropsychological similarities and differences across these two pediatric medically intractable localization-related epilepsies. Thirty-eight children with FLE, 20 children with TLE, and 40 healthy children (HC) participated in this study. A comprehensive battery of standardized tests assessed five neuropsychological domains including intelligence, language, memory, executive function, and motor function. A principal component analysis (PCA) was used to distill our neuropsychological measures into latent components to compare between groups. Principal component analysis extracted 5 latent components: executive function (F1), verbal semantics (F2), motor (F3), nonverbal cognition/impulsivity (F4), and verbal cognition/attention (F5). The group with FLE differed from the HC group on F1, F2, F4, and F5, and had worse performance than the group with TLE on F1; the group with TLE had lower performance relative to the HC group on F2. Our findings suggest that, in comparison with neurotypically developing children, children with medically intractable FLE have more widespread neuropsychological impairments than do children with TLE. The differences between the two patient groups were greatest for the factor score most clearly related to executive function. The results provide mixed support for the concept of specificity in neuropsychological dysfunction among different subtypes of localization-related medically intractable childhood epilepsies. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Young Children in Intractable Conflicts: The Israeli Case.

    Science.gov (United States)

    Nasie, Meytal; Diamond, Aurel Harrison; Bar-Tal, Daniel

    2015-10-08

    The article examines the political socialization of young Jewish-Israeli children who live under the Israeli-Palestinian intractable conflict. It proposes arguments and presents empirical evidence to suggest that the way in which political socialization of young children happens in this context contributes to the development of conflict-supporting narratives of ethos of conflict and collective memory by the youngest generation. As a result, the conflict solidifies adherence to these narratives in adulthood, thereby serving as a major obstacle to the processes of peace-making and peace-building. Specifically, as evidence for showing how the political socialization works in Israel, a series of studies conducted in Israeli kindergartens and elementary schools are presented. These studies recount the contents acquired by young children, as well as contents delivered by teachers, related to the Israeli-Palestinian conflict. This indicates the serious consequences of acquiring conflict-supporting narratives at an early age in societies involved in intractable conflict. © 2015 by the Society for Personality and Social Psychology, Inc.

  19. Embolization of carotid artery branch in intractable epistaxis

    International Nuclear Information System (INIS)

    Kordecki, K.; Janica, J.; Lewszuk, A.; Lebkowska, U.; Ustymowicz, A.

    2008-01-01

    Long-term intractable epistaxis results in a series of complications including demise. Unprofessional therapy may account for severe topical and systemic complications. The authors assessed the efficacy and safety of embolization treatment of intractable epistaxis with the use of available embolizing materials. Embolization was performed in 58 patients (39 males aged 24-48 and 19 females aged 26-44) admitted to the ENT Department, Medical University of Bialystok in years 2000 -2005. 65 embolization procedures, including reembolizations, were performed. In 41 procedures (63%) a sponge was used, in 14 (21.6%) PVA, in 10 (15.4%) PVA and coils. In 9 patients, bleeding of a lesser intensity recurred within early hours following the procedure - 84.5% embolization success. On longer follow-up, embolization success was assessed to be 100%. Embolization with the use of proper embolisation materials is an efficient method of arresting spontaneous and posttraumatic epistaxis and may be a safe treatment procedure when performed by experienced medical personnel. (author)

  20. Modified Atkins diet vs classic ketogenic formula in intractable epilepsy.

    Science.gov (United States)

    El-Rashidy, O F; Nassar, M F; Abdel-Hamid, I A; Shatla, R H; Abdel-Hamid, M H; Gabr, S S; Mohamed, S G; El-Sayed, W S; Shaaban, S Y

    2013-12-01

    The study was designed to evaluate the efficacy, safety, and tolerability of the ketogenic diet (KD) whether classic 4:1 formula or the modified Atkins diet (MAD) in intractable childhood epilepsy. Anthropometric measurements and serum lipid profile were measured upon enrollment and after 3 and 6 months in 40 patients with symptomatic intractable epilepsy. Fifteen were given MAD diet, ten were kept on classic 4:1 ketogenic liquid formula, and the rest were allowed to eat as desired. The liquid ketogenic formula group showed significantly higher body mass index compared with those who did not receive KD after 6 months. The lipid profile of KD patients was within normal limits for age and sex during the study period. The rate of change of frequency and severity of seizures showed best improvement in ketogenic liquid formula patients followed by the MAD group than the patients on anti-epileptic medications alone. The KD whether classic 4:1 or MAD is a tolerable, safe, and effective adjuvant therapy for intractable symptomatic childhood epilepsy with limited adverse effects on the growth parameters and accepted changes in the lipid profile. The liquid ketogenic formula patients showed better growth pattern and significantly more seizure control. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Characterizing colonic motility in children with chronic intractable constipation: a look beyond high-amplitude propagating sequences

    NARCIS (Netherlands)

    Wessel, S.; Koppen, I. J. N.; Wiklendt, L.; Costa, M.; Benninga, M. A.; Dinning, P. G.

    2016-01-01

    Children with chronic intractable constipation experience severe and long-lasting symptoms, which respond poorly to conventional therapeutic strategies. Detailed characterization of colonic motor patterns in such children has not yet been obtained. In 18 children with chronic intractable

  2. Viable Solutions for seemingly Intractable Problems

    Directory of Open Access Journals (Sweden)

    Ashok Natarajan

    2015-10-01

    Full Text Available Life is filled with seemingly intractable problems. But life wisdom affirms that if there is a problem, there must be a solution. Or better yet, the solution to the problem lies within the problem itself. Problems have their roots in disharmony. Disharmony arises when a part separates itself from the whole and acts independently of the wider reality of which it is a part, as financial markets have separated themselves from the real economy and economy has detached itself from social and ecological consequences. Insistence on out-moded approaches under new conditions generates intractable problems, as when the framework of a heterogeneous nation-state is employed for the dominance of a single ethnic or religious group. Knowledge and culture are the supreme values of a society and core element of its capacity for accomplishment and development, yet both tend to be exclusively possessed by elites for their own benefit, rather than freely distributed to maximize their impact on society as a whole. Society evolves by the transformation of ignorance into knowledge. Life evolves by organization. The linking and integration of social organizations spur development. Mind itself is an organization and powerful force for development. Energy makes organization more efficient. Any problem can be solved by raising the effectiveness of energy by converting it into skill or capacity and transforming it into power through organization. What one person sees as a problem is an opportunity for another with wider vision. The difference in perception accounts for the difference in levels of accomplishment. So, those with the right perspective see opportunities where others see insolvable problems. Current problems are the result of irrationality, refusal to benefit from past experience and insistence on repeating past errors. Modern science, which was born to fight the superstition of religion, has become a source of superstition. Fully availing of the latest

  3. Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study

    DEFF Research Database (Denmark)

    Wilbrink, Leopoldine A; Teernstra, Onno Pm; Haan, Joost

    2013-01-01

    study is performed. DISCUSSION: The ICON study will show if ONS is an effective preventive therapy for patients suffering medically intractable chronic cluster headache and if there is a difference between high- and low-amplitude stimulation. The innovative design of the study will, for the first time......BACKGROUND: About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled...

  4. Approximating methods for intractable probabilistic models: Applications in neuroscience

    DEFF Research Database (Denmark)

    Højen-Sørensen, Pedro

    2002-01-01

    This thesis investigates various methods for carrying out approximate inference in intractable probabilistic models. By capturing the relationships between random variables, the framework of graphical models hints at which sets of random variables pose a problem to the inferential step. The appro...

  5. [Therapeutic effect of cervical Jiaji electroacupuncture on postoperative intractable hiccup of liver neoplasms].

    Science.gov (United States)

    Zhang, S K; Gao, W B; Liu, Y; He, H

    2018-02-23

    Objective: To evaluate the therapeutic effect of cervical Jiaji electroacupuncture on postoperative intractable hiccup of liver neoplasms. Methods: A total of 39 patients with postoperative intractable hiccup of liver neoplasms in The First Affiliated Hospital of Heilongjiang University of Chinese Medicine from May 2013 to May 2017 were collected and divided into 2 groups randomly. The electroacupuncture group included 20 cases, the control group included 19 cases. Patients in the electroacupuncture group were treated by cervical Jiaji electroacupuncture (located in C3-5, sympathetic ganglion), while the control group were treated by metoclopramide combined with chlorpromazine for three days. The therapeutic effects of two groups were compared and the onset time were recorded. Results: Total effective rates of electroacupuncture group and control group were 95.0% and 47.4%, respectively. The onset time in electroacupuncture group and control group were (14.8±3.3) h and (30.5±3.1) h, respectively ( P electroacupuncture for 3 days, 6 cases were recovered, 3 cases became better, while 1 case demonstrated no response. No serious adverse reactions were appeared in each group. Conclusion: Cervical Jiaji electroacupuncture is an effective and safe treatment for postoperative intractable hiccup of liver neoplasms, and it can be used as a remedy for intractable hiccup patients who don't respond to drug treatment.

  6. Diffusion tensor imaging of partial intractable epilepsy

    International Nuclear Information System (INIS)

    Dumas de la Roque, Anne; Oppenheim, Catherine; Rodrigo, Sebastian; Meder, Jean-Francois; Chassoux, Francine; Devaux, Bertrand; Beuvon, Frederic; Daumas-Duport, Catherine

    2005-01-01

    Our aim was to assess the value of diffusion tensor imaging (DTI) in patients with partial intractable epilepsy. We used DTI (25 non-collinear directions) in 15 patients with a cortical lesion on conventional MRI. Fractional anisotropy (FA) was measured in the internal capsule, and in the normal-appearing white matter (WM), adjacent tothe lesion, and away from the lesion, at a set distance of 2-3 cm. In each patient, increased or decreased FA measurements were those that varied from mirror values using an arbitrary 10% threshold. Over the whole population, ipsi- and contralateral FA measurements were also compared using a Wilcoxon test (p<0.05). Over the whole population, FA was significantly reduced in the WM adjacent to and away from the lesion, whilst being normal in the internal capsule. FA was reduced by more than 10% in the WM adjacent to and distant from the lesion in 13 and 12 patients respectively. For nine of the ten patients for whom the surgical resection encompassed the limits of the lesion on conventional MRI, histological data showed WM alterations (gliosis, axonal loss, abnormal cells). DTI often reveals WM abnormalities that are undetected on conventional MRI in patients with partial intractable epilepsy. (orig.)

  7. Intractable problems in reversible cellular automata

    International Nuclear Information System (INIS)

    Vatan, F.

    1988-01-01

    The billiard ball model, a classical mechanical system in which all parameters are real variables, can perform all digital computations. An eight-state, 11-neighbor reversible cellular automaton (an entirely discrete system in which all parameters are integer variables) can simulate this model. One of the natural problems for this system is to determine the shape of a container so that they initial specific distribution of gas molecules eventually leads to a predetermined distribution. This problem if PSPACE-complete. Related intractable and decidable problems are discussed as well

  8. Packing of Renal Fossa: Useful Technique for Intractable Bleeding ...

    African Journals Online (AJOL)

    There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone ...

  9. Finite Gaussian Mixture Approximations to Analytically Intractable Density Kernels

    DEFF Research Database (Denmark)

    Khorunzhina, Natalia; Richard, Jean-Francois

    The objective of the paper is that of constructing finite Gaussian mixture approximations to analytically intractable density kernels. The proposed method is adaptive in that terms are added one at the time and the mixture is fully re-optimized at each step using a distance measure that approxima...

  10. [Surgery for intractable epilepsy in a patient with encephalocele of the temporal lobe: a case report].

    Science.gov (United States)

    Semenov, M S; Belyakova-Bodina, A I; Murtazina, A F; Brutyan, A G; Golovteev, A L; Aziatskaya, G A; Samoylov, A S; Zabelin, M V; Udalov, Yu D

    We describe a case of surgical treatment of intractable temporal epilepsy in a female patient with congenital middle cranial fossa encephalocele. We present clinical-anamnestic and neuroimaging data as well as the microscopic and macroscopic pictures of encephalocele. We analyze outcomes of surgery for this pathology, which have been reported in the literature. To date, there have been a few articles on this subject in the domestic literature. The development of neuroimaging techniques and a growing number of verified encephalocele cases promote the widespread use of surgery for treatment of intractable epilepsy. Congenital encephalocele should be considered in the differential diagnosis of intractable temporal epilepsy, and, if verified, surgical treatment is the method of choice in most cases.

  11. Effect of Combined Ketogenic Diet and Valproate Treatment for Intractable Seizures

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2005-09-01

    Full Text Available The safety and tolerability of ketogenic diet (KGD and valproate (VPA cotherapy in the treatment of intractable seizures were evaluated retrospectively at the Massachusetts General Hospital, Boston.

  12. Neuromyelitis Optica: An Often Forgotten Cause of Intractable Nausea and Vomiting

    Directory of Open Access Journals (Sweden)

    Chijioke Enweluzo

    2013-07-01

    Full Text Available Neuromyelitis optica, also known as Devic's disease, is a rare autoimmune disorder in which a patient's immune system affects the optic nerves and the spinal cord, leading to loss of vision and spinal cord dysfunction. We present our experience with a 38-year-old female who presented to our facility with complaints of intractable nausea and vomiting. After extensive evaluation, she was found to have neuromyelitis optica. Her symptoms completely resolved following institution of appropriate therapy. She made a significant recovery and has since been placed on chronic immunosuppressive therapy. Through this article we hope to bring attention to a significant cause of intractable nausea and vomiting that may often be forgotten in general medicine or gastroenterology services.

  13. Physical Feature Encoding and Word Recognition Abilities Are Altered in Children with Intractable Epilepsy: Preliminary Neuromagnetic Evidence

    Science.gov (United States)

    Pardos, Maria; Korostenskaja, Milena; Xiang, Jing; Fujiwara, Hisako; Lee, Ki H.; Horn, Paul S.; Byars, Anna; Vannest, Jennifer; Wang, Yingying; Hemasilpin, Nat; Rose, Douglas F.

    2015-01-01

    Objective evaluation of language function is critical for children with intractable epilepsy under consideration for epilepsy surgery. The purpose of this preliminary study was to evaluate word recognition in children with intractable epilepsy by using magnetoencephalography (MEG). Ten children with intractable epilepsy (M/F 6/4, mean ± SD 13.4 ± 2.2 years) were matched on age and sex to healthy controls. Common nouns were presented simultaneously from visual and auditory sensory inputs in “match” and “mismatch” conditions. Neuromagnetic responses M1, M2, M3, M4, and M5 with latencies of ~100 ms, ~150 ms, ~250 ms, ~350 ms, and ~450 ms, respectively, elicited during the “match” condition were identified. Compared to healthy children, epilepsy patients had both significantly delayed latency of the M1 and reduced amplitudes of M3 and M5 responses. These results provide neurophysiologic evidence of altered word recognition in children with intractable epilepsy. PMID:26146459

  14. Patient with intractable delirium successfully treated with electroconvulsive therapy

    DEFF Research Database (Denmark)

    Lindgren, Eske; Hageman, Ida

    2014-01-01

    and in this situation electroconvulsive therapy (ECT) can be a quick and efficient treatment. In this case report of a 26-year-old man a post-operative intractable delirium persisting for three weeks was efficiently and swiftly relieved by three consecutive ECTs. The patient was discharged without need for further...

  15. [Treatment of intractable aspiration after partial laryngectomy by cuffed tracheostomy tube with inner cannula].

    Science.gov (United States)

    Wang, P; Liu, Y H; Xu, Q S; Zheng, Z S

    2017-06-07

    Objective: To evaluate the efficacy of cuffed tracheostomy tube with inner cannula for the treatment of intractable aspiration after partial laryngectomy. Methods: From May 2010 to June 2015, 15 patients with intractable aspiration after partial laryngectomy of laryngeal and hypopharyngeal carcinoma were enrolled. Cuffed tracheostomy tube with inner cannula was used in the 15 patients for treatment of intractable aspiration. The patients and their family were trained to manage the cuffed tracheostomy tube with inner cannula and to eat since the 14th day after surgery. Cuff was initially inflated with 10 ml air and then deflated of 0.5 ml air every 2-3 days. Until the inflation of cuff was no longer required, the cuffed tracheostomy tube was replaced by metal tracheostomy tube. The patients' swallowing function and aspiration were evaluated 6 months after treatment. Results: The 15 cases with intractable aspiration were treated with cuffed tracheostomy tube with inner cannula and after 2-3 months, 14 of them replaced the cuffed tracheostomy tubes with inner cannula by metal tracheostomy tubes and recovered oral eating, and tracheostomy tubes were no longer required for 12 of 14 patients in following 3-6 months, showing a total decannulation rate of 80% in the patients with refractory aspiration. Conclusion: It was safe and effective to treat aspiration after laryngeal and hypopharyngeal surgery with cuffed tracheostomy tube with inner cannula.

  16. Emergency embolization in the treatment of intractable epistaxis resulted from carotid arterial disease

    International Nuclear Information System (INIS)

    Sun Zengtao; Liu Yanjun; Chao Baoting; Tang Jun; Liu Zuoqin; Chen Jie; Shang Jianqiang; Zhang Lei; Li Jijun

    2012-01-01

    Objective: To evaluate the clinical value of internal carotid artery occlusion in treatment of intractable epistaxis caused by carotid artery siphon traumatic lesions. Methods: A total of 37 patients with intractable epistaxis caused by traumatic carotid artery siphon pseudoaneurysm or carotid cavernous fistula were retrospectively analyzed. All the patients underwent embolization from October 1998 to June 2010, including 34 men and 3 women with the age ranged from 25 to 65 years and a average of 40 years. Only lesions were occluded in 12 cases without involving the internal carotid artery, while occlusions of internal carotid artery were performed in the rest 25 cases. Results: Thirty-six patients were cured without recurrent hemorrhage after embolization. Only 1 patient with carotid artery occlusion died 48 hours after operation. Conclusion: For patients with carotid arterial intractable epistaxis, if the elimination of the lesions is not applicable and the collateral circulation of Willis ring has a good compensation, the use of detachable balloon or coil occlusion of ipsilateral internal carotid artery is a quick and easy method to save patients' lives. (authors)

  17. Prospective study of POLG mutations presenting in children with intractable epilepsy: Prevalence and clinical features

    OpenAIRE

    Uusimaa, Johanna; Gowda, Vasantha; McShane, Anthony; Smith, Conrad; Evans, Julie; Shrier, Annie; Narasimhan, Manisha; O'Rourke, Anthony; Rajabally, Yusuf; Hedderly, Tammy; Cowan, Frances; Fratter, Carl; Poulton, Joanna

    2013-01-01

    Purpose To assess the frequency and clinical features of childhood-onset intractable epilepsy caused by the most common mutations in the POLG gene, which encodes the catalytic subunit of mitochondrial DNA polymerase gamma. Methods Children presenting with nonsyndromic intractable epilepsy of unknown etiology but without documented liver dysfunction at presentation were eligible for this prospective, population-based study. Blood samples were analyzed for the three most common POLG mutations. ...

  18. Mapping of cognitive functions in chronic intractable epilepsy: Role of fMRI

    International Nuclear Information System (INIS)

    Chaudhary, Kapil; Kumaran, S Senthil; Chandra, Sarat P; Wadhawan, Ashima Nehra; Tripathi, Manjari

    2014-01-01

    Functional magnetic resonance imaging (fMRI), a non-invasive technique with high spatial resolution and blood oxygen level dependent (BOLD) contrast, has been applied to localize and map cognitive functions in the clinical condition of chronic intractable epilepsy. fMRI was used to map the language and memory network in patients of chronic intractable epilepsy pre- and post-surgery. After obtaining approval from the institutional ethics committee, six patients with intractable epilepsy with an equal number of age-matched controls were recruited in the study. A 1.5 T MR scanner with 12-channel head coil, integrated with audio-visual fMRI accessories was used. Echo planar imaging sequence was used for BOLD studies. There were two sessions in TLE (pre- and post-surgery). In TLE patients, BOLD activation increased post-surgery in comparison of pre-surgery in inferior frontal gyrus (IFG), middle frontal gyrus (MFG), and superior temporal gyrus (STG), during semantic lexical, judgment, comprehension, and semantic memory tasks. Functional MRI is useful to study the basic concepts related to language and memory lateralization in TLE and guide surgeons for preservation of important brain areas during ATLR. This will help in understanding future directions for the diagnosis and treatment of such disease

  19. Mapping of cognitive functions in chronic intractable epilepsy: Role of fMRI

    Directory of Open Access Journals (Sweden)

    Kapil Chaudhary

    2014-01-01

    Full Text Available Background: Functional magnetic resonance imaging (fMRI, a non-invasive technique with high spatial resolution and blood oxygen level dependent (BOLD contrast, has been applied to localize and map cognitive functions in the clinical condition of chronic intractable epilepsy. Purpose: fMRI was used to map the language and memory network in patients of chronic intractable epilepsy pre- and post-surgery. Materials and Methods: After obtaining approval from the institutional ethics committee, six patients with intractable epilepsy with an equal number of age-matched controls were recruited in the study. A 1.5 T MR scanner with 12-channel head coil, integrated with audio-visual fMRI accessories was used. Echo planar imaging sequence was used for BOLD studies. There were two sessions in TLE (pre- and post-surgery. Results: In TLE patients, BOLD activation increased post-surgery in comparison of pre-surgery in inferior frontal gyrus (IFG, middle frontal gyrus (MFG, and superior temporal gyrus (STG, during semantic lexical, judgment, comprehension, and semantic memory tasks. Conclusion: Functional MRI is useful to study the basic concepts related to language and memory lateralization in TLE and guide surgeons for preservation of important brain areas during ATLR. This will help in understanding future directions for the diagnosis and treatment of such disease.

  20. CDKL5 mutations in boys with severe encephalopathy and early-onset intractable epilepsy.

    Science.gov (United States)

    Elia, M; Falco, M; Ferri, R; Spalletta, A; Bottitta, M; Calabrese, G; Carotenuto, M; Musumeci, S A; Lo Giudice, M; Fichera, M

    2008-09-23

    To search for CDKL5 gene mutations in boys presenting with severe early-onset encephalopathy and intractable epilepsy, a clinical picture very similar to that already described in girls with CDKL5 mutations. Eight boys (age range 3-16 years, mean age 8.5 years, SD 4.38) with severe or profound mental retardation and early-onset intractable seizures were selected for CDKL5 gene mutation screening by denaturing high-performance liquid chromatography analysis. We found three unrelated boys carrying three different missense mutations of the CDKL5 gene: c.872G>A (p.C291Y), c.863C>T (p.T288I), and c.533G>C (p.R178P). They presented early-onset, polymorphous, and drug-resistant seizures, mostly myoclonic and tonic or spasms. EEG showed epileptiform abnormalities which were multifocal during wakefulness, and pseudoperiodic bisynchronous during sleep. This study describes three boys carrying CDKL5 missense mutations and their detailed clinical and EEG data, and indicates that CDKL5 gene mutations may represent a cause of severe or profound mental retardation and early-onset intractable seizures, also in boys. Screening for CDKL5 mutations is strongly recommended in individuals with these clinical features.

  1. Predictors and Course of Medically Intractable Epilepsy in Young Children Presenting Before 36 Months of Age: A Retrospective, Population-Based Study

    Science.gov (United States)

    Wirrell, Elaine; Wong-Kisiel, Lily; Mandrekar, Jay; Nickels, Katherine

    2012-01-01

    Purpose To determine the prevalence and identify predictors of medical intractability in children presenting with epilepsy prior to 36 months of age, and to assess the impact of medical intractability on long-term mortality and intellectual function. Methods Children with newly-diagnosed epilepsy prior to 36 months between 1980–2009 while resident in Olmsted County, MN were identified. Medical records were reviewed to collect epilepsy specific variables and long-term outcome data. Medically intractable epilepsy was defined as either (1) seizures greater than every 6 months at final follow-up and failure of two or more antiepileptic drugs for lack of efficacy, or (2) having undergone epilepsy surgery after failure of two or more antiepileptic drugs. Key Findings One hundred and twenty seven children with new-onset epilepsy were identified and followed for a median of 78 months. Medically intractable seizures occurred in 35%, and significant predictors on multivariate analysis were age ≤12 months at diagnosis (odds ratio [OR] 6.76, 95% confidence interval [CI] 2.00, 22.84, p=0.002), developmental delay at initial diagnosis of epilepsy (OR 20.03, 95% CI 3.49, 114.83, p=0.0008 ), neuroimaging abnormality (OR 6.48, 95% CI 1.96, 21.40, p=0.002) and focal slowing on initial EEG (OR 5.33, 95% CI 1.14, 24.88, p=0.03). Medical intractability occurred early in the course in most children, being seen in 61% by one year, and 93% by five years after initial diagnosis. Mortality was higher (20% vs 0%, p<0.001) and intellectual outcome poorer (p<0.001) if epilepsy was medically intractable. Significance One third of children presenting with epilepsy before 36 months will be medically intractable and significant predictors are identified. Medically intractable epilepsy is associated with increased mortality risk and significant intellectual disability. PMID:22738069

  2. Microcatheter Embolization of Intractable Idiopathic Epistaxis

    International Nuclear Information System (INIS)

    Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi; Kuoppala, Katriina

    1999-01-01

    Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of the sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up

  3. Applying social constructionism in the treatment of patients who are intractably aggressive.

    Science.gov (United States)

    Caldwell, M F

    1994-06-01

    Interventions based on the philosophy of social constructionism can be used for the treatment of patients who are intractably aggressive. The interventions are aimed at disrupting common interactive patterns between the patient and treaters in the treatment milieu and replacing them with patterns that do not allow the intractable symptoms to disrupt treatment efforts. Two case examples illustrate the use of this approach with extremely violent inpatients with long histories of unsuccessful interventions. In both cases the treatment included discontinuing certain therapeutic or prosocial interventions; one case involved determining the patient's daily privilege level randomly. The author discusses the advantages and difficulties of such approaches, including the need for staff to reframe their own logical structure and to overcome resistance from different levels of the treatment system.

  4. Cyclodialysis ab interno as a surgical approach to intractable glaucoma.

    Science.gov (United States)

    Jordan, Jens F; Dietlein, Thomas S; Dinslage, Sven; Lüke, Christoph; Konen, Walter; Krieglstein, Günter K

    2007-08-01

    In glaucoma filtration surgery, the problem of subconjunctival scarring has still not been satisfactorily solved. Suprachoroidal drainage of aqueous humour offers a promising, alternative option for intractable glaucoma. We here present a clinical study on the surgical approach of gonioscopic cyclodialysis ab interno. Twenty-eight eyes of 20 patients with intractable glaucoma were included in this prospective, consecutive, case-control study. The eyes had had a mean of 4.4 +/- 2.4 previous antiglaucomatous interventions. Baseline intraocular pressure (IOP) was 34.3 +/- 10.5 mmHg despite maximum therapy. Under gonioscopic control, cyclodialysis ab interno was performed over two clock times to gain access to the suprachoroidal space. No additional trabecular meshwork surgery was performed. Success was defined as a lowering of IOP to below 21 mmHg without the need for further medication or intervention. Mean postoperative IOP was 14.6 +/- 12.4 mmHg. Mean follow-up (FU) for all eyes was 121.8 days. After a mean of 60 days, 21 eyes (75%) needed further surgical intervention. Qualified success was seen in four eyes (14.3%), with a mean FU of 383.6 days. Three eyes (10.7%) showed absolute success after a mean FU period of 202.7 days. In our series, we obtained the best results for phakic eyes, followed by pseudophakic and aphakic eyes. The results of this study do not provide convincing evidence of the functional efficacy of cyclodialysis ab interno. Nevertheless, the technique is easy to perform and offers safe and atraumatic access to the resorptive capability of the choroid. Conjunctival manipulation is avoided. Contrary to reports in the current literature, in our series, the best results were obtained for phakic eyes, though the small number of eyes included does not allow reliable statistics. Further studies will need to focus on the use of different space-retaining substances or a widening of the cyclodialysis cleft to improve surgical outcome.

  5. Segmental colonic dilation is associated with premature termination of high-amplitude propagating contractions in children with intractable functional constipation

    NARCIS (Netherlands)

    Koppen, I. J. N.; Thompson, B. P.; Ambeba, E. J.; Lane, V. A.; Bates, D. G.; Minneci, P. C.; Deans, K. J.; Levitt, M. A.; Wood, R. J.; Benninga, M. A.; Di Lorenzo, C.; Yacob, D.

    2017-01-01

    Background: Colonic dilation is common in children with intractable functional constipation (FC). Our aim was to describe the association between segmental colonic dilation and colonic dysmotility in children with FC. Methods: We performed a retrospective study on 30 children with intractable FC

  6. Voxel based morphometry of FLAIR MRI in children with intractable focal epilepsy: Implications for surgical intervention

    International Nuclear Information System (INIS)

    Riney, Catherine J.; Chong, William K.; Clark, Chris A.; Cross, J. Helen

    2012-01-01

    Purpose: Magnetic resonance imaging (MRI), in particular fluid-attenuated inversion-recovery (FLAIR), has transformed the delineation of structural brain pathology associated with focal epilepsy. However, to date there is no literature on voxel based morphometry (VBM) of FLAIR in children with epilepsy. The aim of this study was to explore the role of visual and VBM assessment of FLAIR in pre-operative investigation of children with intractable focal epilepsy. Methods: Children with intractable epilepsy due to focal cortical dysplasia (FCD) and children with intractable cryptogenic focal epilepsy (CFE) were investigated. FLAIR and T1-weighted MRI were acquired on a 1.5T MRI scanner (Siemens, Erlangen, Germany). VBM was performed using SPM5 (Wellcome Institute of Cognitive Neuroscience, London). Results: Eight children with FCD (M = 5, age 7.9–17.3 years) and 14 children with CFE (M = 8, 7.8–16.8 years) were enrolled. VBM of FLAIR detected 7/8 (88%) of FCD whilst VBM of T1-weighted MRI detected only 3/8 (38%) FCD. VBM of FLAIR detected abnormality in 4/14 children with CFE, in 2/14 (14%) the abnormality was concordant with other data on the epileptogenic zone and with visible abnormality on repeat visual inspection of MR data. VBM of T1-weighed MRI detected abnormality in 2/14 children with CFE, none of which correlated with visible abnormality. Discussion: This study highlights the important role that FLAIR imaging has in the pre-operative assessment of children with intractable epilepsy. VBM of FLAIR may provide important information allowing selection of children with intractable CFE who are likely to benefit from further neuroradiological or neurophysiological evaluation.

  7. A sterile-female technique proposed for control of Striga hermonthica and other intractable weeds: Advantages, shortcomings, and risk management

    Science.gov (United States)

    Weeds have posed intractable challenges to farmers since the dawn of agriculture. This article describes in detail a proposed control strategy based on the introduction of genes conferring female-sterility into the genomes of intractable target weeds. Spread of these genes through target populations...

  8. De novo formation of cerebral cavernous malformation in a patient with intractable epilepsy: case report and review.

    Science.gov (United States)

    Colpan, Mustafa Efkan; Uckardesler, Levent; Sekerci, Zeki; Slavin, Konstantin

    2010-07-01

    The exact origin and process of development of cerebral cavernous malformations (CCMs) is currently unknown. In this article, the authors present de novo CCM formation in a patient with intractable epilepsy and discuss the pathogenesis of CCM in light of several current theories. A 34-year-old man presented with a 10-year history of intractable seizures. His neurological examination was normal, and the initial magnetic resonance imaging (MRI) was suggestive of right mesial temporal sclerosis (MTS). Follow-up MRI study showed development of CCM in the right frontal region. Subsequently, invasive monitoring revealed right temporal seizure source, prompting right temporal lobectomy that resulted in abolition of epilepsy. Histological diagnosis of CCM was confirmed after the lesion was removed in a separate surgery. The patient recovered to normal lifestyle without any complications. This appears to be a first documented case of de novo CCM formation in the setting of intractable epilepsy with ipsilateral MTS. Since the possibility of lesion development cannot be ruled out based on clinical examination, updated imaging and thorough neurophysiological workup are needed for successful treatment of patients with intractable epilepsy.

  9. Ultrasound-Guided Phrenic Nerve Block for Intractable Hiccups following Placement of Esophageal Stent for Esophageal Squamous Cell Carcinoma.

    Science.gov (United States)

    Arsanious, David; Khoury, Spiro; Martinez, Edgar; Nawras, Ali; Filatoff, Gregory; Ajabnoor, Hossam; Darr, Umar; Atallah, Joseph

    2016-05-01

    Hiccups are actions consisting of sudden contractions of the diaphragm and intercostals followed by a sudden inspiration and transient closure of the vocal cords. They are generally short lived and benign; however, in extreme and rare cases, such as esophageal carcinoma, they can become persistent or intractable, up to and involving significant pain, dramatically impacting the patient's quality of life. This case involves a 60-year-old man with a known history of squamous cell carcinoma of the esophagus. He was considered to have high surgical risk, and therefore he received palliative care through the use of fully covered metallic esophageal self-expandable stents due to a spontaneous perforated esophagus, after which he developed intractable hiccups and associated mediastinal pain. Conservative treatment, including baclofen, chlorpromazine, metoclopramide, and omeprazole, provided no relief for his symptoms. The patient was referred to pain management from gastroenterology for consultation on pain control. He ultimately received an ultrasound-guided left phrenic nerve block with bupivacaine and depomedrol, and 3 days later underwent the identical procedure on the right phrenic nerve. This led to complete resolution of his hiccups and associated mediastinal pain. At follow-up, 2 and 4 weeks after the left phrenic nerve block, the patient was found to maintain complete alleviation of the hiccups. Esophageal dilatation and/or phrenic or vagal afferent fiber irritation can be suspected in cases of intractable hiccups secondary to esophageal stenting. Regional anesthesia of the phrenic nerve through ultrasound guidance offers a long-term therapeutic option for intractable hiccups and associated mediastinal pain in selected patients with esophageal carcinoma after stent placement. Esophageal stent, esophageal stenting, intractable hiccups, intractable singultus, phrenic nerve block, phrenic nerve, ultrasound, palliative care, esophageal carcinoma.

  10. Neurostimulation as an adjuvant therapy for patients with intractable angina pectoris.

    NARCIS (Netherlands)

    Jongste, Michel Johannes Leendert de

    2009-01-01

    In spite of tremendous improvement in treatment of patients with angina pectoris due to significant coronary artery disease, there remains a group of patients who cannot adequately be treated. These patients are considered as having ‘intractale angina’. Patients, suffering from intractable ischemic

  11. Endovascular treatment of intractable epistaxis — results of a 4-year ...

    African Journals Online (AJOL)

    Objective. Transcatheter embolisation is an accepted and effective treatment for intractable epistaxis. We analysed our success and complication rates and compared these with results from other published series. Design. Retrospective review. Setting. Unitas Interventional Unit, Centurion. Methods. Case record review (57 ...

  12. Use of an Oral Elemental Diet in Infants with Severe Intractable Diarrhea

    Science.gov (United States)

    Sherman, Joseph O.; And Others

    1975-01-01

    Evaluated was the use of an oral elemental diet consisting of crystalline amino acids, glucose, electrolytes, and vitamins to control severe intractable diarrhea in 27 infants (1-day to 9-months of age). (DB)

  13. [Management of intractable epistaxis and bleeding points localization].

    Science.gov (United States)

    Yang, Da-Zhang; Cheng, Jing-Ning; Han, Jun; Shu, Ping; Zhang, Hua

    2005-05-01

    To investigate the common nasal bleeding points and the management of intractable epistaxis. The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing. The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92). The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases, gelfoam packing in 8 cases, and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1 - 3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases (89.1%) after 1 time of treatment, 9 cases (9.8%) after 2 times and in one case (1.1%) after 4 times. Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.

  14. Intractable Postoperative Wounds Caused by Self-Inflicted Trauma in a Patient with Cutaneous Munchausen Syndrome Presenting as a Pyoderma Gangrenosum-Like Lesion

    OpenAIRE

    Inui, Keiko; Hanafusa, Takaaki; Namiki, Takeshi; Ueno, Makiko; Igawa, Ken; Yokozeki, Hiroo

    2016-01-01

    A 50-year-old Japanese woman consulted the emergency department of our hospital for bleeding due to an intractable postoperative wound on the lower abdomen; the postoperative wound was owing to a laparoscopic cholecystectomy performed 1 year previously for acute cholecystitis. She presented with a painful ulcer on her right lower abdomen. She also presented with multiple scars, skin grafts on the extremities, and a missing left lower leg, the causes for all of which were unexplained. The resu...

  15. Clinical Observation on Intractable Insomnia Treated by Point Pressure in 42 Cases

    Institute of Scientific and Technical Information of China (English)

    张庆萍

    2002-01-01

    @@ The author have in recent years treated 42 cases of intractable insomnia (with a history of over 2 years) by point pressure, yielding quite satisfactory results when compared with those treated with clonazepam. This is reported as follows.

  16. Clinical analysis of neuromyelitis optica presenting as intractable nausea, vomiting and hiccups.

    Science.gov (United States)

    Jin, Xuehong; Pei, Shaofang; Liu, Yi; Li, Xia

    2017-10-01

    Vomiting and hiccups can be the manifestations of numerous systemic and neurological illnesses. Intractable nausea, vomiting and hiccups (INH) are reported as possible initial manifestations of neuromyelitis optica (NMO), but not correctly identified. Awareness of these atypical presentations is conducive to NMO early diagnosis and proper treatment to prevent further disability. In this paper, 12 NMO were reported, whose intractable vomiting and hiccups were the sole manifestations of the first attack and other attacks involving spinal cord and optic nerves developed later. All the patients were women and serum aquaporin 4 antibody (AQP4-Ab) of 83% patients was positive. MRI of 50% patients showed T2-weighted imaging/fluid attenuated inversion recovery hyperintensity which were longitudinally extensive transverse myelitis or linear signal changes. Sixty-seven percent of patients had medulla lesions, in which dorsomedial and area postrema were involved.

  17. Qualitative and Quantitative Hippocampal MRI Assessments in Intractable Epilepsy

    Directory of Open Access Journals (Sweden)

    Paramdeep Singh

    2013-01-01

    Full Text Available Aims. To acquire normative data of hippocampal volumes and T2 relaxation times, to evaluate and compare qualitative and quantitative assessments in evaluating hippocampi in patients with different durations of intractable epilepsy, and to propose an imaging protocol based on performance of these techniques. Methods. MRI analysis was done in 50 nonepileptic controls and 30 patients with intractable epilepsy on 1.5T scanner. Visual assessment and hippocampal volumetry were done on oblique coronal IR/T2W and T1W MP-RAGE images, respectively. T2 relaxation times were measured using 16-echo Carr-Purcell-Meiboom-Gill sequence. Volumetric data was normalized for variation in head size between individuals. Patients were divided into temporal ( and extratemporal ( groups based on clinical and EEG localization. Results. In controls, right hippocampal volume was slightly more than the left with no effect of age or gender. In TLE patients, hippocampal volumetry provided maximum concordance with EEG. Visual assessment of unilateral pathology concurred well with measured quantitative values but poorly in cases with bilateral pathologies. There were no significant differences of mean values between extratemporal group and controls group. Quantitative techniques detected mild abnormalities, undetected on visual assessment. Conclusions. Quantitative techniques are more sensitive to diagnose bilateral and mild unilateral hippocampal abnormalities.

  18. Analyses of more than 60,000 exomes questions the role of numerous genes previously associated with dilated cardiomyopathy

    DEFF Research Database (Denmark)

    Nouhravesh, Nina; Ahlberg, Gustav; Ghouse, Jonas

    2016-01-01

    BACKGROUND: Hundreds of genetic variants have been described as disease causing in dilated cardiomyopathy (DCM). Some of these associations are now being questioned. We aimed to identify the prevalence of previously DCM associated variants in the Exome Aggregation Consortium (ExAC), in order...... to identify potentially false-positive DCM variants. METHODS: Variants listed as DCM disease-causing variants in the Human Gene Mutation Database were extracted from ExAC. Pathogenicity predictions for these variants were mined from dbNSFP v 2.9 database. RESULTS: Of the 473 DCM variants listed in HGMD, 148...... (31%) were found in ExAC. The expected number of individuals with DCM in ExAC is 25 based on the prevalence in the general population. Yet, 35 variants were found in more than 25 individuals. In 13 genes, we identified all variants previously associated with DCM; four genes contained variants above...

  19. Closure of laryngotracheal cavity and tracheostomy for intractable aspiration secondary to radiation encephalopathy or radiation damage of cranial nerve after radiotherapy of nasopharyngeal carcinoma.

    Science.gov (United States)

    Qu, Shenhong; Su, Zhengzhong; He, Xiaoguang; Li, Min; Li, Tianying

    2006-09-01

    Closure of the laryngotracheal cavity and tracheostomy is especially suitable for intractable aspiration secondary to radiation encephalopathy or damage of cranial nerve after radiation for nasopharyngeal carcinoma (NPC). To investigate the clinical value, technique, indications and contraindications of closure of the laryngotracheal cavity and tracheostomy for intractable aspiration secondary to radiation encephalopathy (REP) or radiation damage of cranial nerve after radiotherapy of NPC. Thirty patients, suffering from intractable aspiration secondary to radiotherapy for nasopharyngeal carcinoma, were treated with closure of the laryngotracheal cavity and tracheostomy and were observed for at least 1 year. Intractable aspiration and dyspnea were completely eradicated in all patients. The quality of their life was greatly improved.

  20. Use of SAMC for Bayesian analysis of statistical models with intractable normalizing constants

    KAUST Repository

    Jin, Ick Hoon; Liang, Faming

    2014-01-01

    Statistical inference for the models with intractable normalizing constants has attracted much attention. During the past two decades, various approximation- or simulation-based methods have been proposed for the problem, such as the Monte Carlo

  1. CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience.

    Science.gov (United States)

    Tzadok, Michal; Uliel-Siboni, Shimrit; Linder, Ilan; Kramer, Uri; Epstein, Orna; Menascu, Shay; Nissenkorn, Andrea; Yosef, Omer Bar; Hyman, Eli; Granot, Dorit; Dor, Michael; Lerman-Sagie, Tali; Ben-Zeev, Bruria

    2016-02-01

    To describe the experience of five Israeli pediatric epilepsy clinics treating children and adolescents diagnosed as having intractable epilepsy with a regimen of medical cannabis oil. A retrospective study describing the effect of cannabidiol (CBD)-enriched medical cannabis on children with epilepsy. The cohort included 74 patients (age range 1-18 years) with intractable epilepsy resistant to >7 antiepileptic drugs. Forty-nine (66%) also failed a ketogenic diet, vagal nerve stimulator implantation, or both. They all started medical cannabis oil treatment between 2-11/2014 and were treated for at least 3 months (average 6 months). The selected formula contained CBD and tetrahydrocannabinol at a ratio of 20:1 dissolved in olive oil. The CBD dose ranged from 1 to 20mg/kg/d. Seizure frequency was assessed by parental report during clinical visits. CBD treatment yielded a significant positive effect on seizure load. Most of the children (66/74, 89%) reported reduction in seizure frequency: 13 (18%) reported 75-100% reduction, 25 (34%) reported 50-75% reduction, 9 (12%) reported 25-50% reduction, and 19 (26%) reported CBD withdrawal. In addition, we observed improvement in behavior and alertness, language, communication, motor skills and sleep. Adverse reactions included somnolence, fatigue, gastrointestinal disturbances and irritability leading to withdrawal of cannabis use in 5 patients. The results of this multicenter study on CBD treatment for intractable epilepsy in a population of children and adolescents are highly promising. Further prospective, well-designed clinical trials using enriched CBD medical cannabis are warranted. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  2. The Use of Hemoglobin Vesicles for Delivering Medicinal Gas for the Treatment of Intractable Disorders.

    Science.gov (United States)

    Taguchi, Kazuaki; Yamasaki, Keishi; Sakai, Hiromi; Maruyama, Toru; Otagiri, Masaki

    2017-09-01

    Bioactive gaseous molecules, such as oxygen (O 2 ) and carbon monoxide (CO), are essential elements for most living organisms to maintain their homeostasis and biological activities. An accumulating body of evidence suggests that such molecules can be used in clinics as a medical gas in the treatment of various intractable disorders. Recent developments in hemoglobin-encapsulated liposomes, namely hemoglobin vesicles (HbV), possess great potential for retaining O 2 and CO and could lead to strategies for the development of novel pharmacological agents as medical gas donors. HbV with either O 2 or CO bound to it has been demonstrated to have therapeutic potential for treating certain intractable disorders and has the possibility to serve as diagnostic and augmenting product by virtue of unique physicochemical characteristics of HbV. The present review provides an overview of the present status of the use of O 2 - or CO-binding HbV in experimental animal models of intractable disorders and discusses prospective clinical applications of HbV as a medical gas donor. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  3. Major amputation for intractable extremity melanoma after failure of isolated limb perfusion

    NARCIS (Netherlands)

    Kapma, M. R.; Vrouenraets, B. C.; Nieweg, O. E.; van Geel, A. N.; Noorda, E. M.; Eggermont, A. M. M.; Kroon, B. B. R.

    2005-01-01

    AIM: The aim of this study was to analyse indications and results of amputation for intractable extremity melanoma after failure of isolated limb perfusion (ILP). METHODS: Between 1978 and 2001, 451 patients with loco-regional advanced extremity melanoma underwent 505 ILPs. Amputation of the

  4. Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

    Science.gov (United States)

    Richardson, R R; Siqueira, E B; Cerullo, L J

    1979-09-01

    Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

  5. CDKL5 Mutations in Boys With Encephalopathy and Early-Onset Intractable Epilepsy

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2008-10-01

    Full Text Available Clinical and EEG data of 3 Italian boys (ages 3, 9, and 13 years with severe early-onset encephalopathy, mental retardation, facial dysmorphisms, and intractable epilepsy were found to carry missense mutations in the CDKL5 gene, in a report from Troina, Italy.

  6. Squamous cell carcinoma arising in previously burned or irradiated skin

    International Nuclear Information System (INIS)

    Edwards, M.J.; Hirsch, R.M.; Broadwater, J.R.; Netscher, D.T.; Ames, F.C.

    1989-01-01

    Squamous cell carcinoma (SCC) arising in previously burned or irradiated skin was reviewed in 66 patients treated between 1944 and 1986. Healing of the initial injury was complicated in 70% of patients. Mean interval from initial injury to diagnosis of SCC was 37 years. The overwhelming majority of patients presented with a chronic intractable ulcer in previously injured skin. The regional relapse rate after surgical excision was very high, 58% of all patients. Predominant patterns of recurrence were in local skin and regional lymph nodes (93% of recurrences). Survival rates at 5, 10, and 20 years were 52%, 34%, and 23%, respectively. Five-year survival rates in previously burned and irradiated patients were not significantly different (53% and 50%, respectively). This review, one of the largest reported series, better defines SCC arising in previously burned or irradiated skin as a locally aggressive disease that is distinct from SCC arising in sunlight-damaged skin. An increased awareness of the significance of chronic ulceration in scar tissue may allow earlier diagnosis. Regional disease control and survival depend on surgical resection of all known disease and may require radical lymph node dissection or amputation

  7. An efficient Markov chain Monte Carlo method for distributions with intractable normalising constants

    DEFF Research Database (Denmark)

    Møller, Jesper; Pettitt, A. N.; Reeves, R.

    2006-01-01

    Maximum likelihood parameter estimation and sampling from Bayesian posterior distributions are problematic when the probability density for the parameter of interest involves an intractable normalising constant which is also a function of that parameter. In this paper, an auxiliary variable metho...

  8. Resting-State Functional MR Imaging for Determining Language Laterality in Intractable Epilepsy.

    Science.gov (United States)

    DeSalvo, Matthew N; Tanaka, Naoaki; Douw, Linda; Leveroni, Catherine L; Buchbinder, Bradley R; Greve, Douglas N; Stufflebeam, Steven M

    2016-10-01

    Purpose To measure the accuracy of resting-state functional magnetic resonance (MR) imaging in determining hemispheric language dominance in patients with medically intractable focal epilepsies against the results of an intracarotid amobarbital procedure (IAP). Materials and Methods This study was approved by the institutional review board, and all subjects gave signed informed consent. Data in 23 patients with medically intractable focal epilepsy were retrospectively analyzed. All 23 patients were candidates for epilepsy surgery and underwent both IAP and resting-state functional MR imaging as part of presurgical evaluation. Language dominance was determined from functional MR imaging data by calculating a laterality index (LI) after using independent component analysis. The accuracy of this method was assessed against that of IAP by using a variety of thresholds. Sensitivity and specificity were calculated by using leave-one-out cross validation. Spatial maps of language components were qualitatively compared among each hemispheric language dominance group. Results Measurement of hemispheric language dominance with resting-state functional MR imaging was highly concordant with IAP results, with up to 96% (22 of 23) accuracy, 96% (22 of 23) sensitivity, and 96% (22 of 23) specificity. Composite language component maps in patients with typical language laterality consistently included classic language areas such as the inferior frontal gyrus, the posterior superior temporal gyrus, and the inferior parietal lobule, while those of patients with atypical language laterality also included non-classical language areas such as the superior and middle frontal gyri, the insula, and the occipital cortex. Conclusion Resting-state functional MR imaging can be used to measure language laterality in patients with medically intractable focal epilepsy. (©) RSNA, 2016 Online supplemental material is available for this article.

  9. PET MRI Coregistration in Intractable Epilepsy and Gray Matter Heterotopia.

    Science.gov (United States)

    Seniaray, Nikhil; Jain, Anuj

    2017-03-01

    A 25-year-old woman with intractable seizures underwent FDG PET/MRI for seizure focus localization. MRI demonstrated bilateral carpetlike nodular subependymal gray matter and asymmetrical focal dilatation in the right temporal horn. PET/MRI showed increased FDG within subependymal gray matter with significant hypometabolism in right anterior temporal lobe. EEG and ictal semiology confirmed the right temporal seizure origin. This case highlights the importance of identification of gray matter heterotopia on FDG PET/MRI.

  10. Up-regulated ephrinB3/EphB3 expression in intractable temporal lobe epilepsy patients and pilocarpine induced experimental epilepsy rat model.

    Science.gov (United States)

    Huang, Hao; Li, Ruohan; Yuan, Jinxian; Zhou, Xin; Liu, Xi; Ou, Shu; Xu, Tao; Chen, Yangmei

    2016-05-15

    EphB family receptor tyrosine kinases, in cooperation with cell surface-bound ephrinB ligands, play a critical role in maintenance of dendritic spine morphogenesis, axons guidance, synaptogenesis, synaptic reorganization and plasticity in the central nervous system (CNS). However, the expression pattern of ephrinB/EphB in intractable temporal lobe epilepsy (TLE) and the underlying molecular mechanisms during epileptogenesis remain poorly understood. Here we investigated the expression pattern and cellular distribution of ephrinB/EphB in intractable TLE patients and lithium chloride-pilocarpine induced TLE rats using real-time quantitative polymerase chain reaction (RT-qPCR), immunohistochemistry, double-labeled immunofluorescence and Western blot analysis. Compared to control groups, ephrinB3 and EphB3 mRNA expression were significantly up-regulated in intractable TLE patients and TLE rats, while the mRNA expression trend of ephrinB1/2 and EphB1/2/4/6 in intractable TLE patients and TLE rats were inconsistent. Western blot analysis and semi-quantitative immunohistochemistry confirmed that ephrinB3 and EphB3 protein level were up-regulated in intractable TLE patients and TLE rats. At the same time, double-labeled immunofluorescence indicate that ephrinB3 was expressed mainly in the cytoplasm and protrusions of glia and neurons, while EphB3 was expressed mainly in the cytoplasm of neurons. Taken together, up-regulated expression of ephrinB3/EphB3 in intractable TLE patients and experimental TLE rats suggested that ephrinB3/EphB3 might be involved in the pathogenesis of TLE. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Treatment of intractable epilepsy in a female with SLC6A8 deficiency

    NARCIS (Netherlands)

    Mercimek-Mahmutoglu, S.; Connolly, M.B.; Poskitt, K.J.; Horvath, G.A.; Lowry, N.; Salomons, G.S.; Casey, B.; Sinclair, G.; Davis, C.; Jakobs, C.; Stockler-Ipsiroglu, S.

    2010-01-01

    A female heterozygous for a novel, disease causing, missense mutation in the X-linked cerebral creatine transporter (SLC6A8) gene (c.1067G > T, p.Gly356Val) presented with intractable epilepsy, mild intellectual disability and moderately reduced cerebral creatine levels. Treatment with creatine

  12. Chronic herpes simplex type-1 encephalitis with intractable epilepsy in an immunosuppressed patient.

    Science.gov (United States)

    Laohathai, Christopher; Weber, Daniel J; Hayat, Ghazala; Thomas, Florian P

    2016-02-01

    Chronic herpes simplex virus type-1 encephalitis (HSE-1) is uncommon. Past reports focused on its association with prior documented acute infection. Here, we describe a patient with increasingly intractable epilepsy from chronic HSE-1 reactivation without history of acute central nervous system infection. A 49-year-old liver transplant patient with 4-year history of epilepsy after initiation of cyclosporine developed increasingly frequent seizures over 3 months. Serial brain magnetic resonance imaging showed left temporoparietal cortical edema that gradually improved despite clinical decline. Herpes simplex virus type-1 (HSV-1) DNA was detected in cerebrospinal fluid by polymerase chain reaction. Cerebrospinal fluid HSV-1&2 IgM was negative. Seizures were controlled after acyclovir treatment, and the patient remained seizure free at 1-year follow-up. Chronic HSE is a cause of intractable epilepsy, can occur without a recognized preceding acute phase, and the clinical course of infection may not directly correlate with neuroimaging changes.

  13. Clinical studies of the Research Committee on Intractable Vasculitides, the Ministry of Health, Labour and Welfare of Japan.

    Science.gov (United States)

    Makino, Hirofumi; Sada, Ken-Ei

    2013-10-01

    In Japan, the Research Committee on Intractable Vasculitides, supported by the Ministry of Health, Labour and Welfare, has been promoting basic and clinical research on vasculitis since 1972. The present Research Committee on Intractable Vasculitides comprises 4 subcommittees under the direction of a Principal Investigator: Basic and Pathological Research Subcommittee, Clinical Research Subcommittee of Small and Medium-sized Vessel Vasculitis, Clinical Research Subcommittee of Large-sized Vessel Vasculitis, and International Cooperation Research Subcommittee. Since 2008, 9 nationwide clinical studies for vasculitis have been conducted and 8 clinical and basic studies are in progress.

  14. Spinal cord stimulation in chronic intractable angina pectoris : A randomized, controlled efficacy study

    NARCIS (Netherlands)

    Hautvast, RWM; DeJongste, MJL; Staal, MJ; van Gilst, WH; Lie, KI

    1998-01-01

    Background Spinel cord stimulation is known to be a successful treatment for chronic intractable angina pectoris. its effect may be anti-ischemic. It is uncertain if the clinical effect is partly caused by a placebo effect of surgery For implantation of a stimulator. In this study, clinical efficacy

  15. [Clinical analyses of patients with intractable epistaxis originated from deep-seated nasal cavity].

    Science.gov (United States)

    Xu, Tong; Li, Na; Jiang, Yan; Yu, Hailing; Yu, Longgang; Jiang, Ye

    2015-07-01

    To investigate the clinical features and management of intractable deep-seated epistaxis. Clinical data were analyzed retrospectively in 195 patients with intractable deep-seated epistaxis treated in Affiliated Hospital of Qingdao College between June 2008 and June 2014. The analyses included common risk factors, bleeding sites, treatments and therapeutic effects. SPSS 17.0 software was used to analyze the data. There were 162 males and 33 females, aged from 15 to 88 years old (mean 52 ± 16 years). One hundred and eighty-seven cases (95.9%) were unilateral and 8 cases (4.1%) were bilateral. One hundred and twenty-six cases (64.6%) had the history of hypertension or blood pressure higher than normal on admission. Eight patients were cured by nasal packing and appropriate drugs, and 187 patients were treated by endoscopy and electrocoagulation. The numbers of treatment needed to stop bleeding were 1 time in 184 cases (98.4%), 2 times in 3 cases (1.6%). Thirteen cases did not have certain bleeding point, while the other 174 had certain one or more bleeding sites. The rewarded bleeding sites were 222, which were found in the following different sites: posterior inferior nasal meatus (33.3%, 74 /222), olfactory cleft of nasal septum (26.6%, 59/222), the root of the middle turbinate (14.0%, 31/222), and so on. Hypertension and diabetes were risk factors (OR value was 3.411, 7.142, both P epistaxis are mainly found in males and are almost unilatera1. Hypertension and diabetes are the common risk factor. The most effective and safe treatment for intractable deep-seated epistaxis is electrocoagulation under nasal endoscopy.

  16. Transarterial embolization in the management of intractable epistaxis: the angiographic findings and results based on etiologies.

    Science.gov (United States)

    Wang, Bin; Zu, Qing-Quan; Liu, Xing-Long; Zhou, Chun-Gao; Xia, Jin-Guo; Zhao, Lin-Bo; Shi, Hai-Bin; Liu, Sheng

    2016-08-01

    Transarterial embolization (TAE) appears to be a safe and effective treatment for patients with intractable epistaxis, despite different etiologies or angiography findings. Idiopathic epistaxis is prone to present with negative angiographic findings. To retrospectively evaluate the safety and effectiveness of TAE for intractable epistaxis, and focus on the factors of etiology and angiographic findings. From March 2008 to December 2014, the data of 43 patients with intractable bleeding undergoing TAE were reviewed. The outcomes of interventional therapy were assessed according to different etiology (malignant or benign disease) and angiographic finding (positive or negative angiogram). Positive angiographic findings were found in 11 of 12 cases with malignant diseases and 22 of 31 cases with benign diseases, respectively (p = 0.237). Among the 10 cases with negative angiographic findings, the negative angiography rate of idiopathic epistaxis was higher than that of epistaxis with definite etiology (p = 0.003). Bleeding was controlled successfully in all of the 43 patients after embolization. During the mean follow-up period of 24.0 ± 16.7 months, five patients relapsed. No significant difference was found in recurrence rates between malignant and benign diseases or between positive and negative angiography (p = 0.241, p = 0.704, respectively).

  17. Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis

    NARCIS (Netherlands)

    Hoving, M.A.; Evers, S.M.A.A.; Ament, A.J.H.A.; van Raak, E.P.M.; Becher, J.G.; Rotteveel, J.; Vles, J.S.H.

    2008-01-01

    In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost-effectiveness of CITB in children with spastic CP are lacking, we

  18. Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis.

    NARCIS (Netherlands)

    Hoving, M.A.; Evers, S.M.; Ament, A.J.; Raak, E.P. van; Vles, J.S.; Becher, J.G.; Vermeulen, R.; Brouwer, O.F.; Maathuis, C.G.B.; Catsman-Berrevoets, C.E.; Gerritsen, J.; Geerts, M.J.; Jongerius, P.H.; Nieuwenhuizen, O.F.; Rotteveel, J.J.; Speth, L.A.; Stroink, H.; Ziel, E.G. van der

    2008-01-01

    In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost-effectiveness of CITB in children with spastic CP are lacking, we

  19. Intractable nausea caused by zolpidem withdrawal: a case report.

    Science.gov (United States)

    Baruch, Edward; Vernon, Leonard F; Hasbun, Rafael J

    2007-03-01

    First launched in France in 1988, zolpidem (Ambien®) is a short-acting hypnotic agent. Early studies reported that that the development of physical dependence and tolerance to sedative-hypnotic drugs, such as the depressant and anticonvulsant effects evidenced with benzodiazepines, is not found with zolpidem. Direct to consumer advertising by the manufacturer continues to state that the risk for dependency is low; however, recent publications seem to contradict this. Additionally, adverse drug reactions affecting the central nervous system, gastrointestinal tract, and respiratory system have been reported. Other studies have examined the interactions of selective serotonin reuptake inhibitors and zolpidem as a possible cause of hallucinations. With continued physician marketing efforts touting the safety and efficacy of zolpidem, there is a high likelihood to overlook the risk of dependency and the symptoms related to zolpidem withdrawal. We report a case of a 41-year-old female who developed a dependency to zolpidem, who on her own decided to decrease her dosage, resulting in intractable nausea requiring hospitalization. Reported cases of zolpidem withdrawal have occurred with doses in excess of 160 mg per day, none of these have reported with intractable nausea as the sole symptom. In our reported case, although exceeding recommended dosage withdrawal phenomenon seemed to be severe after withdrawal from a comparatively low dose of zolpidem. Before zolpidem is prescribed, patient education should include warnings about the potential problems associated with dependency and abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.

  20. Chronic Granulomatous Herpes Encephalitis in a Child with Clinically Intractable Epilepsy

    Directory of Open Access Journals (Sweden)

    James R. Hackney

    2012-01-01

    Full Text Available Most patients with herpes simplex virus Type I encephalitis experience an acute, monophasic illness. Chronic encephalitis is much less common, and few late relapses are associated with intractable seizure disorders. A 10-year-old boy was admitted to our institution for intractable epilepsy as part of an evaluation for epilepsy surgery. His history was significant for herpes meningitis at age 4 months. At that time, he presented to an outside hospital with fever for three days, with acyclovir treatment beginning on day 4 of his 40-day hospital course. He later developed infantile spasms and ultimately a mixed seizure disorder. Video electroencephalogram showed a Lennox-Gastaut-type pattern with frequent right frontotemporal spikes. Imaging studies showed an abnormality in the right frontal operculum. Based on these findings, he underwent a right frontal lobectomy. Neuropathology demonstrated chronic granulomatous inflammation with focal necrosis and mineralizations. Scattered lymphocytes, microglial nodules and nonnecrotizing granulomas were present with multinucleated giant cells. Immunohistochemistry for herpes simplex virus showed focal immunoreactivity. After undergoing acyclovir therapy, he returned to baseline with decreased seizure frequency. This rare form of herpes encephalitis has only been reported in children, but the initial presentation of meningitis and the approximate 10-year-time interval in this case are unusual.

  1. Holistic approach to treatment of intractable central neuropathic itch.

    Science.gov (United States)

    Curtis, Ashley R; Tegeler, Charles; Burdette, Jonathan; Yosipovitch, Gil

    2011-05-01

    Central neuropathic itch can be a lifelong debilitating condition and treatment challenge. We report a patient with a traumatic brain injury with severe intractable pruritus who failed extensive pharmacologic and nonpharmacologic treatment but responded to a holistic approach using healing touch. We discuss the complexity of this type of neuropathic itch and present a holistic approach as an adjunct to therapy in reducing itch intensity. This case presentation along with the literature discussed suggests a therapeutic strategy for the management of complicated central neuropathic itch. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  2. Von-Willebrand Disease Presenting as Intractable Epistaxis after Nasal Polypectomy

    Directory of Open Access Journals (Sweden)

    Jeong Jin Park

    2014-01-01

    Full Text Available Von-Willebrand disease (VWD is one of the platelet dysfunction disorders that results from a deficiency of Von-Willebrand factor, which is essential for hemostasis. VWD patients typically have normal laboratory results on screening for bleeding disorders. To suspect and diagnose VWD, a careful review of past medical history and laboratory tests is critical. A 59-year-old male patient presented with intractable nasal bleeding after nasal polypectomy. The bleeding was controlled by platelet transfusion, and he was later diagnosed with VWD.

  3. Hepatic parenchymal atrophy induction for intractable segmental bile duct injury after liver resection.

    Science.gov (United States)

    Hwang, Shin; Park, Gil-Chun; Ha, Tae-Yong; Ko, Gi-Young; Gwon, Dong-Il; Choi, Young-Il; Song, Gi-Won; Lee, Sung-Gyu

    2012-05-01

    Liver resection can result in various types of bile duct injuries but their treatment is usually difficult and often leads to intractable clinical course. We present an unusual case of hepatic segment III duct (B3) injury, which occurred after left medial sectionectomy for large hepatocellular carcinoma and was incidentally detected 1 week later due to bile leak. Since the pattern of this B3 injury was not adequate for operative biliary reconstruction, atrophy induction of the involved hepatic parenchyma was attempted. This treatment consisted of embolization of the segment III portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site and clamping of the percutaneous transhepatic biliary drainage (PTBD) tube to accelerate segment III atrophy. This entire procedure, from liver resection to PTBD tube removal took 4 months. This patient has shown no other complication or tumor recurrence for 4 years to date. These findings suggest that percutaneous segmental portal vein embolization, followed by intentional clamping of external biliary drainage, can effectively control intractable bile leak from segmental bile duct injury.

  4. Quality of life after surgery for intractable partial epilepsy in children: a cohort study with controls.

    Science.gov (United States)

    Mikati, Mohamad A; Ataya, Nour; Ferzli, Jessica; Kurdi, Rana; El-Banna, Diana; Rahi, Amal; Shamseddine, Alhan; Sinno, Durriyah; Comair, Youssef

    2010-08-01

    Investigate if quality of life (QOL) normalizes on long-term follow-up after surgery for partial epilepsy in children. This is a cohort study with controls in which a consecutive cohort of nineteen 2-14-year-old children who underwent focal resections for intractable partial seizures between 1996 and 2006, were matched with 19 non-surgery intractable partial epilepsy patients, and with 19 healthy subjects. The two epilepsy groups were matched for age, sex, socio-economic status (SES), cognitive level, seizure type, and seizure frequency. The healthy group was matched with the two epilepsy groups for age, sex, SES, and cognitive level. QOL was assessed using the QOLCE (Quality of Life in Childhood Epilepsy Questionnaire). In the surgery group (follow-up 3.84+/-2.26 years), 78.9% had Engel class-I versus 21.1% in non-surgery (p=0.01) (follow-up 3.44+/-2.95 years). Surgery patients were similar to healthy subjects in the social, emotional, cognitive, behavioral, and overall QOL (p>0.05) but had lower scores in the total QOL, physical, and health domains (p0.05, power>0.8). Our data indicate that epilepsy surgery for partial seizures in children is associated with better QOL as compared to children with intractable epilepsy who are not operated on, and suggest that in those who achieve seizure freedom normal QOL may at least potentially be possible.

  5. Case report: a case of intractable Meniere's disease treated with autogenic training.

    Science.gov (United States)

    Goto, Fumiyuki; Nakai, Kimiko; Kunihiro, Takanobu; Ogawa, Kaoru

    2008-01-25

    Psychological stress plays an important role in the onset and course of Meniere's disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT), which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject suffering from intractable Meniere's disease. A 51-year-old male patient has suffered from fluctuating right sensorineural hearing loss with vertigo since 1994. In May 2002, he was first admitted to our hospital due to a severe vertigo attack accompanied by right sensorineural hearing loss. Spontaneous nystagmus toward the right side was observed. Since April 2004, he has experienced vertigo spells with right-sided tinnitus a few times per month that are intractable to conventional medical therapy. After four months, tympanic tube insertion was preformed in the right tympanic membrane. Intratympanic injection of dexamethasone was ineffective. He refused Meniett therapy and intratympanic gentamicin injection. In addition to his vertigo spells, he suffered from insomnia, tinnitus, and anxiety. Tranquilizers such as benzodiazepines and antidepressants such as serotonin selective re-uptake inhibitors (SSRIs) failed to stop the vertigo and only slightly improved his insomnia. In December 2006, the patient began psychological counseling with a psychotherapist. After brief psychological counseling along with cognitive behavior therapy (CBT), he began AT. He diligently and regularly continued his AT training in his home according to a written timetable. His insomnia, tinnitus, and vertigo spells disappeared within a few weeks after only four psychotherapy sessions. In order to master the six standard formulas of AT, he underwent two more sessions. Thereafter, he underwent follow-up for 9 months with no additional treatment. He is now free from drugs, including

  6. Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of intractable trigeminal neuralgia.

    Science.gov (United States)

    Xu, Shu-jun; Zhang, Wen-hua; Chen, Teng; Wu, Cheng-yuan; Zhou, Mao-de

    2006-09-20

    Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion (PRTTG) is regarded as the first choice for most patients with trigeminal neuralgia (TN) because of its safety and feasibility. However, neuronavigator-guided PRTTG has been seldom reported. The purpose of this study was to assess the safety and efficacy of neuronavigator-guided PRTTG for the treatment of intractable TN. Between January 2000 and December 2004, 54 patients with intractable TN were enrolled into this study and were randomly divided into two groups. The patients in navigation group (n = 26) underwent PRTTG with frameless neuronavigation, and those in control group (n = 28) received PRTTG without neuronavigation. Three months after the operation, the efficacy, side effects, and complications of the surgery were recorded. The patients in the control group were followed up for 10 to 54 months (mean, 34 +/- 5), and those in the navigation group were followed up for 13 to 58 months (mean, 36 +/- 7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups. The immediate complete pain-relief rate of the navigation group was 100%, whereas it was 95% in the control. The proportion of sustained pain-relief rates at 12, 24 and 36 months after the procedure were 85%, 77%, and 62% in the navigation group, and 54%, 40%, and 35% in the control. Recurrences in the control group were more common than that in the navigation group. Annual recurrence rate in the first and second years were 15% and 23% in the navigation group, and 46%, 60% in the control group. No side-effect and complication was noted in the navigation group except minimal facial hypesthesia. Neuronavigator-guided PRTTG is a safe and promising method for treatment of intractable TN with better short- and long-term outcomes and lower complication rate than PRTTG without neuronavigation.

  7. A case report of dexmedetomidine used to treat intractable pain and delirium in a tertiary palliative care unit.

    Science.gov (United States)

    Hilliard, Neil; Brown, Stuart; Mitchinson, Steve

    2015-03-01

    This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil. A continuous subcutaneous infusion of dexmedetomidine was started and titrated to achieve pain relief. The patient's pain and delirium cleared. The treatment was successful in fulfilling the patient's goal of care: not to be deeply and continuously sedated, but to be rousable and of clear mind while still having good pain control. Dexmedetomidine is a potentially useful medication for the targeted treatment of intractable pain and delirium in the tertiary palliative care environment. Future research is required to compare dexmedetomidine infusion to standard treatment with midazolam infusion for treatment of intractable symptoms in the palliative care environment. © The Author(s) 2014.

  8. The diagnosis and therapy of intractable upper gastrointestinal hemorrhage caused by hepatic arterioportal vein fistulas in hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Luo Pengfei; Chen Xiaoming; Lu Ligong; Hu Baoshan; Li Yong

    2007-01-01

    Objective: To investigate the hemodynamics of increasing portal venous pressure(PVP) in hepatocellular carcinoma patients complicated with hepatic arterioportal vein fistulas (HAPVF) and the diagnosis and therapy of intractable upper gastrointestinal hemorrhage caused by HAPVF. Methods: One hundred and fifteen cases of hepatocellular carcinoma with upper gastrointestinal hemorrhage were checked by hepatic arteriography and were treated through orifices embolization in cases with severe HAPCF by coils and/or ethanol. Results: Twenty-six out of 31 patients suffering intractable upper gastrointestinal hemorrhage have severe HAPVF (the main stem of portal veins are visible). However, there are only 15 patients with light HAPVF among the 84 patients who have mild upper gastrointestinal hemorrhage (the main stem of portal veins are invisible). After the embolization, all of the 26 patients who have severe HAPVF stopped bleeding. Among them, the main stem of hepatic arteries are occluded in 2 patients. Conclusion: The existence of severe HAPVF should be taken into consideration when intractable upper gastrointestinal hemorrhage occurs in hepatocellular carcinoma patients, and it can be diagnosed through hepatic artery DSA. Orifice embolization is the most effective method for such kind of hemorrhage. (authors)

  9. Intractable Chronic Low-Back Pain Caused by Ligamentopathia Treated Using a Spinous Process Plate (S-plate

    Directory of Open Access Journals (Sweden)

    Yu-ichiro Ohnishi

    2010-03-01

    Full Text Available We report a case of intractable chronic low-back pain in a gymnast that was caused by ligamentopathia in the interspinous region of the lumbar vertebrae. Sprained interspinous ligaments are a common mechanical cause of acute low-back pain in athletes. Although conservative therapy is generally effective in such cases, in this case it was not. The patient experienced severe low-back pain during lumbar flexion with tension between the L5/S interspinous ligaments. We performed interspinous fixation by using a spinous process plate system, which has been developed for short in situ fusions, and following which the low-back pain resolved. Conservative therapy for low-back pain caused by ligamentopathia is first-line choice, but interspinous fixation with instrumentation might be recommended in intractable cases with conservative therapy.

  10. Between the Normative and the Performative: Sex, Parody, and Other (Intractable Issues in Geoffrey Chaucer’s Miller’s Tale

    Directory of Open Access Journals (Sweden)

    Popescu Dan Nicolae

    2016-11-01

    Full Text Available The article explores how Geoffrey Chaucer’s Canterbury Tales discusses human sexuality as a major thematic concern in both its normative and its performative dimension, and sex, an (intractable issue throughout the Middle Ages, as a core motif that helps the author to explore the extant tension between the human and the ideal. On the other hand, parody and audience/reader response are important instruments in the medieval poet’s strategy of approaching delicate matters in his pilgrims’ tales, which become readily apparent in the ‘order of play’ in which the tales come. The Miller disrupts the story-telling order because this disruption serves Chaucer’s purpose of questioning the validity of the courtly love concept through a parody of courtly romance, much like the poet’s purported distancing from the heretical views upon human sexuality expressed by the Miller can be decoded as an attempt to restore the balance of power between doctrinal inflexibility and humans’ timeless desire for the natural.

  11. Clinical observation of a modified surgical method: posterior vaginal mesh suspension of female rectocele with intractable constipation.

    Science.gov (United States)

    Hong, Ling; Li, Huai-Fang; Sun, Jing; Zhu, Jian-Long; Ai, Gui-hai; Li, Li; Zhang, Bo; Chi, Feng-li; Tong, Xiao-Wen

    2012-01-01

    To explore the feasibility and effectiveness of a modified posterior vaginal mesh suspension method in treating female rectocele with intractable constipation. Descriptive study (Canadian Task Force classification II-3). The study was performed in the Study Center for Female Pelvic Dysfunction Disease, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China. The Study Center includes 15 physicians, most of whom have received advanced training in pelvic floor dysfunctional disease and can skillfully perform many types of operations in patients with such disease. Almost 1500 operations to treat pelvic floor dysfunctional disease are performed every year at the center. Thirty-six women with rectocele with intractable constipation. Posterior vaginal mesh suspension. All patients were followed up for 15 to 36 months. In 29 patients, the condition was cured completely; in 5 patients it had improved; and in 2 patients, the intervention had no effect. Insofar as recovery and improved results, the overall effectiveness rate was 94.4%. Posterior vaginal mesh suspension is an effective, harmless, and convenient method for treatment of female rectocele with intractable constipation. It has positive short-term curative effects, with few complications and sequelae. However, the long-term effects of posterior vaginal mesh suspension should be evaluated. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

  12. A Monte Carlo Metropolis-Hastings Algorithm for Sampling from Distributions with Intractable Normalizing Constants

    KAUST Repository

    Liang, Faming; Jin, Ick-Hoon

    2013-01-01

    Simulating from distributions with intractable normalizing constants has been a long-standing problem inmachine learning. In this letter, we propose a new algorithm, the Monte Carlo Metropolis-Hastings (MCMH) algorithm, for tackling this problem. The MCMH algorithm is a Monte Carlo version of the Metropolis-Hastings algorithm. It replaces the unknown normalizing constant ratio by a Monte Carlo estimate in simulations, while still converges, as shown in the letter, to the desired target distribution under mild conditions. The MCMH algorithm is illustrated with spatial autologistic models and exponential random graph models. Unlike other auxiliary variable Markov chain Monte Carlo (MCMC) algorithms, such as the Møller and exchange algorithms, the MCMH algorithm avoids the requirement for perfect sampling, and thus can be applied to many statistical models for which perfect sampling is not available or very expensive. TheMCMHalgorithm can also be applied to Bayesian inference for random effect models and missing data problems that involve simulations from a distribution with intractable integrals. © 2013 Massachusetts Institute of Technology.

  13. A Monte Carlo Metropolis-Hastings Algorithm for Sampling from Distributions with Intractable Normalizing Constants

    KAUST Repository

    Liang, Faming

    2013-08-01

    Simulating from distributions with intractable normalizing constants has been a long-standing problem inmachine learning. In this letter, we propose a new algorithm, the Monte Carlo Metropolis-Hastings (MCMH) algorithm, for tackling this problem. The MCMH algorithm is a Monte Carlo version of the Metropolis-Hastings algorithm. It replaces the unknown normalizing constant ratio by a Monte Carlo estimate in simulations, while still converges, as shown in the letter, to the desired target distribution under mild conditions. The MCMH algorithm is illustrated with spatial autologistic models and exponential random graph models. Unlike other auxiliary variable Markov chain Monte Carlo (MCMC) algorithms, such as the Møller and exchange algorithms, the MCMH algorithm avoids the requirement for perfect sampling, and thus can be applied to many statistical models for which perfect sampling is not available or very expensive. TheMCMHalgorithm can also be applied to Bayesian inference for random effect models and missing data problems that involve simulations from a distribution with intractable integrals. © 2013 Massachusetts Institute of Technology.

  14. Diagnostic reframing of intractable environmental problems: Case of a contested multiparty public land-use conflict

    Science.gov (United States)

    Stanley T. Asah; David N. Bengston; Keith Wendt; Kristen C. Nelson

    2012-01-01

    Intractable conflicts are omnipresent in environmental management. These conflicts do not necessarily resist resolution but need to be fundamentally transformed in order to reach agreement. Reframing, a process that allows disputants to create new alternative understandings of the problem, is one way of transforming these conflicts. Cognitive and interactional...

  15. Case report: a case of intractable Meniere's disease treated with autogenic training

    Directory of Open Access Journals (Sweden)

    Nakai Kimiko

    2008-01-01

    Full Text Available Abstract Background Psychological stress plays an important role in the onset and course of Meniere's disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT, which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject suffering from intractable Meniere's disease. Case presentation A 51-year-old male patient has suffered from fluctuating right sensorineural hearing loss with vertigo since 1994. In May 2002, he was first admitted to our hospital due to a severe vertigo attack accompanied by right sensorineural hearing loss. Spontaneous nystagmus toward the right side was observed. Since April 2004, he has experienced vertigo spells with right-sided tinnitus a few times per month that are intractable to conventional medical therapy. After four months, tympanic tube insertion was preformed in the right tympanic membrane. Intratympanic injection of dexamethasone was ineffective. He refused Meniett therapy and intratympanic gentamicin injection. In addition to his vertigo spells, he suffered from insomnia, tinnitus, and anxiety. Tranquilizers such as benzodiazepines and antidepressants such as serotonin selective re-uptake inhibitors (SSRIs failed to stop the vertigo and only slightly improved his insomnia. In December 2006, the patient began psychological counseling with a psychotherapist. After brief psychological counseling along with cognitive behavior therapy (CBT, he began AT. He diligently and regularly continued his AT training in his home according to a written timetable. His insomnia, tinnitus, and vertigo spells disappeared within a few weeks after only four psychotherapy sessions. In order to master the six standard formulas of AT, he underwent two more sessions. Thereafter, he underwent follow-up for 9 months with no

  16. Presurgical thalamocortical connectivity is associated with response to vagus nerve stimulation in children with intractable epilepsy

    Directory of Open Access Journals (Sweden)

    George M. Ibrahim

    2017-01-01

    Full Text Available Although chronic vagus nerve stimulation (VNS is an established treatment for medically-intractable childhood epilepsy, there is considerable heterogeneity in seizure response and little data are available to pre-operatively identify patients who may benefit from treatment. Since the therapeutic effect of VNS may be mediated by afferent projections to the thalamus, we tested the hypothesis that intrinsic thalamocortical connectivity is associated with seizure response following chronic VNS in children with epilepsy. Twenty-one children (ages 5–21 years with medically-intractable epilepsy underwent resting-state fMRI prior to implantation of VNS. Ten received sedation, while 11 did not. Whole brain connectivity to thalamic regions of interest was performed. Multivariate generalized linear models were used to correlate resting-state data with seizure outcomes, while adjusting for age and sedation status. A supervised support vector machine (SVM algorithm was used to classify response to chronic VNS on the basis of intrinsic connectivity. Of the 21 subjects, 11 (52% had 50% or greater improvement in seizure control after VNS. Enhanced connectivity of the thalami to the anterior cingulate cortex (ACC and left insula was associated with greater VNS efficacy. Within our test cohort, SVM correctly classified response to chronic VNS with 86% accuracy. In an external cohort of 8 children, the predictive model correctly classified the seizure response with 88% accuracy. We find that enhanced intrinsic connectivity within thalamocortical circuitry is associated with seizure response following VNS. These results encourage the study of intrinsic connectivity to inform neural network-based, personalized treatment decisions for children with intractable epilepsy.

  17. Long-term management of intractable epilepsy in children

    Directory of Open Access Journals (Sweden)

    LIU Yu-jie

    2012-10-01

    Full Text Available Achievement of seizure free is the ultimate goal of patients with epilepsy. Lifelong treatment may be needed in some epileptic children, especially in those with intractable epilepsy. To be more realistic, this goal may be modified to reduce the frequency of more disabling types of seizures. Chronic seizures influence children in social activities, psychology,cognition as well as many other aspects. Therefore, their long-term management requires concerted lifelong care of pediatricians, neurologists and social workers. During the course of treatment, doctors should evaluate the patients regularly, prevent and control the side effects of antiepileptic drugs (AEDs and monitor patients for AEDs-associated adverse events. In addition, doctors should choose the optimal therapeutic regimen for patients with refractory epilepsy, and achieve a balance between benefit and risk in order to improve the quality of life of patients.

  18. Mutation screening of the CDKL5 gene in cryptogenic infantile intractable epilepsy and review of clinical sensitivity.

    Science.gov (United States)

    Intusoma, Utcharee; Hayeeduereh, Fadell; Plong-On, Oradawan; Sripo, Thanya; Vasiknanonte, Punnee; Janjindamai, Supachai; Lusawat, Apasri; Thammongkol, Sasipa; Visudtibhan, Anannit; Limprasert, Pornprot

    2011-09-01

    To perform CDKL5 mutation screening in Thai children with cryptogenic infantile intractable epilepsy and to determine the clinical sensitivity of CDKL5 screening when different inclusion criteria were applied. Children with cryptogenic infantile intractable epilepsy were screened for CDKL5 mutation using multiplex ligation-dependent probe amplification and DNA sequencing. The clinical sensitivity was reviewed by combining the results of studies using similar inclusion screening criteria. Thirty children (19 girls and 11 boys) with a median seizure onset of 7 months were screened. Almost a half had infantile spasms and one fifth had stereotypic hand movements. A novel c.2854C>T (p.R952X) was identified in an ambulatory girl who had severe mental retardation, multiple types of seizures without Rett-like features. Her mother had a mild intellectual disability, yet her grandmother and half sister were normal despite having the same genetic alteration (random X-inactivation patterns). The pathogenicity of p.R952X identified here was uncertain since healthy relatives and 6 female controls also harbor this alteration. The clinical sensitivity of CDKL5 mutation screening among females with Rett-like features and negative MECP2 screening was 7.8% while the clinical sensitivity among females having cryptogenic intractable seizures with an onset before the ages of 12, 6 and 3 months were 4.7, 11.6 and 14.3%, respectively. Copyright © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  19. Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis.

    Science.gov (United States)

    Ye, Fang; Li, Xiao-Jia; Jiang, Wan-Lin; Sun, Hong-Bin; Liu, Jie

    2015-01-01

    Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice. Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies of the efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy; the included studies were reviewed. Meta-analyses were performed using STATA to determine combined efficacy rates and combined rates of compliance with the ketogenic diet and its main subtypes. In total, 12 studies qualified for inclusion, and data from 270 patients were evaluated.The results of the meta-analysis revealed combined efficacy rates of all types of ketogenic diet, a classical ketogenic diet, and a modified Atkins diet were 42%, 52%, and 34%, respectively; the corresponding combined compliance rates were 45%, 38%, and 56%. The results indicate that a ketogenic diet is a promising complementary therapy in adult intractable epilepsy, and that while a classical ketogenic diet may be more effective, adult patients are likely to be less compliant with it than with a modified Atkins diet.

  20. Intravenous lignocaine infusion for intractable pain in Ewing's sarcoma

    Directory of Open Access Journals (Sweden)

    Nivedita Page

    2018-01-01

    Full Text Available A 23-year-old female presented to our palliative care center with Ewing's sarcoma of the humerus with lung metastases. Pain in her arm was unrelieved by nonsteroidal anti-inflammatory drugs, neuropathic medication as well as morphine. She could not tolerate any further increase in opioid dose but was so distraught due to the pain that she wanted to die. An intravenous lignocaine infusion in a dose of 2 mg/kg was given over an hour for three successive days. This successfully relieved her pain after which she was settled with her original medication. We feel that in palliative care settings, where intractable pain and tolerance to morphine are so common, intravenous lignocaine infusions could provide a safe and effective tool for pain relief.

  1. The role of executive functioning in quality of life in pediatric intractable epilepsy.

    Science.gov (United States)

    Love, Christina Eguizabal; Webbe, Frank; Kim, Gunha; Lee, Ki Hyeong; Westerveld, Michael; Salinas, Christine M

    2016-11-01

    Children with epilepsy are vulnerable to executive dysfunction, but the relationship between executive functioning (EF) and quality of life (QOL) in children with epilepsy is not fully delineated. This exploratory study elucidated the relationship between ecological EF and QOL in pediatric intractable epilepsy. Fifty-four consecutively referred pediatric epilepsy surgery candidates and their parents were administered IQ measures, the Behavior Rating Inventory of Executive Function (BRIEF), and the Quality of Life in Childhood Epilepsy (QOLCE) as part of a comprehensive neuropsychological evaluation. A significant difference was found in QOL between those with and without clinical impairments on the BRIEF [t(52)=3.93; p<.001]. That is, children with executive dysfunction had lower overall QOL. All seizure variables and BRIEF scales were associated with overall QOL [F(12, 40)=6.508; p=.001; R 2 =.661]. Working memory from the BRIEF was the most frequently elevated scale in our sample (57%). Those with executive dysfunction had 9.7 times the risk of having poor QOL. Poor EF control according to behavior ratings is significantly related to QOL in intractable pediatric epilepsy. Identification of executive dysfunction in home environments is an essential component of presurgical evaluations and target for intervention, which may improve QOL. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Intractable radiation pericarditis and pleuritis developed 20 years after postoperative radiotherapy in a case with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tsuji, Misa; Shintani, Uichirou; Ohmoto, Yasuhiro; Isshiki, Noriyuki; Tanaka, Tsuyoshi; Kitamura, Masami; Kato, Shigetake; Misaki, Moriharu [Mie National Central Hospital, Hisai (Japan); Shouin, Hiroshi

    1999-01-01

    We reported a 64-year-old woman with radiation-related intractable pericarditis and pleuritis which developed 20 years after radiotherapy. She underwent a left total mastectomy for a breast cancer and 50 Gy of radiotherapy postoperatively at the age of 43. She was admitted to our hospital because of facial edema and dyspnea. A chest roentgenogram on admission showed massive bilateral pleural effusion and a echocardiography revealed massive pericardial effusion. Though the symptoms of heart failure subsided after the administration of moderate diuretics and cardiotonics, the pleural effusion and pericardial effusion persisted and, she became worse and died. The histological findings at autopsy, showed chronic fibrous pericarditis with marked pericardial thickening, fibrous pleuritis and myocarditis. These findings were compatible with those of previously reported radiation-induced heart disease. We reported a case of pleuritis and pericarditis probably caused by radiation therapy. A long term observation is necessary for the radiation-related heart disease. (author)

  3. The use of ketogenic diet in special situations: expanding use in intractable epilepsy and other neurologic disorders

    Science.gov (United States)

    2012-01-01

    The ketogenic diet has been widely used and proved to be effective for intractable epilepsy. Although the mechanisms underlying its anti-epileptic effects remain to be proven, there are increasing experimental evidences for its neuroprotective effects along with many researches about expanding use of the diet in other neurologic disorders. The first success was reported in glucose transporter type 1 deficiency syndrome, in which the diet served as an alternative metabolic source. Many neurologic disorders share some of the common pathologic mechanisms such as mitochondrial dysfunction, altered neurotransmitter function and synaptic transmission, or abnormal regulation of reactive oxygen species, and the role of the ketogenic diet has been postulated in these mechanisms. In this article, we introduce an overview about the expanding use and emerging trials of the ketogenic diet in various neurologic disorders excluding intractable epilepsy and provide explanations of the mechanisms in that usage. PMID:23049588

  4. EFFICACY OF SPINAL-CORD STIMULATION AS ADJUVANT THERAPY FOR INTRACTABLE ANGINA-PECTORIS - A PROSPECTIVE, RANDOMIZED CLINICAL-STUDY

    NARCIS (Netherlands)

    DEJONGSTE, MJL; HAUTVAST, RWM; HILLEGE, HL; LIE, KI

    Objectives. In a prospective, randomized study with an 8-week follow-up period, we evaluated the efficacy of spinal cord stimulation an exercise capacity and quality of life in patients with intractable angina. Background. Despite important achievements in therapy for ischemic heart disease, there

  5. Wada test for evaluation of language and memory function in medically intractable epilepsy

    International Nuclear Information System (INIS)

    Hong, Yong Kook; Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Kim, Eun Kyung; Lee, Byung In; Huh, Kyun

    1992-01-01

    The Wada test was performed for lateralization of language and memory function, using intracarotid injection of Sodium Amytal. But the internal carotid artery (ICA) Wada test has some limitations for testing memory function. The posterior cerebral artery (PCA) Wada test has been designed to modify the ICA Wada test for testing memory function selectively. In our study, 10 patients out of 12 patients with intractable seizure underwent only the ICA Wada test and the other 2 patients underwent both the ICA and the selective PCA Wada test. In all 12 patients undergoing the ICA Wada test, we successfully localized speech and language dominance. Four of 12 patients who underwent the ICA Wada test for evaluation of memory function displayed superior memory functions in one hemisphere, but the other hemisphere also significantly contributed to memory. The selective PCA Wada test, performed in 2 patients, showed successful results of memory function test in both patients. Four of 12 patients underwent temporal lobectomy and there was no major post-operative language or memory deficits. We concluded that the ICA and PCA Wada tests are useful for preoperative evaluation of medically intractable epilepsy, and the PCA Wada test is valuable in memory evaluation in some patients who have high risk of postoperative global amnesia after temporal lobectomy following equivocal results of memory function by the ICA Wada test

  6. Typhoid fever as a triggering factor in acute and intractable bronchial asthma attack.

    Science.gov (United States)

    Wardhana; Surachmanto, Eko E; Datau, E A

    2013-10-01

    Typhoid fever is an enteric infection caused by Salmonella typhi. In Indonesia, typhoid fever is endemic with high incidence of the disease. In daily practice we frequently have patients with bronchial asthma, and it is becoming worse when these patients get typhoid fever. After oral ingestion, Salmonella typhi invades the the intestine mucosa after conducted by microbial binding to epithelial cells, destroying the microfold cells (M cell) then passed through the lamina propria and detected by dendritic cells (DC) which express a variety of pathogen recognition receptors on the surfaces, including Toll-Like Receptor (TLR). expressed on macrophages and on intestinal epithelial cells inducing degradation of IB, and translocation of NF-B (Nuclear Factor-Kappa Beta). This process initiates the induction of pro-inflammatory gene expression profile adhesion molecules, chemokines, adhesion molecules, and other proteins that induce and perpetuate the inflammation in host cells then will induce acute ant intractable attack of bronchial asthma. The role of typhoid fever in bronchial asthma, especially in persons with acute attack of bronchial asthma, is not well understood. In this article, we will discuss the role of typhoid fever in the bronchial asthma patients which may cause bronchial asthma significantly become more severe even triggering the acute and intractable attack of bronchial asthma. This fact makes an important point, to treat completely the typhoid fever in patients with bronchial asthma.

  7. Wada test for evaluation of language and memory function in medically intractable epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Yong Kook; Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Kim, Eun Kyung; Lee, Byung In; Huh, Kyun [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    1992-05-15

    The Wada test was performed for lateralization of language and memory function, using intracarotid injection of Sodium Amytal. But the internal carotid artery (ICA) Wada test has some limitations for testing memory function. The posterior cerebral artery (PCA) Wada test has been designed to modify the ICA Wada test for testing memory function selectively. In our study, 10 patients out of 12 patients with intractable seizure underwent only the ICA Wada test and the other 2 patients underwent both the ICA and the selective PCA Wada test. In all 12 patients undergoing the ICA Wada test, we successfully localized speech and language dominance. Four of 12 patients who underwent the ICA Wada test for evaluation of memory function displayed superior memory functions in one hemisphere, but the other hemisphere also significantly contributed to memory. The selective PCA Wada test, performed in 2 patients, showed successful results of memory function test in both patients. Four of 12 patients underwent temporal lobectomy and there was no major post-operative language or memory deficits. We concluded that the ICA and PCA Wada tests are useful for preoperative evaluation of medically intractable epilepsy, and the PCA Wada test is valuable in memory evaluation in some patients who have high risk of postoperative global amnesia after temporal lobectomy following equivocal results of memory function by the ICA Wada test.

  8. Teacher's Questions in Reading Classes

    Directory of Open Access Journals (Sweden)

    Zuliati Rohmah

    2002-01-01

    Full Text Available Abstract: The present paper discusses an English teacher's questions in Reading classes at MAN Malang III. Types of questions, functions of teacher's questions, question levels and the strategies applied by the teacher were put as the research problems. Non-participant observa­tion was applied to collect the data with the researcher as the main in­strument aided by field-notes and a tape recorder. It was found that the distribution of the questions did not allow the students to talk longer and to think more analytically. Meanwhile, the strategies applied by the teacher helped the students to respond to the questions previously unanswered. The teacher is suggested to produce more open and refer­ential question as well as inference and evaluation questions as to give more chances for the students to think aloud more.

  9. Asking a Great Question: A Librarian Teaches Questioning Skills to First-Year Medical Students.

    Science.gov (United States)

    Adams, Nancy E

    2015-01-01

    In a single one-hour session, first-year medical students were taught a framework for differentiating between lower-order questions that lead to knowledge of facts and higher-order questions that lead to integration of concepts and deeper learning, thereby preparing them for problem-based learning (PBL). Students generated lists of questions in response to an assertion prompt and categorized them according to Bloom's Taxonomy. These data were analyzed in addition to data from the course exam, which asked them to formulate a higher-level question in response to a prompt. Categorizing questions according to Bloom's Taxonomy was a more difficult task for students than was formulating higher-order questions. Students reported that the skills that they learned were used in subsequent PBL sessions to formulate higher-order learning objectives that integrated new and previously-learned concepts.

  10. Treatment for intractable anemia with the traditional Chinese medicines Hominis Placenta and Cervi Cornus Colla (deer antler glue

    Directory of Open Access Journals (Sweden)

    Yasuyo Hijikata

    2009-05-01

    Full Text Available Yasuyo Hijikata1, Takashi Kano2, Lu Xi31Toyodo Hijikata Clinic, Osaka, Japan; 2Kano Clinic, Osaka city, Osaka, Japan; 3Traditional Chinese Medicine Institute, Si-chuan Province, ChinaObjective: Intractable anemia, such as aplastic anemia or that presumably associated with chronic herpes virus infections, sometimes require bone marrow transplant. We investigated the use of traditional Chinese medicine (TCM for the treatment of intractable anemia. Method: Placenta Hominis (PH, steam boiled and roasted, and Cervi Cornus Colla (deer antler glue has been used in China for hundreds of years to treat anemia. After consent was obtained, we prescribed these two materials for a 74-year-old female with aplastic anemia and a 26-year-old male with presumably a virus-induced anemia. Concomitant conventional therapy was continued in both patients as prescribed by their respective attending physicians. Conclusion: Conventional therapy with steroid hormones, immunosuppressive drugs, platelet and erythrocyte transfusions were not effective in these patients. In addition, both patients suffered from serious side effects. In two patients, ingestion of Placenta Hominis and Cervi Cornus Colla with TCM prescriptions increased the platelet and enhanced the hemoglobin concentration in several months of therapy accompanied by a dramatic improvement in quality of life. The addition to conventional therapy of PH and Cervi Cornus Colla, the latter of which is very easy to obtain, may be one of the potentially advantageous choices in case of otherwise intractable anemia.Keywords: placenta, antler glue, Cervi Cornus Colla, anemia, aplastic anemia

  11. Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis.

    Science.gov (United States)

    Suzuki, Hideo; Kaneko, Tsuyoshi; Mizokami, Yuji; Narasaka, Toshiaki; Endo, Shinji; Matsui, Hirofumi; Yanaka, Akinori; Hirayama, Aki; Hyodo, Ichinosuke

    2013-05-07

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease that may become intractable when treated with conventional medications such as aminosalicylates, corticosteroids, and azathioprine. The herbal medicine Qing Dai has traditionally been used in Chinese medicine to treat UC patients, but there is a lack of published data on the efficacy of Qing Dai in UC treatment. We report several cases of patients with intractable UC who take Qing Dai in a retrospective observational study. Furthermore, we explore the mechanisms of action of Qing Dai. Nine patients with active UC who received conventional medications but wished to receive Qing Dai as an alternative medication were included in our analysis. The UC severity level was determined based on the clinical activity index (CAI). Additionally, 5 of the 9 patients were endoscopically evaluated according to the Matts grading system. Each patient received 2 g/d of Qing Dai orally and continued taking other medications for UC as prescribed. Electron spin resonance was applied to explore the mechanisms of action of Qing Dai. After 4 mo of treatment with Qing Dai, the CAI score decreased from 8.3 ± 2.4 to 2.4 ± 3.4 (mean ± SD; P Qing Dai possesses strong hydroxyl radical scavenging activity. Qing Dai showed significant clinical and endoscopic efficacy in patients who failed to respond to conventional medications. Scavenging of hydroxyl radicals appears to be a potential mechanism through which Qing Dai acts, but the significance of the scavenging ability of Qing Dai with respect to the anti-inflammatory effect in UC patients warrants further investigation.

  12. Processing of (in)tractable polymers using reactive solvents, 4: Structure development in the model system poly(ethylene)/styrene

    NARCIS (Netherlands)

    Goossens, J.G.P.; Rastogi, S.; Meijer, H.E.H.; Lemstra, P.J.

    1998-01-01

    The use of reactive solvents provides a unique opportunity to extend the processing characteristics of both intractable and standard (tractable) polymers beyond existing limits. The polymer to be processed is dissolved in the reactive solvent (monomer) and the solution is transferred into a mould.

  13. Caring for Patients With Intractable Neurological Diseases

    Directory of Open Access Journals (Sweden)

    Masako Nagase

    2014-08-01

    Full Text Available This is a qualitative descriptive study examining nurses’ attitudes about caring for patients with intractable neurological diseases, with a focus on dedication and conflicts. Semistructured interviews were conducted on 11 nurses with more than 5 years of clinical experience in addition to more than 3 years of experience in neurology wards. Senior nursing officers from each hospital selected the participants. In general, these nurses expressed distress over the inevitable progression of disease. Nurses talked about the “basis of dedication,” “conflicts with dedication,” “reorganization for maintaining dedication,” and “the reason for the change from conflict to commitment.” “Reorganization for maintaining dedication” meant that nurses were able to handle the prospect of rededicating themselves to their patients. Furthermore, “the reason for the change from conflict to commitment” referred to events that changed nurses’ outlooks on nursing care, their pride as nurses, or their learning experiences. They felt dedicated and conflicted both simultaneously and separately. While committing to their patients’ physical care, nurses were empowered to think positively and treat patients with dignity in spite of the care taking much time and effort, as well as entailing considerable risk.

  14. Total lymphoid irradiation of intractable rheumatoid arthritis

    International Nuclear Information System (INIS)

    Herbst, M.; Fritz, H.; Sauer, R.

    1986-01-01

    Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation, (total dose 20 Gy). Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four patients have since died, one of renal failure, another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and reduction in T-helper cells, the number of T-suppressor cells remaining unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored. (author)

  15. Total lymphoid irradiation of intractable rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Herbst, M.; Fritz, H.; Sauer, R.

    1986-12-01

    Eleven patients with intractable rheumatoid arthritis were treated with fractionated total lymphoid irradiation, (total dose 20 Gy). Lasting improvement in clinical symptoms was found in four patients during treatment and the remaining patients experienced similar benefit within 2 months of irradiation. There was marked reduction in exacerbations and number of joints involved. Morning stiffness, joint swelling and tenderness decreased. Complications included severe fatigue during treatment and acute bacterial arthritis in multiple joints in one patient. Four patients have since died, one of renal failure, another of cardiogenic shock following surgery 3 and 24 months after total lymphoid irradiation. Both had generalised amyloidosis. The third patient developed joint empyema and died of toxic cardiac failure. The fourth died 3 months after resection of a Kaposi's sarcoma complicated by wound infection which responded to treatment. Immunologically, total lymphoid irradiation resulted in suppression of the absolute lymphocyte count and reduction in T-helper cells, the number of T-suppressor cells remaining unchanged. These data provide evidence of T-cell involvement in the pathogenesis of rheumatoid arthritis. Total lymphoid irradiation can induce sustained improvement in clinical disease activity, but severe, possibly fatal, side-effects cannot be ignored.

  16. [Preoperative evaluation of surgery for intractable aspiration based on the prognostic nutritional index].

    Science.gov (United States)

    Uchida, Masaya; Hashimoto, Keiko; Mukudai, Shigeyuki; Ushijima, Chihisa; Dejima, Kenji

    2014-12-01

    Because there is no absolute indicator of the nutritional status and prognosis in patients with severe aspiration problems, it is quite difficult to arrive at a true long-time prognosis. By performing surgery for intractable aspiration on such patients, both the prognosis and QOL of the patients could be expected to improve. In our department, we have experienced patients dying within 6 months after surgery. In these cases, the patient's preoperative nutritional status was not good. Therefore, we consider that, when we adopt this procedure, there should be some indicators we should use which could have an effect on the prognosis of such nutritionally-challenged patients. In patients who underwent surgery for intractable aspiration; we examined the relationship between their survival and the prognostic nutritional index (PNI) which is an indicator of the risk of complications such as post-operative events in the surgical field. We investigated the relationship between the prognosis and the postoperative indicators of each of the following: WBC, CRP, serum albumin level, and PNI. Out of a total of 31 cases, the average O-PNI of eight cases in which death occurred was 29.45, and the average of six cases in which death occurred within 6 months after surgery was 28.26. The average O-PNI of the survivors was 36.01. A significant association was noted between the early postoperative deaths and some of the four indicators namely that serum albumin level and O-PNI. Based on the ROC curve, the O-PNI offered higher precision than the albumin level. The cut-off value of the O-PNI value for early postoperative mortality rate was 32. The early postoperative mortality rate was 44.4% in patients with less than 32 O-PNI in the preoperative examination, but if it were O-PNI 32 or more, the early postoperative mortality rate was 9.1%, significantly lower. Therefore, O-PNI could be useful as one of the prognostic evaluation factors in the case of preoperative surgery for intractable

  17. Lymphoid irradiation in intractable rheumatoid arthritis. A double-blind, randomized study comparing 750-rad treatment with 2,000-rad treatment

    International Nuclear Information System (INIS)

    Hanly, J.G.; Hassan, J.; Moriarty, M.; Barry, C.; Molony, J.; Casey, E.; Whelan, A.; Feighery, C.; Bresnihan, B.

    1986-01-01

    Twenty patients with intractable rheumatoid arthritis were treated with 750-rad or 2,000-rad lymphoid irradiation in a randomized double-blind comparative study. Over a 12-month followup period, there was a significant improvement in 4 of 7 and 6 of 7 standard parameters of disease activity following treatment with 750 rads and 2,000 rads, respectively. Transient, short-term toxicity was less frequent with the lower dose. In both groups, there was a sustained peripheral blood lymphopenia, a selective depletion of T helper (Leu-3a+) lymphocytes, and reduced in vitro mitogen responses. These changes did not occur, however, in synovial fluid. These results suggest that 750-rad lymphoid irradiation is as effective as, but less toxic than, that with 2,000 rads in the management of patients with intractable rheumatoid arthritis

  18. Microencephaloceles: another dual pathology of intractable temporal lobe epilepsy in childhood.

    Science.gov (United States)

    Aquilina, Kristian; Clarke, Dave F; Wheless, James W; Boop, Frederick A

    2010-04-01

    Temporal lobe encephaloceles can be associated with temporal lobe epilepsy. The authors report on the case of an adolescent with multiple microencephaloceles, in the anterolateral middle fossa floor, identified at surgery (temporal lobectomy) for intractable partial-onset seizures of temporal origin. Magnetic resonance imaging revealed only hippocampal atrophy. Subdural electrodes demonstrated ictal activity arising primarily from the anterior and lateral temporal lobe, close to the microencephaloceles, spreading to the anterior and posterior mesial structures. Pathological examination revealed diffuse temporal gliosis involving the hippocampus, together with microdysgenesis of the amygdala. The literature on epilepsy secondary to encephaloceles is reviewed and the contribution of the microencephaloceles to the seizure disorder in this patient is discussed.

  19. Etanercept overcomes P-glycoprotein-induced drug resistance in lymphocytes of patients with intractable rheumatoid arthritis.

    Science.gov (United States)

    Tsujimura, Shizuyo; Saito, Kazuyoshi; Nakayamada, Shingo; Tanaka, Yoshiya

    2010-04-01

    P-glycoprotein (P-gp) on activated lymphocytes is an adenosine triphosphate (ATP)-binding cassette transporter that causes drug resistance by exclusion of intracellular drugs in patients with active rheumatoid arthritis (RA). However, infliximab with methotrexate (MTX) can overcome P-gp-mediated drug resistance. We encounter patients who cannot continue infliximab or MTX. Here we tested how etanercept affected P-gp-mediated drug resistance in such intractable RA patients. Peripheral lymphocytes of 11 RA patients (3 switched from infliximab and 8 who could not be treated with MTX) were analyzed for P-gp expression by flow cytometry and for drug exclusion using radioisotope-labeled dexamethasone. Activated lymphocytes of RA patients overexpressed P-gp and coexpressed CD69. Incubation of these lymphocytes with dexamethasone in vitro reduced intracellular dexamethasone levels. Two-week etanercept therapy significantly reduced P-gp expression and eliminated such P-gp- and CD69-high-expressing subgroup. The reduction in P-gp resulted in recovery of intracellular dexamethasone levels in lymphocytes and improvement of disease activity, thus allowing tapering of corticosteroids. None of the patients experienced any severe adverse effects. Etanercept is useful for overcoming P-gp-mediated treatment resistance in intractable RA patients who have to discontinue infliximab or are intolerant to MTX.

  20. Unilateral posterior canal-plugging surgery for intractable bilateral posterior canal-type benign paroxysmal positional vertigo.

    Science.gov (United States)

    Hotta, Sayaka; Imai, Takao; Higashi-Shingai, Kayoko; Okazaki, Suzuyo; Okumura, Tomoko; Uno, Atsuhiko; Ohta, Yumi; Morihana, Tetsuo; Sato, Takashi; Inohara, Hidenori

    2017-10-01

    To investigate the effectiveness of unilateral posterior semicircular canal (PSCC)-plugging surgery for patients with intractable bilateral PSCC-type benign paroxysmal positional vertigo (P-BPPV). From July 2011 to December 2015, we diagnosed 136 patients with P-BPPV. Of these, 3 patients had bilateral P-BPPV, and in 2 of the 3, the condition had been refractory to conservative treatment for more than 1 year. We planned a staged PSCC-plugging surgery for these 2 patients; initially one side was treated, and the contralateral side was treated 6 months later. After the first surgery, both patients experienced improvement in symptoms of vertigo and nystagmus on the operated side and no change on the non-operated side. Patients underwent the Epley maneuver for the non-operated side. In one case, the non-operated side was cured. In the other case, although the P-BPPV was not completely resolved, the patient was satisfied with the result of unilateral surgery because he was now able to turn in bed to the operated side without vertigo. Before surgery, he had experienced vertigo when turning even slightly in bed. We propose that even unilateral PSCC-plugging surgery is effective for some patients with intractable bilateral P-BPPV. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. ST-Segment Elevation Myocardial Infarction with Acute Stent Thrombosis Presenting as Intractable Hiccups: An Unusual Case.

    Science.gov (United States)

    Zhang, Fan; Tongo, Nosakhare Douglas; Hastings, Victoria; Kanzali, Parisa; Zhu, Ziqiang; Chadow, Hal; Rafii, Shahrokh E

    2017-04-29

    BACKGROUND Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as indigestion. Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease. CASE REPORT We report a case of intractable hiccups in a 51-year-old male with cocaine related myocardial infarction (MI) before and after stent placement. Coronary angiogram showed in-stent thrombosis of the initial intervention. Following thrombectomy, balloon angioplasty, and stent, the patient recovered well without additional episodes of hiccups. Although hiccups are not known to present with a predilection for a particular cause of myocardial ischemia, this case may additionally be explained by the sympathomimetic effects of cocaine, which lead to vasoconstriction of coronary arteries. CONCLUSIONS Hiccups associated with cardiac enzyme elevation and EKG ST-segment elevation before and after percutaneous coronary intervention (PCI) maybe a manifestation of acute MI with or without stent. The fact that this patient was a cocaine user may have contributed to the unique presentation.

  2. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain of metastasis in the patient with advanced urachal carcinoma

    International Nuclear Information System (INIS)

    Arakawa, Yasuhiro; Inoue, Daisuke; Sakuyama, Toshikazu; Nagasaki, Eijiro; Aiba, Keisuke

    2011-01-01

    We report a case of a 39-year-old man with intractable multifocal pain caused by metastatic urachal carcinoma to the bone. The patient underwent a partial cystectomy in May 2008, and lung metastasis occurred 9 months after the surgery. He then received salvage chemotherapy, but developed metastasis to the liver, brain, and bone. He was hospitalized due to a shoulder pain, a lower back pain, buttocks pain, numbness in both legs, and drop foot in right leg. MRI revealed metastases to the spine, and lumbar spinal canal stenosis with cauda equina compression. Even a combination of fentanyl-patch, oral acetaminophen, gabapentin and paroxetine was not effective for pain control. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain. The patient could be discharged from hospital and received a palliative care at home for a short period of time. (author)

  3. Treatment of intractable rheumatoid arthritis with total lymphoid irradiation

    International Nuclear Information System (INIS)

    Kotzin, B.L.; Strober, S.; Engleman, E.G.; Calin, A.; Hoppe, R.T.; Kansas, G.S.; Terrell, C.P.; Kaplan, H.S.

    1981-01-01

    Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells in the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweed mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy

  4. Processing of intractable polymers using reactive solvents: 1. Poly(2,6-dimethyl-1,4-phenylene ether)/epoxy resin

    NARCIS (Netherlands)

    Venderbosch, R.W.; Meijer, H.E.H.; Lemstra, P.J.

    1994-01-01

    A new processing route for poly(2,6-dimethyl-1,4-phenylene ether) (PPE), an intractable polymer on account of its thermal and oxidative sensitivity, was explored. PPE can be dissolved at elevated temperatures in epoxy resin and these solutions can then be processed at temperatures as low as 175°C.

  5. Intractable Diseases Treated with Intra-Bone Marrow-Bone Marrow Transplantation

    Directory of Open Access Journals (Sweden)

    Ming eLi

    2014-09-01

    Full Text Available Bone marrow transplantation (BMT is used to treat hematological disorders, autoimmune diseases and lymphoid cancers. Intra bone marrow-BMT (IBM-BMT has been proven to be a powerful strategy for allogeneic BMT due to the rapid hematopoietic recovery and the complete restoration of T cell functions. IBM-BMT not only replaces hematopoietic stem cells but also mesenchymal stem cells (MSMCs. MSMCs are multi-potent stem cells that can be isolated from bone marrow, umbilical cord blood, and adipose tissue. MSMCs play an important role in the support of hematopoiesis, and modify and influence the innate and adaptive immune systems. MSMCs also differentiate into mesodermal, endodermal and ectodermal lineage cells to repair tissues. This review aims to summarize the functions of bone marrow-derived- MSMCs, and the treatment of intractable diseases such as rheumatoid arthritis and malignant tumors with IBM-BMT.

  6. Total lymphoid irradiation for treatment of intractable cardiac allograft rejection

    International Nuclear Information System (INIS)

    Hunt, S.A.; Strober, S.; Hoppe, R.T.; Stinson, E.B.

    1991-01-01

    The ability of postoperative total lymphoid irradiation to reverse otherwise intractable cardiac allograft rejection was examined in a group of 10 patients in whom conventional rejection therapy (including pulsed steroids and monoclonal or polyclonal anti-T-cell antibody therapy) had failed to provide sustained freedom from rejection. Follow-up periods range from 73 to 1119 days since the start of total lymphoid irradiation. No patient died or sustained serious morbidity because of the irradiation. Three patients have had no further rejection (follow-up periods, 105 to 365 days). Two patients died--one in cardiogenic shock during the course of total lymphoid irradiation, the other with recurrent rejection caused by noncompliance with his medical regimen. Total lymphoid irradiation appears to be a safe and a moderately effective immunosuppressive modality for 'salvage' therapy of cardiac allograft rejection unresponsive to conventional therapy

  7. De novo mutations of KIAA2022 in females cause intellectual disability and intractable epilepsy

    Science.gov (United States)

    de Lange, Iris M; Helbig, Katherine L; Weckhuysen, Sarah; Møller, Rikke S; Velinov, Milen; Dolzhanskaya, Natalia; Marsh, Eric; Helbig, Ingo; Devinsky, Orrin; Tang, Sha; Mefford, Heather C; Myers, Candace T; van Paesschen, Wim; Striano, Pasquale; van Gassen, Koen; van Kempen, Marjan; de Kovel, Carolien G F; Piard, Juliette; Minassian, Berge A; Nezarati, Marjan M; Pessoa, André; Jacquette, Aurelia; Maher, Bridget; Balestrini, Simona; Sisodiya, Sanjay; Warde, Marie Therese Abi; De St Martin, Anne; Chelly, Jamel; van ‘t Slot, Ruben; Van Maldergem, Lionel; Brilstra, Eva H; Koeleman, Bobby P C

    2016-01-01

    Background Mutations in the KIAA2022 gene have been reported in male patients with X-linked intellectual disability, and related female carriers were unaffected. Here, we report 14 female patients who carry a heterozygous de novo KIAA2022 mutation and share a phenotype characterised by intellectual disability and epilepsy. Methods Reported females were selected for genetic testing because of substantial developmental problems and/or epilepsy. X-inactivation and expression studies were performed when possible. Results All mutations were predicted to result in a frameshift or premature stop. 12 out of 14 patients had intractable epilepsy with myoclonic and/or absence seizures, and generalised in 11. Thirteen patients had mild to severe intellectual disability. This female phenotype partially overlaps with the reported male phenotype which consists of more severe intellectual disability, microcephaly, growth retardation, facial dysmorphisms and, less frequently, epilepsy. One female patient showed completely skewed X-inactivation, complete absence of RNA expression in blood and a phenotype similar to male patients. In the six other tested patients, X-inactivation was random, confirmed by a non-significant twofold to threefold decrease of RNA expression in blood, consistent with the expected mosaicism between cells expressing mutant or normal KIAA2022 alleles. Conclusions Heterozygous loss of KIAA2022 expression is a cause of intellectual disability in females. Compared with its hemizygous male counterpart, the heterozygous female disease has less severe intellectual disability, but is more often associated with a severe and intractable myoclonic epilepsy. PMID:27358180

  8. Medial release and lateral imbrication for intractable anterior knee pain: diagnostic process, technique, and results

    Directory of Open Access Journals (Sweden)

    Meldrum AR

    2015-01-01

    Full Text Available Alexander R Meldrum,1 Jeremy R Reed,2 Megan D Dash3 1Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada; 2Department of Surgery, University of Saskatchewan College of Medicine, Regina, SK, Canada; 3Department of Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada Purpose: To present two cases of intractable patellofemoral pain syndrome treated with a novel procedure, arthroscopic medial release, and lateral imbrication of the patellar retinaculum. Patients and methods: This case series presents the treatment of three knees in two patients (one bilateral in whom an all-inside arthroscopic medial release and lateral imbrication of the patellar retinaculum was performed. Subjective measurement of pain was the primary outcome measurement, and subjective patellofemoral instability was the secondary outcome measurement. Results: Subjectively the two patients had full resolution of their pain, without any patellofemoral instability. Conclusion: Medial release and lateral imbrication of the patellar retinaculum is a new surgical procedure that has been used in the treatment of intractable patellofemoral pain syndrome. This is the first report of its kind in the literature. While outcome measurements were less than ideal, the patients had positive outcomes, both functionally and in terms of pain. Keywords: anterior knee pain syndrome, chondromalacia patellae, runners knee, patellar chondropathy, patellofemoral dysfunction, patellofemoral tracking disorder

  9. A case of intractable gastrocutaneous fistula after gastric pull-up reconstruction of the pharynx and esophagus

    International Nuclear Information System (INIS)

    Wada, Tadahiko; Tanaka, Shinzo; Hiratsuka, Yasuyuki; Kumabe, Yohei; Yamahara, Kohei; Koyama, Taiji

    2012-01-01

    Pharyngocutaneous or esophagocutaneous fistula formation is not a rare complication after surgical treatment of head/neck cancer. In cases having developed such fistula, conservative treatment with local manipulation or surgical closure of the fistula using a local or pedicled flap is often possible. We recently encountered a case with an intractable gastrocutaneous fistula which occurred a long time after gastric pull-up reconstruction of the pharynx and esophagus. The patient was a 58-year-old female. As treatment for hypopharyngeal and thoracic esophageal cancers, the patient underwent total resections of the laryngopharynx and esophagus and gastric pull-up reconstruction of the esophagus. Postoperatively, 50 Gy radiation was applied to the neck. Although there was no recurrence of cancer, a salivary fistula above the tracheostomy occurred six years after surgery. Closure of the fistula with a local flap was attempted twice, but did not succeed. The fistula was then closed with a deltopectoral (DP) flap, but a fistula recurred five months later. Finally, by resecting the cervical segment of the pulled-up stomach, the esophagus was reconstructed successfully with a free jejunal graft. An intractable fistula should be replaced using tissue with rich blood flow, such as a free jejunal graft. (author)

  10. [Summary of professor YANG Jun's experience for intractable facial paralysis].

    Science.gov (United States)

    Wang, Tao; Li, Zaiyuan; Ge, Tingqiu; Zhang, Man; Yuan, Aihong; Yang, Jun

    2017-06-12

    Professor YANG Jun 's experience of diagnosis and treatment for intractable facial paralysis is introduced. Professor YANG focuses on the thinking model that combines TCM, western medicine and acupuncture, and adopts the differentiation system that combines disease differentiation, syndrome differentiation and meridian differentiation; he adopts the treatment integrates etiological treatment, overall regulation, symptomatic treatment as well as acupuncture, moxibustion, medication and flash cupping. The acupoints of yangming meridians are mostly selected, and acupoints of governor vessel such as Dazhui (GV 14) and Jinsuo (GV 8) are highly valued. The multiple-needles shallow-penetration-insertion twirling lifting and thrusting technique are mostly adopted to achieve slow and mild acupuncture sensation; in addition, the facial muscles are pulled up with mechanics action. The intensive stimulation with electroacupuncture is recommended at Qianzheng (Extra), Yifeng (TE 17) and Yangbai (GB 14), which is given two or three treatments per week.

  11. Atypical language representation in children with intractable temporal lobe epilepsy.

    Science.gov (United States)

    Maulisova, Alice; Korman, Brandon; Rey, Gustavo; Bernal, Byron; Duchowny, Michael; Niederlova, Marketa; Krsek, Pavel; Novak, Vilem

    2016-05-01

    This study evaluated language organization in children with intractable epilepsy caused by temporal lobe focal cortical dysplasia (FCD) alone or dual pathology (temporal lobe FCD and hippocampal sclerosis, HS). We analyzed clinical, neurological, fMRI, neuropsychological, and histopathologic data in 46 pediatric patients with temporal lobe lesions who underwent excisional epilepsy surgery. The frequency of atypical language representation was similar in both groups, but children with dual pathology were more likely to be left-handed. Atypical receptive language cortex correlated with lower intellectual capacity, verbal abstract conceptualization, receptive language abilities, verbal working memory, and a history of status epilepticus but did not correlate with higher seizure frequency or early seizure onset. Histopathologic substrate had only a minor influence on neuropsychological status. Greater verbal comprehension deficits were noted in children with atypical receptive language representation, a risk factor for cognitive morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Impact of scaffolding and question structure on the gender gap

    Science.gov (United States)

    Dawkins, Hillary; Hedgeland, Holly; Jordan, Sally

    2017-12-01

    We address previous hypotheses about possible factors influencing the gender gap in attainment in physics. Specifically, previous studies claim that scaffolding may preferentially benefit female students, and we present some alternative conclusions surrounding this hypothesis. By taking both student attainment level and the degree of question scaffolding into account, we identify questions that exhibit real bias in favor of male students. We find that both multidimensional context and use of diagrams are common elements of such questions.

  13. Management of intractable Ménière's disease after intratympanic injection of gentamicin.

    Science.gov (United States)

    Rah, Yoon C; Han, Jae J; Park, Jaehong; Choi, Byung Y; Koo, Ja-Won

    2015-04-01

    1) To evaluate the efficacy of, and problems with, intratympanic gentamicin injection (ITG) in medically intractable definite Ménière's disease (MD) and secondary endolymphatic hydrops (EH); and 2) to review the vestibular status and treatment options of intractable vertigo even after ITG. Retrospective case review and survey. 780 patients with definite MD and secondary EH were enrolled. Long-term outcomes and problems of applied treatment options including ITG and exploratory tympanotomy and gentamicin application (ETG) were analyzed. Of the 780 patients, 95 patients received ITG. Class A and B control of vertigo was achieved in 85 (89.5%) patients; two patients were class C and eight patients were class F (ETG: 6; labyrinthectomy: 1; vestibular neurectomy: 1). Among seven patients who received ETG including 1 patient who skipped ITG due to chronic otitis media, five patients improved to class A, showing a 71.4% success rate; and labyrinthectomies were performed subsequently in the two remaining patients. Vertigo was controlled (class A) in all the patients who received labyrinthectomies (n = 4) or vestibular neurectomy (n = 1). Eight patients (8.4%) experienced more than 10 dB worsening, and two patients (2.1%) progressed to bilateral Ménière's disease. ITG failed to control vertigo in 10.5% of cases. ETG may be a reasonable option to facilitate the delivery of gentamicin into the inner ear by direct application of gentamicin over the round window and the oval window. Labyrinthectomy and vestibular neurectomy still have roles in the era of ITG. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Readmission Following Surgical Resection for Intractable Epilepsy: Nationwide Rates, Causes, Predictors, and Outcomes.

    Science.gov (United States)

    Rumalla, Kavelin; Smith, Kyle A; Arnold, Paul M; Schwartz, Theodore H

    2018-06-04

    Hospital readmissions can be detrimental to patients and may interfere with the potential benefits of the therapeutic procedure. Government agencies have begun to focus on reducing readmissions; however, the etiology of readmissions is lacking. To report the national rates, risk factors, and outcomes associated with 30- and 90-d readmissions following surgery for intractable epilepsy. We queried the Nationwide Readmissions Database from January to September 2013 using International Classification of Diseases, Ninth Edition, Clinical Modification codes to identify all patients with intractable epilepsy, who underwent hemispherectomy (01.52), brain lobectomy (01.53), amydalohippocampectomy, or partial lobectomy (01.59). Predictor variables included epilepsy type, presurgical diagnostic testing, surgery type, medical complications, surgical complications, and discharge disposition. In 1587 patients, the 30- and 90-d readmission rates were 11.5% and 16.8%, respectively. The most common reasons for readmission were persistent epilepsy, video electroencephalography monitoring, postoperative infection, and postoperative central nervous system complication. In multivariable analysis, risk factors associated with both 30- and 90-d readmission were Medicare payer status, lowest quartile of median income, depression, hemispherectomy, and postoperative complications (P < .05). The only unique predictor of 30-d readmission was small bedsize hospital (P = .001). Readmissions within 30 d were associated with longer length of stay (6.8 vs 5.8 d), greater costs ($18 660 vs $15 515), and increased adverse discharges (26.4% vs 21.8%). Following epilepsy surgery, most readmissions that occurred within 30 d can be attributed to management of persistent epilepsy and predicted by Medicare payer status, depression, and complications. These data can assist the clinician in preventing readmissions and assist policy makers determine which admissions are potentially avoidable.

  15. Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care

    Directory of Open Access Journals (Sweden)

    Zaporowska-Stachowiak I

    2014-10-01

    Full Text Available Iwona Zaporowska-Stachowiak,1,2 Grzegorz Kowalski,3 Jacek Łuczak,2 Katarzyna Kosicka,4 Aleksandra Kotlinska-Lemieszek,3 Maciej Sopata,3 Franciszek Główka4 1Chair and Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland; 2Palliative Medicine In-patient Unit, University Hospital of Lord's Transfiguration, Poznan University of Medical Sciences, Poznan, Poland; 3Palliative Medicine Chair and Department, Poznan University of Medical Sciences, Poznan, Poland; 4Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznan, Poland Background: Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III "pain ladder" drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient's refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective: Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures, and to evaluate the effect of the mode of administration (intrathecal versus rectal on the bupivacaine plasma concentration.Cases: We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25–0.5%, 1–2 mL every 6 hours. The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05–0.1%, 100 m

  16. Impact of scaffolding and question structure on the gender gap

    Directory of Open Access Journals (Sweden)

    Hillary Dawkins

    2017-09-01

    Full Text Available We address previous hypotheses about possible factors influencing the gender gap in attainment in physics. Specifically, previous studies claim that scaffolding may preferentially benefit female students, and we present some alternative conclusions surrounding this hypothesis. By taking both student attainment level and the degree of question scaffolding into account, we identify questions that exhibit real bias in favor of male students. We find that both multidimensional context and use of diagrams are common elements of such questions.

  17. Intractable occipital lobe epilepsy: clinical characteristics and surgical treatment.

    Science.gov (United States)

    Jobst, Barbara C; Williamson, Peter D; Thadani, Vijay M; Gilbert, Karen L; Holmes, Gregory L; Morse, Richard P; Darcey, Terrance M; Duhaime, Ann-Christine; Bujarski, Krysztof A; Roberts, David W

    2010-11-01

    Intractable occipital lobe epilepsy remains a surgical challenge. Clinical characteristics of 14 patients were analyzed. Twelve patients had surgery, seven patients had visual auras (50%) and only eight patients (57%) had posterior scalp EEG changes. Ictal single-proton emission computed tomography (SPECT) incorrectly localized in 7 of 10 patients. Six patients (50%) had Engel's class I outcome. Patients with inferior occipital seizure onset appeared to fare better (three of four class I) than patients with lateral or medial occipital seizure onset (three of eight class I). Patients who had all three occipital surfaces covered with electrodes had a better outcome (four of five class I) than patients who had limited electroencephalography (EEG) coverage (two of seven class I). Magnetic resonance imaging (MRI) lesions did not guarantee a seizure free outcome. In conclusion, visual auras, scalp EEG, and imaging findings are not reliable for correct identification of occipital onset. Occipital seizure onset can be easily missed in nonlesional epilepsy. Comprehensive intracranial EEG coverage of all three occipital surfaces leads to better outcomes.

  18. Partial pleural covering for intractable pneumothorax in patients with Birt-Hogg-Dubé Syndrome.

    Science.gov (United States)

    Okada, Akira; Hirono, Tatsuhiko; Watanabe, Takehiro; Hasegawa, Go; Tanaka, Reiko; Furuya, Mitsuko

    2017-03-01

    Birt-Hogg-Dubé syndrome (BHD) is an inherited disorder associated with a germline mutation of the folliculin (FLCN) gene. Most patients with BHD have multiple pulmonary cysts, and are at high risk of repeated pneumothorax. Although an increasing number of patients are diagnosed with BHD by genetic testing, therapeutic approaches for intractable pneumothorax have not yet been described. We treated three patients who had repeated episodes of pneumothorax. All had multiple pulmonary cysts in the lower lobes, and two had a family history of pneumothorax. Video-assisted thoracic surgery was used to perform wedge resections and partial pleural covering of the cystic lesions. The partial pleural covering technique used sheets of polyglycolic acid felt or regenerative oxidized cellulose mesh. The resected tissues underwent histopathological evaluation, and peripheral blood leukocytes were tested for FLCN mutations. The operative times were less than 2 h, and there were no complications. The resected cysts had histopathological features characteristic of BHD lung. All patients were found to have FLCN germline mutations; thus their repeated pneumothoraces were a manifestation of BHD. None of the patients developed respiratory problems after undergoing the partial pleural covering procedure, and they have all been well without pneumothorax for 30 months or more. Partial pleural covering combined with resection of protruding cysts should be a safe and effective therapeutic approach for BHD patients with intractable pneumothorax. Further investigation is needed to establish a detailed protocol for treatment of pneumothorax that results in minimal functional impairment. © 2015 John Wiley & Sons Ltd.

  19. Understanding complexities of synaptic transmission in medically intractable seizures: A paradigm of epilepsy research

    Directory of Open Access Journals (Sweden)

    Jyotirmoy Banerjee

    2013-01-01

    Full Text Available Investigating the changes associated with the development of epileptic state in humans is complex and requires a multidisciplinary approach. Understanding the intricacies of medically intractable epilepsy still remains a challenge for neurosurgeons across the world. A significant number of patients who has undergone resective brain surgery for epilepsy still continue to have seizures. The reason behind this therapy resistance still eludes us. Thus to develop a cure for the difficult to treat epilepsy, we need to comprehensively study epileptogenesis. Although various animal models are developed but none of them replicate the pathological conditions in humans. So the ideal way to understand epileptogenecity is to examine the tissue resected for the treatment of intractable epilepsy. Advanced imaging and electrical localization procedures are utilized to establish the epileptogenic zone in epilepsy patients. Further molecular and cytological studies are required for the microscopic analysis of brain samples collected from the epileptogenic focus. As alterations in inhibitory as well as excitatory synaptic transmission are key features of epilepsy, understanding the regulation of neurotransmission in the resected surgery zone is of immense importance. Here we summarize various modalities of in vitro slice analysis from the resected brain specimen to understand the changes in GABAergic and glutamatergic synaptic transmission in epileptogenic zone. We also review evidence pertaining to the proposed role of nicotinic receptors in abnormal synaptic transmission which is one of the major causes of epileptiform activity. Elucidation of current concepts in regulation of synaptic transmission will help develop therapies for epilepsy cases that cannot me managed pharmacologically.

  20. The study of controlling intractable upper abdominal pain caused by cancer through neurolytic celiac plexus block guided by CT

    International Nuclear Information System (INIS)

    Cui Hengwu; Tian Jianming; Wang Peijun; Chen Aihua; Zuo Changjing; Xiao Yi; Wang Minjie; Fan Yuelan

    1999-01-01

    Objective: To evaluate the therapeutic effect of neurolytic celiac plexus block (NCPB) and to analyze the factors related to the degree of pain relief. Methods: Forty-two patients who had intractable upper abdominal pain or accompanying referred back pain from cancer of pancreas, liver, stomach, colon and bile duct received bilateral alcohol neurolytic celiac plexus blocks under CT guidance. The results of pain relief were classified into 0-III grade. The spread of neurolytic solution (with contrast material) was observed through 3D reconstruction. Results: During the 3 months follow-up, the total effective rates of pain relief in 2 weeks, 1 month, 2 months and 3 months were 92.86%, 88.10%, 85.00% and 80.56% respectively. Satisfactory pain relief results were obtained when the neurolytic solution encircled the aorta adequately from two sides. There were no severe complications in any case. Conclusion: NCPB guided by CT proves to be an effective and safe means of controlling intractable upper abdominal cancer pain and should be popularized

  1. Questioning the Questions

    Science.gov (United States)

    Tienken, Christopher H.; Goldberg, Stephanie; DiRocco, Dominic

    2010-01-01

    Historical accounts of questioning used in the education process trace back to Socrates. One of the best examples of his use of questioning is found in Plato's "The Republic." Socrates used a series of strategic questions to help his student Glaucon come to understand the concept of justice. Socrates purposefully posed a series of…

  2. Expression and cellular distribution of multidrug transporter proteins in two major causes of medically intractable epilepsy: Focal cortical dysplasia and glioneuronal tumors

    NARCIS (Netherlands)

    Aronica, E.; Gorter, J. A.; Jansen, G. H.; van Veelen, C. W. M.; van Rijen, P. C.; Leenstra, S.; Ramkema, M.; Scheffer, G. L.; Scheper, R. J.; Troost, D.

    2003-01-01

    The cell-specific distribution of multidrug resistance extrusion pumps was studied in developmental glioneuronal lesions, including focal cortical dysplasia (15 cases) and ganglioglioma (15 cases) from patients with medically intractable epilepsy. Lesional, perilesional, as well as normal brain

  3. An intractable empyema proceeded from radiation pneumonitis after operation of lung cancer

    International Nuclear Information System (INIS)

    Masuya, Daiki; Gotoh, Masashi; Nakashima, Takashi; Okamoto, Taku; Liu, Dage; Ishikawa, Shinya; Yamamoto, Yasumichi; Huang, Cheng-Long; Yokomise, Hiroyasu

    2005-01-01

    A 54-year-old man underwent left upper lobectomy with c-stage IIIA lung squamous cell carcinoma after concurrent chemo-radiotherapy. Radiation pneumonitis focusing on the residual left S 6 appeared after operation. Following steroid pulse treatment, the pneumonitic focus was cavitated and proceeded to pulmonary abscess. Although chest drainage was performed, control of the pulmonary fistula was poor, so an operation was performed. Pulmonary decortication and pleurodesis were performed, but failed to control the fistula and infection. Finally, thoracoplasty, omentoplasty and free rectus abdominis musculocutaneous flap were filled in intrathorasic to manage the fistula. In this case of operation following concurrent chemo-radiotherapy, the original recovery power declined. We therefore conclude this was an intractable case of empyema. (author)

  4. Big Data and historical social science

    Directory of Open Access Journals (Sweden)

    Peter Bearman

    2015-11-01

    Full Text Available “Big Data” can revolutionize historical social science if it arises from substantively important contexts and is oriented towards answering substantively important questions. Such data may be especially important for answering previously largely intractable questions about the timing and sequencing of events, and of event boundaries. That said, “Big Data” makes no difference for social scientists and historians whose accounts rest on narrative sentences. Since such accounts are the norm, the effects of Big Data on the practice of historical social science may be more limited than one might wish.

  5. Water Security in Times of Climate Change and Intractability: Reconciling Conflict by Transforming Security Concerns into Equity Concerns

    Directory of Open Access Journals (Sweden)

    Neil Powell

    2017-12-01

    Full Text Available This paper considers how to achieve equitable water governance and the flow-on effects it has in terms of supporting sustainable development, drawing on case studies from the international climate change adaptation and governance project (CADWAGO. Water governance, like many other global issues, is becoming increasingly intractable (wicked with climate change and is, by the international community, being linked to instances of threats to human security, the war in the Sudanese Darfur and more recently the acts of terrorism perpetuated by ISIS. In this paper, we ask the question: how can situations characterized by water controversy (exacerbated by the uncertainties posed by climate change be reconciled? The main argument is based on a critique of the way the water security discourse appropriates expert (normal claims about human-biophysical relationships. When water challenges become increasingly securitized by the climate change discourse it becomes permissible to enact processes that legitimately transgress normative positions through post-normal actions. In contrast, the water equity discourse offers an alternative reading of wicked and post-normal water governance situations. We contend that by infusing norm critical considerations into the process of securitization, new sub-national constellations of agents will be empowered to enact changes; thereby bypassing vicious cycles of power brokering that characterize contemporary processes intended to address controversies.

  6. The effectiveness of the double B-lynch suture as a modification in the treatment of intractable postpartum haemorrhage.

    Science.gov (United States)

    Şahin, Hanifi; Soylu Karapınar, Oya; Şahin, Eda Adeviye; Dolapçıoğlu, Kenan; Baloğlu, Ali

    2018-03-20

    A broader range of more effective compression techniques are needed in the patients who have an intractable postpartum haemorrhage due to uterine atony despite medical treatment and B-Lynch sutures. The aim of this study was to report the outcome of a series of patients with haemorrhage who were managed by double B-Lynch suture. Fourteen patients who were treated in a tertiary hospital between July 2010 and February 2015 were included in the study. The intractable haemorrhage rate was 0.35% over 5 years (14/4000 births). Bleeding was controlled in all the patients with a double B-Lynch suture. The mean age of the patients was 24 ± 3.4 years. The mean estimated blood loss was 1696 ± 272.075 mL, and the mean transfusion rate was 4.2 ± 2.5 units. Pregnancy was observed in five patients at follow up. The double B-Lynch suture seems to be an effective and reliable solution to an intractable postpartum haemorrhage resulting from uterine atony and has no unfavourable impacts on fertility. It should be considered before the use of any aggressive surgical techniques such as a hypogastric artery ligation or a hysterectomy. This the first study to investigate the effectiveness of the double B-Lynch suture, and we showed that the hysterectomy and/or hypogastric artery ligation rate can be decreased by adding a second B-Lynch suture in cases where the medical treatment or a single B-Lynch has failed. Impact statement What is already known on the subject? Uterine atony is the most common cause of a primary postpartum haemorrhage. When a simple massage of the uterus and medication failed to manage this condition, various surgical solutions have been sought, including uterine compression sutures, uterine artery ligation, devascularisation of the uterus, internal iliac artery ligation and, ultimately, a hysterectomy. The B-Lynch suturing technique is particularly useful because of its simplicity of application, life-saving potential, relative safety and capacity

  7. Post-marketing surveillance study of the safety and efficacy of nalfurafine hydrochloride (Remitch® capsules 2.5 μg in 3,762 hemodialysis patients with intractable pruritus

    Directory of Open Access Journals (Sweden)

    Kozono H

    2018-01-01

    Full Text Available Hideki Kozono,* Hiroshi Yoshitani,* Ryoko Nakano* Pharmaceutical and Medical Device Vigilance Department, Toray Industries, Inc., Tokyo, Japan *The authors contributed equally to this work Background: Intractable pruritus in hemodialysis patients can significantly decrease their quality of life and is also associated with poor vital prognosis. Although combined multiple causes of intractable pruritus in these patients have been identified, no existing treatments are proven to be sufficiently effective. We conducted a post-marketing surveillance to follow-up and assess the safety and efficacy of nalfurafine, a selective κ-opioid receptor agonist, for the treatment of intractable pruritus in patients undergoing hemodialysis. Patients and methods: Hemodialysis patients with intractable pruritus from institutions in Japan who received oral nalfurafine hydrochloride between January 2010 and December 2013 were enrolled in the surveillance. Surveillance was completed in July 2015. Safety data during 1 year after nalfurafine treatment onset, and efficacy data of nalfurafine evaluating the first 12-week treatment period and the following period until 1 year after the initial dose of nalfurafine (using global assessment of the itch improvement by the physician, Visual Analog Scale, and the Shiratori’s severity scores were collected and analyzed. Results: In total, 3,762 patients were analyzed for safety. Adverse drug reactions were experienced by 402/3,762 (10.69% patients. The most frequent adverse drug reactions were insomnia (127/3,762 [3.38%] patients, constipation (34 [0.90%], somnolence (32 [0.85%], dizziness (23 [0.61%], nausea (13 [0.35%], and malaise (9 [0.24%]. No patients developed dependence on nalfurafine. Nalfurafine was effective in 82.50% (2,880/3,491 of patients during the first 12 weeks and in 84.95% (2,167/2,551 on treatment during the subsequent period until 1 year after nalfurafine treatment initiation. Statistically significant

  8. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy.

    Science.gov (United States)

    Geller, Eric B; Skarpaas, Tara L; Gross, Robert E; Goodman, Robert R; Barkley, Gregory L; Bazil, Carl W; Berg, Michael J; Bergey, Gregory K; Cash, Sydney S; Cole, Andrew J; Duckrow, Robert B; Edwards, Jonathan C; Eisenschenk, Stephan; Fessler, James; Fountain, Nathan B; Goldman, Alicia M; Gwinn, Ryder P; Heck, Christianne; Herekar, Aamar; Hirsch, Lawrence J; Jobst, Barbara C; King-Stephens, David; Labar, Douglas R; Leiphart, James W; Marsh, W Richard; Meador, Kimford J; Mizrahi, Eli M; Murro, Anthony M; Nair, Dileep R; Noe, Katherine H; Park, Yong D; Rutecki, Paul A; Salanova, Vicenta; Sheth, Raj D; Shields, Donald C; Skidmore, Christopher; Smith, Michael C; Spencer, David C; Srinivasan, Shraddha; Tatum, William; Van Ness, Paul C; Vossler, David G; Wharen, Robert E; Worrell, Gregory A; Yoshor, Daniel; Zimmerman, Richard S; Cicora, Kathy; Sun, Felice T; Morrell, Martha J

    2017-06-01

    Evaluate the seizure-reduction response and safety of mesial temporal lobe (MTL) brain-responsive stimulation in adults with medically intractable partial-onset seizures of mesial temporal lobe origin. Subjects with mesial temporal lobe epilepsy (MTLE) were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. There were 111 subjects with MTLE; 72% of subjects had bilateral MTL onsets and 28% had unilateral onsets. Subjects had one to four leads placed; only two leads could be connected to the device. Seventy-six subjects had depth leads only, 29 had both depth and strip leads, and 6 had only strip leads. The mean follow-up was 6.1 ± (standard deviation) 2.2 years. The median percent seizure reduction was 70% (last observation carried forward). Twenty-nine percent of subjects experienced at least one seizure-free period of 6 months or longer, and 15% experienced at least one seizure-free period of 1 year or longer. There was no difference in seizure reduction in subjects with and without mesial temporal sclerosis (MTS), bilateral MTL onsets, prior resection, prior intracranial monitoring, and prior vagus nerve stimulation. In addition, seizure reduction was not dependent on the location of depth leads relative to the hippocampus. The most frequent serious device-related adverse event was soft tissue implant-site infection (overall rate, including events categorized as device-related, uncertain, or not device-related: 0.03 per implant year, which is not greater than with other neurostimulation devices). Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including patients with unilateral or bilateral MTLE who are not candidates for

  9. Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy.

    Science.gov (United States)

    Kang, Joon Y; Wu, Chengyuan; Tracy, Joseph; Lorenzo, Matthew; Evans, James; Nei, Maromi; Skidmore, Christopher; Mintzer, Scott; Sharan, Ashwini D; Sperling, Michael R

    2016-02-01

    To describe mesial temporal lobe ablated volumes, verbal memory, and surgical outcomes in patients with medically intractable mesial temporal lobe epilepsy (mTLE) treated with magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LiTT). We prospectively tracked seizure outcome in 20 patients at Thomas Jefferson University Hospital with drug-resistant mTLE who underwent MRI-guided LiTT from December 2011 to December 2014. Surgical outcome was assessed at 6 months, 1 year, 2 years, and at the most recent visit. Volume-based analysis of ablated mesial temporal structures was conducted in 17 patients with mesial temporal sclerosis (MTS) and results were compared between the seizure-free and not seizure-free groups. Following LiTT, proportions of patients who were free of seizures impairing consciousness (including those with auras only) are as follows: 8 of 15 patients (53%, 95% confidence interval [CI] 30.1-75.2%) after 6 months, 4 of 11 patients (36.4%, 95% CI 14.9-64.8%) after 1 year, 3 of 5 patients (60%, 95% CI 22.9-88.4%) at 2-year follow-up. Median follow-up was 13.4 months after LiTT (range 1.3 months to 3.2 years). Seizure outcome after LiTT suggests an all or none response. Four patients had anterior temporal lobectomy (ATL) after LiTT; three are seizure-free. There were no differences in total ablated volume of the amygdalohippocampus complex or individual volumes of hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, and fusiform gyrus between seizure-free and non-seizure-free patients. Contextual verbal memory performance was preserved after LiTT, although decline in noncontextual memory task scores were noted. We conclude that MRI-guided stereotactic LiTT is a safe alternative to ATL in patients with medically intractable mTLE. Individualized assessment is warranted to determine whether the reduced odds of seizure freedom are worth the reduction in risk, discomfort, and recovery time. Larger prospective

  10. De novo mutations of KIAA2022 in females cause intellectual disability and intractable epilepsy.

    Science.gov (United States)

    de Lange, Iris M; Helbig, Katherine L; Weckhuysen, Sarah; Møller, Rikke S; Velinov, Milen; Dolzhanskaya, Natalia; Marsh, Eric; Helbig, Ingo; Devinsky, Orrin; Tang, Sha; Mefford, Heather C; Myers, Candace T; van Paesschen, Wim; Striano, Pasquale; van Gassen, Koen; van Kempen, Marjan; de Kovel, Carolien G F; Piard, Juliette; Minassian, Berge A; Nezarati, Marjan M; Pessoa, André; Jacquette, Aurelia; Maher, Bridget; Balestrini, Simona; Sisodiya, Sanjay; Warde, Marie Therese Abi; De St Martin, Anne; Chelly, Jamel; van 't Slot, Ruben; Van Maldergem, Lionel; Brilstra, Eva H; Koeleman, Bobby P C

    2016-12-01

    Mutations in the KIAA2022 gene have been reported in male patients with X-linked intellectual disability, and related female carriers were unaffected. Here, we report 14 female patients who carry a heterozygous de novo KIAA2022 mutation and share a phenotype characterised by intellectual disability and epilepsy. Reported females were selected for genetic testing because of substantial developmental problems and/or epilepsy. X-inactivation and expression studies were performed when possible. All mutations were predicted to result in a frameshift or premature stop. 12 out of 14 patients had intractable epilepsy with myoclonic and/or absence seizures, and generalised in 11. Thirteen patients had mild to severe intellectual disability. This female phenotype partially overlaps with the reported male phenotype which consists of more severe intellectual disability, microcephaly, growth retardation, facial dysmorphisms and, less frequently, epilepsy. One female patient showed completely skewed X-inactivation, complete absence of RNA expression in blood and a phenotype similar to male patients. In the six other tested patients, X-inactivation was random, confirmed by a non-significant twofold to threefold decrease of RNA expression in blood, consistent with the expected mosaicism between cells expressing mutant or normal KIAA2022 alleles. Heterozygous loss of KIAA2022 expression is a cause of intellectual disability in females. Compared with its hemizygous male counterpart, the heterozygous female disease has less severe intellectual disability, but is more often associated with a severe and intractable myoclonic epilepsy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Modified Atkins diet to children and adolescents with medical intractable epilepsy

    DEFF Research Database (Denmark)

    Weber, Susanne; Mølgaard, Christian; Taudorf, Karen

    2008-01-01

    The aim of the present study was to evaluate the tolerability and efficacy of the modified Atkins diet given to children and adolescents with antiepileptic drug (AED) treatment resistant epilepsy. 15 children with medically intractable epilepsy were enrolled in the study. Inclusion criteria were...... further restricted to 10g per day. No change in AED treatment was allowed. The diet was well tolerated. After 3 months six out of the fifteen children (40%) had a seizure reduction of more than 50%, which was seen in different epileptic syndromes and different age groups. The responders reported...... an increase in quality of life and cognition. At 12 months follow-up 3 (20%) continued the diet with an unchanged marked seizure reduction. The present study confirms the high tolerability and effect of the modified Atkins diet on seizure control in AED treatment resistant epilepsy. Further larger prospective...

  12. Neonatal severe intractable diarrhoea as the presenting manifestation of an unclassified congenital disorder of glycosylation (CDG-x)

    Science.gov (United States)

    Mention, K; Michaud, L; Dobbelaere, D; Guimber, D; Gottrand, F; Turck, D

    2001-01-01

    A case of severe and protracted diarrhoea is reported, which started in the neonatal period and progressively associated with neurological impairment, dysmorphy, hepatosplenomegaly, and hepatic insufficiency, from which the patient died at 2 years of age. Isoelectric focusing of serum transferrin showed a congenital disorder of glycosylation type I pattern but the basic defect could not be identified. This observation shows that congenital disorder of glycosylation is a cause of intractable diarrhoea in neonates.

 PMID:11668168

  13. Efficacy of and Patient Compliance with a Ketogenic Diet in Adults with Intractable Epilepsy: A Meta-Analysis

    OpenAIRE

    Ye, Fang; Li, Xiao-Jia; Jiang, Wan-Lin; Sun, Hong-Bin; Liu, Jie

    2015-01-01

    Background and Purpose Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice. Methods Electronic searc...

  14. [Clinical usefulness of the combined empirical therapy with flomoxef and fosfomycin for intractable respiratory tract infections. With a background of increasing MRSA incidence].

    Science.gov (United States)

    Shimada, K; Kudoh, S; Hayashi, I; Shishido, H; Fukuchi, Y; Suzuki, H; Oritsu, M; Nakada, K; Sano, Y; Goto, H

    1994-10-01

    We conducted a multicenter trial to determine the clinical usefulness of the combined therapy with flomoxef (FMOX) and fosfomycin (FOM) (FF therapy) as an empirical therapy in the treatment of intractable respiratory tract infections, because FF therapy has clinically been proved to be very useful for the treatment of severe infections including MRSA infections. The overall efficacy rate of FF therapy was 69.2%. The efficacy rate for "pneumonia/lung abscess," which occupy the largest portions of respiratory tract infections, was 70.0%, showing a statistically significant difference from the efficacy rate for FMOX alone (56.7%) found in a previous study (P = 0.09 by chi-squared test). Although MRSA was eradicated in only 3 cases (37.5%) including superinfection cases, of 8 patients, from whom MRSA had been isolated as causative organisms, none of our patients were superinfected with MRSA. Thus it has been concluded that FF therapy is clinically very useful when used as an empirical therapy in the treatment of respiratory tract infections.

  15. Intractable trigeminal neuralgia: A single institution experience in 26 patients treated with stereotactic gamma knife radiosurgery

    International Nuclear Information System (INIS)

    Mark, Rufus J.; Duma, Christopher M.; Jacques, Dean B.; Kopyov, Oleg V.; Copcutt, Brian

    1996-01-01

    Purpose: In patients with trigeminal neuralgia, severe pain can persist, or recur despite aggressive medical management and open surgery. Recently, Gamma Knife radiosurgery has been used with promising results. We report on our series of 26 patients with intractable trigeminal neuralgia treated with stereotactic Gamma Knife radiosurgery. Materials and Methods: Between 1991 and 1995, 26 patients with intractable trigeminal neuralgia were treated at our institution using stereotactic Gamma Knife radiosurgery. Medical management had failed in all cases. In addition, 13 patients underwent a total of 20 open surgeries, with transient, or no pain relief. There were 19 females, and 7 males. Patient ages ranged from 37 to 87 years, with a median of 74 years. All patients were treated with a 201 source Cobalt-60 Gamma Knife unit. All patients underwent placement of the Leksell frame, followed by MRI scanning and computer treatment planning. The target in all patients was the fifth cranial nerve root entry zone into the brainstem. Twenty-five patients received between 64.3 to 70 Gy prescribed to Dmax in one shot. One patient received 120 Gy to Dmax in one shot. The 4 mm collimator was used in 22 cases, and the 8 mm in 4 cases. Follow-up ranged from 5 to 55 months, with a median of 19 months. Complete resolution (CR) of pain was scored when the patient reported being pain free off all medication. Partial resolution (PR) was scored when the patient reported > 50% pain reduction after Gamma Knife treatment. Results: At last follow-up, 84.6% ((22(26))) reported CR or PR of pain after Gamma Knife treatment. Forty-two percent ((11(26))) of patients reported CR, and 42%((11(26))) reported PR of pain. There was a dose response. In patients receiving < 70 Gy, 25% ((3(12))) reported CR, while 57% ((8(14))) of those receiving ≥ 70 Gy reported CR. Complications occurred in two (8%) patients. One patient developed transient numbness of the face after 70 Gy, and a second patient

  16. Atypical language laterality is associated with large-scale disruption of network integration in children with intractable focal epilepsy.

    Science.gov (United States)

    Ibrahim, George M; Morgan, Benjamin R; Doesburg, Sam M; Taylor, Margot J; Pang, Elizabeth W; Donner, Elizabeth; Go, Cristina Y; Rutka, James T; Snead, O Carter

    2015-04-01

    Epilepsy is associated with disruption of integration in distributed networks, together with altered localization for functions such as expressive language. The relation between atypical network connectivity and altered localization is unknown. In the current study we tested whether atypical expressive language laterality was associated with the alteration of large-scale network integration in children with medically-intractable localization-related epilepsy (LRE). Twenty-three right-handed children (age range 8-17) with medically-intractable LRE performed a verb generation task in fMRI. Language network activation was identified and the Laterality index (LI) was calculated within the pars triangularis and pars opercularis. Resting-state data from the same cohort were subjected to independent component analysis. Dual regression was used to identify associations between resting-state integration and LI values. Higher positive values of the LI, indicating typical language localization were associated with stronger functional integration of various networks including the default mode network (DMN). The normally symmetric resting-state networks showed a pattern of lateralized connectivity mirroring that of language function. The association between atypical language localization and network integration implies a widespread disruption of neural network development. These findings may inform the interpretation of localization studies by providing novel insights into reorganization of neural networks in epilepsy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Transbronchial Catheter Drainage via Fiberoptic Bronchoscope in Intractable Lung Abscess

    Science.gov (United States)

    Jeong, Man Pyo; Kim, Woo Sung; Han, Sung Koo; Shim, Young Soo; Kim, Keun Youl; Han, Yong Chol

    1989-01-01

    The use of the fiberoptic bronchoscope as a drainage procedure for lung abscess has become more and more widespread. We have recently adopted the technique of inserting a simple polyethylene catheter through the flexible fiberoptic bronchoscope into the abscess cavity of 11 patients with lung absess. All cases had not responded to aggressive postural drainage and adequate antibiotic therapy for at least a week. The results were as follows: Among 11 patients, the therapeutic response was dramatic in 6 patients.In the successful group, the abscess sizes were greater than 8cm in diameter and the air-fluid levels were higher than two-thirds of the cavity.Additional diagnoses, other than bacterial lung abscess, could be made in 2 cases when otherwise the diagnosis would have remained in doubt. The authors suggest that catheter drainage via fiberoptic bronchoscpope is an effective treatment modality in the large lung abscess with a high air-fluid level which is intractable to other medical approaches, and it is also a safe procedure. PMID:2487405

  18. Mesial temporal lobe morphology in intractable pediatric epilepsy: so-called hippocampal malrotation, associated findings, and relevance to presurgical assessment.

    Science.gov (United States)

    Leach, James L; Awwad, Reem; Greiner, Hansel M; Vannest, Jennifer J; Miles, Lili; Mangano, Francesco T

    2016-06-01

    OBJECTIVE Diagnostic criteria for hippocampal malrotation (HIMAL) on brain MRI typically include a rounded hippocampus, vertical collateral sulcus, and architectural blurring. Relationship to epileptogenesis remains speculative, and usefulness for surgical guidance is unknown. The study was performed to determine the prevalence of hippocampal rotational anomalies in a cohort of pediatric patients with intractable epilepsy undergoing evaluation for surgery and to determine the significance of this finding in the context of surgical planning. METHODS Forty-eight surgically treated children with intractable epilepsy were compared with matched healthy subjects; reviewers were blinded to surgical side. Each temporal lobe was evaluated for rounded hippocampus, blurring, vertical collateral sulcus, wide choroidal fissure, enlarged temporal horn, low fornix, hippocampal signal, and findings of hippocampal sclerosis. A mesial temporal lobe (MTL) score was calculated by summing the number of features, and the collateral sulcus angle (CSA) was measured in each temporal lobe. Surgical side, pathological diagnosis, and imaging findings elsewhere in the brain were tabulated. Presence of HIMAL, associated imaging features, and MTL score were compared between sides, between epilepsy and control groups, in relationship to side of surgery, and in relationship to postoperative outcome. RESULTS Only 3 epilepsy patients (6.2%) and no controls exhibited all 3 features of HIMAL (p = 0.12). Eight of 48 (16.7%) epilepsy versus 2 of 48 (4.6%) control subjects had both a rounded hippocampus and vertical collateral sulcus (suggesting HIMAL) (p = 0.045). In control and epilepsy subjects, most findings were more prevalent on the left, and the left CSA was more vertical (p Epilepsy subjects had higher MTL scores (z = -2.95, p = 0.002) and more acute CSAs (p = 0.04) than controls. Only lateralizing raw MTL score had a significant association with surgical side (p = 0.03, OR 7.33); however, this

  19. Does ketogenic diet have any negative effect on cardiac systolic and diastolic functions in children with intractable epilepsy?: One-year follow-up results.

    Science.gov (United States)

    Ozdemir, Rahmi; Kucuk, Mehmet; Guzel, Orkide; Karadeniz, Cem; Yilmaz, Unsal; Mese, Timur

    2016-10-01

    The ketogenic diet (KD) has been referred to as an "effective therapy with side effects" for children with intractable epilepsy. Among the most recognized adverse effects, there are cardiac conduction abnormalities, vascular and myocardial dysfunction. However, very limited and controversial data are available regarding the effects of the KD on cardiac functions. We sought to analyze the mid-term effect of ketogenic diet on cardiac functions in patients with intractable epilepsy who received a ketogenic diet for at least 12months using conventional and relatively new imaging techniques. This prospective study included 61 patients with intractable epilepsy who received ketogenic diet for at least 12months. Clinical examinations, serum carnitine and selenium levels as well as electrocardiographic and echocardiographic examinations were scheduled prior to the procedure and at 1, 3, 6 and 12months. We utilized two-dimensional, M-mode, colored Doppler, spectral Doppler and pulsed wave tissue Doppler imaging techniques to investigate ventricular systolic and diastolic functions of this subgroup of patients. In our study, there was no significant difference after 1year of KD therapy compared to baseline values-except a significantly decreased A wave velocity-in terms of pulse wave Doppler echocardiographic measurements of the diastolic function. The tissue Doppler measurements obtained from the lateral wall of tricuspide and mitral annuli were not different at baseline and at month 12 of the treatment, as well. The ketogenic diet appears to have no disturbing effect on ventricular functions in epileptic children in the midterm. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  20. Adjuvant single-fraction radiotherapy is safe and effective for intractable keloids

    International Nuclear Information System (INIS)

    Song, Changhoon; Wu, Honggyun; Chang, Hak; Kim, Il Han; Ha, Sung W.

    2014-01-01

    The aim of this study was to assess the feasibility and efficacy of high-dose, single-fraction electron beam radiotherapy for therapy-resistant keloids. Before 2010, intractable keloids were treated at our institution with post-operative irradiation of 6-15 Gy in 3-5 fractionations. For convenience and cost effectiveness, we have changed our treatment protocol to high-dose single-fraction radiotherapy. A total of 12 patients with 16 keloid lesions were treated from January 2010 to January 2013 in our department. A 10-Gy dose of electron irradiation was given within 72 h of the surgical excision. The mean follow-up period was 20 months. Treatments were well tolerated, and there was no recurrence in any of the patients. Severe adverse effects were not observed. Surgical excision of the keloid, followed by immediate, single-fraction, high-dose radiotherapy, is both safe and effective in preventing recurrence of therapy-resistant keloids. (author)

  1. VQABQ: Visual Question Answering by Basic Questions

    KAUST Repository

    Huang, Jia-Hong

    2017-03-19

    Taking an image and question as the input of our method, it can output the text-based answer of the query question about the given image, so called Visual Question Answering (VQA). There are two main modules in our algorithm. Given a natural language question about an image, the first module takes the question as input and then outputs the basic questions of the main given question. The second module takes the main question, image and these basic questions as input and then outputs the text-based answer of the main question. We formulate the basic questions generation problem as a LASSO optimization problem, and also propose a criterion about how to exploit these basic questions to help answer main question. Our method is evaluated on the challenging VQA dataset and yields state-of-the-art accuracy, 60.34% in open-ended task.

  2. VQABQ: Visual Question Answering by Basic Questions

    KAUST Repository

    Huang, Jia-Hong; Alfadly, Modar; Ghanem, Bernard

    2017-01-01

    Taking an image and question as the input of our method, it can output the text-based answer of the query question about the given image, so called Visual Question Answering (VQA). There are two main modules in our algorithm. Given a natural language question about an image, the first module takes the question as input and then outputs the basic questions of the main given question. The second module takes the main question, image and these basic questions as input and then outputs the text-based answer of the main question. We formulate the basic questions generation problem as a LASSO optimization problem, and also propose a criterion about how to exploit these basic questions to help answer main question. Our method is evaluated on the challenging VQA dataset and yields state-of-the-art accuracy, 60.34% in open-ended task.

  3. Biology Question Generation from a Semantic Network

    Science.gov (United States)

    Zhang, Lishan

    Science instructors need questions for use in exams, homework assignments, class discussions, reviews, and other instructional activities. Textbooks never have enough questions, so instructors must find them from other sources or generate their own questions. In order to supply instructors with biology questions, a semantic network approach was developed for generating open response biology questions. The generated questions were compared to professional authorized questions. To boost students' learning experience, adaptive selection was built on the generated questions. Bayesian Knowledge Tracing was used as embedded assessment of the student's current competence so that a suitable question could be selected based on the student's previous performance. A between-subjects experiment with 42 participants was performed, where half of the participants studied with adaptive selected questions and the rest studied with mal-adaptive order of questions. Both groups significantly improved their test scores, and the participants in adaptive group registered larger learning gains than participants in the control group. To explore the possibility of generating rich instructional feedback for machine-generated questions, a question-paragraph mapping task was identified. Given a set of questions and a list of paragraphs for a textbook, the goal of the task was to map the related paragraphs to each question. An algorithm was developed whose performance was comparable to human annotators. A multiple-choice question with high quality distractors (incorrect answers) can be pedagogically valuable as well as being much easier to grade than open-response questions. Thus, an algorithm was developed to generate good distractors for multiple-choice questions. The machine-generated multiple-choice questions were compared to human-generated questions in terms of three measures: question difficulty, question discrimination and distractor usefulness. By recruiting 200 participants from

  4. Selecting Question-Specific Genes to Reduce Incongruence in Phylogenomics: A Case Study of Jawed Vertebrate Backbone Phylogeny.

    Science.gov (United States)

    Chen, Meng-Yun; Liang, Dan; Zhang, Peng

    2015-11-01

    Incongruence between different phylogenomic analyses is the main challenge faced by phylogeneticists in the genomic era. To reduce incongruence, phylogenomic studies normally adopt some data filtering approaches, such as reducing missing data or using slowly evolving genes, to improve the signal quality of data. Here, we assembled a phylogenomic data set of 58 jawed vertebrate taxa and 4682 genes to investigate the backbone phylogeny of jawed vertebrates under both concatenation and coalescent-based frameworks. To evaluate the efficiency of extracting phylogenetic signals among different data filtering methods, we chose six highly intractable internodes within the backbone phylogeny of jawed vertebrates as our test questions. We found that our phylogenomic data set exhibits substantial conflicting signal among genes for these questions. Our analyses showed that non-specific data sets that are generated without bias toward specific questions are not sufficient to produce consistent results when there are several difficult nodes within a phylogeny. Moreover, phylogenetic accuracy based on non-specific data is considerably influenced by the size of data and the choice of tree inference methods. To address such incongruences, we selected genes that resolve a given internode but not the entire phylogeny. Notably, not only can this strategy yield correct relationships for the question, but it also reduces inconsistency associated with data sizes and inference methods. Our study highlights the importance of gene selection in phylogenomic analyses, suggesting that simply using a large amount of data cannot guarantee correct results. Constructing question-specific data sets may be more powerful for resolving problematic nodes. © The Author(s) 2015. Published by Oxford University Press, on behalf of the Society of Systematic Biologists. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    International Nuclear Information System (INIS)

    Zhang, Chang wei; Xie, Xiao dong; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong

    2010-01-01

    To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudo aneurysms presenting as intractable epistaxis. For 14 consecutive patients with traumatic pseudo aneurysm presenting as refractory epistaxis, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudo aneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (Inca); out of which, two were managed with detachable balloons, two with covered s tents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from Inca pseudo aneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. In patients presenting with a history of cranio cerebral trauma, traumatic pseudo aneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudo aneurysms

  6. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Chang wei; Xie, Xiao dong; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong [Sichuan University West China Hospital, Chengdu (China)

    2010-12-15

    To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudo aneurysms presenting as intractable epistaxis. For 14 consecutive patients with traumatic pseudo aneurysm presenting as refractory epistaxis, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudo aneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (Inca); out of which, two were managed with detachable balloons, two with covered s tents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from Inca pseudo aneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. In patients presenting with a history of cranio cerebral trauma, traumatic pseudo aneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudo aneurysms

  7. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    Science.gov (United States)

    Zhang, Chang wei; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong

    2010-01-01

    Objective To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. Materials and Methods For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Results Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. Conclusion In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms. PMID:21076585

  8. Long-term impact of the ketogenic diet on growth and resting energy expenditure in children with intractable epilepsy.

    Science.gov (United States)

    Groleau, Veronique; Schall, Joan I; Stallings, Virginia A; Bergqvist, Christina A

    2014-09-01

    The long-term effects of the ketogenic diet, a high fat diet for treating intractable epilepsy, on resting energy expenditure (REE) are unknown. The aim of this study was to evaluate the impact of 15 months of ketogenic diet treatment on growth and REE in children with intractable epilepsy. Growth, body composition, and REE were assessed at baseline, 3 months and 15 months in 24 children (14 males, 10 females; mean age 5 y 6 mo [SD 26 mo], range 7 mo-6 y 5 mo), 10 with cerebral palsy [CP]). Fifteen were identified as ketogenic diet responders at 3 months and continued on the ketogenic diet until 15 months. These were compared to 75 healthy children (43 males, 32 females; mean age 6 y 3 mo [SD 21 mo] age range 2-9 y). REE was expressed as percentage predicted, growth as height (HAz) and weight (WAz) z-scores, and body composition as fat and fat free mass (FFM). HAz declined -0.2 and -0.6 from baseline to 3 months and 15 months respectively (p = 0.001), while WAz was unchanged. In ketogenic diet responders, FFM, age and CP diagnosis predicted REE (overall R(2) = 0.76, pketogenic diet, linear growth status declined while weight status and REE were unchanged. REE remained reduced in children with CP. © 2014 Mac Keith Press.

  9. Long-term impact of the ketogenic diet on growth and resting energy expenditure in children with intractable epilepsy

    Science.gov (United States)

    GROLEAU, VERONIQUE; SCHALL, JOAN I; STALLINGS, VIRGINIA A; BERGQVIST, CHRISTINA A

    2014-01-01

    AIM The long-term effects of the ketogenic diet, a high fat diet for treating intractable epilepsy, on resting energy expenditure (REE) are unknown. The aim of this study was to evaluate the impact of 15 months of ketogenic diet treatment on growth and REE in children with intractable epilepsy. METHOD Growth, body composition and REE were assessed at baseline, 3 and 15 months in 24 children (14 males, 10 females; mean age 5y 6mo (SD 26mo), range 7mo–6y 5mo), 10 with cerebral palsy [CP]). Fifteen were identified as ketogenic diet responders at 3 months and continued on the ketogenic diet until 15 months. These were compared to 75 healthy children (43 males, 32 females; mean age 6y 3mo [SD 21mo] age range 2–9y). REE was expressed as percentage predicted, growth as height (HAz) and weight (WAz) z-scores, and body composition as fat and fat free mass (FFM). RESULTS HAz declined −0.2 and −0.6 from baseline to 3 and 15 months, respectively (p=0.001), while WAz was unchanged. In ketogenic diet responders, FFM, age and CP diagnosis predicted REE (overall R2=0.76, pketogenic diet, linear growth status declined while weight status and REE were unchanged. REE remained reduced in children with CP. PMID:24749520

  10. New population-based exome data are questioning the pathogenicity of previously cardiomyopathy-associated genetic variants

    DEFF Research Database (Denmark)

    Andreasen, Charlotte Hartig; Nielsen, Jonas B; Refsgaard, Lena

    2013-01-01

    Cardiomyopathies are a heterogeneous group of diseases with various etiologies. We focused on three genetically determined cardiomyopathies: hypertrophic (HCM), dilated (DCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC). Eighty-four genes have so far been associated with these card......Cardiomyopathies are a heterogeneous group of diseases with various etiologies. We focused on three genetically determined cardiomyopathies: hypertrophic (HCM), dilated (DCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC). Eighty-four genes have so far been associated...... with these cardiomyopathies, but the disease-causing effect of reported variants is often dubious. In order to identify possible false-positive variants, we investigated the prevalence of previously reported cardiomyopathy-associated variants in recently published exome data. We searched for reported missense and nonsense...... variants in the NHLBI-Go Exome Sequencing Project (ESP) containing exome data from 6500 individuals. In ESP, we identified 94 variants out of 687 (14%) variants previously associated with HCM, 58 out of 337 (17%) variants associated with DCM, and 38 variants out of 209 (18%) associated with ARVC...

  11. Using an ontology to automatically generate questions for the determination of situations

    NARCIS (Netherlands)

    Teitsma, Marten; Sandberg, Jacobijn; Maris, Martinus; Wielinga, Bob; Hameurlain, Abdelkader; Liddle, Stephen W.; Schewe, Klaus-Dieter; Zhou, Xiaofang

    2011-01-01

    We investigate whether the automatic generation of questions from an ontology leads to a trustworthy determination of a situation. With our Situation Awareness Question Generator (SAQG) we automatically generate questions from an ontology. The experiment shows that people with no previous experience

  12. Questioning Questions: Elementary Teachers' Adaptations of Investigation Questions Across the Inquiry Continuum

    Science.gov (United States)

    Biggers, Mandy

    2018-02-01

    Questioning is a central practice in science classrooms. However, not every question translates into a "good" science investigation. Questions that drive science investigations can be provided by many sources including the teacher, the curriculum, or the student. The variations in the source of investigation questions were explored in this study. A dataset of 120 elementary science classroom videos and associated lesson plans from 40 elementary teachers (K-5) across 21 elementary school campuses were scored on an instrument measuring the amount of teacher-direction or student-direction of the lessons' investigation questions. Results indicated that the investigation questions were overwhelmingly teacher directed in nature, with no opportunities for students to develop their own questions for investigation. This study has implications for researchers and practitioners alike, calling attention to the teacher-directed nature of investigation questions in existing science curriculum materials, and the need for teacher training in instructional strategies to adapt their existing curriculum materials across the continuum of teacher-directed and student-directed investigation questions. Teachers need strategies for adapting the teacher-directed questions provided in their existing curriculum materials in order to allow students the opportunity to engage in this essential scientific practice.

  13. Emotions in conflicts: understanding emotional processes sheds light on the nature and potential resolution of intractable conflicts.

    Science.gov (United States)

    Halperin, Eran; Tagar, Michal Reifen

    2017-10-01

    In recent years, researchers have been making substantial advances in understanding the central role of emotions in intractable conflict. We now know that discrete emotions uniquely shape policy preferences in conflict through their unique emotional goals and action tendencies in all stages of conflict including conflict management, conflict resolution and reconciliation. Drawing on this understanding, recent research also points to emotion regulation as a path to reduce conflict and advance peace, exploring both direct and indirect strategies of emotion regulation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Intractable Posterior Epistaxis due to a Spontaneous Low-Flow Carotid-Cavernous Sinus Fistula: A Case Report and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    A. Giotakis

    2015-01-01

    Full Text Available We report a case of a 90-year-old patient with intractable posterior epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula. Purpose of this case report is to introduce low-flow carotid-cavernous sinus fistula in the differential diagnosis of intractable posterior epistaxis. We provide a literature review for the sequence of actions for the confrontation of posterior epistaxis. We also emphasize the significance of the radiological diagnostic and therapeutic procedures in the management of posterior epistaxis due to pathology of the cavernous sinus. The gold-standard diagnostic procedure of carotid-cavernous sinus fistula is digital subtraction angiography (DSA. DSA with coils is also the state-of-the-art therapy. By failure of DSA, neurosurgery or stereotactic radiosurgery (SRS may be used as alternatives. SRS may also be used as enhancement procedure of the DSA. Considering the prognosis of a successfully closed carotid-cavernous sinus fistula, recanalization occurs only in a minority of patients. Close follow-up is advised.

  15. Communicating the right emotion makes violence seem less wrong : Power-congruent emotions lead outsiders to legitimize violence of powerless and powerful groups in intractable conflict

    NARCIS (Netherlands)

    Kamans, Elanor; van Zomeren, Martijn; Gordijn, Ernestine H.; Postmes, Tom

    In intractable intergroup conflicts, groups often try to frame intergroup violence as legitimate through the use of emotional appeals. Two experiments demonstrate that outsiders' perception of which emotion conflict parties communicate influences the extent to which they legitimize their violence.

  16. Processing of intractable polymers using reactive solvents. 2. Poly(2,6-Dimethyl-1,4-Phenylene Ether) as a Matrix Material for High-Performance Composites

    NARCIS (Netherlands)

    Venderbosch, R.W.; Meijer, H.E.H.; Lemstra, P.J.

    1995-01-01

    The application of poly(2,6-dimethyl-1,4-phenylene ether) (PPE) as a matrix material for continuous carbon fibre reinforced composites has been studied. Owing to the intractable nature of PPE, melt impregnation is not feasible and therefore a solution impregnation route was explored using epoxy

  17. Use of the Ketogenic Diet to Treat Intractable Epilepsy in Mitochondrial Disorders

    Science.gov (United States)

    Paleologou, Eleni; Ismayilova, Naila; Kinali, Maria

    2017-01-01

    Mitochondrial disorders are a clinically heterogeneous group of disorders that are caused by defects in the respiratory chain, the metabolic pathway of the adenosine tri-phosphate (ATP) production system. Epilepsy is a common and important feature of these disorders and its management can be challenging. Epileptic seizures in the context of mitochondrial disease are usually treated with conventional anti-epileptic medication, apart from valproic acid. However, in accordance with the treatment of intractable epilepsy where there are limited treatment options, the ketogenic diet (KD) has been considered as an alternative therapy. The use of the KD and its more palatable formulations has shown promising results. It is especially indicated and effective in the treatment of mitochondrial disorders due to complex I deficiency. Further research into the mechanism of action and the neuroprotective properties of the KD will allow more targeted therapeutic strategies and thus optimize the treatment of both epilepsy in the context of mitochondrial disorders but also in other neurodegenerative disorders. PMID:28587136

  18. Thalamo–cortical network underlying deep brain stimulation of centromedian thalamic nuclei in intractable epilepsy: a multimodal imaging analysis

    Directory of Open Access Journals (Sweden)

    Kim SH

    2017-10-01

    Full Text Available Seong Hoon Kim,1 Sung Chul Lim,1 Dong Won Yang,1 Jeong Hee Cho,1 Byung-Chul Son,2 Jiyeon Kim,3 Seung Bong Hong,4 Young-Min Shon4 1Department of Neurology, 2Department of Neurosurgery, Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, 3Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, 4Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Objective: Deep brain stimulation (DBS of the centromedian thalamic nucleus (CM can be an alternative treatment option for intractable epilepsy patients. Since CM may be involved in widespread cortico-subcortical networks, identification of the cortical sub-networks specific to the target stimuli may provide further understanding on the underlying mechanisms of CM DBS. Several brain structures have distinguishing brain connections that may be related to the pivotal propagation and subsequent clinical effect of DBS.Methods: To explore core structures and their connections relevant to CM DBS, we applied electroencephalogram (EEG and diffusion tensor imaging (DTI to 10 medically intractable patients – three generalized epilepsy (GE and seven multifocal epilepsy (MFE patients unsuitable for resective surgery. Spatiotemporal activation pattern was mapped from scalp EEG by delivering low-frequency stimuli (5 Hz. Structural connections between the CM and the cortical activation spots were assessed using DTI.Results: We confirmed an average 72% seizure reduction after CM DBS and its clinical efficiency remained consistent during the observation period (mean 21 months. EEG data revealed sequential source propagation from the anterior cingulate, followed by the frontotemporal regions bilaterally. In addition, maximal activation was found in the left cingulate gyrus and the right medial frontal cortex during the right and left CM stimulation, respectively

  19. Application of statistical parametric mapping to SPET in the assessment of intractable childhood epilepsy

    International Nuclear Information System (INIS)

    Bruggemann, Jason M.; Lawson, John A.; Cunningham, Anne M.; Som, Seu S.; Haindl, Walter; Bye, Ann M.E.

    2004-01-01

    Statistical parametric mapping (SPM) quantification and analysis has been successfully applied to functional imaging studies of partial epilepsy syndromes in adults. The present study evaluated whether localisation of the epileptogenic zone (determined by SPM) improves upon visually examined single-photon emission tomography (SPET) imaging in presurgical assessment of children with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The patient sample consisted of 24 children (15 males) aged 2.1-17.8 years (9.8±4.3 years; mean±SD) with intractable TLE or FLE. SPET imaging was acquired routinely in presurgical evaluation. All patient images were transformed into the standard stereotactic space of the adult SPM SPET template prior to SPM statistical analysis. Individual patient images were contrasted with an adult control group of 22 healthy adult females. Resultant statistical parametric maps were rendered over the SPM canonical magnetic resonance imaging (MRI). Two corresponding sets of ictal and interictal SPM and SPET images were then generated for each patient. Experienced clinicians independently reviewed the image sets, blinded to clinical details. Concordance of the reports between SPM and SPET images, syndrome classification and MRI abnormality was studied. A fair level of inter-rater reliability (kappa=0.73) was evident for SPM localisation. SPM was concordant with SPET in 71% of all patients, the majority of the discordance being from the FLE group. SPM and SPET localisation were concordant with epilepsy syndrome in 80% of the TLE cases. Concordant localisation to syndrome was worse for both SPM (33%) and SPET (44%) in the FLE group. Data from a small sample of patients with varied focal structural pathologies suggested that SPM performed poorly relative to SPET in these cases. Concordance of SPM and SPET with syndrome was lower in patients younger than 6 years than in those aged 6 years and above. SPM is effective in localising the potential

  20. Application of statistical parametric mapping to SPET in the assessment of intractable childhood epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Bruggemann, Jason M.; Lawson, John A.; Cunningham, Anne M. [Department of Neurology, Sydney Children' s Hospital and School of Women' s and Children' s Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales (Australia); Som, Seu S.; Haindl, Walter [Department of Nuclear Medicine, Prince of Wales Hospital, Randwick, New South Wales (Australia); Bye, Ann M.E. [Department of Neurology, Sydney Children' s Hospital and School of Women' s and Children' s Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales (Australia); Department of Neurology, Sydney Children' s Hospital, High Street, 2031, Randwick, NSW (Australia)

    2004-03-01

    Statistical parametric mapping (SPM) quantification and analysis has been successfully applied to functional imaging studies of partial epilepsy syndromes in adults. The present study evaluated whether localisation of the epileptogenic zone (determined by SPM) improves upon visually examined single-photon emission tomography (SPET) imaging in presurgical assessment of children with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The patient sample consisted of 24 children (15 males) aged 2.1-17.8 years (9.8{+-}4.3 years; mean{+-}SD) with intractable TLE or FLE. SPET imaging was acquired routinely in presurgical evaluation. All patient images were transformed into the standard stereotactic space of the adult SPM SPET template prior to SPM statistical analysis. Individual patient images were contrasted with an adult control group of 22 healthy adult females. Resultant statistical parametric maps were rendered over the SPM canonical magnetic resonance imaging (MRI). Two corresponding sets of ictal and interictal SPM and SPET images were then generated for each patient. Experienced clinicians independently reviewed the image sets, blinded to clinical details. Concordance of the reports between SPM and SPET images, syndrome classification and MRI abnormality was studied. A fair level of inter-rater reliability (kappa=0.73) was evident for SPM localisation. SPM was concordant with SPET in 71% of all patients, the majority of the discordance being from the FLE group. SPM and SPET localisation were concordant with epilepsy syndrome in 80% of the TLE cases. Concordant localisation to syndrome was worse for both SPM (33%) and SPET (44%) in the FLE group. Data from a small sample of patients with varied focal structural pathologies suggested that SPM performed poorly relative to SPET in these cases. Concordance of SPM and SPET with syndrome was lower in patients younger than 6 years than in those aged 6 years and above. SPM is effective in localising the

  1. Effect of Paper Color and Question Order on Exam Performance

    Science.gov (United States)

    Tal, Ilanit R.; Akers, Katherine G.; Hodge, Gordon K.

    2008-01-01

    To deter cheating, teachers commonly use exams printed on differently colored paper or with varied question orders. Previous studies, however, reported that paper color and question order affect exam performance and suggested that teachers should adjust students' scores accordingly and discontinue the use of alternate exam forms. We conducted 2…

  2. The Effect of Ketogenic Diet on Serum Selenium Levels in Patients with Intractable Epilepsy.

    Science.gov (United States)

    Arslan, Nur; Kose, Engin; Guzel, Orkide

    2017-07-01

    The aim of the present study was to evaluate serum selenium levels in children receiving olive oil-based ketogenic diet (KD) for intractable seizures for at least 1 year. Out of 320 patients who were initiated on KD, patients who continued receiving KD for at least 12 months were enrolled. Sixteen patients who had selenium deficiency at the time of starting KD were excluded. Finally, a total of 110 patients (mean age 7.3 ± 4.2 years) were included. Serum selenium levels were measured at baseline and at 3, 6, and 12 months after treatment initiation by using atomic absorption spectroscopy. Selenium deficiency was defined as a serum selenium level ketogenic diet suggests that patients on this highly prescriptive dietary treatment need close monitoring of this trace element.

  3. Successful control of intractable nausea and vomiting requiring combined ondansetron and haloperidol in a patient with advanced cancer.

    Science.gov (United States)

    Cole, R M; Robinson, F; Harvey, L; Trethowan, K; Murdoch, V

    1994-01-01

    Chemically induced nausea and vomiting is a common symptom of advanced cancer effected through stimulation of dopamine (D2) or serotonin (5-HT3) receptors located in the chemoreceptor trigger zone (CTZ). These may be blocked by therapeutic doses of haloperidol and ondansetron, respectively. This case, reporting on a single patient acting as her own control, establishes that combined blockade of these receptors is sometimes required to relieve intractable nausea and vomiting. It also demonstrates the value of clinical review, audit of care, and quality assurance in the palliative care setting.

  4. Awkward Questions: Language Issues in the 2011 Census in England

    Science.gov (United States)

    Sebba, Mark

    2018-01-01

    The 2011 Census in England broke new ground, as a question about language had never previously been asked. After stakeholder consultations and a series of trials, the census authority decided on two questions based on earlier censuses in the USA: one about the respondent's "main language" and another about proficiency in English. This…

  5. Conducting systematic reviews of intervention questions I: Writing the review protocol, formulating the question and searching the literature.

    Science.gov (United States)

    O'Connor, A M; Anderson, K M; Goodell, C K; Sargeant, J M

    2014-06-01

    This article is the fourth of six articles addressing systematic reviews in animal agriculture and veterinary medicine. Previous articles in the series have introduced systematic reviews, discussed study designs and hierarchies of evidence, and provided details on conducting randomized controlled trials, a common design for use in systematic reviews. This article describes development of a review protocol and the first two steps in a systematic review: formulating a review question, and searching the literature for relevant research. The emphasis is on systematic reviews of questions related to interventions. The review protocol is developed prior to conducting the review and specifies the plan for the conduct of the review, identifies the roles and responsibilities of the review team and provides structured definitions related to the review question. For intervention questions, the review question should be defined by the PICO components: population, intervention, comparison and outcome(s). The literature search is designed to identify all potentially relevant original research that may address the question. Search terms related to some or all of the PICO components are entered into literature databases, and searches for unpublished literature also are conducted. All steps of the literature search are documented to provide transparent reporting of the process. © 2014 Blackwell Verlag GmbH.

  6. Questioning Questions: Elementary Teachers' Adaptations of Investigation Questions across the Inquiry Continuum

    Science.gov (United States)

    Biggers, Mandy

    2018-01-01

    Questioning is a central practice in science classrooms. However, not every question translates into a "good" science investigation. Questions that drive science investigations can be provided by many sources including the teacher, the curriculum, or the student. The variations in the source of investigation questions were explored in…

  7. Nuclear engineering questions: power, reprocessing, waste, decontamination, fusion

    International Nuclear Information System (INIS)

    Walton, R.D. Jr.

    1979-01-01

    This volume contains papers presented at the chemical engineering symposium on nuclear questions. Specific questions addressed by the speakers included: nuclear power - why and how; commercial reprocessing - permanent death or resurrection; long-term management of commercial high-level wastes; long-term management of defense high-level waste; decontamination and decommissioning of nuclear facilities, engineering aspects of laser fusion I; and engineering aspects of laser fusion II. Individual papers have been input to the Energy Data Base previously

  8. Rhetorical questions or rhetorical uses of questions?

    Directory of Open Access Journals (Sweden)

    Špago Džemal

    2016-12-01

    Full Text Available This paper aims to explore whether some rhetorical questions contain certain linguistic elements or forms which would differentiate them from answer-eliciting and action-eliciting questions, and thereby hint at their rhetorical nature even outside the context. Namely, despite the fact that the same questions can be rhetorical in one context, and answer-eliciting in another, some of them are more likely to be associated with rhetorical or non-rhetorical use. The analysis is based on extensive data (over 1200 examples of rhetorical questions taken from 30 plays by two British and two American writers, and the results are expected to give an insight into whether we can talk about rhetorical questions or just a rhetorical use of questions.

  9. Multimodal Stepped Care Approach Involving Topical Analgesics for Severe Intractable Neuropathic Pain in CRPS Type 1: A Case Report

    Directory of Open Access Journals (Sweden)

    David J. Kopsky

    2011-01-01

    Full Text Available A multimodal stepped care approach has been successfully applied to a patient with complex regional pain syndrome type 1 and severe intractable pain, not responding to regular neuropathic pain medication. The choice to administer drugs in creams was made because of the intolerable adverse effects to oral medication. With this method, peak-dose adverse effects did not occur. The multimodal stepped care approach resulted in considerable and clinically relevant decrease in pain after every step, using topical amitriptyline, ketamine, and dimethylsulphoxide.

  10. Importance of questionnaire context for a physical activity question

    DEFF Research Database (Denmark)

    Jørgensen, M. E.; Sørensen, Mette Rosenlund; Ekholm, O.

    2013-01-01

    ; however, this has never been shown for physical activity questions. The aim was to study the influence of different formulations and question order on self-report physical activity in a population-based health interview survey. Four samples of each 1000 adults were drawn at random from the National Person......Adequate information about physical activity habits is essential for surveillance, implementing, and evaluating public health initiatives in this area. Previous studies have shown that question order and differences in wording result in systematic differences in people's responses to questionnaires...... Register. A new question about physical activity was included with minor differences in formulations in samples 1–3. Furthermore, the question in sample 2 was included in sample 4 but was placed in the end of the questionnaire. The mean time spent on moderate physical activity varied between the four...

  11. Parallel pocket incision: Less invasive surgical intervention for the treatment of intractable pressure ulcer with wound edge undermining.

    Science.gov (United States)

    Yamamoto, Takumi; Yoshimatsu, Hidehiko; Hayashi, Akitatsu; Koshima, Isao

    2015-10-01

    The treatment of deep pressure ulcer with a wide wound edge undermining (pocket) is challenging, especially when conservative treatments are ineffective. As most patients with a pressure ulcer suffer from systemic comorbidities, invasive surgery cannot be performed on all patients, and less invasive treatment is required. Less invasive surgical intervention to a deep pressure ulcer, parallel pocket incision (PPI), was performed on 10 patients with intractable pressure ulcers with a pocket formation. In PPI procedures, two parallel skin incisions were made to open up the deepest fold of the pocket and to preserve the skin overlying the pocket lesion; through the created incisions, the necrotic tissues around the deepest fold of the undermining could be easily removed, which facilitated spontaneous wound healing. Postoperative results and complications were evaluated. All PPI procedures were safely performed under local infiltration anesthesia without major postoperative complication; minor bleeding was seen intraoperatively in three patients, which could be easily controlled with electric cautery coagulation. Nine of 10 ulcers were cured after PPI, and one could not be followed up due to the patient's death non-related to the pressure ulcer. For the nine cured patients, the average time for cure was 14.9 weeks, and no recurrence was observed at postoperative 6 months. PPI is a simple, technically easy, and less invasive surgical intervention to an intractable pressure ulcer with a pocket, which can be safely performed under local infiltration anesthesia even on a patient with severe systemic comorbidities. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Some of the unanswered questions in finance

    Directory of Open Access Journals (Sweden)

    Đurić Dragana M.

    2006-01-01

    Full Text Available A very dynamic development of finance in the last 50 years is inter alia probably due to experiments and innovations in this field. Previously theoretical base could not explain and predict movements especially in volatile times. "The new finance" appeared 50 years ago (portfolio theory CAPM, the efficient market theory, M&M theorem and made substantial progress in understanding movements in globalized and internationalized financial markets. However, many questions remain open. The author tries to put emphasis on some of these questions, perfectly aware that these are not the only ones. Unresolved questions are related to company's aims, project's risks, degree of portfolio optimization, importance of liquidity, dividend policy, as well as factors that determine M&A. As the "new finance" is not able to predict and explain volatile movements, a question that should be posed is whether it is appropriate to add some non-economic factors as the behaviorist theory suggests. Although the behaviorist theory is an important part of "new finance", it is unfortunately the only theory able to explain movements in volatile times. In conclusion, many questions still remain unanswered and wait for appropriate theoretical explanations.

  13. Perceptions of a Changing World Induce Hope and Promote Peace in Intractable Conflicts

    Science.gov (United States)

    Cohen-Chen, Smadar; Crisp, Richard J.; Halperin, Eran

    2015-01-01

    The importance of hope in promoting conciliatory attitudes has been asserted in the field of conflict resolution. However, little is known about conditions inducing hope, especially in intractable conflicts, where reference to the outgroup may backfire. In the current research, five studies yielded convergent support for the hypothesis that hope for peace stems from a general perception of the world as changing. In Study 1, coders observed associations between belief in a changing world, hope regarding peace, and support for concessions. Study 2 revealed the hypothesized relations using self-reported measures. Studies 3 and 4 established causality by instilling a perception of the world as changing (vs. unchanging) using narrative and drawing manipulations. Study 5 compared the changing world message with a control condition during conflict escalation. Across studies, although the specific context was not referred to, the belief in a changing world increased support for concessions through hope for peace. PMID:25713171

  14. Perceptions of a changing world induce hope and promote peace in intractable conflicts.

    Science.gov (United States)

    Cohen-Chen, Smadar; Crisp, Richard J; Halperin, Eran

    2015-04-01

    The importance of hope in promoting conciliatory attitudes has been asserted in the field of conflict resolution. However, little is known about conditions inducing hope, especially in intractable conflicts, where reference to the outgroup may backfire. In the current research, five studies yielded convergent support for the hypothesis that hope for peace stems from a general perception of the world as changing. In Study 1, coders observed associations between belief in a changing world, hope regarding peace, and support for concessions. Study 2 revealed the hypothesized relations using self-reported measures. Studies 3 and 4 established causality by instilling a perception of the world as changing (vs. unchanging) using narrative and drawing manipulations. Study 5 compared the changing world message with a control condition during conflict escalation. Across studies, although the specific context was not referred to, the belief in a changing world increased support for concessions through hope for peace. © 2015 by the Society for Personality and Social Psychology, Inc.

  15. Excitatory amino acid transporters EAAT-1 and EAAT-2 in temporal lobe and hippocampus in intractable temporal lobe epilepsy

    DEFF Research Database (Denmark)

    Sarac, Sinan; Afzal, Shoaib; Broholm, Helle

    2009-01-01

    Intractable temporal lobe epilepsy (TLE) is an invalidating disease and many patients are resistant to medical treatment. Increased glutamate concentration has been found in epileptogenic foci and may induce local over-excitation and cytotoxicity; one of the proposed mechanisms involves reduced...... extra-cellular clearance of glutamate by excitatory amino acid transporters (EAAT-1 to EAAT-5). EAAT-1 and EAAT-2 are mainly expressed on astroglial cells for the reuptake of glutamate from the extra-cellular space. We have studied the expression of EAAT-1 and EAAT-2 in the hippocampus and temporal lobe...

  16. Can we share questions? Performance of questions from different question banks in a single medical school.

    Science.gov (United States)

    Freeman, Adrian; Nicholls, Anthony; Ricketts, Chris; Coombes, Lee

    2010-01-01

    To use progress testing, a large bank of questions is required, particularly when planning to deliver tests over a long period of time. The questions need not only to be of good quality but also balanced in subject coverage across the curriculum to allow appropriate sampling. Hence as well as creating its own questions, an institution could share questions. Both methods allow ownership and structuring of the test appropriate to the educational requirements of the institution. Peninsula Medical School (PMS) has developed a mechanism to validate questions written in house. That mechanism can be adapted to utilise questions from an International question bank International Digital Electronic Access Library (IDEAL) and another UK-based question bank Universities Medical Assessment Partnership (UMAP). These questions have been used in our progress tests and analysed for relative performance. Data are presented to show that questions from differing sources can have comparable performance in a progress testing format. There are difficulties in transferring questions from one institution to another. These include problems of curricula and cultural differences. Whilst many of these difficulties exist, our experience suggests that it only requires a relatively small amount of work to adapt questions from external question banks for effective use. The longitudinal aspect of progress testing (albeit summatively) may allow more flexibility in question usage than single high stakes exams.

  17. Intractable Postoperative Wounds Caused by Self-Inflicted Trauma in a Patient with Cutaneous Munchausen Syndrome Presenting as a Pyoderma Gangrenosum-Like Lesion

    Directory of Open Access Journals (Sweden)

    Keiko Inui

    2016-04-01

    Full Text Available A 50-year-old Japanese woman consulted the emergency department of our hospital for bleeding due to an intractable postoperative wound on the lower abdomen; the postoperative wound was owing to a laparoscopic cholecystectomy performed 1 year previously for acute cholecystitis. She presented with a painful ulcer on her right lower abdomen. She also presented with multiple scars, skin grafts on the extremities, and a missing left lower leg, the causes for all of which were unexplained. The results of her blood test were normal, except for the hemoglobin level. Histology of the skin biopsy specimen from the ulcer did not show any specific findings. The previous surgeon who had performed the laparoscopic cholecystectomy revealed that surgical wound dehiscence had occurred during her admission. After a body restraint had been applied, the ulcer improved. Medical records indicated that she had been admitted to the department of plastic surgery at our hospital for skin grafting of a leg ulcer. During that admission, she refused to consult with the department of psychiatry, although the staff suspected mental disorders. Therefore, we diagnosed her with cutaneous Munchausen syndrome. After vacuum-assisted closure (VAC therapy had been performed to prevent her from traumatizing the ulcer again, it rapidly became granulated and reepithelialized. Munchausen syndrome is characterized by feigning physical symptoms to seek attention. Patients self-inflict numerous lesions, keep getting admitted to different hospitals, and feign acute illness, usually spectacular diseases. VAC therapy may be effective for preventing patients with cutaneous Munchausen syndrome from traumatizing their wounds.

  18. Intractable Postoperative Wounds Caused by Self-Inflicted Trauma in a Patient with Cutaneous Munchausen Syndrome Presenting as a Pyoderma Gangrenosum-Like Lesion.

    Science.gov (United States)

    Inui, Keiko; Hanafusa, Takaaki; Namiki, Takeshi; Ueno, Makiko; Igawa, Ken; Yokozeki, Hiroo

    2016-01-01

    A 50-year-old Japanese woman consulted the emergency department of our hospital for bleeding due to an intractable postoperative wound on the lower abdomen; the postoperative wound was owing to a laparoscopic cholecystectomy performed 1 year previously for acute cholecystitis. She presented with a painful ulcer on her right lower abdomen. She also presented with multiple scars, skin grafts on the extremities, and a missing left lower leg, the causes for all of which were unexplained. The results of her blood test were normal, except for the hemoglobin level. Histology of the skin biopsy specimen from the ulcer did not show any specific findings. The previous surgeon who had performed the laparoscopic cholecystectomy revealed that surgical wound dehiscence had occurred during her admission. After a body restraint had been applied, the ulcer improved. Medical records indicated that she had been admitted to the department of plastic surgery at our hospital for skin grafting of a leg ulcer. During that admission, she refused to consult with the department of psychiatry, al-though the staff suspected mental disorders. Therefore, we diagnosed her with cutaneous Munchausen syndrome. After vacuum-assisted closure (VAC) therapy had been performed to prevent her from traumatizing the ulcer again, it rapidly became granulated and reepithelialized. Munchausen syndrome is characterized by feigning physical symptoms to seek attention. Patients self-inflict numerous lesions, keep getting admitted to different hospitals, and feign acute illness, usually spectacular diseases. VAC therapy may be effective for preventing patients with cutaneous Munchausen syndrome from traumatizing their wounds.

  19. Long-term follow-up of echolalia and question answering.

    OpenAIRE

    Foxx, R M; Faw, G D

    1990-01-01

    A long-term follow-up of echolalia and correct question answering was conducted for 6 subjects from three previously published studies. The follow-up periods ranged from 26 to 57 months. In a training site follow-up, subjects were exposed to baseline/posttraining conditions in which the original trainer and/or a novel person(s) presented trained and untrained questions. Four subjects displayed echolalia below baseline levels, and another did so in some assessments. Overall, echolalia was lowe...

  20. Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

    International Nuclear Information System (INIS)

    Field, E.H.; Strober, S.; Hoppe, R.T.

    1983-01-01

    Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values

  1. IIIB or not IIIB: a previously unanswered question.

    Science.gov (United States)

    Thibodeau, Jennifer T; Mishkin, Joseph D; Patel, Parag C; Mammen, Pradeep P A; Markham, David W; Drazner, Mark H

    2012-05-01

    The term New York Heart Association (NYHA) class IIIB has been used increasingly in clinical medicine, including as an inclusion criteria for many clinical trials assessing left ventricular assist devices (LVADs). Indeed, NYHA class IIIB is incorporated in the Food and Drug Administration's approved indication for the Heartmate II. However, on review of the medical literature, we found that there is no consensus definition of NYHA class IIIB. Until the ambiguity is resolved, we suggest that this designation not be used in clinical practice or by investigators leading clinical trials assessing therapies which convey substantial risk to patients and therefore require clarity in describing the enrolled patient population. With ongoing improvements in LVADs, this therapy will increasingly be considered in patients less sick than those who require inotropic support, providing urgency to establish a consensus system of classifying such patients who nevertheless fall within the spectrum of advanced heart failure. Herein we propose a modification of the standard NYHA classification system which can be used to fill this void. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Palliative Sedation and What Constitutes Active Dying: A Case of Severe Progressive Dystonia and Intractable Pain.

    Science.gov (United States)

    Strand, Jacob J; Feely, Molly A; Kramer, Neha M; Moeschler, Susan M; Swetz, Keith M

    2016-05-01

    We present the case of a 34-year-old woman with Klippel-Feil syndrome who developed progressive generalized dystonia of unclear etiology, resulting in intractable pain despite aggressive medical and surgical interventions. Ultimately, palliative sedation was required to relieve suffering. Herein, we describe ethical considerations including defining sedation, determining prognosis in the setting of an undefined neurodegenerative condition, and use of treatments that concurrently might prolong or alter end-of-life trajectory. We highlight pertinent literature and how it may be applied in challenging and unique clinical situations. Finally, we discuss the need for expert multidisciplinary involvement when implementing palliative sedation and illustrate that procedures and rules need to be interpreted to deliver optimal patient-centered plan of care. © The Author(s) 2014.

  3. Presurgical language lateralization assessment by fMRI and dichotic listening of pediatric patients with intractable epilepsy

    Science.gov (United States)

    Norrelgen, Fritjof; Lilja, Anders; Ingvar, Martin; Åmark, Per; Fransson, Peter

    2014-01-01

    Objective The aim of this study was to evaluate the clinical use of a method to assess hemispheric language dominance in pediatric candidates for epilepsy surgery. The method is designed for patients but has previously been evaluated with healthy children. Methods Nineteen patients, 8–18 years old, with intractable epilepsy and candidates for epilepsy surgery were assessed. The assessment consisted of two functional MRI protocols (fMRI) intended to target frontal and posterior language networks respectively, and a behavioral dichotic listening task (DL). Regional left/right indices for each fMRI task from the frontal, temporal and parietal lobe were calculated, and left/right indices of the DL task were calculated from responses of consonants and vowels, separately. A quantitative analysis of each patient's data set was done in two steps based on clearly specified criteria. First, fMRI data and DL data were analyzed separately to determine whether the result from each of these assessments were conclusive or not. Thereafter, the results from the individual assessments were combined to reach a final conclusion regarding hemispheric language dominance. Results For 14 of the 19 subjects (74%) a conclusion was reached about their hemispheric language dominance. Nine subjects had a left-sided and five subjects had a right-sided hemispheric dominance. In three cases (16%) DL provided critical data to reach a conclusive result. Conclusions The success rate of conclusive language lateralization assessments in this study is comparable to reported rates on similar challenged pediatric populations. The results are promising but data from more patients than in the present study will be required to conclude on the clinical applicability of the method. PMID:25610785

  4. Embolization for the treatment of intractable epistaxis: 12 month outcomes in a two centre case series.

    Science.gov (United States)

    Robinson, Anthony E; McAuliffe, William; Phillips, Timothy J; Phatouros, Constantine C; Singh, Tejinder P

    2017-12-01

    Embolization is a treatment option for intractable epistaxis; however, concerns regarding tissue necrosis, stroke and blindness persist in the literature. A retrospective review of patients from September 2010 to January 2016 treated with embolization for epistaxis was performed. No patient was excluded. Follow-up was 12 months and no patient was lost. 62 embolizations on 59 patients occurred. 21 cases were taking anticoagulants, P2Y12 inhibiting agents or had a systemic coagulopathy. Embolized territories typically involved bilateral distal internal maxillary arteries with unilateral or bilateral facial arteries with polyvinyl alcohol particles. 60 cases had procedural general anaesthesia. There were no major complications. Six died of unrelated causes. Of the surviving 53 patients, excluding the 3 patients with hereditary haemorrhagic telangiectasia, 5 had recurrent epistaxis post-embolization. Four were taking P2Y12 inhibiting and/or anticoagulants, none of which required surgery, prolonged packing or repeat embolization. This group had a propensity to recur compared with cases taking aspirin only or no antiplatelet/anticoagulant (77.8 vs 97.1%, p = 0.04). The fifth underwent repeat embolization after previously only having ipsilateral distal internal maxillary and facial arteries treated. Embolization for epistaxis is safe and effective. Of those who had recurrent epistaxis post embolization, most were taking P2Y12 inhibition and/or anticoagulation. We prefer bilateral distal internal maxillary artery and unilateral facial artery embolization under general anaesthesia for optimal safety and efficacy. Advances in knowledge: Embolization with this technique seems to facilitate superior outcomes without complications despite the large proportion of patients taking anticoagulating or P2Y12 inhibiting agents.

  5. When is a research question not a research question?

    Science.gov (United States)

    Mayo, Nancy E; Asano, Miho; Barbic, Skye Pamela

    2013-06-01

    Research is undertaken to answer important questions yet often the question is poorly expressed and lacks information on the population, the exposure or intervention, the comparison, and the outcome. An optimal research question sets out what the investigator wants to know, not what the investigator might do, nor what the results of the study might ultimately contribute. The purpose of this paper is to estimate the extent to which rehabilitation scientists optimally define their research questions. A cross-sectional survey of the rehabilitation research articles published during 2008. Two raters independently rated each question according to pre-specified criteria; a third rater adjudicated all discrepant ratings. The proportion of the 258 articles with a question formulated as methods or expected contribution and not as what knowledge was being sought was 65%; 30% of questions required reworking. The designs which most often had poorly formulated research questions were randomized trials, cross-sectional and measurement studies. Formulating the research question is not purely a semantic concern. When the question is poorly formulated, the design, analysis, sample size calculations, and presentation of results may not be optimal. The gap between research and clinical practice could be bridged by a clear, complete, and informative research question.

  6. Potential use and challenges of functional connectivity mapping in intractable epilepsy

    Directory of Open Access Journals (Sweden)

    Robert Todd Constable

    2013-05-01

    Full Text Available This review focuses on the use of resting-state functional magnetic resonance imaging data to assess functional connectivity in the human brain for surgical planning in intractable epilepsy. This approach has the potential to predict outcomes for a given surgical procedure based on the pre-surgical functional organization of the brain. Functional connectivity can also identify cortical regions that are organized differently in epilepsy patients either as a direct function of the disease or through indirect compensatory responses. Functional connectivity mapping can also potentially help identify epileptogenic tissue, whether this is a single focal location or a network of seizure-generating tissues and this information can assist in guiding the implantation of electrodes for invasive monitoring. This review covers the basics of connectivity analysis and discusses particular issues associated with analyzing such data. These issues include how to define nodes, as well as differences between connectivity analyses of individual nodes, groups of nodes, and whole-brain assessment at the voxel level. The need for arbitrary thresholds in some connectivity analyses is discussed and a solution to this problem is reviewed. Overall, functional connectivity analysis is becoming an important tool for assessing functional brain organization in surgical planning in epilepsy.

  7. Questions and Questioning Techniques: A View of Indonesian Students’ Preferences

    Directory of Open Access Journals (Sweden)

    Debora Tri Ragawanti

    2009-01-01

    Full Text Available This study investigated students’ preference on teacher’s questions and questionings techniques and more importantly on how they could facilitate or impede their learning. The results on teacher’s questioning techniques showed that random nomination was more preferred than pre-arranged format nomination. In addition, techniques of nominating volunteering students and of giving wait-time were disliked by most student-respondents. As for types of question, the yes/no question was favored by most of the respondents. Different from the yes/no question, the number of respondents leaning forward to the analysis question, questions about fact of life, and questions to state opinion did not show a significant difference from the number of those leaning against the same questions.

  8. Evaluation of Pediatric Questions on the Orthopaedic In-Training Examination-An Update.

    Science.gov (United States)

    Murphy, Robert F; Nunez, Leah; Barfield, William R; Mooney, James F

    2017-09-01

    Pediatric orthopaedics is tested frequently on the Orthopaedic In-Training Examination (OITE). The most recent data on the pediatrics section of the OITE were generated from content 10 years old. The purpose of this study is to assess the pediatric orthopaedic questions on the 2011 to 2014 OITE, and to compare question categories and cognitive taxonomy with previous data. Four years (2011 to 2014) of OITE questions, answers, and references were reviewed. The number of pediatric questions per year was recorded, as well as presence of a clinical photo or imaging modality. Each question was categorized and assigned a cognitive taxonomy level. Categories included: knowledge; knowledge-treatment modalities; diagnosis; diagnosis/recognition of associated conditions; diagnosis/further studies; and diagnosis/treatment. Cognitive taxonomy levels included: simple recall, interpretation of data, and advanced problem-solving. The 3 most commonly covered topics were upper extremity trauma (17.4%), scoliosis (10.1%), and developmental dysplasia of the hip (5.7%). Compared with previous data, the percentage of pediatric questions was constant (13% vs. 14%). Categorically, the more recent OITE examinations contained significantly fewer questions testing simple knowledge (19% vs. 39%, P=0.0047), and significantly more questions testing knowledge of treatment modalities (17% vs. 9%, P=0.016) and diagnosis with associated conditions (19% vs. 9%, P=0.0034). Regarding cognitive taxonomy, there was a significant increase in the average number of questions that required advanced problem-solving (57% vs. 46%, P=0.048). Significantly more questions utilized clinical photographs and imaging studies (62% vs. 48%, P=0.012). The most common reference materials provided to support correct responses included Lovell and Winter's Pediatric Orthopaedics (25.7%) and the Journal of Pediatric Orthopaedics (23.4%). Although the percentage of pediatric questions on the OITE has remained essentially

  9. Question popularity analysis and prediction in community question answering services.

    Science.gov (United States)

    Liu, Ting; Zhang, Wei-Nan; Cao, Liujuan; Zhang, Yu

    2014-01-01

    With the blooming of online social media applications, Community Question Answering (CQA) services have become one of the most important online resources for information and knowledge seekers. A large number of high quality question and answer pairs have been accumulated, which allow users to not only share their knowledge with others, but also interact with each other. Accordingly, volumes of efforts have been taken to explore the questions and answers retrieval in CQA services so as to help users to finding the similar questions or the right answers. However, to our knowledge, less attention has been paid so far to question popularity in CQA. Question popularity can reflect the attention and interest of users. Hence, predicting question popularity can better capture the users' interest so as to improve the users' experience. Meanwhile, it can also promote the development of the community. In this paper, we investigate the problem of predicting question popularity in CQA. We first explore the factors that have impact on question popularity by employing statistical analysis. We then propose a supervised machine learning approach to model these factors for question popularity prediction. The experimental results show that our proposed approach can effectively distinguish the popular questions from unpopular ones in the Yahoo! Answers question and answer repository.

  10. Competence-Based Education and Training– about Frequently Asked Questions

    NARCIS (Netherlands)

    Mulder, M.

    2012-01-01

    This article follows the author's previous piece on practical guidelines for the development of comprehensive competence-based education and training (Mulder, 2012). It is about the questions that have been and are still frequently asked in presentations, workshops and classes about the introduction

  11. Importance of questionnaire context for a physical activity question.

    Science.gov (United States)

    Jørgensen, M E; Sørensen, M R; Ekholm, O; Rasmussen, N K

    2013-10-01

    Adequate information about physical activity habits is essential for surveillance, implementing, and evaluating public health initiatives in this area. Previous studies have shown that question order and differences in wording result in systematic differences in people's responses to questionnaires; however, this has never been shown for physical activity questions. The aim was to study the influence of different formulations and question order on self-report physical activity in a population-based health interview survey. Four samples of each 1000 adults were drawn at random from the National Person Register. A new question about physical activity was included with minor differences in formulations in samples 1-3. Furthermore, the question in sample 2 was included in sample 4 but was placed in the end of the questionnaire. The mean time spent on moderate physical activity varied between the four samples from 57 to 100 min/day. Question order was associated with the reported number of minutes spent on moderate-intensity physical activity and with prevalence of meeting the recommendation, whereas physical inactivity was associated with the differences in formulation of the question. Questionnaire context influences the way people respond to questions about physical activity significantly and should be tested systematically in validation studies of physical activity questionnaires. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Robustness Analysis of Visual Question Answering Models by Basic Questions

    KAUST Repository

    Huang, Jia-Hong

    2017-11-01

    Visual Question Answering (VQA) models should have both high robustness and accuracy. Unfortunately, most of the current VQA research only focuses on accuracy because there is a lack of proper methods to measure the robustness of VQA models. There are two main modules in our algorithm. Given a natural language question about an image, the first module takes the question as input and then outputs the ranked basic questions, with similarity scores, of the main given question. The second module takes the main question, image and these basic questions as input and then outputs the text-based answer of the main question about the given image. We claim that a robust VQA model is one, whose performance is not changed much when related basic questions as also made available to it as input. We formulate the basic questions generation problem as a LASSO optimization, and also propose a large scale Basic Question Dataset (BQD) and Rscore (novel robustness measure), for analyzing the robustness of VQA models. We hope our BQD will be used as a benchmark for to evaluate the robustness of VQA models, so as to help the community build more robust and accurate VQA models.

  13. Robustness Analysis of Visual Question Answering Models by Basic Questions

    KAUST Repository

    Huang, Jia-Hong

    2017-01-01

    Visual Question Answering (VQA) models should have both high robustness and accuracy. Unfortunately, most of the current VQA research only focuses on accuracy because there is a lack of proper methods to measure the robustness of VQA models. There are two main modules in our algorithm. Given a natural language question about an image, the first module takes the question as input and then outputs the ranked basic questions, with similarity scores, of the main given question. The second module takes the main question, image and these basic questions as input and then outputs the text-based answer of the main question about the given image. We claim that a robust VQA model is one, whose performance is not changed much when related basic questions as also made available to it as input. We formulate the basic questions generation problem as a LASSO optimization, and also propose a large scale Basic Question Dataset (BQD) and Rscore (novel robustness measure), for analyzing the robustness of VQA models. We hope our BQD will be used as a benchmark for to evaluate the robustness of VQA models, so as to help the community build more robust and accurate VQA models.

  14. Two-Year-Old Children Differentiate Test Questions from Genuine Questions

    Science.gov (United States)

    Grosse, Gerlind; Tomasello, Michael

    2012-01-01

    Children are frequently confronted with so-called "test questions". While genuine questions are requests for missing information, test questions ask for information obviously already known to the questioner. In this study we explored whether two-year-old children respond differentially to one and the same question used as either a genuine question…

  15. The Effect of the Ketogenic Diet on the Vascular Structure and Functions in Children With Intractable Epilepsy.

    Science.gov (United States)

    Özdemir, Rahmi; Güzel, Orkide; Küçük, Mehmet; Karadeniz, Cem; Katipoglu, Nagehan; Yılmaz, Ünsal; Yılmazer, Murat Muhtar; Meşe, Timur

    2016-03-01

    We aimed to determine the midterm effect of a ketogenic diet on serum lipid levels, carotid intima-media thickness, and the elastic properties of the carotid artery and the aorta in patients with intractable epilepsy. A total of 52 children aged between 12 months and 18 years with intractable epilepsy who started the ketogenic diet from September 2014 to September 2015 were included into this prospective study. Carotid intima-media thickness and the elastic properties of the carotid artery and the aorta were assessed by echocardiography in all cases before beginning of the ketogenic diet and after at least 12 months on the ketogenic diet. Twenty-one patients at the third month and 25 patients at the first year of the ketogenic diet were seizure free. A reduction of greater than 90% in the seizure frequency was achieved in three patients at the sixth month and in five patients at the first year of the treatment. The serum levels of total cholesterol, low-density lipoprotein, and triglyceride were increased significantly at a median of 12.6 months (range: 12 to 13.5 months) of the ketogenic diet treatment, whereas serum levels of high-density lipoprotein did not change. Carotid intima-media thickness, aortic and carotid strain, the stiffness index, distensibility, and elastic modulus did not change after 12 months of the ketogenic diet therapy. Olive oil-based ketogenic diet appears to have no disturbing effect on the carotid intima-media thickness and the elastic properties of the aorta and the carotid artery in epileptic children, although it may be associated with increased concentrations of serum lipids. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Nuclear questions; Le nucleaire en questions

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Eugene

    2012-02-15

    Civilian and military nuclear questions fill a multitude of publications these days, especially after the Japanese tsunami and the Fukushima disaster. The author analyses some of them and highlights the links between civil and military nuclear industries, the realities of the nuclear cycle and related industrial questions before concluding on the controversial issue of weapons and their proliferation potential

  17. Intractable Postpartum Bleeding: A Comparison of the Retrospective Analysis of Angiographic Findings and Transcatheter Arterial Embolization According to Delivery Pattern

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Eun Jung; Kim, Young Hwan; Kim, Si Hyung; Choi, Jin Soo; Park, Jun Cheol; Kwon, Sang Hun; Jo, Chi Heum; Cha, Soon Do [Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2008-12-15

    We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility.

  18. Intractable Postpartum Bleeding: A Comparison of the Retrospective Analysis of Angiographic Findings and Transcatheter Arterial Embolization According to Delivery Pattern

    International Nuclear Information System (INIS)

    Ahn, Eun Jung; Kim, Young Hwan; Kim, Si Hyung; Choi, Jin Soo; Park, Jun Cheol; Kwon, Sang Hun; Jo, Chi Heum; Cha, Soon Do

    2008-01-01

    We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility

  19. The intractable cigarette 'filter problem'.

    Science.gov (United States)

    Harris, Bradford

    2011-05-01

    became the fundamental cigarette filter material. By the mid-1960s, the meaning of the phrase 'filter problem' changed, such that the effort to develop effective filters became a campaign to market cigarette designs that would sustain the myth of cigarette filter efficacy. This study indicates that cigarette designers at Philip Morris, British-American Tobacco, Lorillard and other companies believed for a time that they might be able to reduce some of the most dangerous substances in mainstream smoke through advanced engineering of filter tips. In their attempts to accomplish this, they developed the now ubiquitous cellulose acetate cigarette filter. By the mid-1960s cigarette designers realised that the intractability of the 'filter problem' derived from a simple fact: that which is harmful in mainstream smoke and that which provides the smoker with 'satisfaction' are essentially one and the same. Only in the wake of this realisation did the agenda of cigarette designers appear to transition away from mitigating the health hazards of smoking and towards the perpetuation of the notion that cigarette filters are effective in reducing these hazards. Filters became a marketing tool, designed to keep and recruit smokers as consumers of these hazardous products.

  20. Intradural approach to selective stimulation in the spinal cord for treatment of intractable pain: design principles and wireless protocol

    Science.gov (United States)

    Howard, M. A.; Utz, M.; Brennan, T. J.; Dalm, B. D.; Viljoen, S.; Jeffery, N. D.; Gillies, G. T.

    2011-08-01

    We introduce an intradural approach to spinal cord stimulation for the relief of intractable pain, and describe the biophysical rationale that underlies its design and performance requirements. The proposed device relies on wireless, inductive coupling between a pial surface implant and its epidural controller, and we present the results of benchtop experiments that demonstrate the ability to transmit and receive a frequency-modulated 1.6 MHz carrier signal between micro-coil antennae scaled to the ≈ 1 cm dimensions of the implant, at power levels of about 5 mW. Plans for materials selection, microfabrication, and other aspects of future development are presented and discussed.

  1. To Bayes or Not To Bayes? That's no longer the question!

    OpenAIRE

    Fokoue, Ernest

    2018-01-01

    This paper seeks to provide a thorough account of the ubiquitous nature of the Bayesian paradigm in modern statistics, data science and artificial intelligence. Once maligned, on the one hand by those who philosophically hated the very idea of subjective probability used in prior specification, and on the other hand because of the intractability of the computations needed for Bayesian estimation and inference, the Bayesian school of thought now permeates and pervades virtually all areas of sc...

  2. Oxcarbazepine: a new drug in the management of intractable trigeminal neuralgia.

    Science.gov (United States)

    Zakrzewska, J M; Patsalos, P N

    1989-01-01

    The efficacy and tolerability of oxcarbazepine, a keto derivative of carbamazepine, has been assessed in six patients (two males, four females; mean age 61 years, range 42-77), with trigeminal neuralgia refractory to carbamazepine therapy, over a period of 6 months. An excellent therapeutic response to oxcarbazepine was seen in all patients with pain control correlating well with serum drug concentrations of oxcarbazepine and its primary active metabolite 10-OH-carbazepine. Onset of the effect was observed within 24 hours in all cases. An overall serum therapeutic concentration range, in the six patients, of 50-110 mumol/l of 10-OH-carbazepine corresponding to a daily effective dose range of 1200-2400 mg (14.6-35.6 mg/kg body weight) oxcarbazepine, was observed. There was a significant correlation between oxcarbazepine dose and serum oxcarbazepine (r = 0.695, p less than 0.05) and 10-OH-carbazepine (r = 0.957, p less than 0.001) concentrations. Oxcarbazepine was well tolerated and no significant side effects were identified, though a mild hyponatraemia was observed during high doses (greater than 28 and greater than 35 mg/kg/day) in two patients. It is concluded that oxcarbazepine has potent antineuralgic properties in the absence of significant side effects and therefore may be useful in the management of intractable trigeminal neuralgia. Images PMID:2738589

  3. Botulinum toxin type-A injection to treat patients with intractable anismus unresponsive to simple biofeedback training.

    Science.gov (United States)

    Zhang, Yong; Wang, Zhen-Ning; He, Lei; Gao, Ge; Zhai, Qing; Yin, Zhi-Tao; Zeng, Xian-Dong

    2014-09-21

    To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training. This retrospective study included 31 patients suffering from anismus who were unresponsive to simple biofeedback training. Diagnosis was made by anorectal manometry, balloon expulsion test, surface electromyography of the pelvic floor muscle, and defecography. Patients were given botulinum toxin type A (BTX-A) injection and pelvic floor biofeedback training. Follow-up was conducted before the paper was written. Improvement was evaluated using the chronic constipation scoring system. BTX-A injection combined with pelvic floor biofeedback training achieved success in 24 patients, with 23 maintaining persistent satisfaction during a mean period of 8.4 mo. BTX-A injection combined with pelvic floor biofeedback training seems to be successful for intractable anismus.

  4. Can multiple-choice questions simulate free-response questions?

    OpenAIRE

    Lin, Shih-Yin; Singh, Chandralekha

    2016-01-01

    We discuss a study to evaluate the extent to which free-response questions could be approximated by multiple-choice equivalents. Two carefully designed research-based multiple-choice questions were transformed into a free-response format and administered on the final exam in a calculus-based introductory physics course. The original multiple-choice questions were administered in another similar introductory physics course on final exam. Findings suggest that carefully designed multiple-choice...

  5. CT-guided percutaneous ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes for the treatment of intractable carcinomatous abdominal pain

    International Nuclear Information System (INIS)

    Xi Qian; Wang Peijun; Shang Mingyi; Ma Jun; Lu Ying; Huang Zongliang; Tang Junjun; Gao Xiaolong

    2010-01-01

    Objective: To evaluate CT-guided percutaneous ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes in treating intractable carcinomatous abdominal pain. Methods: A total of 104 patients with late stage cancers were enrolled in this study. All patients suffered from serious carcinomatous pain at upper abdomen and their retroperitoneal lymph nodes were extensively enlarged and fused, together with the involved celiac plexus, into a hard crumb. As the patients failed to respond to narcotic analgesics CT-guided ethanol nerve block therapy of celiac plexus was carried out by pushing the puncture needle through the fused lymphatic mass to celiac plexus site. The analgesic effects and complications were observed and the therapeutic results were evaluated. Results: The analgesic effective rate of ethanol nerve block therapy immediately after the procedure was 100%, and at 2 weeks, 1, 2, 3 and 4 months after the treatment it was 100%, 100%, 98.0%, 96.9% and 92.6%, respectively. No serious complications occurred during perioperative period. The living quality was markedly improved in all patients. Conclusion: For the treatment of intractable carcinomatous abdominal pain in patients with their celiac plexus being embedded in mass-like metastatic retroperitoneal lymph nodes CT-guided percutaneous ethanol nerve block therapy by pushing the puncture needle through the fused lymphatic mass to celiac plexus site is of great clinical value in relieving carcinomatous abdominal pain. (authors)

  6. Analysis of 60 706 Exomes Questions the Role of De Novo Variants Previously Implicated in Cardiac Disease

    DEFF Research Database (Denmark)

    Paludan-Müller, Christian; Ahlberg, Gustav; Ghouse, Jonas

    2017-01-01

    BACKGROUND: De novo variants in the exome occur at a rate of 1 per individual per generation, and because of the low reproductive fitness for de novo variants causing severe disease, the likelihood of finding these as standing variations in the general population is low. Therefore, this study...... sought to evaluate the pathogenicity of de novo variants previously associated with cardiac disease based on a large population-representative exome database. METHODS AND RESULTS: We performed a literature search for previous publications on de novo variants associated with severe arrhythmias...... trio studies (>1000 subjects). Of the monogenic variants, 11% (23/211) were present in ExAC, whereas 26% (802/3050) variants believed to increase susceptibility of disease were identified in ExAC. Monogenic de novo variants in ExAC had a total allele count of 109 and with ≈844 expected cases in Ex...

  7. Does Educator Training or Experience Affect the Quality of Multiple-Choice Questions?

    Science.gov (United States)

    Webb, Emily M; Phuong, Jonathan S; Naeger, David M

    2015-10-01

    Physicians receive little training on proper multiple-choice question (MCQ) writing methods. Well-constructed MCQs follow rules, which ensure that a question tests what it is intended to test. Questions that break these are described as "flawed." We examined whether the prevalence of flawed questions differed significantly between those with or without prior training in question writing and between those with different levels of educator experience. We assessed 200 unedited MCQs from a question bank for our senior medical student radiology elective: an equal number of questions (50) were written by faculty with previous training in MCQ writing, other faculty, residents, and medical students. Questions were scored independently by two readers for the presence of 11 distinct flaws described in the literature. Questions written by faculty with MCQ writing training had significantly fewer errors: mean 0.4 errors per question compared to a mean of 1.5-1.7 errors per question for the other groups (P Educator experience alone had no effect on the frequency of flaws; faculty without dedicated training, residents, and students performed similarly. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  8. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

    Energy Technology Data Exchange (ETDEWEB)

    Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp; Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp; Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp; Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp; Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp; Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan); Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp [Kurume University School of Medicine, Department of Obstetrics and Gynecology (Japan); Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp; Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan)

    2016-08-15

    PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

  9. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

    International Nuclear Information System (INIS)

    Koganemaru, Masamichi; Nonoshita, Masaaki; Iwamoto, Ryoji; Kuhara, Asako; Nabeta, Masakazu; Kusumoto, Masashi; Kugiyama, Tomoko; Kozuma, Yutaka; Nagata, Shuji; Abe, Toshi

    2016-01-01

    PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

  10. Is ketogenic diet treatment hepatotoxic for children with intractable epilepsy?

    Science.gov (United States)

    Arslan, Nur; Guzel, Orkide; Kose, Engin; Yılmaz, Unsal; Kuyum, Pınar; Aksoy, Betül; Çalık, Tansel

    2016-12-01

    Long-term ketogenic diet (KD) treatment has been shown to induce liver steatosis and gallstone formation in some in vivo and clinical studies. The aim of this retrospective study was to evaluate the hepatic side effects of KD in epileptic children. A total of 141 patients (mean age: 7.1±4.1years [2-18 years], 45.4% girls), receiving KD at least one year for intractable epilepsy due to different diagnoses (congenital brain defects, GLUT-1 deficiency, West syndrome, tuberous sclerosis, hypoxic brain injury, etc.) were included in the study. Serum triglyceride, cholesterol, aminotransferase, bilirubin, protein and albumin levels and abdominal ultrasonography were recorded before and at 1, 3, 6, and 12 months following after diet initiation. The mean duration of KD was 15.9±4.3months. At one month of therapy, three patients had elevated alanine and aspartate aminotransferase levels. These patients were receiving ketogenic diet for Doose syndrome, idiopathic epilepsy and GLUT-1 deficiency. Hepatosteatosis was detected in three patients at 6 months of treatment. Two of these patients were treated with KD for the primary diagnosis of tuberous sclerosis and one for Landau Kleffner syndrome. Cholelithiasis was detected in two patients at 12 months of treatment. They were receiving treatment for West syndrome and hypoxic brain injury sequelae. Long-term ketogenic diet treatment stimulates liver parenchymal injury, hepatic steatosis and gallstone formation. Patients should be monitored by screening liver enzymes and abdominal ultrasonography in order to detect these side effects. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  11. Four Questions

    Science.gov (United States)

    Hark-Weber, Amara G., Ed.

    2013-01-01

    The author is pleased to introduce a new section in "TAJ," Four Questions. The structure is simple: four questions are asked to teaching artists working in various media and locations. The questions are always the same, but because each teaching artist's approach is unique, their answers will provide an insight into particular methodologies that…

  12. Lymphoid irradiation in intractable rheumatoid arthritis: effects on the production of immunoglobulins and rheumatoid factors

    International Nuclear Information System (INIS)

    Hanly, J.G.; Bresnihan, B.; Hassan, J.; Whelan, A.; Feighery, C.; Moriarty, M.

    1985-01-01

    Changes in the production of immunoglobulins and rheumatoid factors (RF's) were studied in 20 patients with intractable rheumatoid arthritis (RA) following total doses of 750 rad or 2,000 rad lymphoid irradiation. Over a 12 month follow up period there was no consistent change in absolute serum or synovial fluid levels, or in synovial membrane production of either total IgG, IgA or IgM, or the corresponding RF fractions. The in-vitro production of immunoglobulins and IgM RF by peripheral blood mononuclear cells was also unaltered, except for one patient who had a dramatic rise in IgM RF production. Over the same period there was a significant overall reduction in disease activity following both doses of radiotherapy. It is concluded that the clinical response which occurs following lymphoid irradiation is not due to a reduction in RF production. Furthermore, the production of RF's appears to be unaffected by the changes in T cell immunity which occur following lymphoid irradiation. (author)

  13. What's in a Domain: Understanding How Students Approach Questioning in History and Science

    Science.gov (United States)

    Portnoy, Lindsay Blau; Rabinowitz, Mitchell

    2014-01-01

    How students ask questions as they learn has implications for understanding, retention, and problem solving. The current research investigates the influence of domain, age, and previous experience with content on the ways students approach questioning across history and science texts. In 3 experiments, 3rd-, 8th-, and 10th-grade students in large…

  14. The Role Of Gender In Asking Questions At Cool Stars 18 And 19

    Science.gov (United States)

    Schmidt, Sarah J.; Douglas, Stephanie; Gosnell, Natalie M.; Muirhead, Philip S.; Booth, Rachel S.; Davenport, James R. A.; Mace, Gregory N.

    2016-12-01

    We examine the gender balance of the 18th and 19th meetings of the Cambridge Workshop on Cool Stellar Systems and the Sun (CS18 and CS19). The percent of female attendees at both meetings (31% at CS18 and 37% at CS19) was higher than the percent of women in the American Astronomical Society (25%) and the International Astronomical Union (18%). The representation of women in Cool Stars as SOC members, invited speakers, and contributed speakers was similar to or exceeded the percent of women attending the meetings. We requested that conference attendees assist in a project to collect data on the gender of astronomers asking questions after talks. Using this data, we found that men were over-represented (and women were under-represented) in the question sessions after each talk. Men asked 79% of the questions at CS18 and 75% of the questions at CS19, but were 69% and 63% of the attendees respectively. Contrary to findings from previous conferences, we did not find that the gender balance of questions was strongly affected by the session chair gender, the speaker gender, or the length of the question period. We also found that female and male speakers were asked a comparable number of questions after each talk. The contrast of these results from previous incarnations of the gender questions survey indicate that more data would be useful in understanding the factors that contribute to the gender balance of question askers. We include a preliminary set of recommendations based on this and other work on related topics, but also advocate for additional research on the demographics of conference participants. Additional data on the intersection of gender with race, seniority, sexual orientation, ability and other marginalized identities is necessary to fully address the role of gender in asking questions at conferences.

  15. Comparisons of 13NH3, 18FDG PET and MRS in the presurgical evaluation of intractable epilepsy

    International Nuclear Information System (INIS)

    Cai Li; Gao Shuo; Li Dacheng; Li Zugui

    2004-01-01

    Purpose: Surgery offers a high chance of seizure-free outcome in patients with intractable epilepsy. Other than EEG, several functional and morphologic imaging Methods are used to define the spatial seizure origin. Blood flow perfusion and metabolic abnormalities in those patients are well described respectively. Proton MR spectroscopy (MRS) is still in the early stages in the evaluation of epilepsy. Comparisons with 13NH3 perfusion, 18FDG metabolic PET imaging and MRS in the same patients have rarely been documented. The present study was undertaken to compare the merits of 13NH3 PET, 18FDG PET, magnetic resonance imaging (MRI) and MRS for the lateralization of seizure foci. Methods: Preoperative long-term-EEG, Video-EEG, 13NH3 perfusion PET, 18FDG metabolic PET, MRI, MRS and neuropsychological assessment were performed in 15 patients with intractable epilepsy within 2 weeks(mean age=24.8 years, range 4 to 44 years; mean epilepsy duration=11 years, range 2 to 36 years), who received electrocorticography (ECoG). Antiepileptic drug (AED) was stopped taking at least 2 days before PET scanning. 13NH3 and FDG PET was performed in one day and analyzed with a region of interest template. An absolute asymmetry index, |AI|, greater than 0.15 was considered abnormal. 13 subjects were underwent MRS obtained from the hippocampus bilaterally, who had a presumptive temporal seizure focus based on seizure semiology, video-EEG and MRI. Metabolite ratio of NAA/Cho+Cr was calculated from the relative peak height measurements. An NAA/Cho+Cr ratio of 0.72 or less was regarded as abnormal. All the examination Results were compared with EcoG to evaluate their values of seizure foci lateraliaztion. Results: 1. The results were divided into ictal (n=4) and interictal (n= 11) groups. In the ictal group, the sensitivity of 13NH3 PET and 18FDG PET were both 100%(4/4), and 13NH3 PET showed bilateral hippocampus hyperfusion foci in one case. In the interictal group, 13NH3 PET correctly

  16. Use of SAMC for Bayesian analysis of statistical models with intractable normalizing constants

    KAUST Repository

    Jin, Ick Hoon

    2014-03-01

    Statistical inference for the models with intractable normalizing constants has attracted much attention. During the past two decades, various approximation- or simulation-based methods have been proposed for the problem, such as the Monte Carlo maximum likelihood method and the auxiliary variable Markov chain Monte Carlo methods. The Bayesian stochastic approximation Monte Carlo algorithm specifically addresses this problem: It works by sampling from a sequence of approximate distributions with their average converging to the target posterior distribution, where the approximate distributions can be achieved using the stochastic approximation Monte Carlo algorithm. A strong law of large numbers is established for the Bayesian stochastic approximation Monte Carlo estimator under mild conditions. Compared to the Monte Carlo maximum likelihood method, the Bayesian stochastic approximation Monte Carlo algorithm is more robust to the initial guess of model parameters. Compared to the auxiliary variable MCMC methods, the Bayesian stochastic approximation Monte Carlo algorithm avoids the requirement for perfect samples, and thus can be applied to many models for which perfect sampling is not available or very expensive. The Bayesian stochastic approximation Monte Carlo algorithm also provides a general framework for approximate Bayesian analysis. © 2012 Elsevier B.V. All rights reserved.

  17. Clean Power Generation from the Intractable Natural Coalfield Fires: Turn Harm into Benefit.

    Science.gov (United States)

    Shi, Bobo; Su, Hetao; Li, Jinshi; Qi, Haining; Zhou, Fubao; Torero, José L; Chen, Zhongwei

    2017-07-13

    The coal fires, a global catastrophe for hundreds of years, have been proved extremely difficult to control, and hit almost every coal-bearing area globally. Meanwhile, underground coal fires contain tremendous reservoir of geothermal energy. Approximately one billion tons of coal burns underground annually in the world, which could generate ~1000 GW per annum. A game-changing approach, environmentally sound thermal energy extraction from the intractable natural coalfield fires, is being developed by utilizing the waste energy and reducing the temperature of coalfield fires at the same time. Based on the Seebeck effect of thermoelectric materials, the temperature difference between the heat medium and cooling medium was employed to directly convert thermal energy into clean electrical energy. By the time of December 2016, the power generation from a single borehole at Daquan Lake fire district in Xinjiang has been exceeded 174.6 W. The field trial demonstrates that it is possible to exploit and utilize the waste heat resources in the treated coal fire areas. It promises a significant impact on the structure of global energy generation and can also promote progress in thermoelectric conversion materials, geothermal exploration, underground coal fires control and other energy related areas.

  18. Competence-Based Education and Training--About Frequently Asked Questions

    Science.gov (United States)

    Mulder, Martin

    2012-01-01

    This article follows the author's previous piece on practical guidelines for the development of comprehensive competence-based education and training (Mulder, 2012). It is about the questions that have been and are still frequently asked in presentations, workshops and classes about the introduction of competence-based education. Here, the author…

  19. Phrasal Paraphrase Based Question Reformulation for Archived Question Retrieval.

    Directory of Open Access Journals (Sweden)

    Yu Zhang

    Full Text Available Lexical gap in cQA search, resulted by the variability of languages, has been recognized as an important and widespread phenomenon. To address the problem, this paper presents a question reformulation scheme to enhance the question retrieval model by fully exploring the intelligence of paraphrase in phrase-level. It compensates for the existing paraphrasing research in a suitable granularity, which either falls into fine-grained lexical-level or coarse-grained sentence-level. Given a question in natural language, our scheme first detects the involved key-phrases by jointly integrating the corpus-dependent knowledge and question-aware cues. Next, it automatically extracts the paraphrases for each identified key-phrase utilizing multiple online translation engines, and then selects the most relevant reformulations from a large group of question rewrites, which is formed by full permutation and combination of the generated paraphrases. Extensive evaluations on a real world data set demonstrate that our model is able to characterize the complex questions and achieves promising performance as compared to the state-of-the-art methods.

  20. Clinical utility of the Wechsler Memory Scale - Fourth Edition (WMS-IV) in patients with intractable temporal lobe epilepsy.

    Science.gov (United States)

    Bouman, Zita; Elhorst, Didi; Hendriks, Marc P H; Kessels, Roy P C; Aldenkamp, Albert P

    2016-02-01

    The Wechsler Memory Scale (WMS) is one of the most widely used test batteries to assess memory functions in patients with brain dysfunctions of different etiologies. This study examined the clinical validation of the Dutch Wechsler Memory Scale - Fourth Edition (WMS-IV-NL) in patients with temporal lobe epilepsy (TLE). The sample consisted of 75 patients with intractable TLE, who were eligible for epilepsy surgery, and 77 demographically matched healthy controls. All participants were examined with the WMS-IV-NL. Patients with TLE performed significantly worse than healthy controls on all WMS-IV-NL indices and subtests (p<.01), with the exception of the Visual Working Memory Index including its contributing subtests, as well as the subtests Logical Memory I, Verbal Paired Associates I, and Designs II. In addition, patients with mesiotemporal abnormalities performed significantly worse than patients with lateral temporal abnormalities on the subtests Logical Memory I and Designs II and all the indices (p<.05), with the exception of the Auditory Memory Index and Visual Working Memory Index. Patients with either a left or a right temporal focus performed equally on all WMS-IV-NL indices and subtests (F(15, 50)=.70, p=.78), as well as the Auditory-Visual discrepancy score (t(64)=-1.40, p=.17). The WMS-IV-NL is capable of detecting memory problems in patients with TLE, indicating that it is a sufficiently valid memory battery. Furthermore, the findings support previous research showing that the WMS-IV has limited value in identifying material-specific memory deficits in presurgical patients with TLE. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. It's worth the wait: optimizing questioning methods for effective intraoperative teaching.

    Science.gov (United States)

    Barrett, Meredith; Magas, Christopher P; Gruppen, Larry D; Dedhia, Priya H; Sandhu, Gurjit

    2017-07-01

    The use of questioning to engage learners is critical to furthering resident education intraoperatively. Previous studies have demonstrated that higher level questioning and optimal wait times (>3 s) result in learner responses reflective of higher cognition and retention. Given the importance of intraoperative learning, we investigated question delivery in the operating room. A total of 12 laparoscopic cholecystectomies were observed and recorded. All questions were transcribed and classified using Bloom's Taxonomy, a framework associated with hierarchical levels of learning outcomes. Wait time between question end and response was recorded. Six faculty attendings and seven house officers at our institution were observed. A total of 133 questions were recorded with an average number of questions per case of 11.2. The majority of questions 112 out of 133 (84%) were classified as Bloom's levels 1-3, with only 6% of questions of the highest level. The wait time before the resident answered the question averaged 1.75 s, with attendings interceding after 2.50 s. Question complexity and wait time did not vary based on resident postgraduate year level suggesting limited tailoring of question to learner. Intraoperative questioning is not aligned with higher level thinking. The majority of questions were Bloom's level 3 or below, limiting the complexity of answer formulation. Most responses were given within 2 s, hindering opportunity to pursue higher-order thinking. This suggests including higher level questions and tailoring questions to learner level may improve retention and maximize gains. In addition, with attendings answering 20% of their own questions, increasing their wait time offers another area for teaching development. © 2017 Royal Australasian College of Surgeons.

  2. Reoperative sentinel lymph node biopsy after previous mastectomy.

    Science.gov (United States)

    Karam, Amer; Stempel, Michelle; Cody, Hiram S; Port, Elisa R

    2008-10-01

    Sentinel lymph node (SLN) biopsy is the standard of care for axillary staging in breast cancer, but many clinical scenarios questioning the validity of SLN biopsy remain. Here we describe our experience with reoperative-SLN (re-SLN) biopsy after previous mastectomy. Review of the SLN database from September 1996 to December 2007 yielded 20 procedures done in the setting of previous mastectomy. SLN biopsy was performed using radioisotope with or without blue dye injection superior to the mastectomy incision, in the skin flap in all patients. In 17 of 20 patients (85%), re-SLN biopsy was performed for local or regional recurrence after mastectomy. Re-SLN biopsy was successful in 13 of 20 patients (65%) after previous mastectomy. Of the 13 patients, 2 had positive re-SLN, and completion axillary dissection was performed, with 1 having additional positive nodes. In the 11 patients with negative re-SLN, 2 patients underwent completion axillary dissection demonstrating additional negative nodes. One patient with a negative re-SLN experienced chest wall recurrence combined with axillary recurrence 11 months after re-SLN biopsy. All others remained free of local or axillary recurrence. Re-SLN biopsy was unsuccessful in 7 of 20 patients (35%). In three of seven patients, axillary dissection was performed, yielding positive nodes in two of the three. The remaining four of seven patients all had previous modified radical mastectomy, so underwent no additional axillary surgery. In this small series, re-SLN was successful after previous mastectomy, and this procedure may play some role when axillary staging is warranted after mastectomy.

  3. Long-Term Follow-Up of Echolalia and Question Answering.

    Science.gov (United States)

    Foxx, R. M.; Faw, Gerald D.

    1990-01-01

    A long-term followup (from 26 to 57 months) of echolalia and correct question-answering was conducted with six mentally retarded adult subjects identified from three previously published studies. Echolalia was lower than in baseline in 80.6 percent of the followups. Issues related to the study of maintenance are discussed. (Author/DB)

  4. Computing aggregate properties of preimages for 2D cellular automata.

    Science.gov (United States)

    Beer, Randall D

    2017-11-01

    Computing properties of the set of precursors of a given configuration is a common problem underlying many important questions about cellular automata. Unfortunately, such computations quickly become intractable in dimension greater than one. This paper presents an algorithm-incremental aggregation-that can compute aggregate properties of the set of precursors exponentially faster than naïve approaches. The incremental aggregation algorithm is demonstrated on two problems from the two-dimensional binary Game of Life cellular automaton: precursor count distributions and higher-order mean field theory coefficients. In both cases, incremental aggregation allows us to obtain new results that were previously beyond reach.

  5. Predicting intraindividual changes in learning strategies: The effects of previous achievement

    OpenAIRE

    Buško, Vesna; Mujagić, Amela

    2013-01-01

    Socio-cognitive models of self-regulated learning (e.g., Pintrich, 2000) emphasize contextualized nature oflearning process, and within-person variation in learning processes, along with between-person variability in selfregulation.Previous studies about contextual nature of learning strategies have mostly focused on the effects ofdifferent contextual factors on interindividual differences in learning strategies utilization. However, less attentionwas given to the question about contextual ef...

  6. Does Question Structure Affect Exam Performance in the Geosciences?

    Science.gov (United States)

    Day, E. A.; D'Arcy, M. K.; Craig, L.; Streule, M. J.; Passmore, E.; Irving, J. C. E.

    2015-12-01

    The jump to university level exams can be challenging for some students, often resulting in poor marks, which may be detrimental to their confidence and ultimately affect their overall degree class. Previous studies have found that question structure can have a strong impact on the performance of students in college level exams (see Gibson et al., 2015, for a discussion of its impact on physics undergraduates). Here, we investigate the effect of question structure on the exam results of geology and geophysics undergraduate students. Specifically, we analyse the performance of students in questions that have a 'scaffolded' framework and compare them to their performance in open-ended questions and coursework. We also investigate if observed differences in exam performance are correlated with the educational background and gender of students, amongst other factors. It is important for all students to be able to access their degree courses, no matter what their backgrounds may be. Broadening participation in the geosciences relies on removing systematic barriers to achievement. Therefore we recommend that exams are either structured with scaffolding in questions at lower levels, or students are explicitly prepared for this transition. We also recommend that longitudinal studies of exam performance are conducted within individual departments, and this work outlines one approach to analysing performance data.

  7. Indices of resective surgery effectiveness for intractable nonlesional focal epilepsy.

    Science.gov (United States)

    Blume, Warren T; Ganapathy, Gobi R; Munoz, David; Lee, Donald H

    2004-01-01

    Among 70 patients with intractable focal epilepsy and no specific lesion, as determined by both MRI (magnetic resonance imaging) and histopathology, outcome after resective surgery was polarized: 26 (37%) became seizure free (SF), and 27 (39%) were not helped. Eighteen (42%) of 43 standard temporal resections rendered patients SF, somewhat more than eight (30%) of 27 other procedures. To seek reliable prognostic factors, the subsequent correlative data compared features of the 26 SF patients with those of the 27 not helped. Although ictal semiology guided the site of surgical resection, it and other aspects of seizure and neurologic history failed to predict surgical outcome. However, two aspects of preoperative scalp EEGs correlated with SF outcomes: (a) among 25 patients in whom >50% of clinical seizures arose from the later resected lobe and no other origins, 18 (72%) became SF compared with seven (28%) of 25 with other ictal profiles; (b) 13 (93%) of 14 temporal lobe patients whose interictal and ictal EEGs lacked features indicative of multifocal epileptogenesis became SF compared with five (33%) of 15 with such components. The considered need for subdural (SD) EEG reduced SF outcome from 18 (90%) of 20 patients without SD to eight (24%) of 33 with SD; this likely reflected an insufficient congruity of ictal semiology and interictal and ictal scalp EEG for localizing epileptogenesis. Within this SD group, >50% of clinical seizure origins from a later resected lobe increased SF outcome somewhat: from two (14%) of 14 without this attribute to six (40%) of 15 with it; 100% of such origins increased SF outcome from two (12%) of 16 to six (46%) of 13.

  8. Threat, fear, and persuasion: review and critique of questions about functional form

    OpenAIRE

    Shen, Lijiang; Dillard, James Price

    2014-01-01

    Theories of threat appeals have been rightly concerned with the form of the relationship between fear and persuasion: Linear or curvilinear. They have not, however, clearly distinguished the question as a between- or within-persons phenomenon. In fact, the literature often treats these two perspectives as if they were interchangeable. We show that between- versus within-person questions about functional form are distinct from one another. Previous research, which is the product of between-pe...

  9. Argon Plasma Coagulation Therapy Versus Topical Formalin for Intractable Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy for Prostate Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Yeoh, Eric, E-mail: eric.yeoh@health.sa.gov.au [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia); School of Medicine, University of Adelaide, Adelaide (Australia); Tam, William; Schoeman, Mark [School of Medicine, University of Adelaide, Adelaide (Australia); Department of Gastroenterology, Royal Adelaide Hospital, Adelaide (Australia); Moore, James; Thomas, Michelle [School of Medicine, University of Adelaide, Adelaide (Australia); Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide (Australia); Botten, Rochelle; Di Matteo, Addolorata [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide (Australia)

    2013-12-01

    Purpose: To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis. Methods and Materials: Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ≥1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motor and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ≤25 mm, and no longer needing blood transfusions). Results: The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology. Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction.

  10. Argon Plasma Coagulation Therapy Versus Topical Formalin for Intractable Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy for Prostate Carcinoma

    International Nuclear Information System (INIS)

    Yeoh, Eric; Tam, William; Schoeman, Mark; Moore, James; Thomas, Michelle; Botten, Rochelle; Di Matteo, Addolorata

    2013-01-01

    Purpose: To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis. Methods and Materials: Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ≥1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motor and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ≤25 mm, and no longer needing blood transfusions). Results: The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology. Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction

  11. The changes of regional cerebral blood flow: successful pain relief of intractable CRPS type II patients by motor cortex stimulation

    Energy Technology Data Exchange (ETDEWEB)

    Jung, J. A.; Son, H. S.; Kim, S. H.; Jung, S. G [The Catholic University of Korea, Seoul (Korea, Republic of)

    2004-07-01

    Authors report the effectiveness of MCS in extraordinarily extended pain due to intractable CRPS type II and rCBF study result for mechanism of pain control by MCS. A 43-year-old male presented severe spontaneous burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. Authors planned MCS as a neuromodulation therapy for this intractable peripheral neuropathic pain patient because further neurodestructive procedure did not work anymore and have a potential risk of further aggrevation of neuopathic pain. We performed baseline and stimulation brain perfusion SPECT using 20 mCi of Tc-99m ECD. The baseline CBD studies were done with stimulator 'off' state and stimulation studies were done after stimulator 'on' with satisfactory pain relief. For the stimulation study, the radioisotope was injected immediately after pain-relief and the images were taken about 50 minutes after injection of radioisotope. In resting rCBF in the patient was compared with normal control datas, we found significant increase in rCBF in the bilateral prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, left temporooccipital area. When rCBF datas obtained after alleviation of pain with stimulator 'on' . there were significant increase in rCBF in bilateral prefrontal cortex and left temporoocipital area. After subtraction of ECD SPECT, we found significant increase in rCBF in the right premotor and supplementary motor cortex left sensorimotor cortex, right cingulated cortex, right posterior insular cortex, right anterior limb of internal capsule. left orbitofrontal cortex and right pyramidal tract in cerebral peduncle. Authors report exellent pain control by MCS in a case of severe CRPS type II with hemibody involvement and regional cerebral blood flow changes according to successful pain control.

  12. The changes of regional cerebral blood flow: successful pain relief of intractable CRPS type II patients by motor cortex stimulation

    International Nuclear Information System (INIS)

    Jung, J. A.; Son, H. S.; Kim, S. H.; Jung, S. G

    2004-01-01

    Authors report the effectiveness of MCS in extraordinarily extended pain due to intractable CRPS type II and rCBF study result for mechanism of pain control by MCS. A 43-year-old male presented severe spontaneous burning pain in his left hand and forearm and allodynia over the left arm and left hemibody. Authors planned MCS as a neuromodulation therapy for this intractable peripheral neuropathic pain patient because further neurodestructive procedure did not work anymore and have a potential risk of further aggrevation of neuopathic pain. We performed baseline and stimulation brain perfusion SPECT using 20 mCi of Tc-99m ECD. The baseline CBD studies were done with stimulator 'off' state and stimulation studies were done after stimulator 'on' with satisfactory pain relief. For the stimulation study, the radioisotope was injected immediately after pain-relief and the images were taken about 50 minutes after injection of radioisotope. In resting rCBF in the patient was compared with normal control datas, we found significant increase in rCBF in the bilateral prefrontal cortex, right dorsolateral prefrontal cortex, right superior temporal gyrus, left temporooccipital area. When rCBF datas obtained after alleviation of pain with stimulator 'on' . there were significant increase in rCBF in bilateral prefrontal cortex and left temporoocipital area. After subtraction of ECD SPECT, we found significant increase in rCBF in the right premotor and supplementary motor cortex left sensorimotor cortex, right cingulated cortex, right posterior insular cortex, right anterior limb of internal capsule. left orbitofrontal cortex and right pyramidal tract in cerebral peduncle. Authors report exellent pain control by MCS in a case of severe CRPS type II with hemibody involvement and regional cerebral blood flow changes according to successful pain control

  13. Dataset of acute repeated sessions of bifrontal transcranial direct current stimulation for treatment of intractable tinnitus: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ali Yadollahpour

    2017-12-01

    Full Text Available Transcranial direct current stimulation (tDCS has reportedly shown promising therapeutic effects for tinnitus (Forogh et al., 2016; Joos et al., 2014 [1,2]. Studies are ongoing to determine optimum treatment protocol and the site of stimulation. Findings of the early studies are heterogeneous and most studies have focused on single session tDCS and short follow-up periods. There is no study on repeated sessions of tDCS with long term follow-up. This study presents the results of a randomized clinical trial investigating the therapeutic effects of acute multi-session tDCS over dorsolateral prefrontal cortex (DLPFC on tinnitus symptoms and comorbid depression and anxiety in patients with chronic intractable tinnitus. The dataset includes the demographic information, audiometric assessments, tinnitus specific characteristics, and the response variables of the study. The response variables included the scores of tinnitus handicap inventory (THI, tinnitus loudness and tinnitus related distress based on 0–10 numerical visual analogue scale (VAS scores, beck depression inventory (BDI-II and beck anxiety inventory (BAI scores. The dataset included the scores of THI pre and immediately post intervention, and at one month follow-up; the tinnitus loudness and distress scores prior to intervention, and immediately, one hour, one week, and at one month after the last stimulation session. In addition, the BDI-II, and BAI scores pre and post intervention are included. The data of the real (n=25 and sham tDCS (n=17 groups are reported. The main manuscript of this dataset is 'Acute repeated sessions of bifrontal transcranial direct current stimulation for treatment of intractable tinnitus: a randomized controlled trial' (Bayat et al., submitted for publication [3]. Keywords: Transcranial direct current stimulation, Acute stimulations, Tinnitus, Depression, Anxiety, DLPFC

  14. Tactile Electrosurgical Ablation: A Technique for the Treatment of Intractable Heavy and Prolonged Menstrual Bleeding

    Directory of Open Access Journals (Sweden)

    Ali M. El Saman

    2015-01-01

    Full Text Available Objective. To study the efficacy and safety of tactile electrosurgical ablation (TEA in stopping a persistent attack of abnormal uterine bleeding not responding to medical and hormonal therapy. Methods. This is a case series of 19 cases with intractable abnormal uterine bleeding, who underwent TEA at the Women’s Health Center of Assiut University. The outcomes measured were; patient’s acceptability, operative time, complications, menstrual outcomes, and reintervention. Results. None of the 19 counseled cases refused the TEA procedure which took 6–10 minutes without intraoperative complications. The procedure was successful in the immediate cessation of bleeding in 18 out of 19 cases. During the 24-month follow-up period, 9 cases developed amenorrhea, 5 had scanty menstrual bleeding, 3 were regularly menstruating, 1 case underwent repeat TEA ablation, and one underwent a hysterectomy. Conclusions. TEA represents a safe, inexpensive, and successful method for management of uterine bleeding emergencies with additional long-term beneficial effects. However, more studies with more cases and longer follow-up periods are warranted.

  15. Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: A systematic review of the literature

    International Nuclear Information System (INIS)

    Campbell, Allison M.; Glover, Janis; Chiang, Veronica L.S.; Gerrard, Jason; Yu, James B.

    2015-01-01

    Tremor markedly reduces quality of life and causes a significant psychological burden for patients who are severely affected by this movement disorder. Pharmacologic and surgical treatments for tremor exist, but for patients who have failed medical therapy and are not surgical candidates, stereotactic radiosurgery is the only available treatment option. Of available stereotactic radiosurgical techniques for intractable tremor, the authors chose to evaluate the safety and efficacy of gamma knife stereotactic radiosurgical thalamotomy. In order to qualitatively synthesize available data a systematic review was conducted by searching MEDLINE (OvidSP 1946–January Week 1 2014) and Embase (OvidSP 1974–2014 January). The search strategy was not limited by study design or language of publication. All searches were conducted on January 7, 2014. Treatment efficacy, adverse outcomes, and patient deaths were reviewed and tabulated. Complications appeared months to years post procedure and most commonly consisted of mild contralateral numbness and transient hemiparesis. Rarely, more severe complications were reported, including dysphagia and death. Though no data from randomized controlled trials are available, our analysis of the literature indicates that unilateral gamma knife thalamotomy using doses from 130 to 150 Gy appears safe and well tolerated

  16. The intractable cigarette ‘filter problem’

    Science.gov (United States)

    2011-01-01

    production. The synthetic plastic cellulose acetate became the fundamental cigarette filter material. By the mid-1960s, the meaning of the phrase ‘filter problem’ changed, such that the effort to develop effective filters became a campaign to market cigarette designs that would sustain the myth of cigarette filter efficacy. Conclusions This study indicates that cigarette designers at Philip Morris, British-American Tobacco, Lorillard and other companies believed for a time that they might be able to reduce some of the most dangerous substances in mainstream smoke through advanced engineering of filter tips. In their attempts to accomplish this, they developed the now ubiquitous cellulose acetate cigarette filter. By the mid-1960s cigarette designers realised that the intractability of the ‘filter problem’ derived from a simple fact: that which is harmful in mainstream smoke and that which provides the smoker with ‘satisfaction’ are essentially one and the same. Only in the wake of this realisation did the agenda of cigarette designers appear to transition away from mitigating the health hazards of smoking and towards the perpetuation of the notion that cigarette filters are effective in reducing these hazards. Filters became a marketing tool, designed to keep and recruit smokers as consumers of these hazardous products. PMID:21504917

  17. Intractable diarrhea in hyperthyroidism: management with beta-adrenergic blockade.

    Science.gov (United States)

    Bricker, L A; Such, F; Loehrke, M E; Kavanaugh, K

    2001-01-01

    To describe a patient with intractable diarrhea and thyrotoxic Graves' disease, for whom b-adrenergic blockade ultimately proved to be effective therapy for the diarrhea, and to review the types of hyperthyroidism-associated diarrhea. We present the clinical course of a young man with a prolonged siege of diarrhea that proved elusive to diagnostic inquiries and resistant to all means of management until its endocrine basis was discovered. Control of such cases with b-adrenergic blockade is discussed, as are the pathophysiologic bases of intestinal hypermotility in hyperthyroidism. A 26-year-old man with Down syndrome, and no prior gastrointestinal disorder, had insidious, chronic, constant diarrhea, which was associated with loss of 14 kg during a 5-month period. Numerous laboratory and imaging studies and endoscopic examinations failed to disclose the cause of the diarrhea. Furthermore, a broad range of antibiotics and other empiric remedies failed to control the problem. No other symptoms of hyperthyroidism were reported, but when the endocrinopathy was suspected and identified, the diarrhea was promptly controlled by treatment with propranolol. In patients with hyperthyroidism, two types of diarrheal disorders have been described-secretory diarrhea and steatorrhea; bile acid malabsorption may have a role in either of these settings. In addition to its capacity for blocking the peripheral effects of thyroid hormone on the heart and central nervous system, b-adrenergic blockade is effective in slowing intestinal transit time and ameliorating the uncommon diarrhea associated with hyperthyroidism. Thyroid hormone in excess, among its other possible effects on the gastrointestinal tract, may exert a stimulatory effect by means of intermediary sympathetic activation, as it does with the heart. Thus, sympathetic blockade can mimic the salutary effects on the gastrointestinal tract conventionally brought about by direct antithyroid therapy, and well before the

  18. Modified dorsal root entry zone lesioning for intractable pain relief in patients with root avulsion injury.

    Science.gov (United States)

    Takai, Keisuke; Taniguchi, Makoto

    2017-08-01

    OBJECTIVE Dorsal root entry zone (DREZ) lesioning has been the most effective surgical treatment for the relief of intractable pain due to root avulsion injury, but residual pain and a decrease in pain relief in the follow-up period have been reported in 23%-70% of patients. Based on pain topography in the most recent studies on neuropathic pain, the authors modified the conventional DREZ lesioning procedure to improve clinical outcomes. The presumed rationale for this procedure is to eliminate the spontaneous discharges of neurons in the superficial spinal dorsal horn as well as wide dynamic range neurons in the deep spinal dorsal horn. METHODS Ten patients with avulsion-related pain underwent surgery between 2011 and 2015. The surgical procedure was described and postoperative pain relief was assessed as follows: excellent (residual pain never exceeded 3 on the visual analog scale [VAS] without medication), good (residual pain never exceeded 5 on the VAS with medication), and poor (residual pain was greater than 5 with medication). Specific perioperative complications were assessed. RESULTS The aim of this surgical procedure was to destroy the deeper layers of the posterior horn of spinal gray matter, which was in contrast to the procedures of Nashold and Sindou, which were to destroy the superficial layers. All patients achieved excellent (n = 7, pain relief without medication) or good (n = 3, pain relief with medication) pain relief postoperatively, and the recurrence of pain was not reported in any patients (median 29 months after surgery, range 12-64 months). Nine patients (90%) achieved complete pain relief (a score of 0 or 1 on the VAS) with or without medication. No surgical site complications such as infection or CSF leakage were noted. No motor deficit was observed in any patient. A sensory deficit was observed in 2 patients and disappeared within 1 month in 1 patient. New pain at the adjacent level of DREZ lesioning was observed in 3 patients and

  19. Recovery of heavy metals from intractable wastes: A thermal approach

    Energy Technology Data Exchange (ETDEWEB)

    Kirk, D.W. [Univ. of Toronto (Canada)

    1996-12-31

    The generation of industrial solid wastes containing leachable species of environmental concern is a problem for developing and developed nations alike. These materials arise from direct processing of mineral ores, from production of metals and minerals, from manufacturing operations, and from air and water pollution treatment processes. The general characteristics that make these wastes intractable is that their content of hazardous species is not easily liberated from the waste yet is not bound so tightly that they are safe for landfill disposal or industrial use. The approach taken in this work is a thermal treatment that separates the inorganic contaminants from the wastes. The objective is to provide recovery and reuse of both the residual solids and liberated contaminants. The results from operating this technique using two very different types of waste are described. The reasons that the process will work for a wide variety of wastes are explored. By using the knowledge of the thermodynamic stability of the phases found from the characterization analyses, a thermal regime was found that allowed separation of the contaminants without capturing the matrix materials. Bench scale studies were carried out using a tube furnace. Samples of the wastes were heated in crucible boats from 750 to 1150{degrees}C in the presence of various chlorinating agents. The offgas contained 90{sup +}% of the targeted contaminants despite their complex matrix form. The residue was free of contamination. As a result of the efficient concentrating mechanism of the process, the contaminants in the offgas solids are attractive for reuse in metallurgical industries. As an additional benefit, the organic contaminants of the residues were eliminated. Dioxin traces in the solids before treatment were absent after treatment. 15 refs., 4 figs., 4 tabs.

  20. Do Persian Native Speakers Prosodically Mark Wh-in-situ Questions?

    Science.gov (United States)

    Shiamizadeh, Zohreh; Caspers, Johanneke; Schiller, Niels O

    2018-02-01

    It has been shown that prosody contributes to the contrast between declarativity and interrogativity, notably in interrogative utterances lacking lexico-syntactic features of interrogativity. Accordingly, it may be proposed that prosody plays a role in marking wh-in-situ questions in which the interrogativity feature (the wh-phrase) does not move to sentence-initial position, as, for example, in Persian. This paper examines whether prosody distinguishes Persian wh-in-situ questions from declaratives in the absence of the interrogativity feature in the sentence-initial position. To answer this question, a production experiment was designed in which wh-questions and declaratives were elicited from Persian native speakers. On the basis of the results of previous studies, we hypothesize that prosodic features mark wh-in-situ questions as opposed to declaratives at both the local (pre- and post-wh part) and global level (complete sentence). The results of the current study confirm our hypothesis that prosodic correlates mark the pre-wh part as well as the complete sentence in wh-in-situ questions. The results support theoretical concepts such as the frequency code, the universal dichotomous association between relaxation and declarativity on the one hand and tension and interrogativity on the other, the relation between prosody and pragmatics, and the relation between prosody and encoding and decoding of sentence type.

  1. Socratic Questioning-Guided Discovery

    Directory of Open Access Journals (Sweden)

    M. Hakan Türkçapar

    2012-04-01

    Full Text Available “Socratic Method” is a way of teaching philosophical thinking and knowledge by asking questions which was used by antique period greek philosopher Socrates. Socrates was teaching knowledge to his followers by asking questions and the conversation between them was named “Socratic Dialogues”. In this meaning, no novel knowledge is taught to the individual but only what is formerly known is reminded and rediscovered. The form of socratic questioning which is used during the process of cognitive behavioral therapy is known as Guided Discovery. In this method it is aimed to make the client notice the piece of knowledge which he could notice but is not aware with a series of questions. Socratic method or guided discovery consists of several steps which are: Identifying the problem by listening to the client and making reflections, finding alternatives by examining and evaluating, reidentification by using the newly found information and questioning the old distorted belief and reaching to a conclusion and applying it. Question types used during these procedures are, questions for gaining information, questions revealing the meanings, questions revealing the beliefs, questions about behaviours during the similar past experiences, analyse questions and analytic synthesis questions. In order to make the patient feel understood it is important to be empathetic and summarising the problem during the interview. In this text, steps of Socratic Questioning-Guided Discovery will be reviewed with sample dialogues after eachstep. [JCBPR 2012; 1(1.000: 15-20

  2. Percutaneous vertebroplasty in patients with intractable pain from osteoporotic or metastatic fractures: a prospective study using quality-of-life assessment

    International Nuclear Information System (INIS)

    Cheung, G.; Chow, E.; Holden, L.; Vidmar, M.; Danjoux, C.; Yee, A.J.M.; Connolly, R.; Finkelstein, J.

    2006-01-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive outpatient procedure whereby vertebral compression fractures are stabilized by the injection of bone cement, or polymethyl methacrylate (PMMA). Rapid partial or complete pain relief can usually be achieved through this procedure. We prospectively evaluate the efficacy of PVP in the relief of pain and improvement in quality of life of patients with intractable pain from osteoporotic and metastatic fractures. Patients with intractable pain from vertebral metastases (many resistant to palliative radiation therapy) and patients with intractable painful osteoporotic fractures were treated with parapedicular or transpedicular injection of PMMA. Plane X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI) scan were performed on all patients. With a reflex hammer, percussion pain was correlated to the imaging abnormalities. The preplanning CT scan was used to calculate the exact entry point and angle of the bone-biopsy needle. All patients were assessed before and after the procedure for quality of life and amount of pain. The following measures were used: 1) the Edmonton Symptom Assessment System (ESAS), for global pain, nausea, tiredness, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath; 2) a site-specific pain score (SSPS); 3) the amount of analgesic intake in morphine equivalents in the last 24 hours; and 4) the Townsend Functional Assessment Scale (TFAS), ascertaining mobility. A postprocedural CT scan was performed the same day on all patients. Follow-up assessment consisted of a phone call at Days 1, 2, and 4 and Weeks 1, 2, 4, 8, and 12. Patients with recurrent back pain or complications were followed in the bone metastases clinic. Thirty patients (19 women, 11 men) were evaluated. Their median age was 68 years (range 31 to 87 years). Thirty procedures (n=30) at 45 vertebral levels were performed; 13 were for pathologic fractures, and 17 were for

  3. Answering unresolved questions about the relationship between cognitive ability and prejudice

    NARCIS (Netherlands)

    Brandt, M.J.; Crawford, Jarret T

    2016-01-01

    Previous research finds that lower cognitive ability predicts greater prejudice. We test two unresolved questions about this association using a heterogeneous set of target groups and data from a representative sample of the United States (N = 5,914). First, we test “who are the targets of

  4. Beginning EFL Teachers' Beliefs about Quality Questions and Their Questioning Practices

    Science.gov (United States)

    Pham, Ly Ngoc Khanh; Hamid, M. Obaidul

    2013-01-01

    Motivated by the scarcity of research that examines the impact of teacher beliefs on their actual practices in Vietnam, this study investigated the relationship between teachers' beliefs about quality questions and their questioning behaviours in terms of questioning purposes, content focus, students' cognitive level, wording and syntax. Thirteen…

  5. Clinical application of continent anal plug in bedridden patients with intractable diarrhea.

    Science.gov (United States)

    Kim, J; Shim, M C; Choi, B Y; Ahn, S H; Jang, S H; Shin, H J

    2001-08-01

    Some patients bedridden from various causes such as stroke or spinal cord injury experience poor control of bowel movement. This causes fecal leakage and diarrhea, increases the risk of perianal excoriation and bed sores, and is a burden on caregivers. To evaluate the efficacy of fecal evacuation and the prevention and treatment of skin complications in intractable diarrhea patients using a new device. A continent anal plug (US Patent No. 5 569 216) comprises an inner balloon surrounded by an outer balloon, both of which are mounted on a silicone tube containing a pair of air passages and an enema fluid inlet. The tube is secured in place in the rectum by the inflatable outer balloon and is designed to drain fecal matter through a thin collapsible hose situated in the anal canal. Thirty-two patients (21 male; median age 61 (range, 28-76) years) were evaluated after fully informed consent. Median duration was 12 (range, 3-37) days. The continent anal plug evacuated efficiently in those patients with loose or watery stools who only required irrigation once daily or not at all. Skin excoriations improved in three to seven days. Minimal leakage was seen around the anus. There was no anorectal mucosal injury noted over 37 days. The continent anal plug is an efficient method of treating patients with loss of bowel control and incontinence because it enables controlled fecal evacuation and helps reduce skin complications without causing anorectal mucosal injury.

  6. Repetitive Questioning II

    Directory of Open Access Journals (Sweden)

    R. C. Hamdy MD

    2018-02-01

    Full Text Available Repetitive questioning is a major problem for caregivers, particularly taxing if they are unable to recognize and understand the reasons why their loved one keeps asking the same question over and over again. Caregivers may be tempted to believe that the patient does not even try to remember the answer given or is just getting obnoxious. This is incorrect. Repetitive questioning is due to the underlying disease: The patient’s short term memory is impaired and he is unable to register, encode, retain and retrieve the answer. If he is concerned about a particular topic, he will keep asking the same question over and over again. To the patient each time she asks the question, it is as if she asked it for the first time. Just answering repetitive questioning by providing repeatedly the same answer is not sufficient. Caregivers should try to identify the underlying cause for this repetitive questioning. In an earlier case study, the patient was concerned about her and her family’s safety and kept asking whether the doors are locked. In this present case study, the patient does not know how to handle the awkward situation he finds himself in. He just does not know what to do. He is not able to adjust to the new unexpected situation. So he repeatedly wants to reassure himself that he is not intruding by asking the same question over and over again. We discuss how the patient’s son-in-law could have avoided this situation and averted the catastrophic ending.

  7. Pre-operative evaluation of medically intractable partial seizures using [sup 123]I-Iomazenil SPECT. Comparison with Video/EEG-monitoring and post-operative results. Praeoperative Bewertung pharmakoresistenter fokaler Epilepsien mit der [sup 123]J-Iomazenil-SPECT. Vergleich mit dem Video/EEG-Monitoring und postoperativen Ergebnissen

    Energy Technology Data Exchange (ETDEWEB)

    Venz, S [Strahlenklinik und Poliklinik und Neurologische Klinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, FU Berlin (Germany); Cordes, M [Strahlenklinik und Poliklinik und Neurologische Klinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, FU Berlin (Germany); Straub, H B [Strahlenklinik und Poliklinik und Neurologische Klinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, FU Berlin (Germany); Hierholzer, J [Strahlenklinik und Poliklinik und Neurologische Klinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, FU Berlin (Germany); Schroeder, R [Strahlenklinik und Poliklinik und Neurologische Klinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, FU Berlin (Germany); Richter, W [Strahlenklinik und Poliklinik und Neurologische Klinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, FU Berlin (Germany); Schmitz, B [Strahlenklinik und Poliklinik und Neurologische Klinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, FU Ber

    1994-10-01

    SPECT with the benzodiazepine receptor antagonist [sup 123]I-Iomazenil was performed in 33 patients with intractable partial seizures for pre-operative evaluation. The results combined with MRI and [sup 99m]Tc-HMPAO-SPECT findings were compared with the video-assisted EEG monitoring (gold standard'') which localised the focus in 25 patients. 11 patients underwent surgical resection of the epileptogenic area and became seizure-free for a period up to 13 months. The lomazenil SPECT had a significantly higher sensitivity compared to [sup 99m]Tc-HMPAO in the visualization of an epileptogenic area and should be regularly used in the diagnostic of medically intractable partial seizures. (orig.)

  8. Investigation into the mechanisms of vagus nerve stimulation for the treatment of intractable epilepsy, using {sup 99m}Tc-HMPAO SPET brain images

    Energy Technology Data Exchange (ETDEWEB)

    Barnes, Anna; Chisholm, Jennifer A.; Patterson, James; Wyper, David [Department of Clinical Physics, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF (United Kingdom); Duncan, Roderick [Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow (United Kingdom); Lindsay, Kenneth [Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow (United Kingdom)

    2003-02-01

    Vagus nerve stimulation (VNS) has gained recognition as a treatment for refractory epilepsies where surgical treatment is not possible. While it appears that this treatment is effective in some patients, the mechanism of action is not clearly understood. The purpose of this study was to clarify findings of other positron emission tomography and single-photon emission tomography (SPET) investigations by measuring the acute effect of VNS on patients who have normal cerebral anatomy on magnetic resonance imaging and who have not previously been exposed to VNS. We investigated six subjects (two males and four females, mean age 29.5 years, range 21-39 years) with intractable epilepsy. One patient had primary generalised epilepsy causing generalised tonic-clonic seizures; the remaining five patients had localisation-related epilepsy causing complex partial seizures. SPET imaging was performed using 250 MBq of {sup 99m}Tc-HMPAO and a four-scan paradigm - two with and two without stimulation. The stimulation began at VNS current levels of 0.25 mA and was increased according to the limit of patients' tolerance, usually defined by coughing or discomfort. The stimulating waveform was of continuous square wave pulses of 500 {mu}s duration at 30 Hz. Image analysis was by SPM99. Reduced perfusion during stimulation was observed in the ipsilateral brain stem, cingulate, amygdala and hippocampus and contralateral thalamus and cingulate. The study provides further evidence of the involvement of the limbic system in the action of vagal nerve stimulation. (orig.)

  9. Comparison between Two Assessment Methods; Modified Essay Questions and Multiple Choice Questions

    Directory of Open Access Journals (Sweden)

    Assadi S.N.* MD

    2015-09-01

    Full Text Available Aims Using the best assessment methods is an important factor in educational development of health students. Modified essay questions and multiple choice questions are two prevalent methods of assessing the students. The aim of this study was to compare two methods of modified essay questions and multiple choice questions in occupational health engineering and work laws courses. Materials & Methods This semi-experimental study was performed during 2013 to 2014 on occupational health students of Mashhad University of Medical Sciences. The class of occupational health and work laws course in 2013 was considered as group A and the class of 2014 as group B. Each group had 50 students.The group A students were assessed by modified essay questions method and the group B by multiple choice questions method.Data were analyzed in SPSS 16 software by paired T test and odd’s ratio. Findings The mean grade of occupational health and work laws course was 18.68±0.91 in group A (modified essay questions and was 18.78±0.86 in group B (multiple choice questions which was not significantly different (t=-0.41; p=0.684. The mean grade of chemical chapter (p<0.001 in occupational health engineering and harmful work law (p<0.001 and other (p=0.015 chapters in work laws were significantly different between two groups. Conclusion Modified essay questions and multiple choice questions methods have nearly the same student assessing value for the occupational health engineering and work laws course.

  10. Formative student-authored question bank: perceptions, question quality and association with summative performance.

    Science.gov (United States)

    Walsh, Jason L; Harris, Benjamin H L; Denny, Paul; Smith, Phil

    2018-02-01

    There are few studies on the value of authoring questions as a study method, the quality of the questions produced by students and student perceptions of student-authored question banks. Here we evaluate PeerWise, a widely used and free online resource that allows students to author, answer and discuss multiple-choice questions. We introduced two undergraduate medical student cohorts to PeerWise (n=603). We looked at their patterns of PeerWise usage; identified associations between student engagement and summative exam performance; and used focus groups to assess student perceptions of the value of PeerWise for learning. We undertook item analysis to assess question difficulty and quality. Over two academic years, the two cohorts wrote 4671 questions, answered questions 606 658 times and posted 7735 comments. Question writing frequency correlated most strongly with summative performance (Spearman's rank: 0.24, p=<0.001). Student focus groups found that: (1) students valued curriculum specificity; and (2) students were concerned about student-authored question quality. Only two questions of the 300 'most-answered' questions analysed had an unacceptable discriminatory value (point-biserial correlation <0.2). Item analysis suggested acceptable question quality despite student concerns. Quantitative and qualitative methods indicated that PeerWise is a valuable study tool. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Nuclear questions

    International Nuclear Information System (INIS)

    Berg, Eugene

    2012-01-01

    Civilian and military nuclear questions fill a multitude of publications these days, especially after the Japanese tsunami and the Fukushima disaster. The author analyses some of them and highlights the links between civil and military nuclear industries, the realities of the nuclear cycle and related industrial questions before concluding on the controversial issue of weapons and their proliferation potential

  12. Approaches to Exploring Category Information for Question Retrieval in Community Question-Answer Archives

    DEFF Research Database (Denmark)

    Cao, Xin; Cong, Gao; Cui, Bin

    2012-01-01

    , and it applies these approaches to existing question retrieval models, including a state-of-the-art question retrieval model. Experiments conducted on real CQA data demonstrate that the proposed techniques are effective and efficient and are capable of outperforming a variety of baseline methods significantly......Community Question Answering (CQA) is a popular type of service where users ask questions and where answers are obtained from other users or from historical question-answer pairs. CQA archives contain large volumes of questions organized into a hierarchy of categories. As an essential function...

  13. Questioning ORACLE: An Assessment of ORACLE's Analysis of Teachers' Questions and [A Comment on "Questioning ORACLE"].

    Science.gov (United States)

    Scarth, John; And Others

    1986-01-01

    Analysis of teachers' questions, part of the ORACLE (Observation Research and Classroom Learning Evaluation) project research, is examined in detail. Scarth and Hammersley argue that the rules ORACLE uses for identifying different types of questions involve levels of ambiguity and inference that threaten reliability and validity of the study's…

  14. Group members' questions shape participation in health counselling and health education.

    Science.gov (United States)

    Logren, Aija; Ruusuvuori, Johanna; Laitinen, Jaana

    2017-10-01

    This study examines how group members' questions shape member participation in health counselling and health education groups. The study applies conversation analytic principles as a method. The data consist of video-recorded health education lessons in secondary school and health counselling sessions for adults with a high risk of Type 2 diabetes. Group members' questions accomplish a temporary change in participatory roles. They are used to 1) request counselling, 2) do counselling or 3) challenge previous talk. They are usually treated as relevant and legitimate actions by the participants, but are occasionally interpreted as transitions outside the current action or topic. Group members' questions result in a shift from leader-driven to member-driven discussion. Thus they constitute a pivot point for detecting changes in participation in group interventions. Observing the occurrence of group members' questions helps group leaders to adjust their own actions accordingly and thus facilitate or guide group participation. Comparison of the type and frequency of members' questions is a way to detect different trajectories for delivering group interventions and can thus be used to develop methods for process evaluation of interventions. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Packing of renal fossa: Useful technique for intractable bleeding after open pyelolithotomy surgery

    Directory of Open Access Journals (Sweden)

    Mohinder Kumar Malhotra

    2012-01-01

    Full Text Available There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone surgery in peripheral hospitals. Several studies have shown the usefulness of temporary packing to control bleeding in liver injuries and following open heart operations. Packing of the renal fossa with laparotomy pads in unstable patients, and transferring the patient to the surgical intensive care unit (ICU is also described in trauma but not in controlling bleeding after open pyelolithotomy .This study comprises of three such patients whose kidneys were salvaged by a simple procedure of temporary packing of renal fossa for period of 24-48 hours who had developed life threatening haemorrhage after open pyelolithotomy. This technique is simple and worth trying especially for surgeons who are contemplating nephrectomy as prolonged packing has not lead to any compromise in renal functions. The aim of this manuscript is very limited and clear. Packing is not a licence to carry out open pyelolithotomy without proper expertise and local backup or resources. Principles of safe and ethical surgical practice should never be violated as it can lead to medico legal complications.

  16. Curiosity Questions

    Science.gov (United States)

    Nelsen, Jane; DeLorenzo, Chip

    2010-01-01

    Have you ever found yourself lecturing a child, with the best of intentions, in an attempt to help him or her learn a lesson or process a situation in a manner that you feel will be productive? Curiosity questions, which the authors also call What and How questions, help children process an experience, event, or natural consequence so that they…

  17. Intractable lung abscess successfully treated with cavernostomy and free omental plombage using microvascular surgery.

    Science.gov (United States)

    Shimizu, Junzo; Arano, Yoshihiko; Adachi, Iwao; Ikeda, Chikako; Ishikawa, Norihiko; Ohtake, Hiroshi

    2009-11-01

    A 68-year-old man, complaining of fever and puriform sputum, was referred to our hospital. A giant abscess was detected in the upper lobe of the right lung. Percutaneous drainage of a lung abscess was carried out. When the pus collected was cultured, Candida was 1+ and Escherichia coli was 2+. Later, it became difficult to control the abscess by drainage, and cavernostomy was selected. The contents of the abscess cavity were removed, and the cavity was opened, followed by exchange of gauze every day. For 14 months after cavernostomy, once-weekly gauze exchange was continued at the outpatient clinic to clean the abscess cavity. Finally, the abscess was filled with a free greater omentum flap, accompanied by microvascular anastomosis. In this way, the intractable lung abscess was successfully cured. Conventionally, surgical treatment, particularly cavernostomy, has been applied only to limited cases when dealing with a lung abscess. Our experience with the present case suggests that surgical treatment, including cavernostomy as one option, should also be considered when dealing with lung abscesses resisting medical treatment and causing compromised respiratory function. To enable maximum utilization of the greater omental flap, which is available in only a limited amount, it seems useful to prepare and graft a free omental flap making use of microvascular surgery.

  18. The correlation between E.M.I. scan appearances and the pathologic findings in a small group of patients submitted to anterior temporal lobectomy for intractable epilepsy

    International Nuclear Information System (INIS)

    Polkey, C.E.

    1978-01-01

    In a group of nine patients undergoing anterior temporal lobectomy for intractable epilepsy, EMI scans are available for direct comparison with other neuroradiological investigations and the pathology found in the resected temporal lobes. The atrophic lesion of mesial temporal sclerosis is difficult to demonstrated by CAT scanning. However, lesions such as tumours and angiomas containing areas of increased radiodensity are better indentified by this method. Because of this difference, CAT scanning is not a suitable single investigation for screening epileptic populations for surgical candidates. (orig.) [de

  19. Pisa Question and Reasoning Skill

    Directory of Open Access Journals (Sweden)

    Ersoy Esen

    2017-01-01

    Full Text Available The objective of the study is to determine the level of the reasoning skills of the secondary school students. This research has been conducted during the academic year of 2015-2016 with the participation of 51 students in total, from a province in the Black Sea region of Turkey by using random sampling method. Case study method has been used in this study, since it explains an existing situation. In this study, content analysis from the qualitative research methods was carried out. In order to ensure the validity of the scope, agreement percentage formula was used and expert opinions were sought.The problem named Holiday from the Chapter 1 of the normal units in Problem Solving Questions from PISA (Program for International Student Assessments [35] are used as the data collection tool for the study. The problem named Holiday consists of two questions. Applied problems were evaluated according to the mathematical reasoning stages of TIMSS (2003. The findings suggest that the students use proportional reasoning while solving the problems and use the geometric shapes to facilitate the solution of the problem. When they come across problems related to each other, it is observed that they create connections between the problems based on the results of the previous problem. In conclusion, the students perform crosscheck to ensure that their solutions to the problems are accurate.

  20. Acquisition of who-question comprehension in German children with hearing loss.

    Science.gov (United States)

    Wimmer, Eva; Rothweiler, Monika; Penke, Martina

    2017-05-01

    For children with sensorineural hearing loss the ability to understand wh-questions might be particularly challenging because they often have only restricted access to spoken language input during optimal periods of language acquisition. In previous research it has been suggested that this restricted input during critical stages in language acquisition might lead to syntactic deficits that persist into adolescence. In this study we want to pursue this issue by investigating the comprehension of wh-questions in German children with bilateral sensorineural hearing loss. We report results of a who-question comprehension task in a group of 21 3- to 4-year-old German hard-of-hearing children compared to a group of age-matched children with normal hearing. The group data and individual performance patterns suggest that the syntactic comprehension difficulties observed in some, but not all, of the children with hearing loss reflect a delay in the acquisition of who-question comprehension rather than a persistent syntactic deficit. Follow-up data elicited from a subgroup of children confirm this supposition. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. THE EXPLICIT COMPREHENSION-STRATEGY INSTRUCTION: QUESTION-ANSWER RELATIONSHIP VS SELF-QUESTIONING

    Directory of Open Access Journals (Sweden)

    Lalu Thohir

    2017-12-01

    Full Text Available This study was aimed at examining and comparing the effectiveness of the Question-Answer Relationship (QAR and Self-Questioning (SQ strategies in improving the reading ability of the undergraduate students. This study was a quasi-experimental study in which two out of three classes of the third semester students at English department of Mataram University were selected randomly to receive either QAR strategy or SQ strategy instructions for ten weekly meetings. The findings of pre- and posttest with multiple-choice questions revealed that both comprehension strategies were effective in improving the undergraduate students‘ reading ability. The findings from the posttest with multiple-choice questions indicated the students who received SQ strategy instruction scored significantly higher than those students who received QAR strategy instruction. On the other hand, the students who received QAR strategy instruction scored slightly higher than those students who received SQ strategy instruction in the posttest with open-ended questions.

  2. A Two-Tier Multiple Choice Questions to Diagnose Thermodynamic Misconception of Thai and Laos Students

    Science.gov (United States)

    Kamcharean, Chanwit; Wattanakasiwich, Pornrat

    The objective of this study was to diagnose misconceptions of Thai and Lao students in thermodynamics by using a two-tier multiple-choice test. Two-tier multiple choice questions consist of the first tier, a content-based question and the second tier, a reasoning-based question. Data of student understanding was collected by using 10 two-tier multiple-choice questions. Thai participants were the first-year students (N = 57) taking a fundamental physics course at Chiang Mai University in 2012. Lao participants were high school students in Grade 11 (N = 57) and Grade 12 (N = 83) at Muengnern high school in Xayaboury province, Lao PDR. As results, most students answered content-tier questions correctly but chose incorrect answers for reason-tier questions. When further investigating their incorrect reasons, we found similar misconceptions as reported in previous studies such as incorrectly relating pressure with temperature when presenting with multiple variables.

  3. Evolution and Revolution in China's Skill Formation System

    Science.gov (United States)

    Xu, Jing

    2011-01-01

    This article outlines the current problems facing vocational education in China in order to raise the question as to how deep-seated and intractable they might be. In order to address this question a historical analysis of vocational education from the turn of the twentieth century to the end of Mao's period of office is undertaken. The rise of…

  4. Development of a Simple Tool for Identifying Alcohol Use Disorder in Female Korean Drinkers from Previous Questionnaires.

    Science.gov (United States)

    Seo, Yu Ri; Kim, Jong Sung; Kim, Sung Soo; Yoon, Seok Joon; Suh, Won Yoon; Youn, Kwangmi

    2016-01-01

    This study aimed to develop a simple tool for identifying alcohol use disorders in female Korean drinkers from previous questionnaires. This research was conducted on 400 women who consumed at least one alcoholic drink during the past month and visited the health promotion center at Chungnam National University Hospital between June 2013 to May 2014. Drinking habits and alcohol use disorders were assessed by structured interviews using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria. The subjects were also asked to answer the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-Consumption, CAGE (Cut down, Annoyed, Guilty, Eye-opener), TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), TACE (Tolerance, Annoyed, Cut down, Eye-opener), and NET (Normal drinker, Eye-opener, Tolerance) questionnaires. The area under receiver operating characteristic (AUROC) of each question of the questionnaires on alcohol use disorders was assessed. After combining two questions with the largest AUROC, it was compared to other previous questionnaires. Among the 400 subjects, 58 (14.5%) were identified as having an alcohol use disorder. Two questions with the largest AUROC were question no. 7 in AUDIT, "How often during the last year have you had a feeling of guilt or remorse after drinking?" and question no. 5 in AUDIT, "How often during the past year have you failed to do what was normally expected from you because of drinking?" with an AUROC (95% confidence interval [CI]) of 0.886 (0.850-0.915) and 0.862 (0.824-0.894), respectively. The AUROC (95% CI) of the combination of the two questions was 0.958 (0.934-0.976) with no significant difference as compared to the existing AUDIT with the largest AUROC. The above results suggest that the simple tool consisting of questions no. 5 and no. 7 in AUDIT is useful in identifying alcohol use disorders in Korean female drinkers.

  5. The Effect of Question Format and Task Difficulty on Reasoning Strategies and Diagnostic Performance in Internal Medicine Residents

    Science.gov (United States)

    Heemskerk, Laura; Norman, Geoff; Chou, Sophia; Mintz, Marcy; Mandin, Henry; McLaughlin, Kevin

    2008-01-01

    Background: Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and…

  6. Asking Questions in Academia

    DEFF Research Database (Denmark)

    Hansen, Annette Skovsted

    2014-01-01

    Motivation for the activity In academia the most important skill is to ask academically relevant and sound questions. This is not easy and students need to practice asking questions orally and in writing before they write research papers.......Motivation for the activity In academia the most important skill is to ask academically relevant and sound questions. This is not easy and students need to practice asking questions orally and in writing before they write research papers....

  7. Magnetic resonance imaging in 120 patients with intractable partial seizures: a preoperative assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lefkopoulos, A.; Haritanti, A.; Papadopoulou, E.; Karanikolas, D.; Fotiadis, N.; Dimitriadis, A.S. [AHEPA University Hospital, Department of Radiology, Thessaloniki (Greece)

    2005-05-01

    The aim of this study was to describe magnetic resonance imaging (MRI) findings in patients with medically intractable epilepsy and to compare different magnetic resonance (MR) sequences in order to establish a dedicated and shorter scan time imaging protocol of choice. One hundred and twenty patients with seizures that were refractory to medical treatment were assessed by MRI with spin-echo (SE) T1, fast spin-echo (FSE) T2, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR) and contrast-enhanced T1 SE sequences. Pathological scans were acquired in 78 patients. Hippocampal sclerosis was detected in 30 patients (25%), cerebral, tumoral, mass lesions in 12 patients (10%), vascular malformations in nine patients (7.5%), cortical infarcts in eight patients (6.7%), cerebral infections in four patients (4.2%) and developmental disorders in 15 patients (12.5%). The most common location of the lesions was the temporal lobe (60%). Coronal, thin (slice thickness 4-5 mm) images have proven to be the most useful in the assessment of the hippocampus. FLAIR and IR are particularly useful in the detection of lesions abutting cerebrospinal fluid (CSF) spaces and developmental disorders, respectively, while T1 SE sequences before and after the intravenous administration of gadolinium offer great facility in identifying space-occupying lesions and infections. MRI is the most important diagnostic tool for the assessment of epileptogenic foci, thus playing the primary role in indicating the type of treatment to be applied. (orig.)

  8. Magnetic resonance imaging in 120 patients with intractable partial seizures: a preoperative assessment

    International Nuclear Information System (INIS)

    Lefkopoulos, A.; Haritanti, A.; Papadopoulou, E.; Karanikolas, D.; Fotiadis, N.; Dimitriadis, A.S.

    2005-01-01

    The aim of this study was to describe magnetic resonance imaging (MRI) findings in patients with medically intractable epilepsy and to compare different magnetic resonance (MR) sequences in order to establish a dedicated and shorter scan time imaging protocol of choice. One hundred and twenty patients with seizures that were refractory to medical treatment were assessed by MRI with spin-echo (SE) T1, fast spin-echo (FSE) T2, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR) and contrast-enhanced T1 SE sequences. Pathological scans were acquired in 78 patients. Hippocampal sclerosis was detected in 30 patients (25%), cerebral, tumoral, mass lesions in 12 patients (10%), vascular malformations in nine patients (7.5%), cortical infarcts in eight patients (6.7%), cerebral infections in four patients (4.2%) and developmental disorders in 15 patients (12.5%). The most common location of the lesions was the temporal lobe (60%). Coronal, thin (slice thickness 4-5 mm) images have proven to be the most useful in the assessment of the hippocampus. FLAIR and IR are particularly useful in the detection of lesions abutting cerebrospinal fluid (CSF) spaces and developmental disorders, respectively, while T1 SE sequences before and after the intravenous administration of gadolinium offer great facility in identifying space-occupying lesions and infections. MRI is the most important diagnostic tool for the assessment of epileptogenic foci, thus playing the primary role in indicating the type of treatment to be applied. (orig.)

  9. Improving large class performance and engagement through student-generated question banks.

    Science.gov (United States)

    Hancock, Dale; Hare, Nicole; Denny, Paul; Denyer, Gareth

    2018-03-12

    Disciplines such as Biochemistry and Molecular Biology, which involve concepts not included in the high-school curriculum, are very challenging for many first year university students. These subjects are particularly difficult for students accustomed to surface learning strategies involving memorization and recall of facts, as a deeper understanding of the relationship between concepts is needed for successful transfer to related areas and subsequent study. In this article, we explore an activity in a very large first year Molecular Biology course, in which students create multiple-choice questions related to targeted learning outcomes, and then answer and evaluate one another's questions. This activity encompasses elements of both self- and peer-assessment and the generative tasks of creating questions and producing written feedback may contribute to a deeper understanding of the material. We make use of a free online platform to facilitate all aspects of the process and analyze the effect of student engagement with the task on overall course performance. When compared to previous semester's cohorts, we observe a pronounced improvement in class performance on exam questions targeting similar concepts to the student-generated questions. In addition, those students that engage to a greater extent with the activity perform significantly better on the targeted exam questions than those who are less active, yet all students perform similarly on a set of isolated control questions appearing on the same exam. © 2018 by The International Union of Biochemistry and Molecular Biology, 2018. © 2018 The International Union of Biochemistry and Molecular Biology.

  10. Post-event information presented in a question form eliminates the misinformation effect.

    Science.gov (United States)

    Lee, Yuh-shiow; Chen, Kuan-Nan

    2013-02-01

    This study investigated the influences of sentence surface forms on the misinformation effect. After viewing a film clip, participants received a post-event narrative describing the events in the film. Critical sentences in the post-event narrative, presented in either a statement or a question form, contained misinformation instead of questions with embedded false presuppositions; thus participants did not have to answer questions about the original event. During the final cued-recall test, participants were informed that any relevant information presented in the post-event narrative was not in the original event and that they should not report it. Consistent with previous findings, Experiment 1 demonstrated that post-event information presented as an affirmative statement produced the misinformation effect. More importantly, post-event information presented in a question form, regardless of whether it contained a misleading or studied item, increased the recall of correct information and reduced false recall. Experiment 2 replicated the main finding and ruled out an alternative explanation based on the salience of misleading items. Post-event information presented in a question form created a condition similar to that which produces the testing effect. © 2012 The British Psychological Society.

  11. Improving Student Question Classification

    Science.gov (United States)

    Heiner, Cecily; Zachary, Joseph L.

    2009-01-01

    Students in introductory programming classes often articulate their questions and information needs incompletely. Consequently, the automatic classification of student questions to provide automated tutorial responses is a challenging problem. This paper analyzes 411 questions from an introductory Java programming course by reducing the natural…

  12. The Government's role in regulating, coordinating, and standardizing the response to Alzheimer's disease: Anticipated international cooperation in the area of intractable and rare diseases.

    Science.gov (United States)

    Tang, Qi; Song, Peipei; Xu, Lingzhong

    2016-11-01

    The World Health Organization (WHO) has emphasized that aging of the population is inextricably linked to many other global public health issues, such as universal health coverage, non-communicable diseases, and disability. However, Alzheimer's Disease International (ADI) estimates that 46.8 million elderly people worldwide were living with dementia in 2015. Alzheimer's disease (AD), the most common form of dementia, is one of the most common neurodegenerative diseases and is the main cause of cognitive impairment. AD will affect 5-7 out of every 100 older adults who are age 60 years or over. In response to the serious challenge posed by AD, governments are expected to play an important role in the prevention, diagnosis, and treatment of AD. As specific examples, i ) the Japanese Government has instituted and supported regulations to encourage the development of AD drugs in order to accelerate research and development of innovative drugs; ii ) the United States Government has cooperated with multiple partners such as non-governmental organizations in the response to AD; iii ) Chinese governmental measures have standardized clinical diagnosis and treatment as part of the response to AD, including eligible patients, diagnostic criteria, therapeutic schedules, drug selection, and required inspections; iv ) with political support from member governments, the European Union has issued guidelines and conducted clinical studies on medicines for the treatment of AD in order to ascertain the various stages of the disease and the relevance of biomarkers. AD is an intractable disease, so different countries need to share clinic trial information and cooperate in the conduct of those trials. International cooperation will play a key role in the response to other intractable and rare diseases.

  13. Response to Electroconvulsive Therapy in Patients With Autism Spectrum Disorder and Intractable Challenging Behaviors Associated With Symptoms of Catatonia.

    Science.gov (United States)

    Sajith, Sreedharan Geetha; Liew, Siew Fai; Tor, Phern Chern

    2017-03-01

    There are several reports of electroconvulsive therapy (ECT) used in autism spectrum disorder (ASD) in the context of catatonic symptoms. We describe response to ECT in two adults with ASD and intellectual disability with intractable aggression and self-injurious behaviors associated with catatonic symptoms who had not responded to standard interventions. Unilateral ECT at a frequency of 3 times a week was given followed by weekly maintenance ECT. Patients' catatonic symptoms included episodes of agitation and echophenomena. Electroconvulsive therapy resulted in significant improvement in their behavior problems but 1 patient relapsed when the ECT was discontinued or frequency of treatment reduced. The second patient required 2 courses of ECT before improvement which was maintained on weekly ECT. Electroconvulsive therapy could be a potentially beneficial intervention in patients with ASD and severe challenging behaviors associated with catatonic symptoms including agitated or excited forms of catatonia.

  14. Question Formation and Focus Construction in Owo: A Yoruba Dialect

    Directory of Open Access Journals (Sweden)

    Boluwaji Oshodi

    2016-06-01

    Full Text Available Question formation and focusing are two transformational processes attested in Standard Yorùbá both of which have been extensively discussed in previous studies. However, very little is known about these concepts in Owo (Owò̩̩̀ a south-East Yoruba (Yorùbá dialect. This study examines the concept of questions and focusing in Owo ̩̩̀̀dialect with a comparison of the processes in Standard Yorùbá. The study revealed some differences as well as similarities in the two processes in Owo ̩̩̀̀and standard Yorùbá. Just like in Standard Yorùbá, question markers in Owo ̩̩̀̀normally occur in sentence initial and final positions. However, the question marker de ̩̀constantly appears sentence medially before and before verbs in certain constructions. Furthermore, while the focus marker in Yorùbá normally occurs immediately after the focused item with a stable form, the focus marker in Owo ̩̩̀̀usually occurs at the sentence final position as a reduplicated form of the last syllable of the final item. Also, a pronoun which indicates number and agreement usually occurs immediately after the focused item in Owò̩̩̀. Finally, just like in Yorùbá, there is a syntactic relationship between question and focusing in Owo ̩̩̀̀dialect.

  15. Guided Discovery with Socratic Questioning

    Directory of Open Access Journals (Sweden)

    M. Hakan Türkçapar

    2015-04-01

    Full Text Available “The Socratic method” is a way of teaching philosophical thinking and knowledge by asking questions. It was first used by in ancient times by the Greek philosopher Socrates who taught his followers by asking questions; these conversations between them are known as “Socratic dialogues”. In this methodology, no new knowledge is taught to the individual; rather, the individual is guided to remember and rediscover what was formerly known through this process. The main method used in cognitive therapy is guided discovery. There are various methods of guided discovery in cognitive therapy. The form of verbal exchange between the therapist and client which is used during the process of cognitive behavioral therapy is known as “socratic questioning”. In this method the goal is to make the client rediscover, with a series of questions, a piece of knowledge which he could otherwise know but is not presently conscious of. The Socratic Questioning consists of several steps, including: identifying the problem by listening to the client and making reflections, finding alternatives by examining and evaluating, reidentification by using the newly rediscovered information and questioning the old distorted belief, and reaching a new conclusion and applying it. Question types used during these procedures are: questions for collecting information, questions revealing meanings, questions revealing beliefs, questions about behaviours during similar past experiences, analytic questions and analytic synthesis questions. In order to make the patient feel understood, it is important to be empathetic and summarize the problem during the interview. In this text, steps of Socratic Questioning-Guided Discovery will be reviewed with sample dialogues provided for each step. [JCBPR 2015; 4(1.000: 47-53

  16. Glycophospholipid Formulation with NADH and CoQ10 Significantly Reduces Intractable Fatigue in Western Blot-Positive ‘Chronic Lyme Disease’ Patients: Preliminary Report

    Directory of Open Access Journals (Sweden)

    Garth L. Nicolson

    2012-03-01

    Full Text Available Background: An open label 8-week preliminary study was conducted in a small number of patients to determine if a combination oral supplement containing a mixture of phosphoglycolipids, coenzyme Q10 and microencapsulated NADH and other nutrients could affect fatigue levels in long-term, Western blot-positive, multi-symptom ‘chronic Lyme disease’ patients (also called ‘post-treatment Lyme disease’ or ‘post Lyme syndrome’ with intractable fatigue. Methods: The subjects in this study were 6 males (mean age = 45.1 ± 12.4 years and 10 females (mean age = 54.6 ± 7.4 years with ‘chronic Lyme disease’ (determined by multiple symptoms and positive Western blot analysis that had been symptomatic with chronic fatigue for an average of 12.7 ± 6.6 years. They had been seen by multiple physicians (13.3 ± 7.6 and had used many other remedies, supplements and drugs (14.4 ± 7.4 without fatigue relief. Fatigue was monitored at 0, 7, 30 and 60 days using a validated instrument, the Piper Fatigue Scale.Results: Patients in this preliminary study responded to the combination test supplement, showing a 26% reduction in overall fatigue by the end of the 8-week trial (p< 0.0003. Analysis of subcategories of fatigue indicated that there were significant improvements in the ability to complete tasks and activities as well as significant improvements in mood and cognitive abilities. Regression analysis of the data indicated that reductions in fatigue were consistent and occurred with a high degree of confidence (R2= 0.998. Functional Foods in Health and Disease 2012, 2(3:35-47 Conclusions: The combination supplement was a safe and effective method to significantly reduce intractable fatigue in long-term patients with Western blot-positive ‘chronic Lyme disease.’

  17. Pulsed radiofrequency on radial nerve under ultrasound guidance for treatment of intractable lateral epicondylitis.

    Science.gov (United States)

    Oh, Dae Seok; Kang, Tae Hyung; Kim, Hyae Jin

    2016-06-01

    Lateral epicondylitis is a painful and functionally limiting disorder. Although lateral elbow pain is generally self-limiting, in a minority of people symptoms persist for a long time. When various conservative treatments fail, surgical approach is recommended. Surgical denervation of several nerves that innervate the lateral humeral epicondyle could be considered in patients with refractory pain because it denervates the region of pain. Pulsed radiofrequency is a minimally invasive procedure that improves chronic pain when applied to various neural tissues without causing any significant destruction and painful complication. This procedure is safe, minimally invasive, and has less risk of complications relatively compared to the surgical approach. The radial nerve can be identified as a target for pulsed radiofrequency lesioning in lateral epicondylitis. This innovative method of pulsed radiofrequency applied to the radial nerve has not been reported before. We reported on two patients with intractable lateral epicondylitis suffering from elbow pain who did not respond to nonoperative treatments, but in whom the ultrasound-guided pulsed radiofrequency neuromodulation of the radial nerve induced symptom improvement. After a successful diagnostic nerve block, radiofrequency probe adjustment around the radial nerve was performed on the lateral aspect of the distal upper arm under ultrasound guidance and multiple pulsed treatments were applied. A significant reduction in pain was reported over the follow-up period of 12 weeks.

  18. Epistemology: 5 Questions

    DEFF Research Database (Denmark)

    Epistemology: 5 Questions is a collection of short interviews based on 5 questions presented to some of the most influential and prominent scholars in epistemology. We hear their views on epistemology with particular emphasis on the intersection between mainstream and formal approaches to the field...

  19. Lack of Cetuximab induced skin toxicity in a previously irradiated field: case report and review of the literature

    Science.gov (United States)

    2010-01-01

    Introduction Mutation, amplification or dysregulation of the EGFR family leads to uncontrolled division and predisposes to cancer. Inhibiting the EGFR represents a form of targeted cancer therapy. Case report We report the case of 79 year old gentlemen with a history of skin cancer involving the left ear who had radiation and surgical excision. He had presented with recurrent lymph node in the left upper neck. We treated him with radiation therapy concurrently with Cetuximab. He developed a skin rash over the face and neck area two weeks after starting Cetuximab, which however spared the previously irradiated area. Conclusion The etiology underlying the sparing of the previously irradiated skin maybe due to either decrease in the population of EGFR expressing cells or decrease in the EGFR expression. We raised the question that "Is it justifiable to use EGFR inhibitors for patients having recurrence in the previously irradiated field?" We may need further research to answer this question which may guide the physicians in choosing appropriate drug in this scenario. PMID:20478052

  20. Socrates was not a pimp: changing the paradigm of questioning in medical education.

    Science.gov (United States)

    Kost, Amanda; Chen, Frederick M

    2015-01-01

    The slang term "pimping" is widely recognized by learners and educators in the clinical learning environment as the act of more senior members of the medical team publicly asking questions of more junior members. Although questioning as a pedagogical practice has many benefits, pimping, as described in the literature, evokes negative emotions in learners and leads to an environment that is not conducive to adult learning. Medical educators may employ pimping as a pedagogic technique because of beliefs that it is a Socratic teaching method. Although problems with pimping have previously been identified, no alternative techniques for questioning in the clinical environment were suggested. The authors posit that using the term "pimping" to describe questioning in medical education is harmful and unprofessional, and they propose clearly defining pimping as "questioning with the intent to shame or humiliate the learner to maintain the power hierarchy in medical education." Explicitly separating pimping from the larger practice of questioning allows the authors to make three recommendations for improving questioning practices. First, educators should examine the purpose of each question they pose to learners. Second, they should apply historic and modern interpretations of Socratic teaching methods that promote critical thinking skills. Finally, they should consider adult learning theories to make concrete changes to their questioning practices. These changes can result in questioning that is more learner centered, aids in the acquisition of knowledge and skills, performs helpful formative and summative assessments of the learner, and improves community in the clinical learning environment.

  1. Prevalence of body dysmorphic disorder on a psychiatric inpatient ward and the value of a screening question.

    Science.gov (United States)

    Veale, David; Akyüz, Elvan U; Hodsoll, John

    2015-12-15

    The aim of this study was to estimate the prevalence of body dysmorphic disorder (BDD) on an inpatient ward in the UK with a larger sample than previously studied and to investigate the value of a simple screening question during an assessment interview. Four hundred and thirty two consecutive admissions were screened for BDD on an adult psychiatric ward over a period of 13 months. Those who screened positive had a structured diagnostic interview for BDD. The prevalence of BDD was estimated to be 5.8% (C.I. 3.6-8.1%). Our screening question had a slightly low specificity (76.6%) for detecting BDD. The strength of this study was a larger sample size and narrower confidence interval than previous studies. The study adds to previous observations that BDD is poorly identified in psychiatric inpatients. BDD was identified predominantly in those presenting with depression, substance misuse or an anxiety disorder. The screening question could be improved by excluding those with weight or shape concerns. Missing the diagnosis is likely to lead to inappropriate treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. The Priority of the Question: Focus Questions for Sustained Reasoning in Science

    Science.gov (United States)

    Lustick, David

    2010-08-01

    Science education standards place a high priority on promoting the skills and dispositions associated with inquiry at all levels of learning. Yet, the questions teachers employ to foster sustained reasoning are most likely borrowed from a textbook, lab manual, or worksheet. Such generic questions generated for a mass audience, lack authenticity and contextual cues that allow learners to immediately appreciate a question’s relevance. Teacher queries intended to motivate, guide, and foster learning through inquiry are known as focus questions. This theoretical article draws upon science education research to present a typology and conceptual framework intended to support science teacher educators as they identify, develop, and evaluate focus questions with their students.

  3. What Is the Correct Answer about The Dress' Colors? Investigating the Relation between Optimism, Previous Experience, and Answerability.

    Science.gov (United States)

    Karlsson, Bodil S A; Allwood, Carl Martin

    2016-01-01

    The Dress photograph, first displayed on the internet in 2015, revealed stunning individual differences in color perception. The aim of this study was to investigate if lay-persons believed that the question about The Dress colors was answerable. Past research has found that optimism is related to judgments of how answerable knowledge questions with controversial answers are (Karlsson et al., 2016). Furthermore, familiarity with a question can create a feeling of knowing the answer (Reder and Ritter, 1992). Building on these findings, 186 participants saw the photo of The Dress and were asked about the correct answer to the question about The Dress' colors (" blue and black," "white and gold," "other, namely…," or "there is no correct answer" ). Choice of the alternative "there is no correct answer" was interpreted as believing the question was not answerable. This answer was chosen more often by optimists and by people who reported they had not seen The Dress before. We also found that among participants who had seen The Dress photo before, 19%, perceived The Dress as "white and gold" but believed that the correct answer was "blue and black ." This, in analogy to previous findings about non-believed memories (Scoboria and Pascal, 2016), shows that people sometimes do not believe the colors they have perceived are correct. Our results suggest that individual differences related to optimism and previous experience may contribute to if the judgment of the individual perception of a photograph is enough to serve as a decision basis for valid conclusions about colors. Further research about color judgments under ambiguous circumstances could benefit from separating individual perceptual experience from beliefs about the correct answer to the color question. Including the option "there is no correct answer " may also be beneficial.

  4. Partial monosomy Xq(Xq23 --> qter) and trisomy 4p(4p15.33 --> pter) in a woman with intractable focal epilepsy, borderline intellectual functioning, and dysmorphic features.

    Science.gov (United States)

    Bartocci, Arnaldo; Striano, Pasquale; Mancardi, Maria Margherita; Fichera, Marco; Castiglia, Lucia; Galesi, Ornella; Michelucci, Roberto; Elia, Maurizio

    2008-06-01

    Studies of epilepsy associated with chromosomal abnormalities may provide information about clinical and EEG phenotypes and possibly to identify new epilepsy genes. We describe a female patient with intractable focal epilepsy, borderline intellectual functioning, and facial dysmorphisms, in whom genetic study (i.e., karyotype and array-CGH analysis) revealed a distal trisomy 4p and distal monosomy Xq. Although any genetic hypothesis remains speculative, several genes are located in the 4p chromosome segment involved in the rearrangement, some of which may be related to epilepsy.

  5. An active-learning assignment requiring pharmacy students to write medicinal chemistry examination questions.

    Science.gov (United States)

    Kolluru, Srikanth

    2012-08-10

    To implement and assess the effectiveness of an assignment requiring doctor of pharmacy (PharmD) students to write examination questions for the medicinal chemistry sections of a pharmacotherapeutics course. Students were divided into groups of 5-6 and given detailed instructions and grading rubrics for writing multiple-choice examination questions on medicinal chemistry topics. The compiled student-written questions for each examination were provided to the entire class as a study aid. Approximately 5% of the student-written questions were used in course examinations. Student appreciation of and performance in the medicinal chemistry portion of the course was significantly better than that of the previous year's class. Also, students' responses on a qualitative survey instrument indicated that the assignment provided students' guidance on which concepts to focus on, helped them retain knowledge better, and fostered personal exploration of the content, which led to better performance on examinations. Adding an active-learning assignment in which students write examination questions for the medicinal chemistry portion of a pharmacotherapeutics course was an effective means of increasing students engagement in the class and knowledge of the course material.

  6. Living with risk: a management question

    International Nuclear Information System (INIS)

    Ale, Ben J.M.

    2005-01-01

    Public authorities started to be really involved in risk management of hazardous materials some 30 years ago. Recent developments have led to fresh attention for this matter and many further developments are underway. The history of risk management and safety regulation is one of strongly variable interest, forgotten lessons and rude awakenings. The impetus exerted by accidents is short lived. Safety cases become documents to satisfy regulation rather than instruments to reduce risk. Deregulation, privatisation, and outsourcing pose new challenges to safety and risk management. Some of the unfortunate side effects have already become apparent. This invariably leads to the next disaster, which will have a striking resemblance to the previous one when abstracted from the immediate technological context. Lessons can be learned if we really want. The question remains: 'Do we?'

  7. Efficient question answering with question decomposition and multiple answer streams

    OpenAIRE

    Hartrumpf, Sven; Glöckner, Ingo; Leveling, Johannes

    2009-01-01

    The German question answering (QA) system IRSAW (formerly: InSicht) participated in QA@CLEF for the fth time. IRSAW was introduced in 2007 by integrating the deep answer producer InSicht, several shallow answer producers, and a logical validator. InSicht builds on a deep QA approach: it transforms documents to semantic representations using a parser, draws inferences on semantic representations with rules, and matches semantic representations derived from questions and documents. InS...

  8. CAT questions and answers

    International Nuclear Information System (INIS)

    1993-02-01

    This document, prepared in February 1993, addresses the most common questions asked by APS Collaborative Access Teams (CATs). The answers represent the best judgment on the part of the APS at this time. In some cases, details are provided in separate documents to be supplied by the APS. Some of the answers are brief because details are not yet available. The questions are separated into five categories representing different aspects of CAT interactions with the APS: (1) Memorandum of Understanding (MOU), (2) CAT Beamline Review and Construction, (3) CAT Beamline Safety, (4) CAT Beamline Operations, and (5) Miscellaneous. The APS plans to generate similar documents as needed to both address new questions and clarify answers to present questions

  9. Toward Question-Asking Machines: The Logic of Questions and the Inquiry Calculus

    Science.gov (United States)

    Knuth,Kevin H.

    2005-01-01

    For over a century, the study of logic has focused on the algebra of logical statements. This work, first performed by George Boole, has led to the development of modern computers, and was shown by Richard T. Cox to be the foundation of Bayesian inference. Meanwhile the logic of questions has been much neglected. For our computing machines to be truly intelligent, they need to be able to ask relevant questions. In this paper I will show how the Boolean lattice of logical statements gives rise to the free distributive lattice of questions thus defining their algebra. Furthermore, there exists a quantity analogous to probability, called relevance, which quantifies the degree to which one question answers another. I will show that relevance is not only a natural generalization of information theory, but also forms its foundation.

  10. RESOLVING THE QUESTION OF DOUBT: GEOMETRICAL DEMONSTRATION IN THE MEDITATIONS

    Directory of Open Access Journals (Sweden)

    Steven BURGESS

    2012-11-01

    Full Text Available The question of what Descartes did and did not doubt in the Meditations has received a significant amount of scholarly attention in recent years. The process of doubt in Meditation I gives one the impression of a rather extreme form of skepticism, while the responses Descartes offers in the Objections and Replies make it clear that there is in fact a whole background of presuppositions that are never doubted, including many that are never even entertained as possible candidates of doubt. This paper resolves the question of this undoubted background of rationality by taking seriously Descartes’ claim that he is carrying out demonstrations modeled after the great geometers. The rational order of geometrical demonstration demands that we first clear away previous demonstrations not proven with the certainty necessary for genuine science. This is accomplished by the method of doubt, which is only applied to the results of possible demonstrations. What cannot be doubted are the very concepts and principles employed in carrying out geometrical demonstration, which enable it to take place. It would be senseless to ask whether we can doubt the essential components of the structure through which questioning, doubting, and demonstration are made possible.

  11. Scale Sensitivity and Question Order in the Contingent Valuation Method

    OpenAIRE

    Andersson, Henrik; Svensson, Mikael

    2010-01-01

    This study examines the effect on respondents' willingness to pay to reduce mortality risk by the order of the questions in a stated preference study. Using answers from an experiment conducted on a Swedish sample where respondents' cognitive ability was measured and where they participated in a contingent valuation survey, it was found that scale sensitivity is strongest when respondents are asked about a smaller risk reduction first ('bottom-up' approach). This contradicts some previous evi...

  12. Amelioration of intractable epilepsy by adjunct vagus nerve stimulation therapy in a girl with a CDKL5 mutation.

    Science.gov (United States)

    Baba, Shimpei; Sugawara, Yuji; Moriyama, Kengo; Inaji, Motoki; Maehara, Taketoshi; Yamamoto, Toshiyuki; Morio, Tomohiro

    2017-04-01

    We report the case of on an 8-year-old girl with a cyclin-dependent kinase-like 5 mutation and who underwent vagus nerve stimulation (VNS) therapy for 2years. She had developed epilepsy at the age of 6months and had severe developmental delays. Initially, she had tonic and tonic-clonic seizures; however, around the age of 5years, she also developed epileptic spasms. These seizures were never completely controlled by conventional medical treatments. At the age of 7, after VNS initiation, her seizure frequency markedly reduced, and abnormal electrical activities on her electroencephalography tests strikingly decreased. Moreover, using questionnaires, we confirmed an improvement in her quality of life in the fields of alertness and activity. Although the efficacy of VNS therapy for patients with intractable epilepsy associated with a genetic anomaly has not been fully established, adjunctive VNS therapy may widen the scope of treatment choices available to these patients. Copyright © 2016 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  13. Asking the Right Questions

    DEFF Research Database (Denmark)

    Richter, Line

    Based on fieldwork in Mali this paper discusses the role of anthropology (and the anthropologist) in a large public health research project on children's health. In the uncertainty and disquiet that comes with the battle to combat and avoid diseases in a setting where poverty and abysmal diseases......, is the ability to move beyond even the best hidden assumptions and question our own questions, thereby enabling us to ask the right questions....

  14. Role of reflexology and antiepileptic drugs in managing intractable epilepsy--a randomized controlled trial.

    Science.gov (United States)

    Dalal, Krishna; Devarajan, Elanchezhiyan; Pandey, Ravindra Mohan; Subbiah, Vivekanandan; Tripathi, Manjari

    2013-01-01

    This report is based on the results of a randomized parallel controlled trial conducted to determine the efficacy of reflexology therapy in managing intractable epilepsy. Subjects who failed epilepsy surgery or were not candidates for epilepsy surgery or were non-responders of antiepileptic drugs (AEDs) took part in this study. The trial was completed by 77 subjects randomly assigned to 2 arms: control (AEDs) and reflexology (AEDs + reflexology therapy). The hypothesis was that hand reflexology therapy could produce results similar to those of vagus nerve stimulation, and foot reflexology therapy could maintain homeostasis in the functional status of individual body parts. Reflexology therapy was applied by family members. The follow-up period was 1.5 years. Quality of life in epilepsy patients was assessed with the QOLIE-31 instrument. In the reflexology group, the median baseline seizure frequency decreased from 9.5 (range 2-120) to 2 (range 0-110) with statistical significance (p reflexology group were 41.05 ± 7 and 43.6 ± 8, respectively. Posttherapy data were 49.07 ± 6 and 65.4 ± 9, respectively (p reflexology method allowed detection of knee pain in 85% of the reflexology group patients (p reflexology group patients reported nausea/vomiting (n = 1), change in voice (n = 2), and hoarseness (n = 1). Reflexology therapy together with AEDs may help reducing seizure frequency and improving quality of life in individuals with epilepsy. Copyright © 2013 S. Karger AG, Basel.

  15. Patient's anxiety and fear of anesthesia: effect of gender, age, education, and previous experience of anesthesia. A survey of 400 patients.

    Science.gov (United States)

    Mavridou, Paraskevi; Dimitriou, Varvara; Manataki, Adamantia; Arnaoutoglou, Elena; Papadopoulos, Georgios

    2013-02-01

    Patients express high anxiety preoperatively, because of fears related to anesthesia and its implications. The purpose of this survey was to gain insight into these fears and to study whether they are affected by patients' sex, age, education, or previous experience of anesthesia. Questionnaires with fixed questions were distributed to consenting, consecutive surgical patients before the pre-anesthetic visit. The questionnaires included patients' demographics and questions related to their fears about anesthesia. Four-hundred questionnaires were collected and analyzed. Eighty-one percent of patients experience preoperative anxiety. The main sources of their anxiety were fear of postoperative pain (84 %), of not waking up after surgery (64.8 %), of being nauseous or vomiting (60.2 %), and of drains and needles (59.5 %). Patients are less concerned about being paralyzed because of anesthesia (33.5 %) or of revealing personal issues (18.8 %). Gender seems to affect patients fears, with women being more afraid (85.3 vs. 75.6 % of men, p = 0.014). The effects of patients' age, level of education, and previous experience of anesthesia are minor, except for individual questions. Sixty-three percent of our patients (mostly women 67.4 vs. 57.4 % of men, p = 0.039) talk about these fears with their relatives, although a vast majority of 95.5 % would prefer to talk with the anesthesiologist and be reassured by him. All patients, mostly women, express fears about anesthesia; this fear leads to preoperative anxiety. Slight differences are observed for some individual questions among patients of different sex, education level, and previous experience of anesthesia.

  16. Semantic annotation of consumer health questions.

    Science.gov (United States)

    Kilicoglu, Halil; Ben Abacha, Asma; Mrabet, Yassine; Shooshan, Sonya E; Rodriguez, Laritza; Masterton, Kate; Demner-Fushman, Dina

    2018-02-06

    Consumers increasingly use online resources for their health information needs. While current search engines can address these needs to some extent, they generally do not take into account that most health information needs are complex and can only fully be expressed in natural language. Consumer health question answering (QA) systems aim to fill this gap. A major challenge in developing consumer health QA systems is extracting relevant semantic content from the natural language questions (question understanding). To develop effective question understanding tools, question corpora semantically annotated for relevant question elements are needed. In this paper, we present a two-part consumer health question corpus annotated with several semantic categories: named entities, question triggers/types, question frames, and question topic. The first part (CHQA-email) consists of relatively long email requests received by the U.S. National Library of Medicine (NLM) customer service, while the second part (CHQA-web) consists of shorter questions posed to MedlinePlus search engine as queries. Each question has been annotated by two annotators. The annotation methodology is largely the same between the two parts of the corpus; however, we also explain and justify the differences between them. Additionally, we provide information about corpus characteristics, inter-annotator agreement, and our attempts to measure annotation confidence in the absence of adjudication of annotations. The resulting corpus consists of 2614 questions (CHQA-email: 1740, CHQA-web: 874). Problems are the most frequent named entities, while treatment and general information questions are the most common question types. Inter-annotator agreement was generally modest: question types and topics yielded highest agreement, while the agreement for more complex frame annotations was lower. Agreement in CHQA-web was consistently higher than that in CHQA-email. Pairwise inter-annotator agreement proved most

  17. Net improvement of correct answers to therapy questions after pubmed searches: pre/post comparison.

    Science.gov (United States)

    McKibbon, Kathleen Ann; Lokker, Cynthia; Keepanasseril, Arun; Wilczynski, Nancy L; Haynes, R Brian

    2013-11-08

    Clinicians search PubMed for answers to clinical questions although it is time consuming and not always successful. To determine if PubMed used with its Clinical Queries feature to filter results based on study quality would improve search success (more correct answers to clinical questions related to therapy). We invited 528 primary care physicians to participate, 143 (27.1%) consented, and 111 (21.0% of the total and 77.6% of those who consented) completed the study. Participants answered 14 yes/no therapy questions and were given 4 of these (2 originally answered correctly and 2 originally answered incorrectly) to search using either the PubMed main screen or PubMed Clinical Queries narrow therapy filter via a purpose-built system with identical search screens. Participants also picked 3 of the first 20 retrieved citations that best addressed each question. They were then asked to re-answer the original 14 questions. We found no statistically significant differences in the rates of correct or incorrect answers using the PubMed main screen or PubMed Clinical Queries. The rate of correct answers increased from 50.0% to 61.4% (95% CI 55.0%-67.8%) for the PubMed main screen searches and from 50.0% to 59.1% (95% CI 52.6%-65.6%) for Clinical Queries searches. These net absolute increases of 11.4% and 9.1%, respectively, included previously correct answers changing to incorrect at a rate of 9.5% (95% CI 5.6%-13.4%) for PubMed main screen searches and 9.1% (95% CI 5.3%-12.9%) for Clinical Queries searches, combined with increases in the rate of being correct of 20.5% (95% CI 15.2%-25.8%) for PubMed main screen searches and 17.7% (95% CI 12.7%-22.7%) for Clinical Queries searches. PubMed can assist clinicians answering clinical questions with an approximately 10% absolute rate of improvement in correct answers. This small increase includes more correct answers partially offset by a decrease in previously correct answers.

  18. Botulinum neurotoxin for management of intractable central leakage through a voice prosthesis in surgical voice restoration.

    Science.gov (United States)

    Mullan, G P J; Lee, M T; Clarke, P M

    2006-09-01

    Rehabilitation of voice and speech after total laryngectomy has become established practice in recent years. A voice prosthesis is placed within a surgically produced fistula between the trachea and upper oesophagus and acts as a one way valve, allowing passage of pulmonary air from the trachea into the oesophagus and preventing aspiration of food and fluid from the oesophagus into the trachea. Persistent leakage through or around these prostheses is a recognized complication, the aetiology of which can vary widely, from mechanical issues with the prostheses themselves to anatomical and physiological issues associated with the reconstructed pharynx. We report a new technique of using Dysport in the management of intractable central leakage due to premature and forceful closure of the upper oesophageal sphincter during swallowing. This resulted in the pooling of fluids around the posterior flange of the prosthesis. This, along with the increased pressure from the muscle contraction, led to central leakage, as identified on videofluoroscopy. An injection of Dysport paralysed the upper oesophageal sphincter, preventing pooling of fluids around the prosthesis and the forcing open of the valve. The effect was to eliminate the leakage, and the patient did not require further injections over the following 22 months.

  19. Live your questions now

    OpenAIRE

    Brownrigg, Jenny

    2016-01-01

    'Live Your Questions Now' is a case study for Cubitt Education's publication 'Aging in Public: creative practice in ageing and the public realm from across the UK', edited by Daniel Baker and published by Cubitt Gallery, Studios and Education, London in 2016. The publication was linked to Cubitt's programme 'Public Wisdom' (2011-2015). My case study is about 'Live your questions now', a group exhibition I curated in 2011 for Mackintosh Museum, The Glasgow School of Art. 'Live your questions n...

  20. Testing increases suggestibility for narrative-based misinformation but reduces suggestibility for question-based misinformation.

    Science.gov (United States)

    LaPaglia, Jessica A; Chan, Jason C K

    2013-01-01

    A number of recent studies have found that recalling details of an event following its occurrence can increase people's suggestibility to later presented misinformation. However, several other studies have reported the opposite result, whereby earlier retrieval can reduce subsequent eyewitness suggestibility. In the present study, we investigated whether differences in the way misinformation is presented can modulate the effects of testing on suggestibility. Participants watched a video of a robbery and some were questioned about the event immediately afterwards. Later, participants were exposed to misinformation in a narrative (Experiment 1) or in questions (Experiment 2). Consistent with previous studies, we found that testing increased suggestibility when misinformation was presented via a narrative. Remarkably, when misinformation was presented in questions, testing decreased suggestibility. Copyright © 2013 John Wiley & Sons, Ltd.

  1. A Technique Socratic Questioning-Guided Discovery

    Directory of Open Access Journals (Sweden)

    M. Hakan Türkçapar

    2012-03-01

    Full Text Available “Socratic Method” is a way of teaching philosophical thinking and knowledge by asking questions which was used by antique period greek philosopher Socrates. Socrates was teaching knowledge to his followers by asking questions and the conversation between them was named “Socratic Dialogues”. In this meaning, no novel knowledge is taught to the individual but only what is formerly known is reminded and rediscovered. The form of socratic questioning which is used during the process of cognitive behavioral therapy is known as Guided Discovery. In this method it is aimed to make the client notice the piece of knowledge which he could notice but is not aware with a series of questions. Socratic method or guided discovery consists of several steps which are: Identifying the problem by listening to the client and making reflections, finding alternatives by examining and evaluating, reidentification by using the newly found information and questioning the old distorted belief and reaching to a conclusion and applying it. Question types used during these procedures are, questions for gaining information, questions revealing the meanings, questions revealing the beliefs, questions about behaviours during the similar past experiences, analyse questions and analytic synthesis questions. In order to make the patient feel understood it is important to be empathetic and summarising the problem during the interview. In this text, steps of Socratic Questioning-Guided Discovery will be reviewed with sample dialogues after each step

  2. Multifocal epilepsy: the role of palliative resection - intractable frontal and occipital lobe epilepsy secondary to radiotherapy for acute lymphoblastic leukaemia.

    Science.gov (United States)

    Radhakrishnan, Ashalatha; Sithinamsuwan, Pasiri; Harvey, A Simon; Flanagan, Danny; Fitt, Gregory; Berlangieri, Sam; Jackson, Graeme D; Berkovic, Samuel F; Scheffer, Ingrid E

    2008-12-01

    Patients with multifocal epilepsy are often considered unsuitable for epilepsy surgery. We report an adolescent with intractable frontal and occipital lobe seizures, secondary to complications of treatment for acute lymphoblastic leukaemia as a young child. Chemotherapy and radiotherapy were complicated by bilateral, posterior leukoencephalopathy and later an acquired frontal cerebral cavernous malformation (CCM). Detailed electro-clinical and imaging studies showed multiple, frontal lobe seizures per day with less frequent and non-debilitating, simple, occipital lobe seizures. Focal resection of the frontal CCM abolished the socially-disabling seizures with resultant marked improvement in the patient's quality of life at 12 months. Careful analysis of the type and impact of focal seizures in the setting of multifocal epilepsy may demonstrate that one seizure type is more deleterious to quality of life and may be amenable to surgery. In this situation, the patient may benefit significantly from surgery to resect the more active epileptic focus.

  3. Ligation of the internal maxillary artery for intractable epistaxis. 3D imaging of internal maxillary artery using helical CT scan

    International Nuclear Information System (INIS)

    Handa, Toru; Yazin, Koji; Hirakawa, Katsuhiro; Fukushima, Noriyuki; Takumida, Masaya; Hirata, Shitau; Iguchi, Tetsuhiko; Amano, Yoshiharu

    2001-01-01

    Sever posterior epistaxis is one of the serious clinical problems. Nasal bleeding usually occurs in the anterior septal region, where it can be seen easily and controlled with topical cautery or localized packing. When the bleeding occurs in the posterior nose, it becomes a more serious problem. Many methods have been used to control posterior epistaxis. Some of these are electrocautery, posterior nasal packing, vascular ligation and therapeutic percutaneous embolization. Between 1997 and 2000, nineteen patients were admitted to our hospital because of intractable epistaxis. There were 16 male and 3 female patients whose average age was 55 years. Ten of 19 patients were hypertensive, and none of these had undergoing treatment. Five of 19 patients received maxillary artery ligation. Clinical applications of 3D imaging of the internal maxillary artery using helical CT scan were done for 5 patients. These images were helpful for planning of ligation of the internal maxillary artery. (author)

  4. Ligation of the internal maxillary artery for intractable epistaxis. 3D imaging of internal maxillary artery using helical CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Handa, Toru [Akitsu Prefectual Hospital, Hiroshima (Japan); Yazin, Koji; Hirakawa, Katsuhiro; Fukushima, Noriyuki; Takumida, Masaya; Hirata, Shitau; Iguchi, Tetsuhiko; Amano, Yoshiharu

    2001-03-01

    Sever posterior epistaxis is one of the serious clinical problems. Nasal bleeding usually occurs in the anterior septal region, where it can be seen easily and controlled with topical cautery or localized packing. When the bleeding occurs in the posterior nose, it becomes a more serious problem. Many methods have been used to control posterior epistaxis. Some of these are electrocautery, posterior nasal packing, vascular ligation and therapeutic percutaneous embolization. Between 1997 and 2000, nineteen patients were admitted to our hospital because of intractable epistaxis. There were 16 male and 3 female patients whose average age was 55 years. Ten of 19 patients were hypertensive, and none of these had undergoing treatment. Five of 19 patients received maxillary artery ligation. Clinical applications of 3D imaging of the internal maxillary artery using helical CT scan were done for 5 patients. These images were helpful for planning of ligation of the internal maxillary artery. (author)

  5. The influence of previous subject experience on interactions during peer instruction in an introductory physics course: A mixed methods analysis

    Science.gov (United States)

    Vondruska, Judy A.

    Over the past decade, peer instruction and the introduction of student response systems has provided a means of improving student engagement and achievement in large-lecture settings. While the nature of the student discourse occurring during peer instruction is less understood, existing studies have shown student ideas about the subject, extraneous cues, and confidence level appear to matter in the student-student discourse. Using a mixed methods research design, this study examined the influence of previous subject experience on peer instruction in an introductory, one-semester Survey of Physics course. Quantitative results indicated students in discussion pairs where both had previous subject experience were more likely to answer clicker question correctly both before and after peer discussion compared to student groups where neither partner had previous subject experience. Students in mixed discussion pairs were not statistically different in correct response rates from the other pairings. There was no statistically significant difference between the experience pairs on unit exam scores or the Peer Instruction Partner Survey. Although there was a statistically significant difference between the pre-MPEX and post-MPEX scores, there was no difference between the members of the various subject experience peer discussion pairs. The qualitative study, conducted after the quantitative study, helped to inform the quantitative results by exploring the nature of the peer interactions through survey questions and a series of focus groups discussions. While the majority of participants described a benefit to the use of clickers in the lecture, their experience with their discussion partners varied. Students with previous subject experience tended to describe peer instruction more positively than students who did not have previous subject experience, regardless of the experience level of their partner. They were also more likely to report favorable levels of comfort with

  6. Frequent Questions on Recycling

    Science.gov (United States)

    This is a list of frequent questions on recycling, broken down into five categories. These are answers to common questions that EPA has received from press and web inquiries. This list is located on the Reduce, Reuse, Recycle website.

  7. Examining the Impact of Question Surface Features on Students’ Answers to Constructed-Response Questions on Photosynthesis

    Science.gov (United States)

    Weston, Michele; Haudek, Kevin C.; Prevost, Luanna; Urban-Lurain, Mark; Merrill, John

    2015-01-01

    One challenge in science education assessment is that students often focus on surface features of questions rather than the underlying scientific principles. We investigated how student written responses to constructed-response questions about photosynthesis vary based on two surface features of the question: the species of plant and the order of two question prompts. We asked four versions of the question with different combinations of the two plant species and order of prompts in an introductory cell biology course. We found that there was not a significant difference in the content of student responses to versions of the question stem with different species or order of prompts, using both computerized lexical analysis and expert scoring. We conducted 20 face-to-face interviews with students to further probe the effects of question wording on student responses. During the interviews, we found that students thought that the plant species was neither relevant nor confusing when answering the question. Students identified the prompts as both relevant and confusing. However, this confusion was not specific to a single version. PMID:25999312

  8. Use of medications of questionable benefit in advanced dementia.

    Science.gov (United States)

    Tjia, Jennifer; Briesacher, Becky A; Peterson, Daniel; Liu, Qin; Andrade, Susan E; Mitchell, Susan L

    2014-11-01

    Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients' goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized. To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident- and facility-level characteristics associated with such use, and estimate associated medication expenditures. Cross-sectional study of medication use by nursing home residents with advanced dementia using a nationwide long-term care pharmacy database linked to the Minimum Data Set (460 facilities) between October 1, 2009, and September 30, 2010. Use of medication deemed of questionable benefit in advanced dementia based on previously published criteria and mean 90-day expenditures attributable to these medications per resident. Generalized estimating equations using the logit link function were used to identify resident- and facility-related factors independently associated with the likelihood of receiving medications of questionable benefit after accounting for clustering within nursing homes. Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received at least 1 medication with questionable benefit (range, 44.7% in the Mid-Atlantic census region to 65.0% in the West South Central census region). Cholinesterase inhibitors (36.4%), memantine hydrochloride (25.2%), and lipid-lowering agents (22.4%) were the most commonly prescribed. In adjusted analyses, having eating problems (adjusted odds ratio [AOR], 0.68; 95% CI, 0.59-0.78), a feeding tube (AOR, 0.58; 95% CI, 0.48-0.70), or a do-not-resuscitate order (AOR, 0.65; 95% CI, 0.57-0.75), and enrolling in hospice (AOR, 0.69; 95% CI, 0.58-0.82) lowered the likelihood of receiving these medications. High facility-level use of feeding tubes increased the likelihood of receiving these

  9. Conditions for exercising shareholders' right to ask questions

    Directory of Open Access Journals (Sweden)

    Radović Vuk

    2014-01-01

    Full Text Available Law on Business Organizations from 2011 has significantly improved the regulation of shareholders' right to ask questions in Serbia. In contrast to the previous law from 2004, that has completely transferred regulation to companies which is why there was no guarantee for exercising this right, new law contains detailed norms in this respect. They are written under the dominant influence of German law and are completely harmonized with the Shareholders' Rights Directive. All important issues of shareholders' right to ask questions have been regulated mostly with imperative norms (subject of the right, conditions for exercising this right, debtor of this obligation, court protection, etc.. Corporations have a lot of freedom to adjust exercising this right to their needs, but only by giving more rights to shareholders. Limiting the scope of this right is possible only in certain, precisely defined areas. Although the general impression of the new regulation is very positive, there are certain aspects which can be criticized. Some of them can be cured by adequate judicial interpretation, while others cannot be cured without changes to the law. In the area of conditions for exercising this right, the most important deficiency is the fact that the law has not determined when the right to ask questions can be exercised, and that stands in obvious disharmony with the adopted conception to regulate all important aspects of this right. Contrary to conditions, which basically have been properly formulated, other aspects of legislation regarding this shareholders' right contain more profound obscurities that go beyond the scope of this paper.

  10. Wireless "Questions-Bank" System to Enhance M-Learning in School Education

    Directory of Open Access Journals (Sweden)

    Samir Abou El-Seoud

    2010-01-01

    Full Text Available Abstract: Through wireless devices and wireless applications, M-learning supports an integrated access to Web content and services in education anytime and anywhere. This paper describes the analysis, design, and implementation of "Wireless Questions-Bank System", that allows the students to take web-based quizzes, web-based free exercises, web-based exams (midterm, and final, to download course reviews, to download previous exams and their model answers, to access the system through the Mobile and take quick quizzes and exercises. The system facilitates generation of automatic, balanced, and different exam sheets, that containing different types of questions, covering the entire curriculum, and displaying gradually from easiness to difficulty. The exam sheet produced by the system, takes into account the different levels of the students from excellent, good, to fair, and avoids any mistakes of language and non-clear terminologies

  11. Reluctant Rural Regionalists

    Science.gov (United States)

    Hall, Peter V.; Stern, Pamela

    2009-01-01

    Recently, scholars have begun to explore questions of regionalism and regionalization in rural contexts. Regionalism is often understood and presented as a pragmatic solution to intractable problems of fragmentation, inefficiency, accountability, spillover and neglect in the face of economic restructuring and other external threats. These…

  12. Questions for Music Education Research

    Science.gov (United States)

    Jorgensen, Estelle R.

    2008-01-01

    In addressing the question-set "What questions do music education researchers need to address?", an illustrative list of juxtaposed descriptive and normative questions is sketched as follows: What are and should be the dimensions of music education? What are and should be the institutional agencies of music education? What are and should be the…

  13. Dynamic Question Ordering in Online Surveys

    Directory of Open Access Journals (Sweden)

    Early Kirstin

    2017-09-01

    Full Text Available Online surveys have the potential to support adaptive questions, where later questions depend on earlier responses. Past work has taken a rule-based approach, uniformly across all respondents. We envision a richer interpretation of adaptive questions, which we call Dynamic Question Ordering (DQO, where question order is personalized. Such an approach could increase engagement, and therefore response rate, as well as imputation quality. We present a DQO framework to improve survey completion and imputation. In the general survey-taking setting, we want to maximize survey completion, and so we focus on ordering questions to engage the respondent and collect hopefully all information, or at least the information that most characterizes the respondent, for accurate imputations. In another scenario, our goal is to provide a personalized prediction. Since it is possible to give reasonable predictions with only a subset of questions, we are not concerned with motivating users to answer all questions. Instead, we want to order questions to get information that reduces prediction uncertainty, while not being too burdensome. We illustrate this framework with two case studies, for the prediction and survey-taking settings. We also discuss DQO for national surveys and consider connections between our statistics-based question-ordering approach and cognitive survey methodology.

  14. CT-guided interstitial 125I seed implantation for intractable pelvic recurrence of rectal carcinomas

    International Nuclear Information System (INIS)

    Lin Zhenwen; Chu Hong; Kong Jian; Dou Yongchong

    2011-01-01

    Objective: To evaluate the therapeutic effect and safety of CT-guided interstitial 125 I seed implantation in treating intractable pelvic recurrence of rectal carcinomas. Methods: During the period from April 2010 to September 2010 CT-guided interstitial 125 I seed implantation was carried out in 11 patients with pelvic recurrence of rectal carcinoma which developed after the patients had received comprehensive treatments such as surgical resection, chemotherapy and/or radiotherapy. The clinical data were retrospectively analyzed. The clinical symptoms, the tumor size and the quality of life (QOL) before the treatment and at two and six months after the treatment were recorded, and the complications were observed. The results were compared. All the patients were followed up for six months. Results: At two and six months after the treatment, the improvement rate of the clinical symptoms was 100.0% (11/11) and 90.9% (10/11) respectively, while the effective reduction of the tumor size was 90.9% (10/11) and 81.8% (9/11) respectively. At two and six months after the treatment the QOL score was (56.0±3.66) and (54.4±5.41) respectively, both of which were higher than the QOL score determined before the treatment (42.5±6.93), the difference between them was statistically significant (P 125 I seed implantation has satisfactory short-term effect. This treatment is also quite safe and effective for patients who are unbearable to external radiation therapy due to the tissue dose restriction. (authors)

  15. Research, climate, energy : Questions of destiny for the chemical industry

    Energy Technology Data Exchange (ETDEWEB)

    Kastinen, A., email: aimo.kastinen@chemind.fi

    2010-07-01

    Registration for the first phase of Reach finishes at the end of November. Then we will see whether the standard of legislation has been set correctly in respect of the EU's operational ability. If it isn't, significant problems will result for the community's treatment of materials and the EU's competitiveness, and Reach's value as a global model will become questionable. Also, the CLP regulation concerning classification, labelling and packaging of chemicals will start to come into effect as from the beginning of December. In the first phase, the question is one of classification of substances, and gradually the requirements will be applied to mixtures too. At the same time, Safety Data Sheets shall be renewed in accordance with their own transition period. The current product legislation concerning chemicals shall be fully revised by the mid-point of the decade, but before then company safety officers will have to do lots of work to change the previous routines

  16. Repetitive Questioning Exasperates Caregivers

    Directory of Open Access Journals (Sweden)

    R. C. Hamdy MD

    2018-01-01

    Full Text Available Repetitive questioning is due to an impaired episodic memory and is a frequent, often presenting, problem in patients with Alzheimer’s disease (amnestic type. It is due to the patients’ difficulties learning new information, retaining it, and recalling it, and is often aggravated by a poor attention span and easy distractibility. A number of factors may trigger and maintain repetitive questioning. Caregivers should try to identify and address these triggers. In the case discussion presented, it is due to the patient’s concerns about her and her family’s safety triggered by watching a particularly violent movie aired on TV. What went wrong in the patient/caregiver interaction and how it could have been avoided or averted are explored. Also reviewed are the impact of repetitive questioning, the challenges it raises for caregivers, and some effective intervention strategies that may be useful to diffuse the angst that caregivers experience with repetitive questioning.

  17. Wh-Questions, Universal Statements and Free Choice Inferences in Child Mandarin.

    Science.gov (United States)

    Huang, Haiquan; Zhou, Peng; Crain, Stephen

    2017-11-16

    This study investigated 5-year-old Mandarin-speaking children's comprehension of wh-questions, universal statements and free choice inferences. Previous research has found that Mandarin-speaking children assign a universal interpretation to sentences with a wh-word (e.g., shei 'who') followed by the adverbial quantifier dou 'all' (Zhou in Appl Psycholinguist 36:411-435, 2013). Children also compute free choice inferences in sentences that contain a modal verb in addition to a wh-word and dou (Zhou, in: Nakayama, Su, Huang (eds.) Studies in Chinese and Japanese language acquisition: in honour of Stephen Crain. John Benjamins Publishing Company, Amsterdam, pp 223-235, 2017). The present study used a Question-Statement Task to assess children's interpretation of sentences containing shei + dou, both with and without the modal verb beiyunxu 'was allowed to', as well as the contrast between sentences with shei + dou, which are statements for adults, versus ones with dou + shei, which are wh-questions for adults. The 5-year-old Mandarin-speaking child participants exhibited adult-like linguistic knowledge of the semantics and pragmatics of wh-words, the adverbial quantifier dou, and the deontic modal verb beiyunxu.

  18. Threat, Fear, and Persuasion: Review and Critique of Questions About Functional Form

    Directory of Open Access Journals (Sweden)

    Lijiang Shen

    2014-01-01

    Full Text Available Theories of threat appeals have been rightly concerned with the form of the relationship between fear and persuasion: Linear or curvilinear. They have not, however, clearly distinguished the question as a between- or within-persons phenomenon. In fact, the literature often treats these two perspectives as if they were interchangeable. We show that between- versus within-person questions about functional form are distinct from one another. Previous research, which is the product of between-persons designs, shows a linear relationship between fear and persuasion. Betweenpersons studies cannot address the question of how changes in fear over time produce persuasion. Consequently, a major piece of the fear appeals-persuasion puzzle may have been overlooked. Reanalysis of an existing data set shows curvilinearity of fear in within-persons data and demonstrates that the curve predicts persuasion. Audience segmentation reveals different curves for different groups as well as differential associations between those curves and persuasion. Overall, the argument and the empirical results suggest that a great deal less is known about fear appeals than it is currently believed.

  19. Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football.

    Science.gov (United States)

    Clausen, M B; Tang, L; Zebis, M K; Krustrup, P; Hölmich, P; Wedderkopp, N; Andersen, L L; Christensen, K B; Møller, M; Thorborg, K

    2016-08-01

    Knee injuries are common in adolescent female football. Self-reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self-reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15-18, without knee injury at baseline, were included. Data on self-reported previous knee injury and KOOS questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (female football. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. The Question Complexity Rubric: Development and Application for a National Archive of Astro 101 Multiple-Choice Questions

    Science.gov (United States)

    Cormier, Sebastien; Prather, E. E.; Brissenden, G.; Collaboration of Astronomy Teaching Scholars CATS

    2011-01-01

    For the last two years we have been developing an online national archive of multiple-choice questions for use in the Astro 101 classroom. These questions are intended to either supplement an instructor's implementation of Think-Pair-Share or be used for assessment purposes (i.e. exams and homework). In this talk we will describe the development, testing and implementation of the Question Complexity Rubric (QCR), which is designed to guide the ranking of questions in this archive based on their conceptual complexity. Using the QCR, a score is assigned to differentiate each question based on the cognitive steps necessary to comprehensively explain the reasoning pathway to the correct answer. The lowest QCR score is given to questions with a reasoning pathway requiring only declarative knowledge whereas the highest QCR score is given to questions that require multiple pathways of multi-step reasoning. When completed, the online question archive will provide users with the utility to 1) search for and download questions based on subject and average QCR score, 2) use the QCR to score questions, and 3) add their own questions to the archive. We will also discuss other potential applications of the QCR, such as how it informs our work in developing and testing of survey instruments by allowing us to calibrate the range of question complexity. This material is based upon work supported by the National Science Foundation under Grant No. 0715517, a CCLI Phase III Grant for the Collaboration of Astronomy Teaching Scholars (CATS). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation.

  1. The Value Question in Metaphysics

    Science.gov (United States)

    Kahane, Guy

    2012-01-01

    Much seems to be at stake in metaphysical questions about, for example, God, free will or morality. One thing that could be at stake is the value of the universe we inhabit—how good or bad it is. We can think of competing philosophical positions as describing possibilities, ways the world might turn out to be, and to which value can be assigned. When, for example, people hope that God exists, or fear that we do not possess free will, they express attitudes towards these possibilities, attitudes that presuppose answers to questions about their comparative value. My aim in this paper is to distinguish these evaluative questions from related questions with which they can be confused, to identify structural constraints on their proper pursuit, and to address objections to their very coherence. Answers to such evaluative questions offer one measure of the importance of philosophical disputes. PMID:23024399

  2. The Value Question in Metaphysics.

    Science.gov (United States)

    Kahane, Guy

    2012-07-01

    Much seems to be at stake in metaphysical questions about, for example, God, free will or morality. One thing that could be at stake is the value of the universe we inhabit-how good or bad it is. We can think of competing philosophical positions as describing possibilities, ways the world might turn out to be, and to which value can be assigned. When, for example, people hope that God exists, or fear that we do not possess free will, they express attitudes towards these possibilities, attitudes that presuppose answers to questions about their comparative value. My aim in this paper is to distinguish these evaluative questions from related questions with which they can be confused, to identify structural constraints on their proper pursuit, and to address objections to their very coherence. Answers to such evaluative questions offer one measure of the importance of philosophical disputes.

  3. Legal Philosophy - Five Questions

    DEFF Research Database (Denmark)

    This collection gathers together a host of the most eminent contemporary legal philosophers, who writes about their take on legal philosophy, its fundamental questions and potential.......This collection gathers together a host of the most eminent contemporary legal philosophers, who writes about their take on legal philosophy, its fundamental questions and potential....

  4. Positive, negative, and bipolar questions: The effect of question polarity on ratings of text readability

    Directory of Open Access Journals (Sweden)

    Naomi Kamoen

    2013-12-01

    Full Text Available For decades, survey researchers have known that respondents give different answers to attitude questions worded positively (X is good. Agree-Disagree, negatively (X is bad. Agree-Disagree or on a bipolar scale (X is bad-good. This makes survey answers hard to interpret, especially since findings on exactly how the answers are affected are conflicting. In the current paper, we present twelve studies in which the effect of question polarity was measured for a set of thirteen contrastive adjectives. In each study, the same adjectives were used so the generalizability of wording effects across studies could be examined for each word pair. Results show that for five of the word pairs an effect of question wording can be generalized. The direction of these effects are largely consistent: respondents generally give the same answers to positive and bipolar questions, but they are more likely to disagree with negative questions than to agree with positive questions or to choose the positive side of the bipolar scale. In other words, respondents express their opinions more positively when the question is worded negatively. Even though answers to the three wording alternatives sometimes differ, results also show that reliable answers can be obtained with all three wording alternatives. So, for survey practice, these results suggest that all three wording alternatives may be used for attitude measurement.

  5. INTERPLAY OF SOCIAL REPRESENTATIONS, TRAUMA AND VICTIMIZATION IN INTRACTABLE CONFLICTS: THE CASE OF THE CYPRUS CONFLICT

    Directory of Open Access Journals (Sweden)

    Cristiana Lavinia Bădulescu

    2017-12-01

    Full Text Available Intractable conflicts are conflicts that persist over a long period of time, resist various attempts of resolution, and present sporadic episodes of violence juxtaposed with periods of relative calm. Also, they contain a large share of psychosocial factors which lend to their uniqueness while also adding to their complexity. The Cypriot conflict is such a conflict. It has been on the agenda of the international community for over four decades, it has gone through a number of occasional violent episodes that fluctuated in frequency and intensity, and has resisted various peace mediation efforts. As a result, the conflicting parties remained locked in an adversarial relationship and fixed in terms of fundamental grievances. This paper aims to explore the interplay of social representations, trauma and victimization in the Cyprus conflict, and their implications on the prospects for its further settlement. Specifically, using discourse analysis as a research method, this paper analyses both the Greek-Cypriot and Turkish-Cypriot official discourse during 1983-2012 in order to see how the two parties represent the conflict, and whether past trauma and victimization influence their social representations. Close attention to the key themes emerging from the two parties’ official discourse helps to deepen understanding of the role and effect social representations, trauma and victimization play in the perpetuation of the Cyprus conflict.

  6. Closing the gap in travel medicine: reframing research questions for a new era.

    Science.gov (United States)

    Chen, Lin H; Leder, Karin; Wilson, Mary E

    2017-07-01

    Travel medicine needs are changing. New patterns of travel, including greater travel by individuals from emerging economies with different values in costs, risks and benefits, must be considered. This review aims to (1) highlight selected studies that have been published that address previously identified gaps in knowledge; (2) propose possible ways to consider questions regarding travel medicine practice for travelers from emerging economies, underscoring priorities for research focusing on these important populations; (3) highlight potential deficiencies in relevance of current international guidelines as they pertain to travelers from emerging economies; (4) frame research questions for travelers from emerging economies and (5) consider roles for ISTM in closing the gap. We reviewed past travel medicine research priorities published in 2010 to identify publications that responded to some research questions posed. We also reviewed CDC and WHO recommendations and assessed their applicability to travelers from emerging economies. Recent publications have responded to some research questions, but gaps remain and new questions have emerged. Re-framing of several key research questions is needed for travelers from emerging economies. A new challenge looms for traditional travel medicine fields to identify and attend to knowledge and guideline gaps, particularly to rethink questions regarding travel medicine to make them relevant for travelers from emerging economies. The International Society of Travel Medicine is well positioned to assist emerging economies assess their resources and needs, formulate research priorities and tailor the development of travel medicine into a framework aligned to their requirements. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  7. Thousand Questions

    DEFF Research Database (Denmark)

    2012-01-01

    (perhaps as an expanded Turing test) on its listeners. These questions are extracted in real-time from Twitter with the keyword search of the ‘?’ symbol to create a spatio-temporal experience. The computerized voice the audience hears is a collective one, an entanglement of humans and non-humans......In this work the network asks “If I wrote you a love letter would you write back?” Like the love letters which appeared mysteriously on the noticeboards of Manchester University’s Computer Department in the 1950s, thousands of texts circulate as computational processes perform the questions......, that circulates across networks. If I wrote you a love letter would you write back? (and thousands of other questions’ ) (封不回的情書?千言萬語無人回 was commissioned by the Microwave International New Media Festival 2012....

  8. Interictal rCBF SPECT, MRI and Surgical Outcome of Intractable Temporal Lobe Epilepsy

    International Nuclear Information System (INIS)

    Zeon, Seok Kil; Joo, Yang Goo; Lee, Sang Doe; Son, Eun Ik; Lee, Young Hwan

    1994-01-01

    Interictal single photon emission computed tomography of regional cerebral blood flow (rCBF SPECT) in 18 intractable temporal lobe epilepsy patients (8 male and 10 female patients: average 23.5 years old) were compared with 2.0 T magnetic resonance imaging (MRI). And surgical outcome was analysed with the findings, symptom duration and lateralization of temporal lobe. Preoperatively rCRF SPECT was done in all 18 patients with intravenous injection of 740 MRq 99 m T c-HMPAO. MRI was also done preoperatively in 13 patients. Surgical outcome was classified by Engel's outcome classification (four part classification recommended at the first Palm Desert conference). rCRF SPECT detected correctly lateralising abnormality of temporal lobe hypoperfusion in 13/ 18 (72.2%), contralateral temporal lobe hypoperfusion in 2/18 (11.1%) and showed no definite abnormality in 3/18 (16.7%). The positive predictive value of unilateral temporal lobe hypoperfusion was 87%. MRI detected correct localising abnormality in 8/13 (61.5%), such as hippocampal atrophy (7/13), asymmetric temporal horn (6/13), anterior temporal lobe atrophy (1/13), increased signal intensity from hippocampus (1/13) and calcific density (1/13), and no abnormal finding was noted in 5/13 (38.5%), There was no false positive findings and the positive predictive value of MRI was 100%, Only 2 cases showed same lateralization findings in rCBF SPECT and MRI. There was no significant correlation between symptom duration and no abnormal findings on SPECT or MRI. Surgical outcome showed class I in 15/18 (83.3%), and class II in 2/18 (11.1%). One case of no abnormal finding in both SPECT and MRI showed class III surgical outcome. No class IV surgical out.come was noted. Surgical outcome, lateralization of epileptic focus in temporal lobe and abnormal findings in rCBR SPECT or MRI were not significantly correlated.

  9. Explaining topic prevalence in answers to open-ended survey questions about climate change

    Science.gov (United States)

    Tvinnereim, Endre; Fløttum, Kjersti

    2015-08-01

    Citizens’ opinions are crucial for action on climate change, but are, owing to the complexity of the issue, diverse and potentially unformed. We contribute to the understanding of public views on climate change and to knowledge needed by decision-makers by using a new approach to analyse answers to the open survey question `what comes to mind when you hear the words `climate change’?’. We apply automated text analysis, specifically structural topic modelling, which induces distinct topics based on the relative frequencies of the words used in 2,115 responses. From these data, originating from the new, nationally representative Norwegian Citizen Panel, four distinct topics emerge: Weather/Ice, Future/Impact, Money/Consumption and Attribution. We find that Norwegians emphasize societal aspects of climate change more than do respondents in previous US and UK studies. Furthermore, variables that explain variation in closed questions, such as gender and education, yield different and surprising results when employed to explain variation in what respondents emphasize. Finally, the sharp distinction between scepticism and acceptance of conventional climate science, often seen in previous studies, blurs in many textual responses as scepticism frequently turns into ambivalence.

  10. Lumbar paravertebral blockade as intractable pain management method in palliative care

    Directory of Open Access Journals (Sweden)

    Zaporowska-Stachowiak I

    2013-09-01

    ranges during the whole treatment course (22.9–927.4 ng · mL-1. In the case presented, lumbar PVB with bupivacaine in boluses (≤137.5 mg · 24 hours-1 was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150 mg · 12 hours-1 had an acceptable risk-benefits ratio, but was ineffective. Keywords: bone metastases, bupivacaine, intractable pain, opioid ineffectiveness

  11. Legacy question

    International Nuclear Information System (INIS)

    Healy, J.W.

    1977-01-01

    The legacy question discussed refers to the definition of appropriate actions in this generation to provide a world that will allow future generations to use the earth without excessive limitations caused by our use and disposal of potentially hazardous materials

  12. An Online National Archive of Multiple-Choice Questions for Astro 101 and the Development of the Question Complexity Rubric

    Science.gov (United States)

    Cormier, S.; Prather, E.; Brissenden, G.

    2011-09-01

    We are developing a national archive of multiple-choice questions for use in the Astronomy 101 classroom. These questions are intended to supplement an instructor's implementation of Think-Pair-Share or for their assessment purposes (i.e., exams and homework). We are also developing the Question Complexity Rubric (QCR) to guide members of the Astro 101 teaching and learning community in assisting us with hierarchically ranking questions in this archive based on their conceptual complexity. Using the QCR, a score is assigned to differentiate each question based on the cognitive steps necessary to comprehensively explain the reasoning pathway to the correct answer. The lowest QCR score is given to questions with a reasoning pathway requiring only declarative knowledge. The highest QCR score is given to questions with a reasoning pathway that requires multiple connected cognitive steps. When completed, the online question archive will provide users with the utility to 1) use the QCR to score questions 2) search for and download questions based on topic and/or QCR score, and 3) add their own questions to the archive. Stop by our poster to test your skills at determining question complexity by trying out the QCR with our sample questions.

  13. Difficult Questions of Difficult Questions: The Role of The Researcher and Transcription Styles

    Science.gov (United States)

    Henderson, Holly

    2018-01-01

    This paper refracts a comparison of three distinct transcription styles through questions of researcher reflexivity. It uses the data from a single question asked by the researcher in multiple interviews for a small empirical project. These data are transcribed in three ways, and the resulting transcripts are discussed in relation to the analysis…

  14. Conceptual question response times in Peer Instruction classrooms

    Directory of Open Access Journals (Sweden)

    Kelly Miller

    2014-08-01

    Full Text Available Classroom response systems are widely used in interactive teaching environments as a way to engage students by asking them questions. Previous research on the time taken by students to respond to conceptual questions has yielded insights on how students think and change conceptions. We measure the amount of time students take to respond to in-class, conceptual questions [ConcepTests (CTs] in two introductory physics courses taught using Peer Instruction and use item response theory to determine the difficulty of the CTs. We examine response time differences between correct and incorrect answers both before and after the peer discussion for CTs of varying difficulty. We also determine the relationship between response time and student performance on a standardized test of incoming physics knowledge, precourse self-efficacy, and gender. Our data reveal three results of interest. First, response time for correct answers is significantly faster than for incorrect answers, both before and after peer discussion, especially for easy CTs. Second, students with greater incoming physics knowledge and higher self-efficacy respond faster in both rounds. Third, there is no gender difference in response rate after controlling for incoming physics knowledge scores, although males register significantly more attempts before committing to a final answer than do female students. These results provide insight into effective CT pacing during Peer Instruction. In particular, in order to maintain a pace that keeps everyone engaged, students should not be given too much time to respond. When around 80% of the answers are in, the ratio of correct to incorrect responses rapidly approaches levels indicating random guessing and instructors should close the poll.

  15. 硫糖铝联合黄连素片治疗慢性顽固性胃炎患者临床分析%Clinical Analysis of Sucralfate Combination Berberine in the Treatment of Chronic Intractable Gastritis

    Institute of Scientific and Technical Information of China (English)

    沈刚

    2015-01-01

    Objective To explore clinical analysis of Sucralfate combination Bberberine in the treatment of chronic intractable gastritis. Methods Selecte 110 cases with chronic intractable gastritis were randomly divided into observation group and control group, 55 cases in each group, the control was given berberine, the observation group was given Sucralfate combination Bberberine to treate, comparing the therapeutic ef ect. Results Total ef ective rate of observation group was significantly higher than the control, the dif erence is statistical y significant ( < 0.05); After a year, the recur ence rate of control is higher than observation group ( < 0.05). Conclusion Clinical ef ect Sucralfate combination Bberberine in the treatment of chronic intractable gastritis gastritis is remarkable, and the recur ence rate is low.%目的:探析硫糖铝联合黄连素片治疗慢性顽固性胃炎的临床效果。方法选取慢性顽固性胃炎患者110例随机分为观察组和对照组,每组各55例,对照组病患给予黄连素治疗,而观察组在对照组黄连素治疗的基础上联合硫糖铝药物进行治疗,统计分析对比两组的治疗效果。结果观察组患者治疗总有效率明显高于对照组,差异具有统计学意义(<0.05);1年后对照组复发率高于观察组差异具有统计学意义(<0.05)。结论硫糖铝联合黄连素片治疗慢性顽固性胃炎的临床效果显著,且复发率较低。

  16. Questioning Student Learning: An Exploration of Student's Views on Learning to Become Independent Nurse Prescribers

    Science.gov (United States)

    Banning, Maggi; Cortazzi, Martin

    2004-01-01

    This illuminative evaluation study gives insights into attitudes to learning, interaction and the perceived roles of theory, evidence, reading and previous experience. These insights lead us to question some aspects of the course as currently presented. Students indicated that they found the course material stimulating but prior guidance on the…

  17. Let's talk nuclear energy in 30 questions; Parlons nucleaire en 30 questions

    Energy Technology Data Exchange (ETDEWEB)

    Reuss, Paul

    2012-01-11

    The Fukushima catastrophe of March 11, 2011 has called into question the share of nuclear energy in France and in foreign countries. Its replacement by renewable energy sources and the safety of nuclear power plants are in the center of today's debates. But what is the reality behind the mass of contradictory information that exists on this complex topic? This book moves the question out of the media noise and supplies objective and factual information with reliable figures about the nuclear industry by answering 30 key-questions. (J.S.)

  18. Question, answer, compare: a cross-category comparison of answers on question and answer websites

    Science.gov (United States)

    Ocepek, Melissa G.; Westbrook, Lynn

    2015-10-01

    Online information seekers make heavy use of websites that accept their natural language questions. This study compared the three types of such websites: social question and answer (Q&A), digital reference services, and ask-an-expert services. Questions reflecting daily life, research, and crisis situations were posed to high use websites of all three types. The resulting answers' characteristics were analyzed in terms of speed, transparency, formality, and intimacy. The results indicate that social Q&A websites excel in speed, ask-an-expert websites in intimacy, and digital reference services in transparency and formality.

  19. Examining the Impact of Question Surface Features on Students' Answers to Constructed-Response Questions on Photosynthesis

    Science.gov (United States)

    Weston, Michele; Haudek, Kevin C.; Prevost, Luanna; Urban-Lurain, Mark; Merrill, John

    2015-01-01

    One challenge in science education assessment is that students often focus on surface features of questions rather than the underlying scientific principles. We investigated how student written responses to constructed-response questions about photosynthesis vary based on two surface features of the question: the species of plant and the order of…

  20. Generic Drugs: Questions and Answers

    Science.gov (United States)

    ... Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products Drugs Home Drugs Resources for You Information for Consumers (Drugs) Questions & Answers Generic Drugs: Questions & Answers Share Tweet Linkedin Pin it More ...

  1. Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football

    DEFF Research Database (Denmark)

    Clausen, Mikkel Bek; Tang, L; Zebis, M K

    2016-01-01

    with low KOOS subscale scores (Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P time-loss knee...... questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (... as independent variables in the risk factor analyses. The study showed that self-reported previous knee injury significantly increased the risk of time-loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73-7.68; P time-loss knee injury was also significantly increased in players...

  2. Computational Science: Ensuring America's Competitiveness

    National Research Council Canada - National Science Library

    Reed, Daniel A; Bajcsy, Ruzena; Fernandez, Manuel A; Griffiths, Jose-Marie; Mott, Randall D; Dongarra, J. J; Johnson, Chris R; Inouye, Alan S; Miner, William; Matzke, Martha K; Ponick, Terry L

    2005-01-01

    ... previously deemed intractable. Yet, despite the great opportunities and needs, universities and the Federal government have not effectively recognized the strategic significance of computational science in either...

  3. A Survey of Patients' Preoperative Need for Information About Postoperative Pain-Effect of Previous Surgery Experience.

    Science.gov (United States)

    Mavridou, Paraskevi; Manataki, Adamantia; Arnaoutoglou, Elena; Damigos, Dimitrios

    2017-10-01

    The aim of this study was to determine the kind of information patients need preoperatively about postoperative pain (POP) and whether this is affected by previous surgery experience. A descriptive study design using preoperative questionnaires. Questionnaires with fixed questions related to POP and its management were distributed preoperatively to consenting, consecutive surgical patients. Patients were divided into two groups: patients with previous surgery experience (group A) and patients without previous surgery experience (group B). Of the patients who participated in the study, 94.2% wanted information about POP and 77.8% of them believe that they will feel calmer if they get the information they need. The patients' biggest concern relates to pain management issues after discharge. Next, in order of preference is information about the analgesics that they need to take. The patients want to be informed primarily with a personal interview (59.4%). Previous surgery experience has no effect on patients' needs for information. Most of the patients want to be informed about the management of the POP after being discharged. It is remarkable that patients who had previous surgery experience need the same information with those who had no previous surgery. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  4. Intractable secretory diarrhea in a Japanese boy with mitochondrial respiratory chain complex I deficiency.

    Science.gov (United States)

    Murayama, Kei; Nagasaka, Hironori; Tsuruoka, Tomoko; Omata, Yuko; Horie, Hiroshi; Tregoning, Simone; Thorburn, David R; Takayanagi, Masaki; Ohtake, Akira

    2009-03-01

    The etiology of secretory diarrhea in early life is often unclear. We report a Japanese boy who survived until 3 years of age, despite intractable diarrhea commencing soon after birth. The fecal sodium content was strikingly high (109 mmol/L [normal range, 27-35 mmol/L]) and the osmotic gap was decreased (15 mOsm/kg), consistent with the findings of congenital sodium diarrhea. We examined the mitochondrial respiratory chain function by blue native polyacrylamide gel electrophoresis (BN-PAGE) in-gel enzyme staining, BN-PAGE western blotting, respiratory chain enzyme activity assay, and immunohistochemistry. Liver respiratory chain complex (Co) I activity was undetectable, while other respiratory chain complex activities were increased (Co II, 138%; Co III, 153%; Co IV, 126% versus respective control activities). Liver BN-PAGE in-gel enzyme staining and western blotting showed an extremely weak complex I band, while immunohistochemistry showed extremely weak staining for the 30-kDa subunit of complex I, but normal staining for the 70-kDa subunit of complex II. The patient was, therefore, diagnosed with complex I deficiency. The overall complex I activity of the jejunum was substantially decreased (63% of the control activity). The immunohistochemistry displayed apparently decreased staining of the 30-kDa complex I subunit, together with a slightly enhanced staining of the 70-kDa complex II subunit in intestinal epithelial cells. These data imply that intestinal epithelial cells are also complex I-deficient in this patient. Complex I deficiency is a novel cause of secretory diarrhea and may act via disrupting the supply of adenosine triphosphate (ATP) needed for the maintenance of ion gradients across membranes.

  5. Lente intra-ocular opaca em diplopia intratável: relato de caso Opaque intraocular lens in intractable diplopia: case report

    Directory of Open Access Journals (Sweden)

    Fernanda Teixeira Krieger

    2006-08-01

    Full Text Available Diplopia intratável tem sido descrita em várias situações. Métodos convencionais como prismas e correção cirúrgica do estrabismo falham em neutralizá-la. O objetivo do trabalho é documentar o caso de uma paciente com estrabismo de longa data, cuja diplopia deteriorou-se ao longo dos anos, e não foi possível resolução com cirurgia, prisma, e oclusão com óculos e lente de contato com pupila opaca. A paciente foi então submetida à facoemulsificação com implante de lente intra-ocular opaca que atingiu o objetivo desejado.Intractable diplopia has been described in many situations but poor results are the rule with standard treatment modalities. The authors report a case of a woman with long-standing strabismus and diplopia who failed to improve following surgery, prism, and occlusive spectacles or contact lenses. Then, she was submitted to phacoemulsification and opaque intraocular lens implantation, which successfully neutralized diplopia.

  6. Comparison of Performance on Multiple-Choice Questions and Open-Ended Questions in an Introductory Astronomy Laboratory

    Science.gov (United States)

    Wooten, Michelle M.; Cool, Adrienne M.; Prather, Edward E.; Tanner, Kimberly D.

    2014-01-01

    When considering the variety of questions that can be used to measure students' learning, instructors may choose to use multiple-choice questions, which are easier to score than responses to open-ended questions. However, by design, analyses of multiple-choice responses cannot describe all of students' understanding. One method that can…

  7. Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

    Science.gov (United States)

    Charise, Andrea; Witteman, Holly; Whyte, Sarah; Sutton, Erica J.; Bender, Jacqueline L.; Massimi, Michael; Stephens, Lindsay; Evans, Joshua; Logie, Carmen; Mirza, Raza M.; Elf, Marie

    2011-01-01

    Abstract Objective  To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. Background  Decision‐making processes and outcomes may be shaped by a range of non‐medical or ‘contextual’ factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide‐ranging research for health decision‐making purposes. Methods  To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision‐making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings  We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide‐ranging contextual factors relevant to health decision making. The BTPW tool encompasses health‐related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. Conclusions  These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health‐related research. PMID:21029277

  8. Annotating Logical Forms for EHR Questions.

    Science.gov (United States)

    Roberts, Kirk; Demner-Fushman, Dina

    2016-05-01

    This paper discusses the creation of a semantically annotated corpus of questions about patient data in electronic health records (EHRs). The goal is to provide the training data necessary for semantic parsers to automatically convert EHR questions into a structured query. A layered annotation strategy is used which mirrors a typical natural language processing (NLP) pipeline. First, questions are syntactically analyzed to identify multi-part questions. Second, medical concepts are recognized and normalized to a clinical ontology. Finally, logical forms are created using a lambda calculus representation. We use a corpus of 446 questions asking for patient-specific information. From these, 468 specific questions are found containing 259 unique medical concepts and requiring 53 unique predicates to represent the logical forms. We further present detailed characteristics of the corpus, including inter-annotator agreement results, and describe the challenges automatic NLP systems will face on this task.

  9. Generating ethnographic research questions

    DEFF Research Database (Denmark)

    Friberg, Torbjörn

    2015-01-01

    ? By drawing on the conceptual history of anthropology, the aim of this article is to generate ethnographic-oriented research questions concerned with higher education. The first part of the article provides an ethnographic background, while the second part focuses on Paul Willis's reasoning on ethnographic......As part of recent complex transformations, it seems that higher educational organisations are being forced to reorganise, standardise and streamline in order to survive in the new political and economic context. How are ethnographers in general going to approach these contemporary phenomena...... imagination, as a prerequisite for generating alternative research questions. The third part makes explicit anthropologist Maurice Godelier's theoretical imagination, carving out some specific theoretical parts which may be used in the generating process. The conclusion then suggests a number of questions...

  10. Will Veterans Answer Sexual Orientation and Gender Identity Questions?

    Science.gov (United States)

    Ruben, Mollie A; Blosnich, John R; Dichter, Melissa E; Luscri, Lorry; Shipherd, Jillian C

    2017-09-01

    The Veterans Health Administration does not routinely collect and document sexual orientation and gender identity (SOGI) data, despite existing health disparities among sexual and gender minority Veterans. Because of the legacy of previous Department of Defense (DoD) policies that prohibited disclosure of sexual or gender minority identities among active duty personnel, Veterans may be reluctant to respond to SOGI questions. This population-based study assesses item nonresponse to SOGI questions by Veteran status. This is a secondary analysis of data from a population-based sample of adults in 20 US states that elected to administer a SOGI module in the 2014 Behavioral Risk Factor Surveillance System survey. Prevalence of SOGI refusals and responses of "don't know" were compared for Veterans and non-Veterans. Veterans (n=22,587) and non-Veterans (n=146,475) were surveyed. Nearly all Veteran respondents (≥98%) completed the SOGI questions, with 95.4% identifying as heterosexual, 1.2% as gay or lesbian, 1.2% as bisexual, and 0.59% as transgender. A significantly lower proportion of Veterans than non-Veterans refuse to answer sexual orientation (1.5% vs. 1.9%). There was no difference between Veterans and non-Veterans in responses for gender identity. Veterans are just as likely as non-Veterans to complete SOGI items in survey research. Asking Veterans about SOGI is unlikely to yield significant nonresponse. These data suggest that future research should investigate Veterans' perspectives on being asked about SOGI in research settings and as part of routine clinical care.

  11. Instance-Based Question Answering

    Science.gov (United States)

    2006-12-01

    cluster-based query expan- sion, learning answering strategies, machine learning in NLP To my wife Monica Abstract During recent years, question...process is typically tedious and involves expertise in crafting and implement- ing these models (e.g. rule-based), utilizing NLP resources, and...questions. For languages that use capitalization (e.g. not Chinese or Arabic ) for named entities, IBQA can make use of NE classing (e.g. “Bob Marley

  12. Protein Electrochemistry: Questions and Answers.

    Science.gov (United States)

    Fourmond, V; Léger, C

    This chapter presents the fundamentals of electrochemistry in the context of protein electrochemistry. We discuss redox proteins and enzymes that are not photoactive. Of course, the principles described herein also apply to photobioelectrochemistry, as discussed in later chapters of this book. Depending on which experiment is considered, electron transfer between proteins and electrodes can be either direct or mediated, and achieved in a variety of configurations: with the protein and/or the mediator free to diffuse in solution, immobilized in a thick, hydrated film, or adsorbed as a sub-monolayer on the electrode. The experiments can be performed with the goal to study the protein or to use it. Here emphasis is on mechanistic studies, which are easier in the configuration where the protein is adsorbed and electron transfer is direct, but we also explain the interpretation of signals obtained when diffusion processes affect the response.This chapter is organized as a series of responses to questions. Questions 1-5 are related to the basics of electrochemistry: what does "potential" or "current" mean, what does an electrochemical set-up look like? Questions 6-9 are related to the distinction between adsorbed and diffusive redox species. The answers to questions 10-13 explain the interpretation of slow and fast scan voltammetry with redox proteins. Questions 14-19 deal with catalytic electrochemistry, when the protein studied is actually an enzyme. Questions 20, 21 and 22 are general.

  13. IMS Learning Design Frequently Asked Questions

    NARCIS (Netherlands)

    Tattersall, Colin; Manderveld, Jocelyn; Hummel, Hans; Sloep, Peter; Koper, Rob; De Vries, Fred

    2004-01-01

    This list of frequently asked questions was composed on the basis of questions asked of the Educational Technology Expertise Centrum. The questions addessed are: Where can I find the IMS Learning Design Specification? What is meant by the phrase “Learning Design”? What is the IMS LD Specification

  14. Effect of two types of control questions and two question formats on the outcomes of polygraph examinations.

    Science.gov (United States)

    Horvath, Frank; Palmatier, John J

    2008-07-01

    Two major variations of polygraph "Control Question" testing, the Zone Comparison (ZoC) and the Modified General Question Test (MGQT) were evaluated. Within each, the type of control question, Exclusive or "time bar" (e.g., "Before you were 21, did you ever...") and Nonexclusive or "no time bar" (e.g., "Did you ever....?") was manipulated in a mock theft scenario, with 80 male and 40 female subjects randomly assigned to be either innocent or guilty. Polygraphic data collected by experienced field examiners were numerically scored by an evaluator blind to all aspects of the study. Decision accuracy was not related to the type of procedure (ZoC/MGQT) used or the subject's sex. Accuracy was significantly related to the type of control question [chi(2) (2) = 11.46, p = 0.003; tau c = 0.29]. Nonexclusive control questions produced greater accuracy than Exclusive control questions on both innocent and guilty subjects. These results and subjects' self-reports support the general "theory" on which control question (CQ) testing is based. The need for better empirical support of accepted dogma and current field practices is strongly indicated by these findings.

  15. Questioning As a Pedagogical Tool for Eliciting Student Generated Questions During the Teaching of Acid-base Equilibria

    Directory of Open Access Journals (Sweden)

    Ayoade Ejiwale Okanlawon

    2012-04-01

    Full Text Available Traditionally, teachers simply taught problem-solving by explaining the worked-out examples taken from textbooks and students were expected to listen quietly, copy the solution to the problem, and then work independently at their desks. But a large body of research notes that guiding students to develop a solution pathway with questioning is more effective than simply explaining the sequence of steps to solve the problem. Students involved in question- and-answer sessions are more attentive than those who listen passively to teacher explanations and they are more likely to generate questions. The questions students ask during a lesson perform a number of important functions, including providing the teacher with valuable information about students’ understanding and misunderstanding, fostering self-regulation, inviting classroom discussions and aiding comprehension of contents presented. The skill of posing questions during classroom instruction is often under-valued and under taught in today’s classrooms. To encourage students to ask quality and thought provoking questions related to the contents taught, explicit instruction is required. This paper, therefore, qualitatively reports factors that foster student generated questions during the problem-solving instruction involving acid-base titration problem.

  16. Developing a comprehensive presurgical functional MRI protocol for patients with intractable temporal lobe epilepsy: a pilot study

    International Nuclear Information System (INIS)

    Deblaere, K.; Vandemaele, P.; Achten, E.; Backes, W.H.; Hofman, P.; Wilmink, J.; Boon, P.A.; Vonck, K.; Boon, P.; Troost, J.; Vermeulen, J.; Aldenkamp, A.

    2002-01-01

    Our aim was to put together and test a comprehensive functional MRI (fMRI) protocol which could compete with the intracarotid amytal (IAT) or Wada test for the localisation of language and memory function in patients with intractable temporal lobe epilepsy. The protocol was designed to be performed in under 1 h on a standard 1.5 tesla imager. We used five paradigms to test nine healthy right-handed subjects: complex scene-encoding, picture-naming, reading, word-generation and semantic-decision tasks. The combination of these tasks generated two activation maps related to memory in the mesial temporal lobes, and three language-related maps of activation in a major part of the known language network. The functional maps from the encoding and naming tasks showed typical and symmetrical posterior mesial temporal lobe activation related to memory in all subjects. Only four of nine subjects also showed symmetrical anterior hippocampal activation. Language lateralisation was best with the word generation and reading paradigms and proved possible in all subjects. The reading paradigm enables localisation of language function in the left anterior temporal pole and middle temporal gyrus, areas typically resected during epilepsy surgery. The combined results of this comprehensive f MRI protocol are adequate for a comparative study with the IAT in patients with epilepsy being assessed for surgery. (orig.)

  17. Developing a comprehensive presurgical functional MRI protocol for patients with intractable temporal lobe epilepsy: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Deblaere, K.; Vandemaele, P.; Achten, E. [MRI Department -1 K12, Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent (Belgium); Backes, W.H.; Hofman, P.; Wilmink, J. [Department of Neuroradiology, University Hospital Maastricht, Postbus 5800, 6202 AZ Maastricht (Netherlands); Boon, P.A.; Vonck, K. [Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent (Belgium); Boon, P. [Department of Medical Psychology, University Hospital Maastricht (Netherlands); Troost, J. [Department of Neurology, University Hospital Maastricht (Netherlands); Vermeulen, J. [S.E.I.N Heemstede, Psychological Laboratory, Achterweg 5, 2103 SW Heemstede (Netherlands); Aldenkamp, A. [Epilepsy Center ' Kempenhaeghe' , Postbus 61, 5900 AB Heeze (Netherlands)

    2002-08-01

    Our aim was to put together and test a comprehensive functional MRI (fMRI) protocol which could compete with the intracarotid amytal (IAT) or Wada test for the localisation of language and memory function in patients with intractable temporal lobe epilepsy. The protocol was designed to be performed in under 1 h on a standard 1.5 tesla imager. We used five paradigms to test nine healthy right-handed subjects: complex scene-encoding, picture-naming, reading, word-generation and semantic-decision tasks. The combination of these tasks generated two activation maps related to memory in the mesial temporal lobes, and three language-related maps of activation in a major part of the known language network. The functional maps from the encoding and naming tasks showed typical and symmetrical posterior mesial temporal lobe activation related to memory in all subjects. Only four of nine subjects also showed symmetrical anterior hippocampal activation. Language lateralisation was best with the word generation and reading paradigms and proved possible in all subjects. The reading paradigm enables localisation of language function in the left anterior temporal pole and middle temporal gyrus, areas typically resected during epilepsy surgery. The combined results of this comprehensive f MRI protocol are adequate for a comparative study with the IAT in patients with epilepsy being assessed for surgery. (orig.)

  18. Percutaneous endoscopic colostomy of the left colon: a new technique for management of intractable constipation in children.

    Science.gov (United States)

    Rawat, David J; Haddad, Munther; Geoghegan, Niamh; Clarke, Simon; Fell, John M

    2004-07-01

    The antegrade colonic enema is accepted as effective for management of intractable constipation in children when conventional bowel management has failed. This study describes experience with a new, minimally invasive technique, the distal antegrade colonic enema, which involves percutaneous endoscopic colostomy of the left colon. Fifteen children with refractory constipation and soiling who had radiographic evidence of megarectum and/or distal colonic delay were selected for the procedure. The junction of the descending and the sigmoid colon was identified colonoscopically, and the percutaneous endoscopic colostomy tube, through which antegrade distal colonic enema are administered, was inserted. Fourteen children underwent distal percutaneous endoscopic colostomy insertion. The median time required for the procedure was 30 minutes (20-50 minutes). Excluding one child (technical difficulties with percutaneous endoscopic colostomy placement), median post-procedural hospital stay was 4 days (2-27 days). Thirteen children were no longer soiling, and improvement in quality of life was reported at 2 months' follow-up. At 6 months' follow-up, 90% of children were clean during intervals between enemas. All children evaluated at 12 months' follow-up remained clean. Median duration of follow-up was 12.5 months (2-51 months). The distal percutaneous endoscopic colostomy is a simple alternative to established methods for delivery of antegrade enemas. It is less invasive and on reversal leaves only minor scarring.

  19. The effect of question format and task difficulty on reasoning strategies and diagnostic performance in Internal Medicine residents.

    Science.gov (United States)

    Heemskerk, Laura; Norman, Geoff; Chou, Sophia; Mintz, Marcy; Mandin, Henry; McLaughlin, Kevin

    2008-11-01

    Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.

  20. The Question Concerning Thinking

    DEFF Research Database (Denmark)

    Riis, Søren

    2008-01-01

    Martin Heidegger's thought-provoking essay "The Question Concerning Technology" (1977a) placed technology at the heart of philosophy. Heidegger tried to show that the essence of technology provokes humans to think about the world in a very dangerous way. Yet if we follow Heidegger's analysis...... of technology, what role does that ascribe to philosophy? To be able to understand the programmatic scope of Heidegger's question ‘concerning' technology, we need to see it as inseparable from his famous thesis about the end of philosophy (1977c) and what he considers to be the ideal kind of thinking. However......, by doing so, we will in the end realize two important things. First, that Heidegger's declaration of the end of philosophy in fact also means the end of anything we can meaningfully call thinking. Second, that Heidegger's own thinking is completely different from his own ideal of thinking. Our question...

  1. Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

    Directory of Open Access Journals (Sweden)

    Meena Pradhan

    2014-03-01

    Full Text Available Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage. Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61 due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333 during the same study period. Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i blood loss 1000-2000 ml, crude odd ratio (OR =18.48 (95% CI 5.1-65.7, adjusted odd ratio (AOR = 9.1 (95% CI 2.2-37.7; (ii blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4, AOR = 45.3 (95% CI 11.6-176.9; (iii previous caesarean section, OR = 5.5 (95% CI 2.9-9.7, AOR = 3.7(95% CI 1.4-9.9; (iv uterine atony, OR = 11.9 (95% CI 5.8-24.6, AOR = 7.5 (95% CI 1.8-30.2; (v placenta previa, OR = 2.04 (95% CI 1.1-3.5, AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy. Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

  2. Comparison of performance on multiple-choice questions and open-ended questions in an introductory astronomy laboratory

    OpenAIRE

    Michelle M. Wooten; Adrienne M. Cool; Edward E. Prather; Kimberly D. Tanner

    2014-01-01

    When considering the variety of questions that can be used to measure students’ learning, instructors may choose to use multiple-choice questions, which are easier to score than responses to open-ended questions. However, by design, analyses of multiple-choice responses cannot describe all of students’ understanding. One method that can be used to learn more about students’ learning is the analysis of the open-ended responses students’ provide when explaining their multiple-choice response. I...

  3. Unreviewed Disposal Question Evaluation: Waste Disposal In Engineered Trench #3

    Energy Technology Data Exchange (ETDEWEB)

    Hamm, L. L.; Smith, F. G. III; Flach, G. P.; Hiergesell, R. A.; Butcher, B. T.

    2013-07-29

    Because Engineered Trench #3 (ET#3) will be placed in the location previously designated for Slit Trench #12 (ST#12), Solid Waste Management (SWM) requested that the Savannah River National Laboratory (SRNL) determine if the ST#12 limits could be employed as surrogate disposal limits for ET#3 operations. SRNL documented in this Unreviewed Disposal Question Evaluation (UDQE) that the use of ST#12 limits as surrogates for the new ET#3 disposal unit will provide reasonable assurance that Department of Energy (DOE) 435.1 performance objectives and measures (USDOE, 1999) will be protected. Therefore new ET#3 inventory limits as determined by a Special Analysis (SA) are not required.

  4. Analysis of students’ generated questions in laboratory learning environments

    Directory of Open Access Journals (Sweden)

    Juan Antonio Llorens-Molina

    2012-03-01

    Full Text Available In order to attain a reliable laboratory work assessment, we argue taking the Learning Environment as a core concept and a research paradigm that considers the factors affecting the laboratory as a particularly complex educational context. With regard to Laboratory Learning Environments (LLEs, a well known approach is the SLEI (Science Laboratory Environment Inventory. The aim of this research is to design and apply an alternative and qualitative assessment tool to characterize Laboratory Learning Environments in an introductory course of organic chemistry. An alternative and qualitative assessment tool would be useful for providing feed-back for experimental learning improvement; serving as a complementary triangulation tool in educational research on LLEs; and generating meaningful categories in order to design quantitative research instruments. Toward this end, spontaneous questions by students have been chosen as a reliable source of information. To process these questions, a methodology based on the Grounded Theory has been developed to provide a framework for characterizing LLEs. This methodology has been applied in two case studies. The conclusions lead us to argue for using more holistic assessment tools in both everyday practice and research. Likewise, a greater attention should be paid to metacognition to achieve suitable self-perception concerning students’ previous knowledge and manipulative skills.

  5. Using Mind Maps to Make Student Questioning Effective: Learning Outcomes of a Principle-Based Scenario for Teacher Guidance

    Science.gov (United States)

    Stokhof, Harry; de Vries, Bregje; Bastiaens, Theo; Martens, Rob

    2018-01-01

    Student questioning is an important learning strategy, but rare in many classrooms, because teachers have concerns if these questions contribute to attaining curricular objectives. Teachers face the challenge of making student questioning effective for learning the curriculum. To address this challenge, a principle-based scenario for guiding effective student questioning was developed and tested for its relevance and practicality in two previous studies. In the scenario, which consists of a sequence of pedagogical activities, mind maps support teachers and students to explore and elaborate upon a core curriculum, by raising, investigating, and exchanging student questions. In this paper, a follow-up study is presented that tested the effectiveness of the scenario on student outcomes in terms of attainment of curricular objectives. Ten teachers and their 231 students participated in the study. Pre- and posttest mind maps were used to measure individual and collective learning outcomes of student questioning. Findings show that a majority of students progressed in learning the core curriculum and elaborated upon it. The findings suggest that visualizing knowledge construction in a shared mind map supports students to learn a core curriculum and to refine their knowledge structures.

  6. Intelligence, Personality and Mentality of Patients with Intractable Epilepsy%难治性癫痫患者智力、个性及心理健康状况的临床分析

    Institute of Scientific and Technical Information of China (English)

    尹昱; 李卫泊; 闫桂芳; 李文玲; 杜亚丽; 王秀芬; 赵文清

    2011-01-01

    目的 探讨难治性癫痫患者智力、个性及心理健康状况,并分析对智能的影响因素。方法 分别采用瑞文标准推理能力测验(SPM)、艾森克人格问卷(EPQ)以及症状自测量表(SCL-90)对68例难治性癫痫患者及60名健康者进行评测,并分析年龄、病程、发作情况等因素对难治性癫痫患者智力的影响。结果 难治性癫痫患者的SPM总分及IQ值均较对照组低(P<0.05);存在智力缺陷的占51.4%,高于对照组1.7%(P<0.05);难治性癫痫患者EPQ各量表得分、个性分型分布与对照组无显著性差异(P>0.05)。难治性癫痫患者SCL-90的总分及躯体化、人际关系、抑郁、焦虑、敌对等因子分均高于对照组(P<0.05)。起病年龄、病程、发作类型、发作频率、发作持续时间、用药种数、SCL-90得分均与癫痫患者智力状况相关(P<0.05)。结论 多数难治性癫痫患者的智力明显受损,并伴有不同程度的心理障碍。起病年龄、病程、发作类型、发作频率、发作持续时间、用药种数是难治性癫痫患者智力损害的重要影响因素。%Objective To explore the characteristic of intelligence, personality and mentality of patients with intractable epilepsy and analyze the related factors on intelligence. Methods 68 patients with intractable epilepsy and 60 healthy persons were assessed with Raven's standard progressive matrices (SPM), Eysenck personality questionnaire (EPQ) and 90 symptoms checklist (SCL-90). The related factors on intelligence were analyzed. Results Compared with controls, the total score and IQ of SPM of the patients decreased significantly (P0.05). The total score of SCL-90 and the factor score, such as somatization, interpersonal sensitivity, depression, anxiety and hostility in patients were higher than those in controls(P<0.05). Various factors, including the onset age, course of disease, seizure types, frequency, duration, number of drug, the

  7. The Impact of Similarity-Based Interference in Processing Wh-Questions in Aphasia

    Directory of Open Access Journals (Sweden)

    Shannon Mackenzie

    2014-04-01

    Full Text Available We describe two experiments investigating the comprehension of different types of Wh-questions in neurotypical adults (Experiment 1 and adults with Broca’s aphasia (Experiment 2. Consider as examples: Two mailmen and a fireman got into a fight yesterday afternoon. 1a. Who pushed the fireman yesterday afternoon? – Subject-extracted Who 1b. Who did the fireman push ___ yesterday afternoon? – Object-extracted Who 2a. Which mailman pushed the fireman yesterday afternoon? – Subject-extracted Which 2b. Which mailman did the fireman push ___ yesterday afternoon? – Object-extracted Which There is evidence from the linguistic and psycholinguistic literatures that suggest Which-questions are more difficult to understand than Who/What-questions and within those, that object-extracted are more difficult than subject-extracted. We used a unique eye tracking-while listening method where listeners were presented with sentences like (1 and (2 above while gazing at a three-figure picture (e.g., a picture of a mailman pushing a fireman who is pushing another mailman; we measured gazes to the referents in the pictures across the time-course of the sentences, and also collected accuracy and response time data to answer the questions (by button press. We examined four specific hypotheses: Discourse, Memory Retrieval, Word Order, and Intervener. The Discourse hypothesis suggests that Which-questions should be more difficult to process than Who-questions because the former is required to refer to an individual taken from a set of entities previously mentioned in the discourse (Donkers & Stowe, 2006; Shapiro, 2000. The Memory Retrieval hypothesis makes the opposite claim; Which-questions, unlike Who-questions, contain specific information in the Wh-phrase that should speed memory retrieval (Hofmeister, 2007. The Word Order hypothesis suggests that, regardless of question type (Which or Who, object-extracted questions should be more difficult to understand

  8. The new history of psychology II: Some (different) answers to Watrin's four questions.

    Science.gov (United States)

    Brock, Adrian C

    2017-05-01

    This article is mainly a response to the article by João Paulo Watrin, "The Ambiguous 'New History of Psychology': Some New Questions to Brock (2017)" (Watrin, 2017), which was itself a reply to my article, "The New History of Psychology: Some (Different) Answers to Lovett's Five Questions" (Brock, 2017). Watrin (2017) suggested that previous writers have conflated the terms "critical history" and "new history." They are said to differ, in that although the former is merely a name for a loose collection of approaches to the history of psychology, the latter involves rhetoric about the historiographical commitments of critical history. He also disputed the validity of the distinction between "old" and "new" history. I suggest that he is wrong on all these points. Watrin then poses and answers four rhetorical questions on Whig history, textbooks, critical thinking, and ad hominem arguments, and I provide alternative answers to all of them. After suggesting that our different views can be attributed to different agendas, I conclude with some reflections on how professional historians and psychologists can work together. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. 99Tcm brain imaging for the assessment of patients with intractable partial epilepsy - our experience

    International Nuclear Information System (INIS)

    Schlicht, S.; Bruns, M.; Booth, R.; Octigan, K.; Karamoskos, P.; Cook, M.; O'Brien, T.

    2000-01-01

    Full text: 99 Tc m - Ethyl Cysteinate Diethylester (ECD) or Bicisate is a new radiopharmaceutical used for the assessment of cerebral perfusion. Unlike 99 Tc m Hexamethylpropylene Amine Oxime ( 99 Tc m - HMPAO) which is unstable and needs to be reconstituted immediately prior to injection, 99 Tc m -ECD is stable for up to eight hours following reconstitution. Therefore, 99 Tc m -ECD does not require mixing just prior to injection and is readily available on a daily inpatient basis to the epilepsy unit, facilitating earlier and faster injections, and the acquisition of true ictal studies. This is particularly important with patients who have extra temporal seizures which are typically brief in duration. 45 patients have undergone 99 Tc m -ECD studies for epilepsy in our department over a period of one year. Image acquisition routinely commences within two hours of injection, and consists of a 360 degree elliptical SPECT using an ADAC Dual Headed Gamma Camera. Patients undergo both ictal and inter ictal SPECT studies, and an MRI. Visual comparison of the ictal, inter ictal and MRI images is performed, as well as subtraction and co-registration. The SISCOM analysis technique is used which allows subtraction of the SPECTs and co registration with MRI. This has the advantage of improved specificity, sensitivity, and accurate anatomical localisation. The results of our experience with 99Tcm-ECD will be presented. In conclusion, we have found that 99 Tc m -ECD is ideally suited for peri-ictal SPECT studies as part of the pre-operative assessment of patients with intractable partial epilepsy. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  10. Congenital Sodium Diarrhea: A Form of Intractable Diarrhea, With a Link to Inflammatory Bowel Disease.

    Science.gov (United States)

    Janecke, Andreas R; Heinz-Erian, Peter; Müller, Thomas

    2016-08-01

    Congenital diarrheal disorders (CDDs) represent a group of challenging clinical conditions for pediatricians because of the severity of the presentation and the broad range of possible differential diagnoses. CDDs arise from alterations in the transport of nutrients and electrolytes across the intestinal mucosa, from enterocyte and enteroendocrine cell differentiation and/or polarization defects, and from the modulation of the intestinal immune response. Advances were made recently in deciphering the etiology and pathophysiology of one of these disorders, congenital sodium diarrhea (CSD). CSD refers to an intractable diarrhea of intrauterine onset with high fecal sodium loss. CSD is clinically and genetically heterogeneous. A syndromic form of CSD features choanal and intestinal atresias as well as recurrent corneal erosions. Small bowel histology frequently detects an epithelial "tufting" dysplasia. It is autosomal recessively inherited, and caused by SPINT2 mutations. The nonsyndromic form of CSD can be caused by dominant activating mutations in GUCY2C, encoding intestinal receptor guanylate cyclase C (GC-C), and by autosomal recessive SLC9A3 loss-of-function mutations. SLC9A3 encodes Na/H antiporter 3, the major intestinal brush border Na/H exchanger, and a downstream target of GC-C. A number of patients with GUCY2C and SLC9A3 mutations developed inflammatory bowel disease. Both the number of recognized CDD forms as well as the number of underlying disease genes are gradually increasing. Knowledge of these CDD genes enables noninvasive, next-generation gene panel-based testing to facilitate an early diagnosis in CDD. Primary Na/H antiporter 3 and GC-C malfunction is implicated as a predisposition for inflammatory bowel disease in subset of patients.

  11. Questioning the Patient, Questioning Hippocrates: Rufus of Ephesus and the Pursuit of Knowledge.

    Science.gov (United States)

    Letts, Melinda

    2016-01-01

    Rufus of Ephesus' short treatise, Quaestiones Medicinales, the only ancient medical work that takes as its topic the dialogue between doctor and patient, has usually been seen as a procedural practical handbook serving an essentially operational purpose. In this paper I argue that the treatise, with its insistent message that doctors cannot properly understand and treat illnesses unless they supplement their own knowledge by questioning patients, and its remarkable appreciation of the singularity of each patient's experience, shows itself to be no mere handbook but a work addressing the place of questioning in the clinical encounter. I illustrate some of the differences between Rufus' conceptualisation of the relevance and use of questioning and that which can be seen in the theoretical and descriptive writings of Galen and in the Hippocratic corpus, and show how apparent resonances with some of the preoccupations of modern Western healthcare can be used judiciously to elucidate the significance of those differences.

  12. Good questions require good answers. Critics on current climate research contradicted

    International Nuclear Information System (INIS)

    Vellinga, P.; Van Dorland, R.; Kabat, P.

    2008-01-01

    In some of the previous issues of this magazine (Spil 2007, issue 4 and 5-6, and Spil 2008, issue 1) the authors Labohm, Roersch and Thoenes started a frontal attack of the greenhouse theory and the researchers who report on the state of science in the framework of the IPCC. The author of this article addresses two main questions arising from the above-mentioned authors: (1) Does the use of fossil fuels affect global climate?; and (2) Is the warming of the last 30 years related to the increasing concentrations of greenhouse gases in the atmosphere? [mk] [nl

  13. Structured Attentions for Visual Question Answering

    OpenAIRE

    Zhu, Chen; Zhao, Yanpeng; Huang, Shuaiyi; Tu, Kewei; Ma, Yi

    2017-01-01

    Visual attention, which assigns weights to image regions according to their relevance to a question, is considered as an indispensable part by most Visual Question Answering models. Although the questions may involve complex relations among multiple regions, few attention models can effectively encode such cross-region relations. In this paper, we demonstrate the importance of encoding such relations by showing the limited effective receptive field of ResNet on two datasets, and propose to mo...

  14. A Technique Socratic Questioning-Guided Discovery

    OpenAIRE

    M. Hakan Türkçapar; A. Emre Sargýn

    2012-01-01

    “Socratic Method” is a way of teaching philosophical thinking and knowledge by asking questions which was used by antique period greek philosopher Socrates. Socrates was teaching knowledge to his followers by asking questions and the conversation between them was named “Socratic Dialogues”. In this meaning, no novel knowledge is taught to the individual but only what is formerly known is reminded and rediscovered. The form of socratic questioning which is used during t...

  15. Traveling questions

    DEFF Research Database (Denmark)

    Hoeyer, Klaus

    2016-01-01

    In this paper, I argue that uncertainty and nonknowledge, and not just research results, can be important vehicles of translation through which genetic research participation comes to affect the lives of research participants. Based on interviews with participants in a genetic research project, I....... Research questions, and not just results, may serve as a generative form of knowledge that can travel as fast as any answer....

  16. Complete recovery from intractable complex regional pain syndrome, CRPS-type I, following anesthetic ketamine and midazolam.

    Science.gov (United States)

    Kiefer, Ralph-Thomas; Rohr, Peter; Ploppa, Annette; Altemeyer, Karl-Heinz; Schwartzman, Robert Jay

    2007-06-01

    To describe the treatment of an intractable complex regional pain syndrome I (CRPS-I) patient with anesthetic doses of ketamine supplemented with midazolam. A patient presented with a rapidly progressing contiguous spread of CRPS from a severe ligamentous wrist injury. Standard pharmacological and interventional therapy successively failed to halt the spread of CRPS from the wrist to the entire right arm. Her pain was unmanageable with all standard therapy. As a last treatment option, the patient was transferred to the intensive care unit and treated on a compassionate care basis with anesthetic doses of ketamine in gradually increasing (3-5 mg/kg/h) doses in conjunction with midazolam over a period of 5 days. On the second day of the ketamine and midazolam infusion, edema, and discoloration began to resolve and increased spontaneous movement was noted. On day 6, symptoms completely resolved and infusions were tapered. The patient emerged from anesthesia completely free of pain and associated CRPS signs and symptoms. The patient has maintained this complete remission from CRPS for 8 years now. In a patient with severe spreading and refractory CRPS, a complete and long-term remission from CRPS has been obtained utilizing ketamine and midazolam in anesthetic doses. This intensive care procedure has very serious risks but no severe complications occurred. The psychiatric side effects of ketamine were successfully managed with the concomitant use of midazolam and resolved within 1 month of treatment. This case report illustrates the effectiveness and safety of high-dose ketamine in a patient with generalized, refractory CRPS.

  17. Patterns of verbal learning and memory in children with intractable temporal lobe or frontal lobe epilepsy.

    Science.gov (United States)

    Fuentes, Amanda; Smith, Mary Lou

    2015-12-01

    The objective of this study was to provide a better understanding of the verbal learning and memory (VLM) patterns that might differentiate children with frontal lobe epilepsy (FLE) from children with temporal lobe epilepsy (TLE) and to examine the impact of variables thought to influence outcomes (seizure laterality, age at seizure onset, age at assessment, epilepsy duration, number of antiepileptic drugs). Retrospective analyses were carried out for children with intractable unilateral TLE (n=100) and FLE (n=27) who completed standardized measures of VLM entailing lists of single words or lists of word pairs. Mean intelligent quotients and VLM scores on single words fell within the average range for both groups, whereas scores fell within the low average to borderline range on word pairs. No significant overall differences in VLM were found between the group with TLE and the group with FLE. Older age at assessment and older age at seizure onset were generally associated with better VLM in both groups but were related to better performance in a number of indices in the group with TLE and only fewer intrusions in the group with FLE. The VLM profiles of children with TLE and FLE are generally similar. Older age at assessment and older age at seizure onset have a favorable impact on both groups but are related to better encoding, retrieval, and monitoring processes for the group with TLE and improved memory monitoring (i.e., as indicated by fewer intrusions) in the group with FLE. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Cosmetic Procedure Questions

    Science.gov (United States)

    ... for Every Season How to Choose the Best Skin Care Products In This Section Dermatologic Surgery What is dermatologic ... for Every Season How to Choose the Best Skin Care Products Cosmetic Procedure Questions Want to look younger? Start ...

  19. QUESTION ANSWERING SYSTEM DAN PENERAPANNYA PADA ALKITAB

    Directory of Open Access Journals (Sweden)

    Gunawan Gunawan

    2006-01-01

    Full Text Available Question answering system is a system that allows user to state his or her information need in the form of natural language question, and return short text excerpts or even phrases as an answer. The availability of a wide and various information source and improvements in the techniques of natural language processing, information extraction (wrapper, and information retrieval give a big effect on the development of question answering system, from just answering questions in a specific domain by consulting to structured information source such as database, and like in this research, answering any questions based on information stored in an unstructured text collection. A general architecture of question answering system based on text consists of six processing stages, i.e. question analysis, document collection preprocessing, candidate document selection, candidate document analysis, answer extraction, and response generation. Application of question answering system like AnswerBus, Mulder, and Webclopedia that are developed with its own characteristics has similar processing steps as in the general architecture. Answers returned by a question answering system need to be evaluated for performance measure. This research completed with a simple question answering system application using english Bible in World English Bible (WEB version as the source of information to answer some questions. Because specific domain is selected: Bible, questions that can be posed by user could ask about information in the Bible itself only. Question is also limited to three types of answers that can be supported by the application: person (who, location (where, and date (when. Abstract in Bahasa Indonesia : Question answering system (QA system adalah sistem yang mengijinkan user menyatakan kebutuhan informasinya dalam bentuk natural language question (pertanyaan dalam bahasa alami, dan mengembalikan kutipan teks singkat atau bahkan frase sebagai jawaban. Ketersediaan

  20. Association between framing of the research question using the PICOT format and reporting quality of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Thabane Lehana

    2010-02-01

    Full Text Available Abstract Background Experts recommend formulating a structured research question to guide the research design. However, the basis for this recommendation has not been formally evaluated. The aim of this study was to examine if a structured research question using the PICOT (Population, Intervention, Comparator, Outcome, Time-frame format is associated with a better reporting quality of randomized controlled trials (RCTs. Methods We evaluated 89 RCTs reports published in three endocrinology journals in 2005 and 2006, the quality of reporting of which was assessed in a previous study. We examined whether the reports stated each of the five elements of a structured research question: population, intervention, comparator, outcome and time-frame. A PICOT score was created with a possible score between 0 and 5. Outcomes were: 1 a 14-point overall reporting quality score (OQS based on the Consolidated Standards for Reporting Trials; and 2 a 3-point key score (KS, based on allocation concealment, blinding and use of intention-to-treat analysis. We conducted multivariable regression analyses using generalized estimating equations to determine if a higher PICOT score or the use of a structured research question were independently associated with a better reporting quality. Journal of publication, funding source and sample size were identified as factors associated with OQS in our previous report on this dataset, and therefore included in the model. Results A higher PICOT score was independently associated with OQS (incidence rate ratio (IRR = 1.021, 95% CI: 1.012 to 1.029 and KS (IRR = 1.142, 95% CI: 1.079 to 1.210. A structured research question was present in 33.7% of the reports and it was associated with a better OQS (IRR = 1.095, 95% CI 1.059-1.132 and KS (IRR = 1.530, 95% CI 1.311-1.786. Conclusions Better framing of the research question using the PICOT format is independently associated with better overall reporting quality - although the effect

  1. Frequently Asked Questions about Bunion Surgery

    Science.gov (United States)

    ... A | Print | Share Frequently Asked Questions About Bunion Surgery Here are some frequently asked questions (FAQs) and ... best for you. 5. How can I avoid surgery? Sometimes observation of the bunion is all that ...

  2. Impact of Students’ Class Attendance on Recalling Previously Acquired Information

    Directory of Open Access Journals (Sweden)

    Camellia Hemyari

    2018-03-01

    Full Text Available Background: In recent years, availability of class material including typed lectures, the professor’s Power Point slides, sound recordings, and even videos made a group of students feel that it is unnecessary to attend the classes. These students usually read and memorize typed lectures within two or three days prior to the exams and usually pass the tests even with low attendance rate. Thus, the question is how effective is this learning system and how long the one-night memorized lessons may last.Methods: A group of medical students (62 out of 106 students, with their class attendance and educational achievements in the Medical Mycology and Parasitology course being recorded since two years ago, was selected and their knowledge about this course was tested by multiple choice questions (MCQ designed based on the previous lectures.Results: Although the mean re-exam score of the students at the end of the externship was lower than the corresponding final score, a significant association was found between the scores of the students in these two exams (r=0.48, P=0.01. Moreover, a significant negative association was predicted between the number of absences and re-exam scores (r=-0.26, P=0.037.Conclusion: As our findings show, the phenomenon of recalling the acquired lessons is preserved for a long period of time and it is associated with the students’ attendance. Many factors including generation effect (by taking notes and cued-recall (via slide picture might play a significant role in the better recalling of the learned information in students with good class attendance.Keywords: STUDENT, MEMORY, LONG-TERM, RECALL, ABSENTEEISM, LEARNING

  3. New treatments of hereditary blindness

    DEFF Research Database (Denmark)

    Bertelsen, Mette; Rosenberg, Thomas; Larsen, Michael

    2013-01-01

    Ongoing clinical trials are targeting several previously intractable hereditary causes of blindness of congenital, childhood or early adulthood onset, mainly in the optic nerve and retina. The intended stage of initiation of the new therapeutic approaches ranges from neonatal life and a structura......Ongoing clinical trials are targeting several previously intractable hereditary causes of blindness of congenital, childhood or early adulthood onset, mainly in the optic nerve and retina. The intended stage of initiation of the new therapeutic approaches ranges from neonatal life...... and a structurally intact retinal tissue to adult life with a complete loss of photoreceptors. It must be assumed that some of the trials will succeed in producing new therapies and action must be taken to refine and accelerate diagnostics and to preserve therapeutic potential in blind people....

  4. Finding Question-Answer Pairs from Online Forums

    DEFF Research Database (Denmark)

    Cong, Gao; Wang, Long; Lin, Chin-Yew

    2008-01-01

    Online forums contain a huge amount of valuable user generated content. In this paper we address the problem of extracting question-answer pairs from forums. Question-answer pairs extracted from forums can be used to help Question Answering services (e.g. Yahoo! Answers) among other applications...

  5. How to…write a good research question

    NARCIS (Netherlands)

    Mattick, Karen; Johnston, Jenny; de la Croix, Anne

    This paper, on writing research questions, is the first in a series that aims to support novice researchers within clinical education, particularly those undertaking their first qualitative study. Put simply, a research question is a question that a research project sets out to answer. Most research

  6. The Socratic Method and Levels of Questioning.

    Science.gov (United States)

    Watson, Karilee

    1980-01-01

    Determines if instruction in the Socratic method would increase higher level questioning during peer teaching experiences in teacher education programs. Raters, using the higher order questioning strategy, evaluated 14 students. A significant increase in higher level questions being asked suggests the Socratic Method may be useful. (Author)

  7. [The Terminal Phase of an Intractable Neurological Disease from the Viewpoint of Nursing Care: The Importance of the Promotion of a Barrier-Free Mind for ALS Care].

    Science.gov (United States)

    Muraoka, Koko

    2015-08-01

    Amyotrophic lateral sclerosis (ALS) is a particularly serious intractable neurological disease. Patients with ALS have high mortality rates if they are not put on an artificial respirator. Even with an artificial respirator, individuals with ALS are forced to witness their own physical deterioration. Because 24 hour care is usually required, an intense relationship ofter develops between patients with ALS and family caregivers. This relationship forms an invisible barrier and can impede a smooth introduction of external services. As a result, there can be a degradation in the quality of care. The purpose of this paper is to describe the voluntary efforts of patients and family caregivers in order to break down this barrier and to discuss what types of care support are available to promote barrier-free minds.

  8. Multinuclear solid-state nuclear magnetic resonance of inorganic materials

    CERN Document Server

    MacKenzie, Kenneth J D

    2002-01-01

    Techniques of solid state nuclear magnetic resonance (NMR) spectroscopy are constantly being extended to a more diverse range of materials, pressing into service an ever-expanding range of nuclides including some previously considered too intractable to provide usable results. At the same time, new developments in both hardware and software are being introduced and refined. This book covers the most important of these new developments. With sections addressed to non-specialist researchers (providing accessible answers to the most common questions about the theory and practice of NMR asked by novices) as well as a more specialised and up-to-date treatment of the most important areas of inorganic materials research to which NMR has application, this book should be useful to NMR users whatever their level of expertise and whatever inorganic materials they wish to study.

  9. Question Answering for Dutch : Simple does it

    NARCIS (Netherlands)

    Hoekstra, A.H.; Hiemstra, Djoerd; van der Vet, P.E.; Huibers, Theo W.C.; Schobbens, Pierre-Yves; Vanhoof, Wim; Schwanen, Gabriel

    2006-01-01

    When people pose questions in natural language to search for information on the web, the role of question answering (QA) systems becomes important. In this paper the QAsystem simpleQA, capable of answering Dutch questions on which the answer is a person or a location, is described. The system's

  10. A framework for laboratory pre-work based on the concepts, tools and techniques questioning method

    International Nuclear Information System (INIS)

    Huntula, J; Sharma, M D; Johnston, I; Chitaree, R

    2011-01-01

    Learning in the laboratory is different from learning in other contexts because students have to engage with various aspects of the practice of science. They have to use many skills and knowledge in parallel-not only to understand the concepts of physics but also to use the tools and analyse the data. The question arises, how to best guide students' learning in the laboratory. This study is about creating and using questions with a specifically designed framework to aid learning in the laboratory. The concepts, tools and techniques questioning (CTTQ) method was initially designed and used at Mahidol University, Thailand, and was subsequently extended to laboratory pre-work at the University of Sydney. The CTTQ method was implemented in Sydney with 190 first-year students. Three pre-work exercises on a series of electrical experiments were created based on the CTTQ method. The pre-works were completed individually and submitted before the experiment started. Analysed pre-work, surveys and interviews were used to evaluate the pre-work questions in this study. The results indicated that the CTTQ method was successful and the flow in the experiments was better than that in the previous year. At the same time students had difficulty with the last experiment in the sequence and with techniques.

  11. "I didn't write the questions!" - Negotiating telephone-survey questions on birth timing

    Directory of Open Access Journals (Sweden)

    Marian May

    2008-06-01

    Full Text Available This paper examines interviewer-respondent interaction in the collection of demographic data. Conversation analysis (CA makes transparent the interaction between an interviewer and 25 respondents on a question about pregnancy and birth timing in an Australian telephone survey, Negotiating the Life Course. The analysis focuses on the troubles that occur and the work interviewers do to fit respondents' answers to the survey researcher's categories. Interviewers are shown to act as mediators in difficult interaction, with responses often distorted by question format, the imperative of achieving an allowed response, and the need to keep the respondent in the survey.

  12. Radiography and scanner: let us ask the right questions

    International Nuclear Information System (INIS)

    2012-07-01

    By answering simple questions, this document proposes a brief overview of radiographic and scanner-based examinations. It recalls that these both techniques use X rays, the cumulative dose of which could slightly increase a risk of cancer on a long term. It outlines that the benefits of these examinations are much more important that the related risks. It indicates the received dose (compared to a daily natural irradiation) for different kinds of examination and for different parts of the human body. It outlines the sensitivity of children to X rays, gives some recommendations regarding these examinations (they are not automatic; the doctor must explain why he chooses them, previous examinations and photos must be kept and brought with; the received dose must be specified in the examination report)

  13. Do emotional intelligence and previous caring experience influence student nurse performance? A comparative analysis.

    Science.gov (United States)

    Stenhouse, Rosie; Snowden, Austyn; Young, Jenny; Carver, Fiona; Carver, Hannah; Brown, Norrie

    2016-08-01

    Reports of poor nursing care have focused attention on values based selection of candidates onto nursing programmes. Values based selection lacks clarity and valid measures. Previous caring experience might lead to better care. Emotional intelligence (EI) might be associated with performance, is conceptualised and measurable. To examine the impact of 1) previous caring experience, 2) emotional intelligence 3) social connection scores on performance and retention in a cohort of first year nursing and midwifery students in Scotland. A longitudinal, quasi experimental design. Adult and mental health nursing, and midwifery programmes in a Scottish University. Adult, mental health and midwifery students (n=598) completed the Trait Emotional Intelligence Questionnaire-short form and Schutte's Emotional Intelligence Scale on entry to their programmes at a Scottish University, alongside demographic and previous caring experience data. Social connection was calculated from a subset of questions identified within the TEIQue-SF in a prior factor and Rasch analysis. Student performance was calculated as the mean mark across the year. Withdrawal data were gathered. 598 students completed baseline measures. 315 students declared previous caring experience, 277 not. An independent-samples t-test identified that those without previous caring experience scored higher on performance (57.33±11.38) than those with previous caring experience (54.87±11.19), a statistically significant difference of 2.47 (95% CI, 0.54 to 4.38), t(533)=2.52, p=.012. Emotional intelligence scores were not associated with performance. Social connection scores for those withdrawing (mean rank=249) and those remaining (mean rank=304.75) were statistically significantly different, U=15,300, z=-2.61, p$_amp_$lt;0.009. Previous caring experience led to worse performance in this cohort. Emotional intelligence was not a useful indicator of performance. Lower scores on the social connection factor were associated

  14. Designing effective questions for classroom response system teaching

    Science.gov (United States)

    Beatty, Ian D.; Gerace, William J.; Leonard, William J.; Dufresne, Robert J.

    2006-01-01

    Classroom response systems can be powerful tools for teaching physics. Their efficacy depends strongly on the quality of the questions. Creating effective questions is difficult and differs from creating exam and homework problems. Each classroom response system question should have an explicit pedagogic purpose consisting of a content goal, a process goal, and a metacognitive goal. Questions can be designed to fulfill their purpose through four complementary mechanisms: directing students' attention, stimulating specific cognitive processes, communicating information to the instructor and students via classroom response system-tabulated answer counts, and facilitating the articulation and confrontation of ideas. We identify several tactics that are useful for designing potent questions and present four "makeovers" to show how these tactics can be used to convert traditional physics questions into more powerful questions for a classroom response system.

  15. Cannabis and intractable chronic pain: an explorative retrospective analysis of Italian cohort of 614 patients.

    Science.gov (United States)

    Fanelli, Guido; De Carolis, Giuliano; Leonardi, Claudio; Longobardi, Adele; Sarli, Ennio; Allegri, Massimo; Schatman, Michael E

    2017-01-01

    Despite growing interest in the therapeutic use of cannabis to manage chronic pain, only limited data that address these issues are available. In recent years, a number of nations have introduced specific laws to allow patients to use cannabis preparations to treat a variety of medical conditions. In 2015, the Italian government authorized the use of cannabis to treat several diseases, including chronic pain generally, spasticity in multiple sclerosis, cachexia and anorexia among AIDS and cancer patients, glaucoma, Tourette syndrome, and certain types of epilepsy. We present the first snapshot of the Italian experience with cannabis use for chronic pain over the initial year of its use. This is a retrospective case series analysis of all chronic pain patients treated with oral or vaporized cannabis in six hubs during the initial year following the approval of the new Italian law (December 2015 to November 2016). We evaluated routes of administration, types of cannabis products utilized, dosing, and effectiveness and safety of the treatment. As only one of the six centers has extensively used cannabinoids for intractable chronic pain (614 patients of 659), only the population from Azienda Ospedaliero Universitaria Pisana (Pisa) was considered. Cannabis tea was the primary mode of delivery, and in almost all cases, it was used in association with all the other pain treatments. Initial and follow-up cannabinoid concentrations were found to vary considerably. At initial follow-up, 76.2% of patients continued the treatment, and <15% stopped the treatment due to side effects (none of which were severe). We present the first analysis of Italian clinical practice of the use of cannabinoids for a large variety of chronic pain syndromes. From this initial snapshot, we determined that the treatment seems to be effective and safe, although more data and subsequent trials are needed to better investigate its ideal clinical indication.

  16. Cannabis and intractable chronic pain: an explorative retrospective analysis of Italian cohort of 614 patients

    Science.gov (United States)

    Fanelli, Guido; De Carolis, Giuliano; Leonardi, Claudio; Longobardi, Adele; Sarli, Ennio; Allegri, Massimo; Schatman, Michael E

    2017-01-01

    Background Despite growing interest in the therapeutic use of cannabis to manage chronic pain, only limited data that address these issues are available. In recent years, a number of nations have introduced specific laws to allow patients to use cannabis preparations to treat a variety of medical conditions. In 2015, the Italian government authorized the use of cannabis to treat several diseases, including chronic pain generally, spasticity in multiple sclerosis, cachexia and anorexia among AIDS and cancer patients, glaucoma, Tourette syndrome, and certain types of epilepsy. We present the first snapshot of the Italian experience with cannabis use for chronic pain over the initial year of its use. Methods This is a retrospective case series analysis of all chronic pain patients treated with oral or vaporized cannabis in six hubs during the initial year following the approval of the new Italian law (December 2015 to November 2016). We evaluated routes of administration, types of cannabis products utilized, dosing, and effectiveness and safety of the treatment. Results As only one of the six centers has extensively used cannabinoids for intractable chronic pain (614 patients of 659), only the population from Azienda Ospedaliero Universitaria Pisana (Pisa) was considered. Cannabis tea was the primary mode of delivery, and in almost all cases, it was used in association with all the other pain treatments. Initial and follow-up cannabinoid concentrations were found to vary considerably. At initial follow-up, 76.2% of patients continued the treatment, and <15% stopped the treatment due to side effects (none of which were severe). Conclusion We present the first analysis of Italian clinical practice of the use of cannabinoids for a large variety of chronic pain syndromes. From this initial snapshot, we determined that the treatment seems to be effective and safe, although more data and subsequent trials are needed to better investigate its ideal clinical indication. PMID

  17. 30 CFR 250.1200 - Question index table.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Question index table. 250.1200 Section 250.1200 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR... Security § 250.1200 Question index table. The table in this section lists questions concerning Oil and Gas...

  18. Questions and dependency in intuitionistic logic

    NARCIS (Netherlands)

    Ciardelli, Ivano; Iemhoff, Rosalie; Yang, Fan

    2017-01-01

    In recent years, the logic of questions and dependencies has been investigated in the closely related frameworks of inquisitive logic and dependence logic. These investigations have assumed classical logic as the background logic of statements, and added formulas expressing questions and

  19. Questions and Answers About Nuclear Power Plants.

    Science.gov (United States)

    Environmental Protection Agency, Washington, DC.

    This pamphlet is designed to answer many of the questions that have arisen about nuclear power plants and the environment. It is organized into a question and answer format, with the questions taken from those most often asked by the public. Topics include regulation of nuclear power sources, potential dangers to people's health, whether nuclear…

  20. Up-regulated BAFF and BAFF receptor expression in patients with intractable temporal lobe epilepsy and a pilocarpine-induced epilepsy rat model.

    Science.gov (United States)

    Ma, Limin; Li, Ruohan; Huang, Hao; Yuan, Jinxian; Ou, Shu; Xu, Tao; Yu, Xinyuan; Liu, Xi; Chen, Yangmei

    2017-05-01

    Some studies have suggested that BAFF and BAFFR are highly expressed in the central nervous system (CNS) and participate in inflammatory and immune associated diseases. However, whether BAFF and BAFFR are involved in the pathogenesis of epilepsy remains unknown. This study aimed to investigate the expression of BAFF and BAFFR proteins in the brains of patients with temporal lobe epilepsy (TLE) and in a pilocarpine-induced rat model of TLE to identify possible roles of the BAFF-BAFFR signaling pathway in epileptogenesis. Real-time quantitative polymerase chain reaction (RT-qPCR), western blot, immunohistochemistry, and double-immunofluorescence were performed in this study. The results showed that BAFF and BAFFR expression levels were markedly up-regulated in intractable TLE patients and TLE rats. Moreover, BAFF and BAFFR proteins mainly highly expressed in the membranes and cytoplasms of the dendritic marker MAP2 in the cortex and hippocampus. Therefore, the significant increased in BAFF and BAFFR protein expression in both TLE patients and rats suggest that BAFF and BAFFR may play important roles in regulating the pathogenesis of epilepsy. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  1. The Relationship between Feelings-of-Knowing and Partial Knowledge for General Knowledge Questions.

    Science.gov (United States)

    Norman, Elisabeth; Blakstad, Oskar; Johnsen, Øivind; Martinsen, Stig K; Price, Mark C

    2016-01-01

    Feelings of knowing (FoK) are introspective self-report ratings of the felt likelihood that one will be able to recognize a currently unrecallable memory target. Previous studies have shown that FoKs are influenced by retrieved fragment knowledge related to the target, which is compatible with the accessibility hypothesis that FoK is partly based on currently activated partial knowledge about the memory target. However, previous results have been inconsistent as to whether or not FoKs are influenced by the accuracy of such information. In our study (N = 26), we used a recall-judge-recognize procedure where stimuli were general knowledge questions. The measure of partial knowledge was wider than those applied previously, and FoK was measured before rather than after partial knowledge. The accuracy of reported partial knowledge was positively related to subsequent recognition accuracy, and FoK only predicted recognition on trials where there was correct partial knowledge. Importantly, FoK was positively related to the amount of correct partial knowledge, but did not show a similar incremental relation with incorrect knowledge.

  2. US fertility prevention as poverty prevention: an empirical question and social justice issue.

    Science.gov (United States)

    Romero, Diana; Agénor, Madina

    2009-01-01

    This paper examines the impact of the US welfare reform family-cap policy on the childbearing decisions of poor and low-income women by posing two complementary questions, both placed within a broader historical context. Specifically, it raises an empirical question pertaining to the family cap's effectiveness and a social justice question pertaining to the policy's ethical and legal justification in terms of human and reproductive rights. To address the first question, a thorough review of past and current research pertaining to the family cap at both the state and national levels is provided. The second question is addressed with an overview of international human and reproductive rights documents of relevance to the family-cap policy, as well as an analysis of the covenants' numerous components with which the family cap is in conflict. Finally, this paper situates the family cap in its historical context by investigating previous governmental attempts to control and regulate the reproductive health and rights of poor women and women of color in the United States. The majority of empirical analyses of the family cap have found that the policy has not had an impact on poor women's reproductive health behaviors. In addition, the exclusive application of this policy to poor women receiving cash assistance is demonstrated to be in violation of eight international human and reproductive rights documents, several of which the US is a signatory. These two findings make a strong case that policy makers and social and health researchers alike critically reexamine whether a policy that has not achieved its ostensible goal and is applied in a disparate manner-primarily to poor women and families and women of color-should continue to be implemented by the states.

  3. How do 5-year-olds understand questions?

    DEFF Research Database (Denmark)

    Sauerland, Uli; Grohmann, Kleanthes; Teresa Guasti, Maria

    2016-01-01

    developing children across 19 European countries, 18 different languages, and 7 language (sub-)families. The study investigated the effects of two factors on question formation: (a) whether the question contains a simple interrogative word like ‘who’ or a complex one like ‘which princess’, and (b) whether......The comprehension of constituent questions is an important topic for language acquisition research and for applications in the diagnosis of language impairment. This article presents the results of a study investigating the comprehension of different types of questions by 5-year-old, typically...... the question word was related to the sentential subject or object position of the verb. The findings show that there is considerable variation among languages, but the two factors mentioned consistently affect children’s performance. The cross-linguistic variation shows that three linguistic factors facilitate...

  4. Environmental Ethics: Questions for Adult Education.

    Science.gov (United States)

    Parker, Jenneth

    1993-01-01

    Presents a series of questions through which adult educators can explore controversial questions of environmental values and moral behavior in their programs. The subjects include geography, local history, natural history, economics, politics, business, labor education, world affairs, literature, women's studies, psychology, and courses for the…

  5. From Question Answering to Visual Exploration

    Energy Technology Data Exchange (ETDEWEB)

    McColgin, Dave W.; Gregory, Michelle L.; Hetzler, Elizabeth G.; Turner, Alan E.

    2006-08-11

    Research in Question Answering has focused on the quality of information retrieval or extraction using the metrics of precision and recall to judge success; these metrics drive toward finding the specific best answer(s) and are best supportive of a lookup type of search. These do not address the opportunity that users? natural language questions present for exploratory interactions. In this paper, we present an integrated Question Answering environment that combines a visual analytics tool for unstructured text and a state-of-the-art query expansion tool designed to compliment the cognitive processes associated with an information analysts work flow. Analysts are seldom looking for factoid answers to simple questions; their information needs are much more complex in that they may be interested in patterns of answers over time, conflicting information, and even related non-answer data may be critical to learning about a problem or reaching prudent conclusions. In our visual analytics tool, questions result in a comprehensive answer space that allows users to explore the variety within the answers and spot related information in the rest of the data. The exploratory nature of the dialog between the user and this system requires tailored evaluation methods that better address the evolving user goals and counter cognitive biases inherent to exploratory search tasks.

  6. Cochrane Qualitative and Implementation Methods Group guidance series-paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis.

    Science.gov (United States)

    Harris, Janet L; Booth, Andrew; Cargo, Margaret; Hannes, Karin; Harden, Angela; Flemming, Kate; Garside, Ruth; Pantoja, Tomas; Thomas, James; Noyes, Jane

    2018-05-01

    This paper updates previous Cochrane guidance on question formulation, searching, and protocol development, reflecting recent developments in methods for conducting qualitative evidence syntheses to inform Cochrane intervention reviews. Examples are used to illustrate how decisions about boundaries for a review are formed via an iterative process of constructing lines of inquiry and mapping the available information to ascertain whether evidence exists to answer questions related to effectiveness, implementation, feasibility, appropriateness, economic evidence, and equity. The process of question formulation allows reviewers to situate the topic in relation to how it informs and explains effectiveness, using the criterion of meaningfulness, appropriateness, feasibility, and implementation. Questions related to complex questions and interventions can be structured by drawing on an increasingly wide range of question frameworks. Logic models and theoretical frameworks are useful tools for conceptually mapping the literature to illustrate the complexity of the phenomenon of interest. Furthermore, protocol development may require iterative question formulation and searching. Consequently, the final protocol may function as a guide rather than a prescriptive route map, particularly in qualitative reviews that ask more exploratory and open-ended questions. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. 'Any questions?'--Clinicians' usage of invitations to ask questions (IAQs) in outpatient plastic surgery consultations.

    Science.gov (United States)

    Bristowe, Katherine; Patrick, Peter L

    2014-12-01

    To explore use of 'Invitations to Ask Questions' (IAQs) by plastic surgeons in outpatient consultations, and consider how type of IAQ impacts on patients' responses to, and recollection of, IAQs. Descriptive study: 63 patients were audio recorded in consultation with 5 plastic surgeons, and completed a brief questionnaire immediately after the consultation. Consultation transcripts were analyzed using inductive qualitative methods of Discourse Analysis and compared with questionnaire findings. A taxonomy of IAQs was developed, including three types of IAQ (Overt, Covert, and Borderline). Overt IAQs were rarely identified, and almost all IAQs occurred in the closing stages of the consultation. However, when an overt IAQ was used, patients always recollected being asked if they had any questions after the consultation. Patients are rarely explicitly offered the opportunity to ask questions. When this does occur, it is often in the closing stages of the consultation. Clinicians should openly encourage patients to ask questions frequently throughout the consultation, and be mindful that subtle differences in construction of these utterances may impact upon interpretation. Clear communication, of message and intention, is essential in clinical encounters to minimize misunderstanding, misinterpretation, or missed opportunities for patients to raise concerns. Copyright © 2014. Published by Elsevier Ireland Ltd.

  8. Probability of climatic change. Identification of key questions

    International Nuclear Information System (INIS)

    Fransen, W.

    1995-01-01

    Addressing the question what the probability is of an anthropogenically induced change in the climate, leads to a number of other, underlying questions. These questions, which deal with the characteristics of climate, of climatic change, and of probabilistic statements on climatic change, should be addressed first. The long-term objective of the underlying study, i.e. a quantitative assessment of the risks and opportunities of the predicted climatic change, sets the context against which of those questions should be answered. In addition, this context induces extra questions, i.e. about the characteristics of risk

  9. Question-answer sequences in survey interviews

    NARCIS (Netherlands)

    Dijkstra, W.; Ongena, Y.P.

    2006-01-01

    Interaction analysis was used to analyze a total of 14,265 question-answer sequences of (Q-A Sequences) 80 questions that originated from two face-to-face and three telephone surveys. The analysis was directed towards the causes and effects of particular interactional problems. Our results showed

  10. HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

    Directory of Open Access Journals (Sweden)

    R. Sh. Saitgareev

    2016-01-01

    cited in the review may have important clinical applications, because they outline the range of problems and possible solutions in the performance of the HTx in recipients previously operated on open heart. This knowledge can facilitate the decision making process with regard to the opportunities and risks of the implementation of HTx. Given the uniqueness of each of the recipient and the donor, it is required to make a personalized approach to the question of the possible risks and to the preventive measures to reduce those risks in any given clinical situation. 

  11. Question Word in the Mandarin Language

    Directory of Open Access Journals (Sweden)

    Xu Yunyu

    2016-12-01

    Full Text Available In an interrogative sentence in Mandarin language, a question word can be placed in the beginning, middle or end of a sentence. Because of the different nation and culture, when a foreign student learns Mandarin, they find it difficult to understand the question words and the position of the question words in that language. Because of that, the writer proposes to explain such problems. This research aims to find out what are the types of question words in Mandarin, and also to explain the function and usage of question words in the Mandarin interrogative sentence. An interrogative sentence is a very important sentence. In Mandarin, the following question words: 谁(shuí “Who”,在哪里(zài nǎli “where”, 在哪儿(zài nǎ’er “where”,为什么(wèi shénme “why”, 怎么(zěnme “why”,多少(duō shǎo) “how many”,多久(duō jiǔ “how long”,什么时候 (shénme shíhòu “when”,什么(shénme “what”,做什么(zuò shénme “why”,干 什么(gàn shénme “why”,干嘛(gànma “why” and so on are used to ask “who”, “where”, “what”, “how much”, “when”, “what time”, and “why”. Those words have different functions and usage. Each sentence has a certain structure and word order. A question word can be placed in the beginning, middle, or end of a sentence. When the place is changed, there is a possibility of miscommunication.   DOI: https://doi.org/10.24071/llt.2013.160106

  12. Laparoscopy After Previous Laparotomy

    Directory of Open Access Journals (Sweden)

    Zulfo Godinjak

    2006-11-01

    Full Text Available Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previouslaparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.

  13. Reversal of laryngotracheal separation in paediatric patients.

    LENUS (Irish Health Repository)

    Young, Orla

    2012-02-01

    OBJECTIVE: Laryngotracheal separation (LTS) is an effective and reliable definitive treatment for intractable aspiration. A major advantage of this treatment for intractable aspiration is its\\' potential reversibility. Should the underlying disorder improve, a reversal of the procedure may be attempted. This has been successfully achieved in the adult population. To our knowledge, no previous cases have been reported of successful reversal of LTS in children. METHODS: A retrospective review from 2003 to 2010 identified four cases of intractable aspiration treated with LTS in our department. Two of these patients displayed objective evidence of sufficient recovery of their underlying aspiration to consider reversal. Patient selection for reversal was dependent upon successful oral intake for 9 months along with videofluoroscopic evidence of normal or minimally impaired swallow. RESULTS: Two children who were successfully treated for intractable aspiration with LTS demonstrated objective evidence of recovery sufficient to attempt reversal. Both children underwent successful surgical reversal of LTS using a cricotracheal resection with end-to-end anastamosis, similar to that used in treatment of subglottic stenosis. Both children can now tolerate oral diet and their speech and language development is in line with their overall developmental level. CONCLUSIONS: Laryngotracheal separation is an effective and reliable definitive treatment for intractable aspiration facilitating protection of the airway and allowing safe swallowing with unimpeded respiration, but with the major drawback of loss of phonation. To our knowledge, we document the first two cases of successful LTS reversal in children.

  14. Academic Oversight: Asking Questions, Building Bridges

    Science.gov (United States)

    Wilson, E. B.

    2011-01-01

    The best way for trustees to fully understand and fulfill their responsibility to ensure that their institution is providing quality education and meeting academic goals is by asking appropriate questions. Collaboration among trustees, faculty members, and administrators is essential to framing questions from a strategic perspective. Just the act…

  15. 37 CFR 354.2 - Novel questions.

    Science.gov (United States)

    2010-07-01

    ... of law, referral to the Register of Copyrights by the Copyright Royalty Judges is mandatory. A “novel... discretionary referral of material questions of copyright law to the Register of Copyrights by the Copyright... Copyrights in resolving material questions of substantive law is binding upon the Copyright Royalty Judges...

  16. Heterologous embryo transfer: Magisterial answers and metaphysical questions.

    Science.gov (United States)

    Accad, Michel

    2014-02-01

    The debate regarding the morality of heterologous embryo transfer (HET) as a solution for the fate of cryopreserved embryos remains active. This paper endeavors to show that the magisterial instructions on bioethical issues can only lead to the conclusion that HET is always morally illicit. I begin by showing that the text of Dignitas personae recognizes HET as a procedure accomplishing a procreative function, and I indicate that it is through gestation that this procreative function occurs. I further show that the previous Instruction, Donum vitae, implicitly points to an ontological or spiritual consideration at play during gestation. This consideration is likely related to the procreative function identified in Dignitas personae. Finally, I place these two textual arguments in the context of the debate concerning HET and conclude that metaphysical questions must be clarified in order for the immorality of HET to be understood from a suitable anthropological perspective and gain more widespread acceptance.

  17. Robustness Analysis of Visual QA Models by Basic Questions

    KAUST Repository

    Huang, Jia-Hong

    2017-09-14

    Visual Question Answering (VQA) models should have both high robustness and accuracy. Unfortunately, most of the current VQA research only focuses on accuracy because there is a lack of proper methods to measure the robustness of VQA models. There are two main modules in our algorithm. Given a natural language question about an image, the first module takes the question as input and then outputs the ranked basic questions, with similarity scores, of the main given question. The second module takes the main question, image and these basic questions as input and then outputs the text-based answer of the main question about the given image. We claim that a robust VQA model is one, whose performance is not changed much when related basic questions as also made available to it as input. We formulate the basic questions generation problem as a LASSO optimization, and also propose a large scale Basic Question Dataset (BQD) and Rscore (novel robustness measure), for analyzing the robustness of VQA models. We hope our BQD will be used as a benchmark for to evaluate the robustness of VQA models, so as to help the community build more robust and accurate VQA models.

  18. Robustness Analysis of Visual QA Models by Basic Questions

    KAUST Repository

    Huang, Jia-Hong; Alfadly, Modar; Ghanem, Bernard

    2017-01-01

    Visual Question Answering (VQA) models should have both high robustness and accuracy. Unfortunately, most of the current VQA research only focuses on accuracy because there is a lack of proper methods to measure the robustness of VQA models. There are two main modules in our algorithm. Given a natural language question about an image, the first module takes the question as input and then outputs the ranked basic questions, with similarity scores, of the main given question. The second module takes the main question, image and these basic questions as input and then outputs the text-based answer of the main question about the given image. We claim that a robust VQA model is one, whose performance is not changed much when related basic questions as also made available to it as input. We formulate the basic questions generation problem as a LASSO optimization, and also propose a large scale Basic Question Dataset (BQD) and Rscore (novel robustness measure), for analyzing the robustness of VQA models. We hope our BQD will be used as a benchmark for to evaluate the robustness of VQA models, so as to help the community build more robust and accurate VQA models.

  19. "Wh"-Questions in the English Language

    Science.gov (United States)

    Mowarin, Macaulay

    2011-01-01

    This paper analyzes "wh"-questions in the English Language based mainly on Chomsky's Minimalist Programme of transformational grammar as the theoretical model. The four main objectives of this paper are as follows: first, it undertakes a cross linguistic typological analysis of "wh"-questions and it then discusses the derivation of…

  20. Three Key Questions on Measuring Learning

    Science.gov (United States)

    McTighe, Jay

    2018-01-01

    The author examines three essential questions on educational assessment: What really matters in a contemporary education? How should we assess those things that matter? How might our assessments enhance learning that matters, not just measure it? In answering these question, he argues that schools need a broader collection of measures, with a…

  1. The acquisition of wh-questions in Russian

    Directory of Open Access Journals (Sweden)

    Nina Rojina

    2005-02-01

    Full Text Available In this paper, I study the acquisition of wh-questions in Russian by one Russian-speaking child from an early stage of syntactic development. For my analysis, I follow Plunkett (1992:73 in adopting a weak version of the Continuity Hypothesis where all the principles of UG are available from the outset of the acquisition process, but the structure of the functional template must be built up before parameter setting can begin. I adopt this hypothesis due to its compatibility with my finding that in the acquisition of Russian wh-questions, the functional projection CP appears at a later stage of syntactic development than other functional projections. Following Plunkett, I assume that in the beginning, the landing site for the wh-word is [Spec,TP] and later, for the valuation of other features (such as finiteness, the child is forced to acquire another functional projection (CP in order to create a landing site for the wh-word. The analysis shows that the first wh-questions acquired by the child are wh-complement questions. The child starts to produce subject wh-questions when the CP projection is acquired, and by the age of 2;4.14, the child’s structure of wh-questions is close to that of adult speech.

  2. Semi-automated categorization of open-ended questions

    Directory of Open Access Journals (Sweden)

    Matthias Schonlau

    2016-08-01

    Full Text Available Text data from open-ended questions in surveys are difficult to analyze and are frequently ignored. Yet open-ended questions are important because they do not constrain respondents’ answer choices. Where open-ended questions are necessary, sometimes multiple human coders hand-code answers into one of several categories. At the same time, computer scientists have made impressive advances in text mining that may allow automation of such coding. Automated algorithms do not achieve an overall accuracy high enough to entirely replace humans. We categorize open-ended questions soliciting narrative responses using text mining for easy-to-categorize answers and humans for the remainder using expected accuracies to guide the choice of the threshold delineating between “easy” and “hard”. Employing multinomial boosting avoids the common practice of converting machine learning “confidence scores” into pseudo-probabilities. This approach is illustrated with examples from open-ended questions related to respondents’ advice to a patient in a hypothetical dilemma, a follow-up probe related to respondents’ perception of disclosure/privacy risk, and from a question on reasons for quitting smoking from a follow-up survey from the Ontario Smoker’s Helpline. Targeting 80% combined accuracy, we found that 54%-80% of the data could be categorized automatically in research surveys.

  3. Total hip arthroplasty after a previous pelvic osteotomy: A systematic review and meta-analysis.

    Science.gov (United States)

    Shigemura, T; Yamamoto, Y; Murata, Y; Sato, T; Tsuchiya, R; Wada, Y

    2018-06-01

    There are several reports regarding total hip arthroplasty (THA) after a previous pelvic osteotomy (PO). However, to our knowledge, until now there has been no formal systematic review and meta-analysis published to summarize the clinical results of THA after a previous PO. Therefore, we conducted a systematic review and meta-analysis of results of THA after a previous PO. We focus on these questions as follows: does a previous PO affect the results of subsequent THA, such as clinical outcomes, operative time, operative blood loss, and radiological parameters. Using PubMed, Web of Science, and Cochrane Library, we searched for relevant original papers. The pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. Eleven studies were included in this meta-analysis. The pooled results indicated that there was no significant difference in postoperative Merle D'Aubigne-Postel score (I 2 =0%, SMD=-0.15, 95% CI: -0.36 to 0.06, p=0.17), postoperative Harris hip score (I 2 =60%, SMD=-0.23, 95% CI: -0.50 to 0.05, p=0.10), operative time (I 2 =86%, SMD=0.37, 95% CI: -0.09 to 0.82, p=0.11), operative blood loss (I 2 =82%, SMD=0.23, 95% CI: -0.17 to 0.63, p=0.25), and cup abduction angle (I 2 =43%, SMD=-0.08, 95% CI: -0.25 to 0.09, p=0.38) between THA with and without a previous PO. However, cup anteversion angle of THA with a previous PO was significantly smaller than that of without a previous PO (I 2 =77%, SMD=-0.63, 95% CI: -1.13 to -0.13, p=0.01). Systematic review and meta-analysis of results of THA after a previous PO was performed. A previous PO did not affect the results of subsequent THA, except for cup anteversion. Because of the low quality evidence currently available, high-quality randomized controlled trials are required

  4. Efficacy and safety of cyclic pyranopterin monophosphate substitution in severe molybdenum cofactor deficiency type A : a prospective cohort study

    NARCIS (Netherlands)

    Schwahn, Bernd C.; Van Spronsen, Francjan J.; Belaidi, Abdel A.; Bowhay, Stephen; Christodoulou, John; Derks, Terry G.; Hennermann, Julia B.; Jameson, Elisabeth; Koenig, Kai; McGregor, Tracy L.; Font-Montgomery, Esperanza; Santamaria-Araujo, Jose A.; Santra, Saikat; Vaidya, Mamta; Vierzig, Anne; Wassmer, Evangeline; Weis, Ilona; Wong, Flora Y.; Veldman, Alex; Schwarz, Guenter

    2015-01-01

    Background Molybdenum cofactor deficiency (MoCD) is characterised by early, rapidly progressive postnatal encephalopathy and intractable seizures, leading to severe disability and early death. Previous treatment attempts have been unsuccessful. After a pioneering single treatment we now report the

  5. The Effects of Secret Instructions and Yes/no Questions on Maltreated and Non-maltreated Children's Reports of a Minor Transgression.

    Science.gov (United States)

    Ahern, Elizabeth C; Stolzenberg, Stacia N; McWilliams, Kelly; Lyon, Thomas D

    2016-11-01

    This study examined the effects of secret instructions (distinguishing between good/bad secrets and encouraging disclosure of bad secrets) and yes/no questions (DID: "Did the toy break?" versus DYR: "Do you remember if the toy broke?") on 262 maltreated and non-maltreated children's (age range 4-9 years) reports of a minor transgression. Over two-thirds of children failed to disclose the transgression in response to free recall (invitations and cued invitations). The secret instruction increased disclosures early in free recall, but was not superior to no instruction when combined with cued invitations. Yes/no questions specifically asking about the transgression elicited disclosures from almost half of the children who had not previously disclosed, and false alarms were rare. DYR questions led to ambiguous responding among a substantial percentage of children, particularly younger children. The findings highlight the difficulties of eliciting transgression disclosures without direct questions. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Two questions about surrogacy and exploitation.

    Science.gov (United States)

    Wertheimer, Alan

    1992-01-01

    In this article I will consider two related questions about surrogacy and exploitation: (1) Is surrogacy exploitative? (2) If surrogacy is exploitative, what is the moral force of this exploitation? Briefly stated, I shall argue that whether surrogacy is exploitative depends on whether exploitation must be harmful to the exploited party or whether (as I think) there can be mutually advantageous exploitation. It also depends on some facts about surrogacy about which we have little reliable evidence and on our philosophical view on what counts as a harm to the surrogate. Our answer to the second question will turn in part on the account of exploitation we invoke in answering the first question and in part on the way in which we resolve some other questions about the justification of state interference. I shall suggest, however, that if surrogacy is a form of voluntary and mutually advantageous exploitation, then there is a strong presumption that surrogacy contracts should be permitted and even enforceable, although that presumption may be overridden on other grounds.

  7. KEMAMPUAN MAHASISWA DALAM MEMBUAT COMPREHENSION QUESTIONS

    Directory of Open Access Journals (Sweden)

    Pudiyono Pudiyono

    2016-10-01

    Full Text Available The aims of the research were to find out (a the level of the students’ ability in making comprehension questions, (b the students’ map of problems in making comprehension questions. The population of the research was all students joining Reading 4 academic year 2016, totaling to 30 students, while the sample was taken from all students. The result of data analysis showed that the average ability of the students, with score more than 70 reached 66.66%. In details, only 4 of the samples (13.33% got no wrong answers or an A. Those who got good achievement (B, considered as majority, amounted to 16 students (53.33%. The participants achieving enough grades (C reached 7 students or 23.33%. The last level achieved in this research was D with the number reaching 3 (10%. The map of problems laid on their inability in identifying between yes/no and WH questions, inverted sentence, choosing the right auxiliary and verbs and their spelling ability. Keyword: comprehension, questions, inversion, problem map, ability

  8. Preoperative screening: value of previous tests.

    Science.gov (United States)

    Macpherson, D S; Snow, R; Lofgren, R P

    1990-12-15

    To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. Retrospective cohort analysis of computerized laboratory data (complete blood count, sodium, potassium, and creatinine levels, prothrombin time, and partial thromboplastin time). Urban tertiary care Veterans Affairs Hospital. Consecutive sample of 1109 patients who had elective surgery in 1988. At admission, 7549 preoperative tests were done, 47% of which duplicated tests performed in the previous year. Of 3096 previous results that were normal as defined by hospital reference range and done closest to the time of but before admission (median interval, 2 months), 13 (0.4%; 95% CI, 0.2% to 0.7%), repeat values were outside a range considered acceptable for surgery. Most of the abnormalities were predictable from the patient's history, and most were not noted in the medical record. Of 461 previous tests that were abnormal, 78 (17%; CI, 13% to 20%) repeat values at admission were outside a range considered acceptable for surgery (P less than 0.001, frequency of clinically important abnormalities of patients with normal previous results with those with abnormal previous results). Physicians evaluating patients preoperatively could safely substitute the previous test results analyzed in this study for preoperative screening tests if the previous tests are normal and no obvious indication for retesting is present.

  9. Transforming classroom questioning using emerging technology.

    Science.gov (United States)

    Mahon, Paul; Lyng, Colette; Crotty, Yvonne; Farren, Margaret

    2018-04-12

    Classroom questioning is a common teaching and learning strategy in postgraduate nurse education. Technologies such as audience response systems (ARS) may offer advantage over traditional approaches to classroom questioning. However, despite being available since the 1960s, ARSs are still considered novel in many postgraduate nurse education classroom settings. This article aims to explicate the attitudes of postgraduate nursing students in an Irish academic teaching hospital towards classroom questioning (CQ) and the use of ARSs as an alternative to traditional CQ techniques. The results of this small-scale study demonstrate that ARSs have a role to play in CQ in the postgraduate setting, being regarded by students as beneficial to learning, psychological safety and classroom interaction.

  10. Comparison of integrated testlet and constructed-response question formats

    Directory of Open Access Journals (Sweden)

    Aaron D. Slepkov

    2014-09-01

    Full Text Available Constructed-response (CR questions are a mainstay of introductory physics textbooks and exams. However, because of the time, cost, and scoring reliability constraints associated with this format, CR questions are being increasingly replaced by multiple-choice (MC questions in formal exams. The integrated testlet (IT is a recently developed question structure designed to provide a proxy of the pedagogical advantages of CR questions while procedurally functioning as set of MC questions. ITs utilize an answer-until-correct response format that provides immediate confirmatory or corrective feedback, and they thus allow not only for the granting of partial credit in cases of initially incorrect reasoning, but, furthermore, the ability to build cumulative question structures. Here, we report on a study that directly compares the functionality of ITs and CR questions in introductory physics exams. To do this, CR questions were converted to concept-equivalent ITs, and both sets of questions were deployed in midterm and final exams. We find that both question types provide adequate discrimination between stronger and weaker students, with CR questions discriminating slightly better than the ITs. There is some indication that any difference in discriminatory power may result from the baseline score for guessing that is inherent in MC testing. Meanwhile, an analysis of interrater scoring of the CR questions raises serious concerns about the reliability of the granting of partial credit when this traditional assessment technique is used in a realistic (but nonoptimized setting. Furthermore, we show evidence that partial credit is granted in a valid manner in the ITs. Thus, together with consideration of the vastly reduced costs of administering IT-based examinations compared to CR-based examinations, our findings indicate that ITs are viable replacements for CR questions in formal examinations where it is desirable both to assess concept integration and to

  11. Interviewers' question rewording: not always a bad thing

    NARCIS (Netherlands)

    Haan, Marieke; Ongena, Yfke; Huiskes, Mike

    2013-01-01

    Although correct question reading is a fundamental assumption of standardized interviewing, in surveys, interviewers will not always read all questions exactly as worded. In this study the deviations in question reading by interviewers were analyzed. In addition, we studied if these deviations were

  12. Probability and Statistics: 5 Questions

    DEFF Research Database (Denmark)

    Probability and Statistics: 5 Questions is a collection of short interviews based on 5 questions presented to some of the most influential and prominent scholars in probability and statistics. We hear their views on the fields, aims, scopes, the future direction of research and how their work fits...... in these respects. Interviews with Nick Bingham, Luc Bovens, Terrence L. Fine, Haim Gaifman, Donald Gillies, James Hawthorne, Carl Hoefer, James M. Joyce, Joseph B. Kadane Isaac Levi, D.H. Mellor, Patrick Suppes, Jan von Plato, Carl Wagner, Sandy Zabell...

  13. Accuracy of questions related to allergic contact dermatitis.

    Science.gov (United States)

    Fleming, C J; Burden, A D; Forsyth, A

    2000-12-01

    The ability of a physician to select individuals likely to benefit from patch testing depends on his or her ability to interpret responses to enquiries related to contact allergy. The significance of such responses to questions of nickel, fragrance and colophon allergy is unclear. The specificity, sensitivity and predictive value of questions relating to nickel, fragrance and colophony allergy were determined. A total of 258 patients attending for routine patch testing were questioned about skin reactions to nickel, fragrances and Elastoplast (Smith and Nephew Healthcare, Hull, England). All subjects were then patch tested to nickel, fragrance mix, and colophony. Responses to questions were compared with patch test results. The sensitivity of questions relating to nickel, fragrance, and colophony was 82%, 49%, and 71%, respectively. The specificity of the same questions was 77%, 79%, and 90%; the positive predictive value was 54%, 46% and 29%, respectively. After adjustment to include clinical relevance, the sensitivity of nickel questions rose to 100%. These data permit greater understanding of the role of patient history in selection of patients for patch testing. Copyright 2000 by W.B. Saunders Company

  14. Children's Question Asking and Curiosity: A Training Study

    Science.gov (United States)

    Jirout, Jamie; Klahr, David

    2011-01-01

    A primary instructional objective of most early science programs is to foster children's scientific curiosity and question-asking skills (Jirout & Klahr, 2011). However, little is known about the relationship between curiosity, question-asking behavior, and general inquiry skills. While curiosity and question asking are invariably mentioned in…

  15. D-linking or set-restriction? Processing Which-questions in Dutch

    NARCIS (Netherlands)

    Donkers, Jantien; Hoeks, John C. J.; Stowe, Laurie A.

    2013-01-01

    Research on Wh-questions suggests that Which questions are harder to process than Who questions (e.g., Who/Which athlete won the competition?). According to the Discourse (D)-linking Hypothesis, Which-questions differ from Who-questions in that Which questions need a link to a preceding discourse,

  16. Questioning care at the end of life.

    Science.gov (United States)

    Ruopp, Patricia; Good, Mary-Jo Delvecchio; Lakoma, Matthew; Gadmer, Nina M; Arnold, Robert M; Block, Susan D

    2005-06-01

    The goal of the larger study was to explore physicians' emotional responses to the death of their patients; this study analyzed a subset of physician transcripts to elucidate the construct of questioning care, which emerged from the larger study. To analyzes how physicians question care-expressing concern, unease, or uncertainty about treatment decisions and practices, errors, or adverse events-as they attend dying patients. Retrospective interview study of physicians caring for randomly selected deaths on the medical service of a major academic teaching hospital, using qualitative and quantitative measures. SETTING, SUBJECTS: 188 attendings, residents, and interns on the internal medical services of two academic medical centers were part of the larger study. A subsample of 75 physician narratives was selected for qualitative data analysis for this study. Qualitative measures included open-ended questions eliciting physicians' stories of the most recent and a most emotionally powerful patient death they have experienced. Grounded theory was used to analyze physician narratives. Quantitative instruments measured physician attitudes toward end-of-life care and responses to the most recent and most emotional patient death. Physicians question care more frequently in most emotional deaths (42%) than in most recent deaths (34%). Physicians question communication with patients and families and within medical teams, medical judgment and technique, standards of practice, and high-risk treatments, often assigning responsibility for medical management they perceive as inappropriate, futile, overly aggressive, or mistakes in judgment and technique. Responsibility ranges from the distal (the culture of medicine) to the proximal (personal). Frustration, guilt, and anger are more frequently expressed in these narratives when care is questioned. A typology of questioning care emerged from these physicians' narratives that parallels and reflects recent and classic research on

  17. Perspectives from the Avian Phylogenomics Project: Questions that Can Be Answered with Sequencing All Genomes of a Vertebrate Class.

    Science.gov (United States)

    Jarvis, Erich D

    2016-01-01

    The rapid pace of advances in genome technology, with concomitant reductions in cost, makes it feasible that one day in our lifetime we will have available extant genomes of entire classes of species, including vertebrates. I recently helped cocoordinate the large-scale Avian Phylogenomics Project, which collected and sequenced genomes of 48 bird species representing most currently classified orders to address a range of questions in phylogenomics and comparative genomics. The consortium was able to answer questions not previously possible with just a few genomes. This success spurred on the creation of a project to sequence the genomes of at least one individual of all extant ∼10,500 bird species. The initiation of this project has led us to consider what questions now impossible to answer could be answered with all genomes, and could drive new questions now unimaginable. These include the generation of a highly resolved family tree of extant species, genome-wide association studies across species to identify genetic substrates of many complex traits, redefinition of species and the species concept, reconstruction of the genomes of common ancestors, and generation of new computational tools to address these questions. Here I present visions for the future by posing and answering questions regarding what scientists could potentially do with available genomes of an entire vertebrate class.

  18. Question-asking behavior as a form of cognitive activity

    Directory of Open Access Journals (Sweden)

    Elvira A. Baranova

    2017-03-01

    Full Text Available Children’s questions are an indicator of active cognitive perception of reality. Questions but not answers are relevant in revealing a child’s mental life, consciousness and thinking. The lack of question-asking skills can hinder learning, searching and exploration in children. To determine in 7- and 8-year-old school children the common and variable peculiarities of designing a search process for necessary information concerning an unknown object by volitionally formulated questions, as well as the dynamics of the questioning process throughout a school year. The study was based on an experimental methodology, codenamed Guess what there is in the box, and was conducted in four schools in Cheboksary. The sample comprised 158 primary school first-graders who took part in a confirmatory experiment twice, once in September and once in May. The research showed that 96.3% of the questions asked were search questions. Only 30% of the first-graders initiated their searching activities of their own will without having to resort to the given search algorithm, while 70% did not begin asking questions without outside stimulation. The analysis of the dynamics of children’s question-asking behavior exhibited a tendency to decrease in a number of questions asked over the course of the school year. Primary school children need psychological and pedagogical scaffolding aimed at developing a question-asking behavior as a form of cognitive activity to achieve a possible age potential in development.

  19. A questions-based investigation of consumer mental-health information

    Science.gov (United States)

    Kart, Joyce Brothers

    2015-01-01

    Despite the wealth of mental-health information available online to consumers, research has shown that the mental-health information needs of consumers are not being met. This study contributes to that research by soliciting consumer questions directly, categorizing them, analyzing their form, and assessing the extent to which they can be answered from a trusted and vetted source of online information, namely the website of the US National Institute of Mental Health (NIMH). As an alternative to surveys and analyses of online activity, this study shows how consumer questions provide new insight into what consumers do not know and how they express their information needs. The study crowdsourced 100 consumer questions through Amazon Inc.’s Mechanical Turk. Categorization of the questions shows broad agreement with earlier studies in terms of the content of consumer questions. It also suggests that consumers’ grasp of mental health issues may be low compared to other health topics. The majority of the questions (74%) were simple in form, with the remainder being multi-part, multifaceted or narrative. Even simple-form questions could, however, have complex interpretations. Fifty four questions were submitted to the search box at the NIMH website. For 32 questions, no answer could be found in the top one to three documents returned. Inadequacies in the search and retrieval technology deployed at websites account for some of the failure to find answers. The nature of consumer questions in mental health also plays a role. A question that has a false presupposition is less likely to have an answer in trusted and vetted sources of information. Consumer questions are also expressed with a degree of specificity that makes the retrieval of relevant information difficult. The significance of this study is that it shows what an analysis of consumer mental-health questions can tell us about consumer information needs and it provides new insight into the difficulties facing

  20. The role of teacher questions in the chemistry classroom

    DEFF Research Database (Denmark)

    Dohrn, Sofie Weiss; Dohn, Niels Bonderup

    2018-01-01

    , the students become highly accomplished in recalling facts but have difficulties when higher order thinking is required. The findings suggest that an interactive classroom can be created by using many engaging teacher questions. The six different categories of questions promote the students' learning process......The purpose of this study was to investigate how a chemistry teacher's questions influence the classroom discourse. It presents a fine-grained analysis of the rich variety of one teacher's questions and the roles they play in an upper secondary chemistry classroom. The study identifies six...... different functions for the teacher's questions: Student Knowledge, Request, Monologic Discourse, Clarification, Relations and Interaction of Contexts. Overall, these questions create a safe and interactive learning environment. However, the questions are predominantly closed in form. As a result...

  1. Usage-based vs. rule-based learning: the acquisition of word order in wh-questions in English and Norwegian.

    Science.gov (United States)

    Westergaard, Marit

    2009-11-01

    This paper discusses different approaches to language acquisition in relation to children's acquisition of word order in wh-questions in English and Norwegian. While generative models assert that children set major word order parameters and thus acquire a rule of subject-auxiliary inversion or generalized verb second (V2) at an early stage, some constructivist work argues that English-speaking children are simply reproducing frequent wh-word+auxiliary combinations in the input. The paper questions both approaches, re-evaluates some previous work, and provides some further data, concluding that the acquisition of wh-questions must be the result of a rule-based process. Based on variation in adult grammars, a cue-based model to language acquisition is presented, according to which children are sensitive to minor cues in the input, called micro-cues. V2 is not considered to be one major parameter, but several smaller-scale cues, which are responsible for children's lack of syntactic (over-)generalization in the acquisition process.

  2. QUESTION FORMATION OF BAHASA INDONESIA AS A SECOND LANGUAGE

    Directory of Open Access Journals (Sweden)

    zulfa Sakhiyya

    2013-07-01

    Full Text Available Abstract: This article aims to implement Processability Theory (PT to Bahasa Indonesia or Indonesian language and to identify developmental stages for question formation in the setting of Bahasa Indonesia as a second language (ISL. PT provides a theoretical framework in making predictions about the course of language development, in this case the question formation acquisition. This study proposes developmental stages of question formation in ISL setting by contrasting the lexical functional grammar of Indonesian question as compared to ESL question formation. Four stages of ISL question formation were proposed. The proposed stages serve as the basis for data analysis and to show its plausibility.

  3. On the placement of practice questions during study.

    Science.gov (United States)

    Weinstein, Yana; Nunes, Ludmila D; Karpicke, Jeffrey D

    2016-03-01

    Retrieval practice improves retention of information on later tests. A question remains: When should retrieval occur during learning-interspersed throughout study or at the end of each study period? In a lab experiment, an online experiment, and a classroom study, we aimed to determine the ideal placement (interspersed vs. at-the-end) of retrieval practice questions. In the lab experiment, 64 subjects viewed slides about APA style and answered short-answer practice questions about the content or restudied the slides (restudy condition). The practice questions either appeared 1 every 1-2 slides (interspersed condition), or all at the end of the presentation (at-the-end condition). One week later, subjects returned and answered the same questions on a final test. In the online experiment, 175 subjects completed the same procedure. In the classroom study, 62 undergraduate students took quizzes as part of class lectures. Short-answer practice questions appeared either throughout the lectures (interspersed condition) or at the end of the lectures (at-the-end condition). Nineteen days after the last quiz, students were given a surprise final test. Results from the 3 experiments converge in demonstrating an advantage for interspersing practice questions on the initial tests, but an absence of this advantage on the final test. (c) 2016 APA, all rights reserved).

  4. Radiation protection in questions and answers

    International Nuclear Information System (INIS)

    Ewen, K.; Hoppe, G.

    1976-01-01

    An easily surveyable catalogue of questions is presented which is to make it easier for medical personnel to get acquainted with the basic knowledge according to the X-ray Ordinance and to acquire the expert knowledge in radiation protection. The catalogue is arranged according to different subjects. There are several alternative answers to every question. The right answer is given in the solution index (annex). (HP) [de

  5. The implications of nonauthentic questions in Galatians | Verster ...

    African Journals Online (AJOL)

    A new classification of non-authentic questions is helpful in understanding the way in which Paul uses persuasion in Galatians. Paul uses many non-authentic questions, and the implications thereof are evident in the type of question used. The way in which he violates the maxims identified by Grice also entails certain ...

  6. Questions about elastic waves

    CERN Document Server

    Engelbrecht, Jüri

    2015-01-01

    This book addresses the modelling of mechanical waves by asking the right questions about them and trying to find suitable answers. The questions follow the analytical sequence from elementary understandings to complicated cases, following a step-by-step path towards increased knowledge. The focus is on waves in elastic solids, although some examples also concern non-conservative cases for the sake of completeness. Special attention is paid to the understanding of the influence of microstructure, nonlinearity and internal variables in continua. With the help of many mathematical models for describing waves, physical phenomena concerning wave dispersion, nonlinear effects, emergence of solitary waves, scales and hierarchies of waves as well as the governing physical parameters are analysed. Also, the energy balance in waves and non-conservative models with energy influx are discussed. Finally, all answers are interwoven into the canvas of complexity.

  7. Rabies: Questions and Answers

    Science.gov (United States)

    Rabies: Questions and Answers Information about the disease and vaccines What causes rabies? Rabies is caused by a virus. The virus invades ... nervous system and disrupts its functioning. How does rabies spread? The rabies virus is transmitted in the ...

  8. Bayesian random-effect model for predicting outcome fraught with heterogeneity--an illustration with episodes of 44 patients with intractable epilepsy.

    Science.gov (United States)

    Yen, A M-F; Liou, H-H; Lin, H-L; Chen, T H-H

    2006-01-01

    The study aimed to develop a predictive model to deal with data fraught with heterogeneity that cannot be explained by sampling variation or measured covariates. The random-effect Poisson regression model was first proposed to deal with over-dispersion for data fraught with heterogeneity after making allowance for measured covariates. Bayesian acyclic graphic model in conjunction with Markov Chain Monte Carlo (MCMC) technique was then applied to estimate the parameters of both relevant covariates and random effect. Predictive distribution was then generated to compare the predicted with the observed for the Bayesian model with and without random effect. Data from repeated measurement of episodes among 44 patients with intractable epilepsy were used as an illustration. The application of Poisson regression without taking heterogeneity into account to epilepsy data yielded a large value of heterogeneity (heterogeneity factor = 17.90, deviance = 1485, degree of freedom (df) = 83). After taking the random effect into account, the value of heterogeneity factor was greatly reduced (heterogeneity factor = 0.52, deviance = 42.5, df = 81). The Pearson chi2 for the comparison between the expected seizure frequencies and the observed ones at two and three months of the model with and without random effect were 34.27 (p = 1.00) and 1799.90 (p dispersion attributed either to correlated property or to subject-to-subject variability.

  9. Categorization of questions posed before and after inquiry-based learning

    Directory of Open Access Journals (Sweden)

    Sandra Milena García González

    2014-07-01

    Full Text Available Posing research questions is the central ability of the scientific thought. This article examines the ability of sixth grade children to pose researchable questions before and after a three months’ work on a didactic sequence based on the inquiry school model. According to their purpose, the questions asked by children, after reading a text, were classified into researchable questions -susceptible to be empirically explored-, questions about a cause, and questions on a piece of data. The results show that the amount and the type of questions the students were able to pose during the intervention changed, from most of questions on data or information, to most of researchable questions, subsequently, the importance of designing teaching approaches to foster this ability was proved.

  10. Questioning Strategies of Literature Teachers among Grade 8 Filipino Students

    Directory of Open Access Journals (Sweden)

    Magdalena M. Ocbian

    2015-11-01

    Full Text Available Questioning is a useful and relevant tool to facilitate classroom discussion in a literature class. This study identified the levels of questions teachers use in their literature class, determined the different question strategies they utilized and proposed activities to enhance the questioning strategies of literature teachers. Video analysis was the main instrument used. These videos were provided during the conduct of class observations by the researchers. There were eight respondents in the study selected through total enumeration. They are teachers from Gubat Cluster of secondary schools of Sorsogon Province. To identify the levels of questions and questioning strategies, question tally form and percentage were used. Results revealed that knowledge was the most used level of questions followed by comprehension, application, analysis, synthesis and evaluation. The most used question technique is the participation, followed by proving, sequencing, wait time, balance and student questions. It was recommended that literature teachers vary their level of questions when discussing literary pieces. They may utilize different question techniques to develop critical thinking skills of their students. The use of the proposed activities may enhance the questioning strategies of literature teachers. Likewise, school heads and program supervisors may utilize video analysis technique as a mode for classroom observation.

  11. Children's Exhaustive Readings of Questions

    Science.gov (United States)

    Cremers, Alexandre; Tieu, Lyn; Chemla, Emmanuel

    2017-01-01

    Questions, just like plain declarative sentences, can give rise to multiple interpretations. As discussed by Spector & Egré (2015), among others, questions embedded under know are ambiguous between "weakly exhaustive" (WE), "intermediate exhaustive" (IE), and "strongly exhaustive" (SE) interpretations (for…

  12. Sample Focus Group Questions for Girls in STEM

    Energy Technology Data Exchange (ETDEWEB)

    Coronado, Elizabeth Phillips [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2018-02-13

    These are sample questions for focus groups to be conducted as part of qualitative data collection for Year 2- Year 6 of Girls in STEM. You may use any of the questions from the list during the two sessions during the school year, as long as those questions are not repeated in both Baseline and follow-up sessions.

  13. Novel polymeric bioerodable microparticles for prolonged-release intrathecal delivery of analgesic agents for relief of intractable cancer-related pain.

    Science.gov (United States)

    Han, Felicity Y; Thurecht, Kristofer J; Lam, Ai-Leen; Whittaker, Andrew K; Smith, Maree T

    2015-07-01

    Intractable cancer-related pain complicated by a neuropathic component due to nerve impingement is poorly alleviated even by escalating doses of a strong opioid analgesic. To address this unmet medical need, we developed sustained-release, bioerodable, hydromorphone (potent strong opioid)- and ketamine (analgesic adjuvant)-loaded microparticles for intrathecal (i.t.) coadministration. Drug-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles were prepared using a water-in-oil-in-water method with evaporation. Encapsulation efficiency of hydromorphone and ketamine in PLGA (50:50) microparticles was 26% and 56%, respectively. Microparticles had the desired size range (20-60 μm) and in vitro release was prolonged at ≥28 days. Microparticles were stable for ≥6 months when stored refrigerated protected from light in a desiccator. Desirably, i.t. injected fluorescent dye-labeled PLGA microparticles in rats remained in the lumbar region for ≥7 days. In a rat model of neuropathic pain, i.t. coinjection of hydromorphone- and ketamine-loaded microparticles (each 1 mg) produced analgesia for 8 h only. Possible explanations include inadequate release of ketamine and/or hydromorphone into the spinal fluid, and/or insufficient ketamine loading to prevent development of analgesic tolerance to the released hydromorphone. As sub-analgesic doses of i.t. ketamine at 24-48 h intervals restored analgesia on each occasion, insufficient ketamine loading appears problematic. We will investigate these issues in future work. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.

  14. The kinds of questions asked by novice teachers in learning mathematics

    Science.gov (United States)

    Zahra, L.; Kusmayadi, T. A.; Usodo, B.

    2018-05-01

    This study describes the kinds of questions asked by novice teachers during mathematics learning process in senior high school. This study used descriptive analysis. The subjects of this study were two novice teachers who teach mathematics in 10th grade. The result showed that the frequently asked questions by novice teachers based on the objective were compliance questions, rethorical questions and sometimes prompting questions and probing questions. The frequently questions asked by novice teacher based on the cognitive process dimension of Revised Bloom’s Taxonomy were questions of remembering, questions of understanding, questions of applying, questions of analyzing and questions of evaluating. The novice teachers asked the routine questions which had same thinking level. The question with the highest level of thinking did not asked by the novice teachers.

  15. Questions and Answers about Sex (For Parents)

    Science.gov (United States)

    ... español Preguntas y respuestas sobre sexo Answering their kids' questions about sex is a responsibility that many parents dread. Otherwise ... avoided. Parents can help foster healthy feelings about sex if they answer kids' questions in an age-appropriate way. When do ...

  16. Question presentation methods for paired-associate learning

    NARCIS (Netherlands)

    Engel, F.L.; Geerings, M.P.W.

    1988-01-01

    Four different methods of question presentation, in interactive computeraided learning of Dutch-English word pairs are evaluated experimentally. These methods are: 1) the 'open-question method', 2) the 'multiple-choice method', 3) the 'sequential method' and 4) the 'true/ false method'. When

  17. [Two simple questions to diagnose post-stroke depression].

    Science.gov (United States)

    Nolte, C H; Müller-Nordhorn, J; Jungehülsing, G J; Rossnagel, K; Reich, A; Roll, S; Laumeier, I; Beerfelde, D; Willich, S N; Villringer, A

    2006-05-01

    Many patients develop a depression after having suffered a stroke. Such a Post-Stroke Depression (PSD) impairs rehabilitation and quality of life. PSD is underdiagnosed in spite of available treatment. Several questionnaires have been created to diagnose a PSD. But questionnaires have been considered cumbersome and time-consuming. The aim of this study was to find out whether two simple, standardised questions will identify those stroke patients, who have developed a PSD. The two case-finding questions and the Beck Depression Inventory (BDI) were sent to patients of the Berlin Acute Stroke Study (BASS) four years after their stroke. Incomplete questionnaires were complemented via mail or telephone. Severity of depression was assessed by means of BDI. Out of 211 patients, 199 responded to the questionnaire (94 %). 193 questionnaires were complete (97 %). Forty-two patients affirmed both case-finding questions (22 %). Compared to patients, who did not affirm both questions, these patients had a higher BDI score (19 +/- 8 vs. 7 +/- 5; p two questions were 89 % and 90 %, respectively. The positive and negative predictive value were 60 % and 98 % respectively. The number of confirmed questions (0, 1, 2) correlated well with the BDI score (r (2) = 0.67, p Two standardized questions can identify patients with PSD for further diagnostic evaluation and therapy. Diagnosis of PSD might be facilitated by using them as screening instrument.

  18. Chloroplast phylogenomic analyses resolve deep-level relationships of an intractable bamboo tribe Arundinarieae (poaceae).

    Science.gov (United States)

    Ma, Peng-Fei; Zhang, Yu-Xiao; Zeng, Chun-Xia; Guo, Zhen-Hua; Li, De-Zhu

    2014-11-01

    relationships, albeit with low support values. We believe that the inferred phylogeny is robust to taxon sampling. Having resolved the deep-level relationships of Arundinarieae, we illuminate how chloroplast phylogenomics can be used for elucidating difficult phylogeny at low taxonomic levels in intractable plant groups. © The Author(s) 2014. Published by Oxford University Press, on behalf of the Society of Systematic Biologists. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. America in Perspective: Yesterday's Questions and Today's Students.

    Science.gov (United States)

    Danzer, Gerald A.

    In 1780, a prize was established in France for the best answer to the question; "Was the discovery of America a blessing or a curse to mankind?" This question and its only response from an individual living in America, constitute the basis of a high school history class unit. The background of the question and the content are developed,…

  20. On safety goals and related questions

    International Nuclear Information System (INIS)

    Kaplan, S.

    1985-01-01

    The question of what safety goals should be established for nuclear power plants has been receiving a great deal of urgent attention and debate recently, both by those responsible for reactor licensing and by others interested in establishing a quantitative measure of reactor safety. The same question, phrased alternately in the forms: ''What is acceptable risk?'' and ''How safe is safe enough?,'' has been debated extensively for quite a long time. The purpose of the present paper, therefore, is to show that the above questions, taken at face value, exist within an unworkable context, which the authors shall call the Old Regulatory Context (ORC), and that within this context lead to several absurdities. They shall argue that this context needs to be replaced by another context, which they call the Decision Theory Context (DTC), and which the authors discuss here