29 CFR 4022.93 - Who will get benefits the PBGC may owe me at the time of my death?

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Who will get benefits the PBGC may owe me at the time of my... Upon Death § 4022.93 Who will get benefits the PBGC may owe me at the time of my death? (a) In general... the time of your death, we will pay any benefits we owe you at the time of your death to the person(s...

Automated theorem proving theory and practice

CERN Document Server

Newborn, Monty

2001-01-01

As the 21st century begins, the power of our magical new tool and partner, the computer, is increasing at an astonishing rate. Computers that perform billions of operations per second are now commonplace. Multiprocessors with thousands of little computers - relatively little! -can now carry out parallel computations and solve problems in seconds that only a few years ago took days or months. Chess-playing programs are on an even footing with the world's best players. IBM's Deep Blue defeated world champion Garry Kasparov in a match several years ago. Increasingly computers are expected to be more intelligent, to reason, to be able to draw conclusions from given facts, or abstractly, to prove theorems-the subject of this book. Specifically, this book is about two theorem-proving programs, THEO and HERBY. The first four chapters contain introductory material about automated theorem proving and the two programs. This includes material on the language used to express theorems, predicate calculus, and the rules of...

Theorem Proving In Higher Order Logics

Science.gov (United States)

Carreno, Victor A. (Editor); Munoz, Cesar A.; Tahar, Sofiene

2002-01-01

The TPHOLs International Conference serves as a venue for the presentation of work in theorem proving in higher-order logics and related areas in deduction, formal specification, software and hardware verification, and other applications. Fourteen papers were submitted to Track B (Work in Progress), which are included in this volume. Authors of Track B papers gave short introductory talks that were followed by an open poster session. The FCM 2002 Workshop aimed to bring together researchers working on the formalisation of continuous mathematics in theorem proving systems with those needing such libraries for their applications. Many of the major higher order theorem proving systems now have a formalisation of the real numbers and various levels of real analysis support. This work is of interest in a number of application areas, such as formal methods development for hardware and software application and computer supported mathematics. The FCM 2002 consisted of three papers, presented by their authors at the workshop venue, and one invited talk.

Probabilistic Discounting of Hypothetical Monetary Gains: University Students Differ in How They Discount "Won" and "Owed" Money

Science.gov (United States)

Weatherly, Jeffrey N.; Derenne, Adam

2013-01-01

The present study tested whether participants would discount "won" money differently than they would "owed" money in a probability-discounting task. Participants discounted $1000 or $100,000 that they had won in a sweepstakes or that was owed to them using the multiple-choice (Experiment 1) or fill-in-the-blank (Experiment 2) method of collecting…

Models and Techniques for Proving Data Structure Lower Bounds

DEFF Research Database (Denmark)

Larsen, Kasper Green

In this dissertation, we present a number of new techniques and tools for proving lower bounds on the operational time of data structures. These techniques provide new lines of attack for proving lower bounds in both the cell probe model, the group model, the pointer machine model and the I...... bound of tutq = (lgd􀀀1 n). For ball range searching, we get a lower bound of tutq = (n1􀀀1=d). The highest previous lower bound proved in the group model does not exceed ((lg n= lg lg n)2) on the maximum of tu and tq. Finally, we present a new technique for proving lower bounds....../O-model. In all cases, we push the frontiers further by proving lower bounds higher than what could possibly be proved using previously known techniques. For the cell probe model, our results have the following consequences: The rst (lg n) query time lower bound for linear space static data structures...

Effective communication during difficult conversations.

Science.gov (United States)

Polito, Jacquelyn M

2013-06-01

A strong interest and need exist in the workplace today to master the skills of conducting difficult conversations. Theories and strategies abound, yet none seem to have found the magic formula with universal appeal and success. If it is such an uncomfortable skill to master is it better to avoid or initiate such conversations with employees? Best practices and evidence-based management guide us to the decision that quality improvement dictates effective communication, even when difficult. This brief paper will offer some suggestions for strategies to manage difficult conversations with employees. Mastering the skills of conducting difficult conversations is clearly important to keeping lines of communication open and productive. Successful communication skills may actually help to avert confrontation through employee engagement, commitment and appropriate corresponding behavior

Do Schools Owe a Special Duty of Care to "Special-Needs" Students?

Science.gov (United States)

Fossey, Richard; Russo, Charles J.

2009-01-01

Schools officials owe a duty of care to all the students in their custody. An emerging, but not unanimous, judicial consensus seems to agree that school board officials have a greater legal duty when supervising students with disabilities. A case on this important issue arose in "Jennifer C. v. Los Angeles Unified School District"…

Proving termination of logic programs with delay declarations

NARCIS (Netherlands)

E. Marchiori; F. Teusink (Frank)

1996-01-01

textabstractIn this paper we propose a method for proving termination of logic programs with delay declarations. The method is based on the notion of recurrent logic program, which is used to prove programs terminating wrt an arbitrary selection rule. Most importantly, we use the notion of bound

Do Hospitals Owe A So-Called 'Non-Delegable' Duty of Care to their Patients?

Science.gov (United States)

Beuermann, Christine

2018-02-01

It is not uncommon for the duty of care owed by a hospital to its patients to be described as 'non-delegable'. Use of this label suggests that a hospital may be held strictly liable to a patient for the wrongdoing of a third party beyond the circumstances in which vicarious liability might be imposed. To date, no higher court has used the label to impose such liability. Notwithstanding, it was assumed by Lord Sumption in Woodland v Swimming Teachers Association that the duty of care owed by a hospital to a patient could be so described when formulating his test for determining the existence of a 'non-delegable duty of care'. This article challenges that assumption and, in turn, the veracity of the test devised by Lord Sumption.

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

DEFF Research Database (Denmark)

Zoffmann, Vibeke; Kirkevold, Marit

2007-01-01

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

20 CFR 219.23 - Evidence to prove death.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Evidence to prove death. 219.23 Section 219... EVIDENCE REQUIRED FOR PAYMENT Evidence of Age and Death § 219.23 Evidence to prove death. (a) Preferred evidence of death. The best evidence of a person's death is— (1) A certified copy of or extract from the...

Elliptic curves and primality proving

Science.gov (United States)

Atkin, A. O. L.; Morain, F.

1993-07-01

The aim of this paper is to describe the theory and implementation of the Elliptic Curve Primality Proving algorithm. Problema, numeros primos a compositis dignoscendi, hosque in factores suos primos resolvendi, ad gravissima ac utilissima totius arithmeticae pertinere, et geometrarum tum veterum tum recentiorum industriam ac sagacitatem occupavisse, tam notum est, ut de hac re copiose loqui superfluum foret.

Primary Hepatic Lymphoma Is Difficult to Discriminate from a Liver Abscess

Directory of Open Access Journals (Sweden)

Nobuhiro Takeuchi

2014-01-01

Full Text Available An 82-year-old woman presented with a high-grade fever of 40°C and was admitted to our institution for intensive examination and treatment. Noncontrast abdominal computed tomography (CT revealed low-density masses at segments 5 and 8, suggestive of a liver abscess. On further examination, a contrast-enhanced abdominal CT showed a 30×30 mm mass with an enhanced margin at segment 8 in the arterial phase; the contrast agents were washed out in the venous phase. In addition, a 63×52 mm mass with a density lower than that of liver parenchyma was observed at segment 8 in the portal phase. On the basis of these findings, either a liver abscess or hepatocellular carcinoma was suspected. To confirm the diagnosis, a fine needle biopsy was scheduled. Histopathological analysis of the biopsied specimens confirmed the diagnosis of diffuse large B-cell lymphoma. Chemotherapy was not indicated owing to the patient’s age and poor performance status; thus, best supportive care was planned. On day 22 after admission, the patient died of pneumonia. We experienced a case of PHL that was difficult to discriminate from a liver abscess. Imaging alone is insufficient to diagnose PHL; therefore, fine needle biopsy is recommended for a definitive diagnosis.

Seismic proving test of PWR reactor containment vessel

International Nuclear Information System (INIS)

Akiyama, H.; Yoshikawa, T.; Tokumaru, Y.

1987-01-01

The seismic reliability proving tests of nuclear power plant facilities are carried out by Nuclear Power Engineering Test Center (NUPEC), using the large-scale, high-performance vibration of Tadotsu Engineering Laboratory, and sponsored by the Ministry of International Trade and Industry (MITI). In 1982, the seismic reliability proving test of PWR containment vessel started using the test component of reduced scale 1/3.7 and the test component proved to have structural soundness against earthquakes. Subsequently, the detailed analysis and evaluation of these test results were carried out, and the analysis methods for evaluating strength against earthquakes were established. Whereupon, the seismic analysis and evaluation on the actual containment vessel were performed by these analysis methods, and the safety and reliability of the PWR reactor containment vessel were confirmed

Overcoming difficult conversations in clinical supervision

Directory of Open Access Journals (Sweden)

Williams B

2016-06-01

Full Text Available Brett Williams,1 Christine King,1 Tanya Edlington,21Department of Community Emergency Health and Paramedic Practice, Monash University, Franskton, VIC, 2The Conversation Clinic Pty Ltd, Melbourne, VIC, Australia Background: Clinical supervisors are responsible for managing many facets of clinical learning and face a range of challenges when the need for "difficult" conversations arises, including the need to manage conflict and relationships. Methods: Spotlight on Conversations Workshop was developed to improve the capacity of clinical supervisors to engage in difficult conversations. They were designed to challenge the mindset of clinical supervisors about difficult conversations with students, the consequences of avoiding difficult conversations, and to offer activities for practicing difficult conversations. Preworkshop, postworkshop, and 4-month follow-up evaluations assessed improvements in knowledge, intent to improve, and confidence along with workshop satisfaction. Results: Nine workshops were delivered in a range of locations across Victoria, Australia, involving a total of 117 clinical supervisors. Preworkshop evaluations illustrated that more than half of the participants had avoided up to two difficult conversations in the last month in their workplace. Postworkshop evaluation at 4 months showed very high levels of satisfaction with the workshop's relevancy, content, and training, as well as participants' intention to apply knowledge and skills. Also shown were significant changes in participants' confidence to have difficult conversations not only with students but also with other peers and colleagues. In follow-up in-depth interviews with 20 of the 117 participants, 75% said they had made definite changes in their practice because of what they learned in the workshop and another 10% said they would make changes to their practice, but had not had the opportunity yet to do so. Conclusion: We conclude that the Spotlight on

Despite being known as the Wild Coast, owing to its rough seas and ...

African Journals Online (AJOL)

spamer

Despite being known as the Wild Coast, owing to its rough seas and ...... prognosis for the skiboat fishery is not good. Com- ... from the Margate/Port Edward area, as well as Messrs. G. Meyers from ... FIELDING, P. J., ROBERTSON, W. D., DYE, A. H., TOMALIN, ... HARRISON, T. D., COOPER, J. A. G. and A. E. L. RAMM 2000.

Preservice Mathematics Teachers' Metaphorical Perceptions towards Proof and Proving

Science.gov (United States)

Ersen, Zeynep Bahar

2016-01-01

Since mathematical proof and proving are in the center of mathematics; preservice mathematics teachers' perceptions against these concepts have a great importance. Therefore, the study aimed to determine preservice mathematics teachers' perceptions towards proof and proving through metaphors. The participants consisted of 192 preservice…

Proving test on the reliability for nuclear valves

International Nuclear Information System (INIS)

Kajiyama, Yasuo; Tashiro, Hisao; Uga, Takeo; Maeda, Shunichi.

1986-01-01

Since valves are the most common components, they could be the most frequent causes of troubles in nuclear power plants. This proving test, therefore, has an important meaning to examine and verify the reliability of various valves under simulating conditions of abnormal and transient operations of the nuclear power plant. The test was performed mainly for the various types and pressure ratings of valves which were used in the primary and secondary systems in BWR and PWR nuclear power plants and which had major operating or safety related functions in those nuclear power plants. The results of the proving test, confirmed for more than four years, showed relatively favourable performance of the tested valves. It is concluded that performances of valves including operability, seat sealing and structural integrity were proved under the thermal cycling, vibration and pipe reaction load conditions. Operating functions during and after accident such as loss of coolant accident were satisfactory. From these results, it was considered that the purpose of this proving test was satisfactorily fulfilled. Several data accumulated by the test would be useful to get better reliability if it was evaluated with the actually experienced data of valves in the nuclear power plants. (Nogami, K.)

Responsibility for proving and defining in abstract algebra class

Science.gov (United States)

Fukawa-Connelly, Timothy

2016-07-01

There is considerable variety in inquiry-oriented instruction, but what is common is that students assume roles in mathematical activity that in a traditional, lecture-based class are either assumed by the teacher (or text) or are not visible at all in traditional math classrooms. This paper is a case study of the teaching of an inquiry-based undergraduate abstract algebra course. In particular, gives a theoretical account of the defining and proving processes. The study examines the intellectual responsibility for the processes of defining and proving that the professor devolved to the students. While the professor wanted the students to engage in all aspects of defining and proving, he was only successful at devolving responsibility for certain aspects and much more successful at devolving responsibility for proving than conjecturing or defining. This study suggests that even a well-intentioned instructor may not be able to devolve responsibility to students for some aspects of mathematical practice without using a research-based curriculum or further professional development.

Geometric inequalities methods of proving

CERN Document Server

Sedrakyan, Hayk

2017-01-01

This unique collection of new and classical problems provides full coverage of geometric inequalities. Many of the 1,000 exercises are presented with detailed author-prepared-solutions, developing creativity and an arsenal of new approaches for solving mathematical problems. This book can serve teachers, high-school students, and mathematical competitors. It may also be used as supplemental reading, providing readers with new and classical methods for proving geometric inequalities. .

Reasoning and Proving Opportunities in Textbooks: A Comparative Analysis

Science.gov (United States)

Hong, Dae S.; Choi, Kyong Mi

2018-01-01

In this study, we analyzed and compared reasoning and proving opportunities in geometry lessons from American standard-based textbooks and Korean textbooks to understand how these textbooks provide student opportunities to engage in reasoning and proving activities. Overall, around 40% of exercise problems in Core Plus Mathematics Project (CPMP)…

A New Approach for Proving or Generating Combinatorial Identities

Science.gov (United States)

Gonzalez, Luis

2010-01-01

A new method for proving, in an immediate way, many combinatorial identities is presented. The method is based on a simple recursive combinatorial formula involving n + 1 arbitrary real parameters. Moreover, this formula enables one not only to prove, but also generate many different combinatorial identities (not being required to know them "a…

Generic Example Proving Criteria for All

Science.gov (United States)

Yopp, David; Ely, Rob; Johnson­-Leung, Jennifer

2015-01-01

We review literature that discusses generic example proving and highlight ambiguities that pervade our research community's discourse about generic example arguments. We distinguish between pedagogical advice for choosing good examples that can serve as generic examples when teaching and advice for developing generic example arguments. We provide…

SARS – Koch´Postulates proved.

Indian Academy of Sciences (India)

SARS – Koch´Postulates proved. Novel coronavirus identified from fluids of patients. Virus cultured in Vero cell line. Sera of patients have antibodies to virus. Cultured virus produces disease in Macaque monkeys. -produces specific immune response; -isolated virus is SARS CoV; -pathology similar to human.

Clinical review: Management of difficult airways

Science.gov (United States)

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

2006-01-01

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

Clinical review: management of difficult airways.

Science.gov (United States)

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

2006-01-01

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

The Earth is Flat, and I Can Prove It!

Science.gov (United States)

Klinger, Art

1998-01-01

Describes an educational program that asks students to attempt to prove that the earth is spherical and that it rotates. Presents tips to pique student interest and charts related to sensing the spin, nonrotation notions, flat earth fallacies, evidence that the earth is spherical and rotates, and the role of watersheds in proving that the earth…

Management of the difficult airway.

Science.gov (United States)

Schwartz, D E; Wiener-Kronish, J P

1991-09-01

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

Pengembangan Perangkat Pembelajaran Geometri Ruang dengan Model Proving Theorem

Directory of Open Access Journals (Sweden)

Bambang Eko Susilo

2016-03-01

Full Text Available Kemampuan berpikir kritis dan kreatif mahasiswa masih lemah. Hal ini ditemukan pada mahasiswa yang mengambil mata kuliah Geometri Ruang yaitu dalam membuktikan soal-soal pembuktian (problem to proof. Mahasiswa masih menyelesaikan secara algoritmik atau prosedural sehingga diperlukan pengembangan perangkat pembelajaran Geometri Ruang berbasis kompetensi dan konservasi dengan model Proving Theorem. Dalam penelitian ini perangkat perkuliahan yang dikembangkan yaitu Silabus, Satuan Acara Perkuliahan (SAP, Kontrak Perkuliahan, Media Pembelajaran, Bahan Ajar, Tes UTS dan UAS serta Angket Karakter Konservasi telah dilaksanakan dengan baik dengan kriteria (1 validasi perangkat pembelajaran mata kuliah Geometri ruang berbasis kompetensi dan konservasi dengan model proving theorem berkategori baik dan layak digunakan dan (2 keterlaksanaan RPP pada pembelajaran yang dikembangkan secara keseluruhan berkategori baik.Critical and creative thinking abilities of students still weak. It is found in students who take Space Geometry subjects that is in solving problems to to prove. Students still finish in algorithmic or procedural so that the required the development of Space Geometry learning tools based on competency and conservation with Proving Theorem models. This is a research development which refers to the 4-D models that have been modified for the Space Geometry learning tools, second semester academic year 2014/2015. Instruments used include validation sheet, learning tools and character assessment questionnaire. In this research, the learning tools are developed, namely Syllabus, Lesson Plan, Lecture Contract, Learning Media, Teaching Material, Tests, and Character Conservation Questionnaire had been properly implemented with the criteria (1 validation of Space Geometry learning tools based on competency and conservation with Proving Theorem models categorized good and feasible to use, and (2 the implementation of Lesson Plan on learning categorized

Psychopathology in difficult asthma

NARCIS (Netherlands)

Prins, L.C.; van Son, M.J.M.; Keimpema, A.R.; van Ranst, D; Pommer, A; Meijer, J.W.; Pop, V.J.M.

2015-01-01

OBJECTIVE: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed

Validated questionnaires heighten detection of difficult asthma comorbidities.

Science.gov (United States)

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

2017-04-01

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

Evidence-based guidelines of the spanish psoriasis group on the use of biologic therapy in patients with psoriasis in difficult-to-treat sites (nails, scalp, palms, and soles).

Science.gov (United States)

Sánchez-Regaña, M; Aldunce Soto, M J; Belinchón Romero, I; Ribera Pibernat, M; Lafuente-Urrez, R F; Carrascosa Carrillo, J M; Ferrándiz Foraster, C; Puig Sanz, L; Daudén Tello, E; Vidal Sarró, D; Ruiz-Villaverde, R; Fonseca Capdevila, E; Rodríguez Cerdeira, M C; Alsina Gibert, M M; Herrera Acosta, E; Marrón Moya, S E

2014-12-01

Psoriatic lesions affecting the scalp, nails, palms, and the soles of the feet are described as difficult-to-treat psoriasis and require specific management. Involvement of these sites often has a significant physical and emotional impact on the patient and the lesions are difficult to control with topical treatments owing to inadequate penetration of active ingredients and the poor cosmetic characteristics of the vehicles used. Consequently, when difficult-to-treat sites are involved, psoriasis can be considered severe even though the lesions are not extensive. Scant information is available about the use of biologic therapy in this setting, and published data generally comes from clinical trials of patients who also had moderate to severe extensive lesions or from small case series and isolated case reports. In this article we review the quality of the scientific evidence for the 4 biologic agents currently available in Spain (infliximab, etanercept, adalimumab, and ustekinumab) and report level i evidence for the use of biologics to treat nail psoriasis (level of recommendation A) and a somewhat lower level of evidence in the case of scalp involvement and palmoplantar psoriasis. Copyright © 2013 Elsevier España, S.L.U. y AEDV. All rights reserved.

The Constrained Maximal Expression Level Owing to Haploidy Shapes Gene Content on the Mammalian X Chromosome

KAUST Repository

Hurst, Laurence D.; Ghanbarian, Avazeh T.; Forrest, Alistair R. R.; Huminiecki, Lukasz

2015-01-01

to the ancestral rate (per promoter) prior to the X chromosome formation, then the X is not a tolerable environment for genes with very high maximal net levels of expression, owing to transcriptional traffic jams. We test this hypothesis using The Encyclopedia

On proving syntactic properties of CPS programs

DEFF Research Database (Denmark)

Danvy, Olivier; Dzafic, Belmina; Pfenning, Frank

1999-01-01

Higher-order program transformations raise new challenges for proving properties of their output, since they resist traditional, first-order proof techniques. In this work, we consider (1) the “one-pass” continuation-passing style (CPS) transformation, which is second-order, and (2) the occurrences...

Crisis management during anaesthesia: difficult intubation.

Science.gov (United States)

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

2005-06-01

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

Making marketing difficult

DEFF Research Database (Denmark)

Meyer, Gitte

2005-01-01

embraced by the market-place, while maintaining the old scientific alienation from political life. The case is made that modern science was born ambiguous towards the market-place, and that such ambivalence - relating to different interpretations of the idea of knowledge as a common good - is still...... to be encountered among scientists. Drawing on series of interviews with scientists from bioscience and biotechnology it is argued that, on the one hand, scientists are into marketing and PR exercises; but, on the other hand, they also voice a demand that journalists should make such marketing difficult...

Proving the correctness of unfold/fold program transformations using bisimulation

DEFF Research Database (Denmark)

Hamilton, Geoff W.; Jones, Neil

2011-01-01

by a labelled transition system whose bisimilarity relation is a congruence that coincides with contextual equivalence. Labelled transition systems are well-suited to represent global program behaviour. On the other hand, unfold/fold program transformations use generalization and folding, and neither is easy......This paper shows that a bisimulation approach can be used to prove the correctness of unfold/fold program transformation algorithms. As an illustration, we show how our approach can be use to prove the correctness of positive supercompilation (due to Sørensen et al). Traditional program equivalence...... to describe contextually, due to use of non-local information. We show that weak bisimulation on labelled transition systems gives an elegant framework to prove contextual equivalence of original and transformed programs. One reason is that folds can be seen in the context of corresponding unfolds....

LIHTC Difficult to Develop Areas

Data.gov (United States)

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

"Stiction Syndrome": Non-Operative Management of Patients With Difficult AMS 700 Series Inflation.

Science.gov (United States)

Kavoussi, Nicholas L; Viers, Boyd R; VanDyke, Maia E; Pagliara, Travis J; Morey, Allen F

2017-09-01

Static friction (stiction) is a mechanical phenomenon in which a state of increased resistance exists across a control valve mechanism. To present a strategy for non-operative management of inflatable penile prosthesis (IPP) cases with pump malfunction from pump valve stiction. All patients had American Medical Systems (AMS; Minnetonka, MN, USA) 700 series Momentary Squeeze IPPs with transient pump malfunction owing to pump valve stiction after extended periods of device inactivity. Our evolving non-operative management experience with the "forced deflation" maneuver is described. This technique has successfully prevented the need for surgical pump replacement. Of patients with IPP who were instructed to inflate and deflate daily to prevent stiction recurrence, none have re-presented with difficult inflation. Of 306 patients receiving the AMS 700 series IPP at our institution from 2007 through 2015, 6 (1.9%) presented with difficulty activating the Momentary Squeeze pump (from 2011 through 2015). Four additional patients were referred from outside institutions with the same complaint. All patients (10 of 10, 100%) presented after a prolonged period of inactivity (minimum = 6 weeks) during which the IPP was not cycled and remained stagnant. Although the initial four patients (40%) underwent surgical exploration with pump mobilization and replacement, the six most recent patients (60%) were successfully instructed in the forced deflation maneuver in the office, which enabled the device to cycle normally thereafter. Device inactivity, for as little as 6 weeks, can predispose to Momentary Squeeze pump valve malfunction; and a regimen of daily IPP cycling could prevent stiction-related malfunction. Our findings should encourage practitioners to attempt conservative management of patients with "stiction syndrome" whenever possible, thereby avoiding unnecessary surgery. Kavoussi NL, Viers BR, VanDyke ME, et al. "Stiction Syndrome": Non-Operative Management of Patients

Difficult to control atopic dermatitis

NARCIS (Netherlands)

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

2013-01-01

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

Use of a Flexible Intubating Scope in Combination with a Channeled Video Laryngoscope for Managing a Difficult Airway in the Emergency Department.

Science.gov (United States)

Sowers, Nicholas; Kovacs, George

2016-02-01

Difficulty with intubation is not uncommon in the emergency setting. Video laryngoscopes (VLs) are commonly used to manage the difficult airway in the emergency department (ED). Intubation using a flexible bronchoscope, while considered the gold standard for managing the anticipated difficult airway in the operating room, is not commonly used in the ED. We present a case describing VL-assisted flexible scope intubation performed in the ED as a novel feasible approach to managing the difficult airway. A 65-year-old male, post cardiac arrest, with multiple unsuccessful attempts at prehospital intubation had rapid sequence intubation (RSI) performed and, despite obtaining a view with a King Vision™ VL, the skilled operator was unable to advance the endotracheal tube (ETT). An Ambu™ aScope3 flexible intubating scope (FIS) was placed through the ETT loaded in the channel of the King Vision and advanced through the cords to a position proximal to the carina. The ETT was then advanced easily over the FIS and down the trachea. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although video laryngoscopy is commonly used in the ED, intubation can prove difficult, despite having an adequate view of the glottis. Use of an FIS, however, through a channeled VL makes navigation of the ETT easier and facilitates tube advancement, which can be difficult with VL. Channeled VL-assisted use of an FIS is a viable option for managing the difficult airway. Copyright © 2016 Elsevier Inc. All rights reserved.

Seismic proving test of BWR primary loop recirculation system

International Nuclear Information System (INIS)

Sato, H.; Shigeta, M.; Karasawa, Y.

1987-01-01

The seismic proving test of BWR Primary Loop Recirculation system is the second test to use the large-scale, high-performance vibration table of Tadotsu Engineering Laboratory. The purpose of this test is to prove the seismic reliability of the primary loop recirculation system (PLR), one of the most important safety components in the BWR nuclear plants, and also to confirm the adequacy of seismic analysis method used in the current seismic design. To achieve the purpose, the test was conducted under conditions and scale as near as possible to actual systems. The strength proving test was carried out with the test model mounted on the vibration table in consideration of basic design earthquake ground motions and other conditions to confirm the soundness of structure and the strength against earthquakes. Detailed analysis and analytic evaluation of the data obtained from the test was conducted to confirm the adequacy of the seismic analysis method and earthquake response analysis method used in the current seismic design. Then, on the basis of the results obtained, the seismic safety and reliability of BWR primary loop recirculation of the actual plants was fully evaluated

How Difficult It Is to Be God

DEFF Research Database (Denmark)

Wilson, Fiona

2014-01-01

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

Psychopathology in difficult asthma : Review

NARCIS (Netherlands)

Prins, L.C.J.; van Son, M.A.C.; van Keimpema, A.R.J.; van Ranst, D.; Antonissen-Pommer, A.M.; Meijer, J.W.G.; Pop, V.J.M.

2015-01-01

Objective: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed

Guidelines and algorithms for managing the difficult airway.

Science.gov (United States)

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

2018-01-01

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

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

OpenAIRE

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

2015-01-01

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

How to manage a child with difficult asthma?

Science.gov (United States)

Saglani, Sejal; Fleming, Louise

2016-08-01

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

Kidney paired exchange and desensitization: Strategies to transplant the difficult to match kidney patients with living donors.

Science.gov (United States)

Pham, Thomas A; Lee, Jacqueline I; Melcher, Marc L

2017-01-01

With organs in short supply, only a limited number of kidney transplants can be performed a year. Live donor donation accounts for 1/3rd of all kidney transplants performed in the United States. Unfortunately, not every donor recipient pair is feasible because of Human leukocyte antigen (HLA) sensitization and ABO incompatibility. To overcome these barriers to transplant, strategies such as kidney paired donation (KPD) and desensitization have been developed. KPD is the exchange of donors between at least two incompatible donor-recipient pairs such that they are now compatible. Desensitization is the removal of circulating donor specific antibodies to prevent graft rejection. Regardless of the treatment strategy, highly sensitized patients whose calculated panel reactive antibody (cPRA) is ≥95% remain difficult to transplant with match rates as low as 15% in KPD pools. Desensitization has proved to be difficult in those with high antibody titers. A novel approach is the combination of both KPD and desensitization to facilitate compatible and successful transplantation. A highly sensitized patient can be paired with a better immunological match in the KPD pool and subsequently desensitized to a lesser degree. This article reviews the current progress in KPD and desensitization and their use as a combined therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

On proving syntactic properties of CPS programs

DEFF Research Database (Denmark)

Danvy, Olivier; Dzafic, Belmina; Pfenning, Frank

1999-01-01

Higher-order program transformations raise new challenges for proving properties of their output, since they resist traditional, first-order proof techniques. In this work, we consider (1) the “one-pass” continuation-passing style (CPS) transformation, which is second-order, and (2) the occurrences...... of parameters of continuations in its output. To this end, we specify the one-pass CPS transformation relationally and we use the proof technique of logical relations....

A novel cannulation technique for difficult urethral catheterization

Directory of Open Access Journals (Sweden)

Mehmet Kaynar

2016-03-01

Full Text Available Introduction: To propose a novel cannulation technique for difficult urethral catheterization procedures. Technique: The sheath tip of an intravenous catheter is cut off, replaced to the needle tip and pushed through the distal drainage side hole to Foley catheter tip, and finally withdrawn for cannulation. In situations making urethral catheterization difficult, a guide wire is placed under direct vision. The modified Foley catheter is slid successfully over the guide wire from its distal end throughout the urethral passage into the bladder. Results: The modified Foley catheter was used successfully in our clinic in cases requiring difficult urethral catheterization. Conclusions: This easy and rapid modification of a Foley catheter may minimize the potential complications of blind catheter placement in standard catheterization.

Preparing for Mars: The Evolvable Mars Campaign 'Proving Ground' Approach

Science.gov (United States)

Bobskill, Marianne R.; Lupisella, Mark L.; Mueller, Rob P.; Sibille, Laurent; Vangen, Scott; Williams-Byrd, Julie

2015-01-01

As the National Aeronautics and Space Administration (NASA) prepares to extend human presence beyond Low Earth Orbit, we are in the early stages of planning missions within the framework of an Evolvable Mars Campaign. Initial missions would be conducted in near-Earth cis-lunar space and would eventually culminate in extended duration crewed missions on the surface of Mars. To enable such exploration missions, critical technologies and capabilities must be identified, developed, and tested. NASA has followed a principled approach to identify critical capabilities and a "Proving Ground" approach is emerging to address testing needs. The Proving Ground is a period subsequent to current International Space Station activities wherein exploration-enabling capabilities and technologies are developed and the foundation is laid for sustained human presence in space. The Proving Ground domain essentially includes missions beyond Low Earth Orbit that will provide increasing mission capability while reducing technical risks. Proving Ground missions also provide valuable experience with deep space operations and support the transition from "Earth-dependence" to "Earth-independence" required for sustainable space exploration. A Technology Development Assessment Team identified a suite of critical technologies needed to support the cadence of exploration missions. Discussions among mission planners, vehicle developers, subject-matter-experts, and technologists were used to identify a minimum but sufficient set of required technologies and capabilities. Within System Maturation Teams, known challenges were identified and expressed as specific performance gaps in critical capabilities, which were then refined and activities required to close these critical gaps were identified. Analysis was performed to identify test and demonstration opportunities for critical technical capabilities across the Proving Ground spectrum of missions. This suite of critical capabilities is expected to

Dealing with difficult pasts

DEFF Research Database (Denmark)

McAtackney, Laura

2013-01-01

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

Advances in Rosetta structure prediction for difficult molecular-replacement problems

International Nuclear Information System (INIS)

DiMaio, Frank

2013-01-01

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

Unexploded ordnance issues at Aberdeen Proving Ground: Background information

Energy Technology Data Exchange (ETDEWEB)

Rosenblatt, D.H.

1996-11-01

This document summarizes currently available information about the presence and significance of unexploded ordnance (UXO) in the two main areas of Aberdeen Proving Ground: Aberdeen Area and Edgewood Area. Known UXO in the land ranges of the Aberdeen Area consists entirely of conventional munitions. The Edgewood Area contains, in addition to conventional munitions, a significant quantity of chemical-munition UXO, which is reflected in the presence of chemical agent decomposition products in Edgewood Area ground-water samples. It may be concluded from current information that the UXO at Aberdeen Proving Ground has not adversely affected the environment through release of toxic substances to the public domain, especially not by water pathways, and is not likely to do so in the near future. Nevertheless, modest but periodic monitoring of groundwater and nearby surface waters would be a prudent policy.

Classificació de proves no paramètriques. Com aplicar-les en SPSS

Directory of Open Access Journals (Sweden)

Vanesa Berlanga-Silvente

2012-07-01

Full Text Available Les proves no paramètriques engloben una sèrie de proves estadístiques, que tenen com a denominador comú l'absència de assumpcions sobre la llei de probabilitat que segueix la població de la qual ha estat extreta la mostra. Per aquesta raó és comú referir-s'hi com a proves de distribució lliure. A l'article es descriuen i treballen les proves no paramètriques ressaltant el seu fonament i les indicacions per al seu ús quan es tracta d'una sola mostra (Chi-quadrat, de dues mostres amb dades independents (U de Mann-Whitney, de dues mostres amb dades relacionades (T de Wilcoxon, de diverses mostres amb dades independents (H de Kruskal-Wallis i de diverses mostres amb dades relacionades (Friedman.

Why Translation Is Difficult

DEFF Research Database (Denmark)

Carl, Michael; Schaeffer, Moritz Jonas

2017-01-01

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

Evaluation of depleted uranium in the environment at Aberdeen Proving Grounds, Maryland and Yuma Proving Grounds, Arizona. Final report

International Nuclear Information System (INIS)

Kennedy, P.L.; Clements, W.H.; Myers, O.B.; Bestgen, H.T.; Jenkins, D.G.

1995-01-01

This report represents an evaluation of depleted uranium (DU) introduced into the environment at the Aberdeen Proving Grounds (APG), Maryland and Yuma Proving Grounds (YPG) Arizona. This was a cooperative project between the Environmental Sciences and Statistical Analyses Groups at LANL and with the Department of Fishery and Wildlife Biology at Colorado State University. The project represents a unique approach to assessing the environmental impact of DU in two dissimilar ecosystems. Ecological exposure models were created for each ecosystem and sensitivity/uncertainty analyses were conducted to identify exposure pathways which were most influential in the fate and transport of DU in the environment. Research included field sampling, field exposure experiment, and laboratory experiments. The first section addresses DU at the APG site. Chapter topics include bioenergetics-based food web model; field exposure experiments; bioconcentration by phytoplankton and the toxicity of U to zooplankton; physical processes governing the desorption of uranium from sediment to water; transfer of uranium from sediment to benthic invertebrates; spead of adsorpion by benthic invertebrates; uptake of uranium by fish. The final section of the report addresses DU at the YPG site. Chapters include the following information: Du transport processes and pathway model; field studies of performance of exposure model; uptake and elimination rates for kangaroo rates; chemical toxicity in kangaroo rat kidneys

Evaluation of depleted uranium in the environment at Aberdeen Proving Grounds, Maryland and Yuma Proving Grounds, Arizona. Final report

Energy Technology Data Exchange (ETDEWEB)

Kennedy, P.L.; Clements, W.H.; Myers, O.B.; Bestgen, H.T.; Jenkins, D.G. [Colorado State Univ., Fort Collins, CO (United States). Dept. of Fishery and Wildlife Biology

1995-01-01

This report represents an evaluation of depleted uranium (DU) introduced into the environment at the Aberdeen Proving Grounds (APG), Maryland and Yuma Proving Grounds (YPG) Arizona. This was a cooperative project between the Environmental Sciences and Statistical Analyses Groups at LANL and with the Department of Fishery and Wildlife Biology at Colorado State University. The project represents a unique approach to assessing the environmental impact of DU in two dissimilar ecosystems. Ecological exposure models were created for each ecosystem and sensitivity/uncertainty analyses were conducted to identify exposure pathways which were most influential in the fate and transport of DU in the environment. Research included field sampling, field exposure experiment, and laboratory experiments. The first section addresses DU at the APG site. Chapter topics include bioenergetics-based food web model; field exposure experiments; bioconcentration by phytoplankton and the toxicity of U to zooplankton; physical processes governing the desorption of uranium from sediment to water; transfer of uranium from sediment to benthic invertebrates; spead of adsorpion by benthic invertebrates; uptake of uranium by fish. The final section of the report addresses DU at the YPG site. Chapters include the following information: Du transport processes and pathway model; field studies of performance of exposure model; uptake and elimination rates for kangaroo rates; chemical toxicity in kangaroo rat kidneys.

Therapist reactions in self-experienced difficult situations: an exploration

NARCIS (Netherlands)

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

2007-01-01

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

Theorem Proving in Intel Hardware Design

Science.gov (United States)

O'Leary, John

2009-01-01

For the past decade, a framework combining model checking (symbolic trajectory evaluation) and higher-order logic theorem proving has been in production use at Intel. Our tools and methodology have been used to formally verify execution cluster functionality (including floating-point operations) for a number of Intel products, including the Pentium(Registered TradeMark)4 and Core(TradeMark)i7 processors. Hardware verification in 2009 is much more challenging than it was in 1999 - today s CPU chip designs contain many processor cores and significant firmware content. This talk will attempt to distill the lessons learned over the past ten years, discuss how they apply to today s problems, outline some future directions.

Formalizing and proving a typing result for security protocols in Isabelle/HOL

DEFF Research Database (Denmark)

Hess, Andreas Viktor; Modersheim, Sebastian

2017-01-01

or the positive output of a verification tool. However several of these works have used a typed model, where the intruder is restricted to "well-typed" attacks. There also have been several works that show that this is actually not a restriction for a large class of protocols, but all these results so far...... are again pen-and-paper proofs. In this work we present a formalization of such a typing result in Isabelle/HOL. We formalize a constraint-based approach that is used in the proof argument of such typing results, and prove its soundness, completeness and termination. We then formalize and prove the typing...... result itself in Isabelle. Finally, to illustrate the real-world feasibility, we prove that the standard Transport Layer Security (TLS) handshake satisfies the main condition of the typing result....

IHSI [Induction Heating Stress Improvement] proves its worth

International Nuclear Information System (INIS)

Froehlich, C.H.; Cofie, N.G.; Sheffield, J.R.

1988-01-01

Based upon the wealth of experimental test data, extensive and successful in-plant application, and the decreasing cost of applying the process, IHSI is proving itself an important part of overall IGSCC mitigation programmes. Work is ongoing on the development of new temperature sensing systems, more efficient equipment immobilization/demobilization hardware configurations, and craft support management practices to further enhance the cost-effectiveness of IHSI. (author)

The “incredible” difficulty of proving “incredibility” – Example of fire-induced multiple spurious operations

International Nuclear Information System (INIS)

Gallucci, Raymond H.V.

2016-01-01

“Risk-informed” regulation is often an alternative to “deterministically-based” regulation that offers relaxation in criteria for acceptability while possibly requiring greater analytical effort. “Risk-informed determinism” is an attempt to meld the best of both worlds by using risk information to set deterministic acceptance criteria a priori. A recent joint effort by the US Nuclear Regulatory Commission’s Office of Nuclear Regulatory Research (RES) and Electric Power Research Institute (EPRI) originally endeavored to do this for several examples involving fire-induced multiple spurious operations (MSOs) in electrical circuits at nuclear power plants. While a noble effort, this did not consider the actual distributions involved in the events, originally limiting the analysis to mean values and, in some cases, qualitative considerations. A much more comprehensive and defensible approach is performed here where the probabilistic distributions for all the factors are considered via simulation to meet quantitative acceptance criteria related to the concept of “incredibility” that is often the figure of merit that must be met in a deterministic world. The effort demonstrates that it can be “incredibly” difficult to prove “incredibility” in this context.

The “incredible” difficulty of proving “incredibility” – Example of fire-induced multiple spurious operations

Energy Technology Data Exchange (ETDEWEB)

Gallucci, Raymond H.V., E-mail: Ray.Gallucci@nrc.gov

2016-11-15

“Risk-informed” regulation is often an alternative to “deterministically-based” regulation that offers relaxation in criteria for acceptability while possibly requiring greater analytical effort. “Risk-informed determinism” is an attempt to meld the best of both worlds by using risk information to set deterministic acceptance criteria a priori. A recent joint effort by the US Nuclear Regulatory Commission’s Office of Nuclear Regulatory Research (RES) and Electric Power Research Institute (EPRI) originally endeavored to do this for several examples involving fire-induced multiple spurious operations (MSOs) in electrical circuits at nuclear power plants. While a noble effort, this did not consider the actual distributions involved in the events, originally limiting the analysis to mean values and, in some cases, qualitative considerations. A much more comprehensive and defensible approach is performed here where the probabilistic distributions for all the factors are considered via simulation to meet quantitative acceptance criteria related to the concept of “incredibility” that is often the figure of merit that must be met in a deterministic world. The effort demonstrates that it can be “incredibly” difficult to prove “incredibility” in this context.

Duration of coming life associated with disablement owing to ophthalmothology

Directory of Open Access Journals (Sweden)

N. M. Rustamova

2014-07-01

Full Text Available It was conducted the comparison of the middle duration of coming life associated with disablement owing to the different groups of eye disease in work. The difference between the duration of coming life of country population and the patient’ age were used as the gauge of life duration associated with disablement at the moment of the primary recognition by an invalid. It was determined that the middle duration of coming life associated with disablement changed and shook in the groups from 11,31 to 36,37 years for men and from 17,58 to 42,37 years for women subject to the reason of disablement. It is considered that the middle duration of coming life associated with disablement is integral criterion for an estimation of the medico-social burden of disease. It is differed 3 degrees of heaviness of the medico-social burden. The moderate heaviness of the medico-social burden (the middle duration of coming lif associated with disablement less than 20 years is characteristic for diabetic retinopathy, glaucoma and uveitis and the high degree of heaviness (the middle duration of coming life associated with disablement more than 30 years for disease of eyeball, visual nerve, eye traumas, myopia and anophthalmia.

Duration of coming life associated with disablement owing to ophthalmothology

Directory of Open Access Journals (Sweden)

N. M. Rustamova

2013-01-01

Full Text Available It was conducted the comparison of the middle duration of coming life associated with disablement owing to the different groups of eye disease in work. The difference between the duration of coming life of country population and the patient’ age were used as the gauge of life duration associated with disablement at the moment of the primary recognition by an invalid. It was determined that the middle duration of coming life associated with disablement changed and shook in the groups from 11,31 to 36,37 years for men and from 17,58 to 42,37 years for women subject to the reason of disablement. It is considered that the middle duration of coming life associated with disablement is integral criterion for an estimation of the medico-social burden of disease. It is differed 3 degrees of heaviness of the medico-social burden. The moderate heaviness of the medico-social burden (the middle duration of coming lif associated with disablement less than 20 years is characteristic for diabetic retinopathy, glaucoma and uveitis and the high degree of heaviness (the middle duration of coming life associated with disablement more than 30 years for disease of eyeball, visual nerve, eye traumas, myopia and anophthalmia.

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

Science.gov (United States)

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

2018-04-05

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

Disarming Contankerous People: Coping with Difficult Personalities in ECE Work Settings

Science.gov (United States)

Hernandez, Luis; Smith, Connie Jo

2009-01-01

Difficult personalities come in a variety of roles in just about every setting. While types have been identified in the typical corporate and business culture, difficult work personalities also inhabit the world of early childhood education (ECE) workplaces. Because difficult people have an impact on workplace morale and productivity, the topic…

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

Science.gov (United States)

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

2009-09-01

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

SPoRT's Participation in the GOES-R Proving Ground Activity

Science.gov (United States)

Jedlovec, Gary; Fuell, Kevin; Smith, Matthew; Stano, Geoffrey; Molthan, Andrew

2011-01-01

The next generation geostationary satellite, GOES-R, will carry two new instruments with unique atmospheric and surface observing capabilities, the Advanced Baseline Imager (ABI) and the Geostationary Lightning Mapper (GLM), to study short-term weather processes. The ABI will bring enhanced multispectral observing capabilities with frequent refresh rates for regional and full disk coverage to geostationary orbit to address many existing and new forecast challenges. The GLM will, for the first time, provide the continuous monitoring of total lightning flashes over a hemispherical region from space. NOAA established the GOES-R Proving Ground activity several years ago to demonstrate the new capabilities of these instruments and to prepare forecasters for their day one use. Proving Ground partners work closely with algorithm developers and the end user community to develop and transition proxy data sets representing GOES-R observing capabilities. This close collaboration helps to maximize refine algorithms leading to the delivery of a product that effectively address a forecast challenge. The NASA Short-term Prediction Research and Transition (SPoRT) program has been a participant in the NOAA GOES-R Proving Ground activity by developing and disseminating selected GOES-R proxy products to collaborating WFOs and National Centers. Established in 2002 to demonstrate the weather and forecasting application of real-time EOS measurements, the SPoRT program has grown to be an end-to-end research to operations activity focused on the use of advanced NASA modeling and data assimilation approaches, nowcasting techniques, and unique high-resolution multispectral data from EOS satellites to improve short-term weather forecasts on a regional and local scale. Participation in the Proving Ground activities extends SPoRT s activities and taps its experience and expertise in diagnostic weather analysis, short-term weather forecasting, and the transition of research and experimental

Renewable Energy Opportunties at Dugway Proving Ground, Utah

Energy Technology Data Exchange (ETDEWEB)

Orrell, Alice C.; Kora, Angela R.; Russo, Bryan J.; Horner, Jacob A.; Williamson, Jennifer L.; Weimar, Mark R.; Gorrissen, Willy J.; Nesse, Ronald J.; Dixon, Douglas R.

2010-05-31

This document provides an overview of renewable resource potential at Dugway Proving Ground, based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. This effort focuses on grid-connected generation of electricity from renewable energy sources and ground source heat pumps (GSHPs). The effort was funded by the U.S. Army Installation Management Command (IMCOM) as follow-on to the 2005 Department of Defense (DoD) Renewables Assessment.

Unusual tumour ablations: report of difficult and interesting cases

OpenAIRE

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

2017-01-01

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

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

Directory of Open Access Journals (Sweden)

Ishwar Singh

2009-01-01

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

How libraries make tough choices in difficult times purposeful abandonment

CERN Document Server

Stern, David

2013-01-01

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

Difficult diagnoses in the skeletal radiology

International Nuclear Information System (INIS)

Freyschmidt, Juergen

2013-01-01

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

Unicorns do exist: a tutorial on "proving" the null hypothesis.

Science.gov (United States)

Streiner, David L

2003-12-01

Introductory statistics classes teach us that we can never prove the null hypothesis; all we can do is reject or fail to reject it. However, there are times when it is necessary to try to prove the nonexistence of a difference between groups. This most often happens within the context of comparing a new treatment against an established one and showing that the new intervention is not inferior to the standard. This article first outlines the logic of "noninferiority" testing by differentiating between the null hypothesis (that which we are trying to nullify) and the "nill" hypothesis (there is no difference), reversing the role of the null and alternate hypotheses, and defining an interval within which groups are said to be equivalent. We then work through an example and show how to calculate sample sizes for noninferiority studies.

Usage of I++ Simulator to Program Coordinate Measuring Machines when Common Programming Methods are difficult to apply

Directory of Open Access Journals (Sweden)

Gąska A.

2014-02-01

Full Text Available Nowadays, simulators facilitate tasks performed daily by the engineers of different branches, including coordinate metrologists. Sometimes it is difficult or almost impossible to program a Coordinate Measuring Machine (CMM using standard methods. This happens, for example, during measurements of nano elements or in cases when measurements are performed on high-precision (accurate measuring machines which work in strictly air-conditioned spaces and the presence of the operator in such room during the programming of CMM could cause an increase in temperature, which in turn could make it necessary to wait some time until conditions stabilize. This article describes functioning of a simulator and its usage during Coordinate Measuring Machine programming in the latter situation. Article also describes a general process of programming CMMs which ensures the correct machine performance after starting the program on a real machine. As an example proving the presented considerations, measurement of exemplary workpiece, which was performed on the machine working in the strictly air-conditioned room, was described

Emotional distance to so-called difficult patients

DEFF Research Database (Denmark)

Michaelsen, Jette Joost

2012-01-01

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

On the problem of proving the existence of ''charmed'' particles

International Nuclear Information System (INIS)

Tyapkin, A.A.

1975-01-01

In order to search for ''charmed'' particles a possibility of performing an experiment is discussed in which one could observe a new particle and prove a necessity of introducting for this particle a new quantum number conserved in strong interactions

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

Science.gov (United States)

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

2017-12-21

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

Valutazione economica dello studio PROVE-IT

Directory of Open Access Journals (Sweden)

Lorenzo G. Mantovani

2007-10-01

Full Text Available Introduction: the PROVE-IT (“Intensive versus moderate lipid lowering with statins after acute coronary syndromes” was a comparison of pravastatin 40 mg/die versus atorvastatin 80 mg/die in patients with an acute coronary syndrome (ACS. Aim: our aim was to investigate the economic consequence of high dose of atorvastatin vs usual-dose of pravastatin in Italian patients with a history of acute coronary syndrome. Methods: the analysis is conducted on the basis of clinical outcomes of the PROVE-IT study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die versus usual-dose of pravastatin (40 mg/die in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2006. Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years gained and frequency of hospitalizations. We considered an observation period of 24 months. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. We also conducted a threshold analysis. Results: the cost of pravastatin or atorvastatin therapy over the 2 years period amounted to approximately 1.3 millions euro and 870,000 euro per 1,000 patients respectively. Atorvastatin was more efficacious compared to pravastatin and the overall cost of care per 1,000 patients over 24 months of follow-up was estimated at 3.2 millions euro in the pravastatin and 2.5 millions euro in the atorvastatin group, resulting into a cost saving of about 700,000 euro that is 27% of total costs occurred in the pravastatin group. Discussion: this study demonstrates that high does atorvastatin treatment leads to a reduction of direct costs for the National Health System

The long shadows of the difficult past?

DEFF Research Database (Denmark)

Wolnik, Kevin; Busse, Britta; Tholen, Jochen

2017-01-01

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

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

Science.gov (United States)

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

2012-08-01

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

The Constrained Maximal Expression Level Owing to Haploidy Shapes Gene Content on the Mammalian X Chromosome

KAUST Repository

Hurst, Laurence D.

2015-12-18

X chromosomes are unusual in many regards, not least of which is their nonrandom gene content. The causes of this bias are commonly discussed in the context of sexual antagonism and the avoidance of activity in the male germline. Here, we examine the notion that, at least in some taxa, functionally biased gene content may more profoundly be shaped by limits imposed on gene expression owing to haploid expression of the X chromosome. Notably, if the X, as in primates, is transcribed at rates comparable to the ancestral rate (per promoter) prior to the X chromosome formation, then the X is not a tolerable environment for genes with very high maximal net levels of expression, owing to transcriptional traffic jams. We test this hypothesis using The Encyclopedia of DNA Elements (ENCODE) and data from the Functional Annotation of the Mammalian Genome (FANTOM5) project. As predicted, the maximal expression of human X-linked genes is much lower than that of genes on autosomes: on average, maximal expression is three times lower on the X chromosome than on autosomes. Similarly, autosome-to-X retroposition events are associated with lower maximal expression of retrogenes on the X than seen for X-to-autosome retrogenes on autosomes. Also as expected, X-linked genes have a lesser degree of increase in gene expression than autosomal ones (compared to the human/Chimpanzee common ancestor) if highly expressed, but not if lowly expressed. The traffic jam model also explains the known lower breadth of expression for genes on the X (and the Z of birds), as genes with broad expression are, on average, those with high maximal expression. As then further predicted, highly expressed tissue-specific genes are also rare on the X and broadly expressed genes on the X tend to be lowly expressed, both indicating that the trend is shaped by the maximal expression level not the breadth of expression per se. Importantly, a limit to the maximal expression level explains biased tissue of expression

The Constrained Maximal Expression Level Owing to Haploidy Shapes Gene Content on the Mammalian X Chromosome.

Directory of Open Access Journals (Sweden)

Laurence D Hurst

2015-12-01

Full Text Available X chromosomes are unusual in many regards, not least of which is their nonrandom gene content. The causes of this bias are commonly discussed in the context of sexual antagonism and the avoidance of activity in the male germline. Here, we examine the notion that, at least in some taxa, functionally biased gene content may more profoundly be shaped by limits imposed on gene expression owing to haploid expression of the X chromosome. Notably, if the X, as in primates, is transcribed at rates comparable to the ancestral rate (per promoter prior to the X chromosome formation, then the X is not a tolerable environment for genes with very high maximal net levels of expression, owing to transcriptional traffic jams. We test this hypothesis using The Encyclopedia of DNA Elements (ENCODE and data from the Functional Annotation of the Mammalian Genome (FANTOM5 project. As predicted, the maximal expression of human X-linked genes is much lower than that of genes on autosomes: on average, maximal expression is three times lower on the X chromosome than on autosomes. Similarly, autosome-to-X retroposition events are associated with lower maximal expression of retrogenes on the X than seen for X-to-autosome retrogenes on autosomes. Also as expected, X-linked genes have a lesser degree of increase in gene expression than autosomal ones (compared to the human/Chimpanzee common ancestor if highly expressed, but not if lowly expressed. The traffic jam model also explains the known lower breadth of expression for genes on the X (and the Z of birds, as genes with broad expression are, on average, those with high maximal expression. As then further predicted, highly expressed tissue-specific genes are also rare on the X and broadly expressed genes on the X tend to be lowly expressed, both indicating that the trend is shaped by the maximal expression level not the breadth of expression per se. Importantly, a limit to the maximal expression level explains biased

Malignant neoplasms on the territories of Russia damaged owing to the Chernobyl accident

International Nuclear Information System (INIS)

Remennik, L.V.; Starinsky, V.V.; Mokina, V.D.; Chissov, V.I.; Scheplyagina, L.A.; Petrova, G.V.; Rubtsova, M.M.

1996-01-01

The work presents the results of descriptive analysis of development of onco epidemiological situation in six of the most polluted regions owing to the Chernobyl accident in 1981-1994. The growth of malignancies incidence is marked in all territories as well as in the Russian Federation as a whole. The most adverse tendencies have been revealed in the Bryansk, Orel, Ryazan regions. It is marked that the formation of a structure, levels and trends of the malignancies incidence has been occurring under influence of a complex of factors usual up to the accident. The analysis of the data from the specialized cancer-register evidences that the incidence of thyroid malignancies is actively growing in the population of the Bryansk region. The probability of connection of growth of the thyroid cancer incidence in children of the Bryansk region with the Chernobyl accident is reasonably high, but should be confirmed through the application of methods of analytical epidemiology

The in-pile proving test for fuel assembly of Qinshan nuclear power plant

International Nuclear Information System (INIS)

Chen Dianshan; Zhang Shucheng; Kang Rixin; Wang Huarong; Chen Guanghan

1989-10-01

The in-pile proving test for fuel assembly of Qinshan nuclear power plant had been conducted in the experimental loop of HWRR at IAE (Institute of Atomic Energy) in Beijing, China, from January 1985 to December 1986. Average burnup of 27000 MWd/tU and peak burnup of 34000 MWd/tU of fuel rod had already been reached. The basic status of the experiment are described, emphasis is placed on the discussion of proving test parameters and analysis of experiment results

Clinical review: Management of difficult airways

OpenAIRE

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

2006-01-01

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

“Deliberate distortion of facts” and the problem of proving bias:

African Journals Online (AJOL)

user

informed observer would reasonably perceive bias on the part of the officer .... represent an excellent illustration of what an Australian Chief Justice once .... the appellants prove that the Justice of Appeal who had no financial or other.

Proving test on the performance of a Multiple-Excitation Simulator

International Nuclear Information System (INIS)

Fujita, Katsuhisa; Ito, Tomohiro; Kojima, Nobuyuki; Sasaki, Yoichi; Abe, Hiroshi; Kuroda, Katsuhiko

1995-01-01

Seismic excitation test on large scale piping systems is scheduled to be carried out by the Nuclear power Engineering Corporation (NUPEC) using the large-scale, high-performance vibration table at the Tadotsu Engineering Laboratory, under the sponsorship of the Ministry of International Trade and Industry (MITI). In the test, the piping systems simulate the main steam piping system and the main feed water piping system in the nuclear power plants. In this study, a fundamental test was carried out to prove the performance of the Multiple Excitation Simulator which consists of the hydraulic actuator and the control system. An L-shaped piping system and a hydraulic actuator were installed on the shaking table. Acceleration and displacement generated by the actuator were measured. The performance of the actuator and the control system was discussed comparing the measured values and the target values on the time histories and the response spectrum of the acceleration. As a result, it was proved that the actuator and the control system have good performance and will be applicable to the verification test

Proving the AGT relation for N f = 0, 1, 2 antifundamentals

Science.gov (United States)

Hadasz, Leszek; Jaskólski, Zbigniew; Suchanek, Paulina

2010-06-01

Using recursive relations satisfied by Nekrasov partition functions and by irregular conformal blocks we prove the AGT correspondence in the case of mathcal{N} = 2 superconformal SU(2) quiver gauge theories with N f = 0, 1, 2 antifundamental hypermultiplets.

Medical Students' Personal Determinants of Overcoming Strategies in Difficult Situations

Directory of Open Access Journals (Sweden)

Veretelnikova Yu.Ya.

2013-03-01

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

Socio-economic consequences of Chernobyl catastrophe. Social protection of the citizens, affected owing to Chernobyl catastrophe

International Nuclear Information System (INIS)

Kholosha, V.; Kovalchuk, V.

2003-01-01

The accident on Chernobyl NPP has affected the destiny of 35 million people in Ukraine. The social protection of the population affected during Chernobyl catastrophe is founded on the Law of Ukraine 'About the status and social protection of citizens affected owing to Chernobyl catastrophe' (see further - 'Law'), and is the principal direction of activity and the subject of the special state attention to total complex of problems bound to Chernobyl catastrophe consequences elimination. The current legislation stipulates partial compensation of material losses connected with resettlement of the affected population. According to the current legislation in Ukraine about 50 kinds of aid, privileges and compensations are submitted to the affected citizens

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

Science.gov (United States)

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

2017-08-01

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

Preoperative Ultrasonography as a Predictor of Difficult ...

African Journals Online (AJOL)

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

Difficult Tracheal Intubation in Obese Gastric Bypass patients

DEFF Research Database (Denmark)

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

2016-01-01

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

Seeking the best training model for difficult conversations in neonatology.

Science.gov (United States)

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

2016-05-01

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

Logic for computer science foundations of automatic theorem proving

CERN Document Server

Gallier, Jean H

2015-01-01

This advanced text for undergraduate and graduate students introduces mathematical logic with an emphasis on proof theory and procedures for algorithmic construction of formal proofs. The self-contained treatment is also useful for computer scientists and mathematically inclined readers interested in the formalization of proofs and basics of automatic theorem proving. Topics include propositional logic and its resolution, first-order logic, Gentzen's cut elimination theorem and applications, and Gentzen's sharpened Hauptsatz and Herbrand's theorem. Additional subjects include resolution in fir

E-squared nine do-it-yourself energy experiments that prove your thoughts create your reality

CERN Document Server

Grout, Pam

2013-01-01

E-Squared is a lab manual with simple experiments to prove once and for all that there really is a good, loving, totally hip force in the universe. Rather than take it on faith, you are invited to conduct ten 48-hour experiments to prove each of the principles in this book. Yes, you read that right. It says prove. The experiments, each of which can be conducted with absolutely no money and very little time expenditure, demonstrate that spiritual principles are as dependable as gravity, as consistent as Newton's 2nd law of motion. For years, you've been hoping and praying that spiritual principles are true. Now, you can know.

Using eternity variables to specify and prove a serializable database interface

NARCIS (Netherlands)

Hesselink, Wim H.

Eternity variables are introduced to specify and verify serializability of transactions of a distributed database. Eternity variables are a new kind of auxiliary variables. They do not occur in the implementation but are used in specification and verification. Elsewhere it has been proved that

Automatically Proving Termination and Memory Safety for Programs with Pointer Arithmetic

DEFF Research Database (Denmark)

Ströder, Thomas; Giesl, Jürgen; Brockschmidt, Marc

2017-01-01

While automated verification of imperative programs has been studied intensively, proving termination of programs with explicit pointer arithmetic fully automatically was still an open problem. To close this gap, we introduce a novel abstract domain that can track allocated memory in detail. We use...

Difficult intubation: are you prepared for it?

Science.gov (United States)

Balcom, C

1994-01-01

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

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A ...

African Journals Online (AJOL)

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

Surfactant-induced deposit structures in relation to the biological efficacy of glyphosate on easy- and difficult-to-wet weed species.

Science.gov (United States)

Kraemer, Thorsten; Hunsche, Mauricio; Noga, Georg

2009-08-01

Typical active ingredient (AI) residue patterns are formed during droplet drying on plant surfaces owing to the interaction of spray solution characteristics and leaf micromorphology. Currently, comparatively little is known about the influence of AI deposit patterns within a spray droplet residue area on the penetration and biological efficacy of glyphosate. A scanning electron microscope with energy dispersive X-ray microanalysis has been used to characterise residue patterns and to quantify the area ultimately covered by glyphosate within the droplet spread area. The easy-to-wet weed species Stellaria media L. and Viola arvensis L., as well as the difficult-to-wet Chenopodium album L. and Setaria viridis L., differing in their surface micromorphology, have been used. Rapeseed oil ethoxylates (RSO 5 or RSO 60) were added to glyphosate solutions to provide different droplet spread areas. Addition of RSO 5 enhanced droplet spread area more than RSO 60, and both caused distinct glyphosate residue patterns. The biological efficacy of treatment solutions showed no significant correlation with the area ultimately covered by glyphosate. The results have implications on herbicide uptake models. This study shows that droplet spread area does not correspond to the area ultimately covered by glyphosate, and that the latter does not affect glyphosate phytotoxicity.

41 CFR 301-54.1 - Is my agency allowed to collect undisputed delinquent amounts that I owe to a Government travel...

Science.gov (United States)

2010-07-01

... BILLED TRAVEL CHARGE CARD General Rules § 301-54.1 Is my agency allowed to collect undisputed delinquent... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Is my agency allowed to collect undisputed delinquent amounts that I owe to a Government travel charge card contractor? 301-54.1...

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

Directory of Open Access Journals (Sweden)

Moustafa Abdelaziz Moustafa

2017-04-01

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

Difficult Sudoku Puzzles Created by Replica Exchange Monte Carlo Method

OpenAIRE

Watanabe, Hiroshi

2013-01-01

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

Technical report on the Piping Reliability Proving Tests at the Japan Atomic Energy Research Institute

International Nuclear Information System (INIS)

1993-05-01

Japan Atomic Energy Research Institute (JAERI) conducts Piping Reliability Proving Tests from 1975 to 1992 based upon the contracts between JAERI and Science and Technology Agency of Japan (STA) under the auspices of the special account law for electric power development promotion. The purpose of these tests are to prove the structural reliability of the primary cooling piping constituting a part of the pressure boundary in the light water reactor power plants. The tests with large experimental facilities had ended already in 1990. Presently piping reliability analysis by the probabilistic fracture mechanics method is being done. Until now annual reports concerning the proving tests were produced and submitted to STA, whereas this report summarizes the test results done during these 16 years. Objectives of the piping reliability proving tests are to prove that the primary piping of the light water reactor (1) be reliable throughout the service period, (2) have no possibility of rupture, (3) bring no detrimental influence on the surrounding instrumentations or equipments near the break location even if it ruptured suddenly. To attain these objectives (i) pipe fatigue tests, (ii) unstable pipe fracture tests, (iii) pipe rupture tests and also the analyses by computer codes were done. After carrying out these tests, it is verified that the piping is reliable throughout the service period. The authors of this report are T. Isozaki, K. Shibata, S. Ueda, R. Kurihara, K. Onizawa and A. Kohsaka. The parts they wrote are shown in contents. (author)

76 FR 50771 - Submission for Review: RI 25-37, Evidence To Prove Dependency of a Child, 3206-0206

Science.gov (United States)

2011-08-16

... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: RI 25-37, Evidence To Prove Dependency of a...) 3206-0206, Evidence to Prove Dependency of a Child. As required by the Paperwork Reduction Act of 1995... or faxed to (202) 395-6974. SUPPLEMENTARY INFORMATION: Evidence to Prove Dependency of a Child is...

Origin of choriocarcinoma in previous molar pregnancy proved by DNA analysis

International Nuclear Information System (INIS)

Vojtassak, J.; Repiska, V.; Konecna, B.; Zajac, V.; Korbel, M.; Danihel, L.

1996-01-01

A 17-year old woman had in a short time period (seven months) a very exciting reproduction history. Molar pregnancy in December 1993, choriocarcinoma in January 1994 and induced abortion in June 1994. DNA analysis proved the origin of the choriocarcinoma in the previous molar pregnancy. (author)

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

Science.gov (United States)

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

2016-01-01

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

Nitrogen mineralization in forestry-drained peatland soils in the Stołowe Mountains National Park (Central Sudetes Mts

Directory of Open Access Journals (Sweden)

Glina Bartłomiej

2016-06-01

Full Text Available The aim of this work was to determine the intensity of nitrogen mineralization in forestry drained ombrotrophic peatland soils in the Stołowe Mountains National Park, SW Poland. Additionally discussion about the shallow organic soils classification according to Polish Soil Classification (2011 is presented. For the study three research transects were established on forestry drained ombrotrophic peatlands in the Stołowe Mountains. Each of the transect consisted of four (site A and B or five (site C sampling plots. Sampling was conducted in the year 2012. The soil samples for the basic soil properties analysis were sampled in April, whereas undisturbed soil samples were collected in stainless steel rings (100 cm3 every 10 cm in April (spring, July (summer and October (autumn to show the seasonal dynamics of nitrogen mineralization. Statistical analysis showed that the content of N-NH4 was mainly determined by actual soil moisture and precipitation rate, whereas the content of N-NO3 was positively correlated with air temperature. Among investigated peatlands the highest concentrations of mineral nitrogen forms was observed in the Długie Mokradło bog, situated on the Skalniak Plateau-summit. Additionally, the results obtained showed that implementation of new subtype: shallow fibric peat soils (in Polish: gleby torfowe fibrowe płytkie within the type of peat soils (in polish: gleby torfowe should be considered during developing of the next update of Polish Soil Classification.

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

Directory of Open Access Journals (Sweden)

K R Brown

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

Rare cause of upper gastrointestinal bleeding owing to hepatic cancer invasion: a case report.

Science.gov (United States)

Wu, Wei-Ding; Wu, Jia; Yang, Hong-Guo; Chen, Yuan; Zhang, Cheng-Wu; Zhao, Da-Jian; Hu, Zhi-Ming

2014-09-21

Upper gastrointestinal bleeding refers to bleeding that arises from the gastrointestinal tract proximal to the ligament of Treitz. The primary reason for gastrointestinal bleeding associated with hepatocellular carcinoma is rupture of a varicose vein owing to pericardial hypotension. We report a rare case of gastrointestinal bleeding with hepatocellular carcinoma in a patient who presented with recurrent gastrointestinal bleeding. The initial diagnosis was gastric cancer with metastasis to the multiple lymph nodes of the lesser curvature. The patient underwent exploratory laparotomy, which identified two lesions in the gastric wall. Total gastrectomy and hepatic local excision was then performed. Pathological results indicated that the hepatocellular carcinoma had invaded the stomach directly, which was confirmed immunohistochemically. The patient is alive with a disease-free survival of 1 year since the surgery. Hepatocellular carcinoma with gastric invasion should be considered as a rare cause of upper gastrointestinal bleeding in hepatocellular carcinoma patients, especially with lesions located in the left lateral hepatic lobe. Surgery is the best solution.

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

Directory of Open Access Journals (Sweden)

Huang AS

2016-11-01

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

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

Directory of Open Access Journals (Sweden)

Azzurra Ruggeri

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

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

Science.gov (United States)

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

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

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

Science.gov (United States)

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

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

Proof and Proving: Logic, Impasses, and the Relationship to Problem Solving

Science.gov (United States)

Savic, Milos

2012-01-01

Becoming a skillful prover is critical for success in advanced undergraduate and graduate mathematics courses. In this dissertation, I report my investigations of proof and the proving process in three separate studies. In the first study, I examined the amount of logic used in student-constructed proofs to help in the design of…

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

Directory of Open Access Journals (Sweden)

Shih-Yi Lee

2017-09-01

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

Utility of dengue NS1 antigen rapid diagnostic test for use in difficult to reach areas and its comparison with dengue NS1 ELISA and qRT-PCR.

Science.gov (United States)

Shukla, Mohan K; Singh, Neeru; Sharma, Ravendra K; Barde, Pradip V

2017-07-01

The objective of this study was to demonstrate the utility of dengue virus (DENV) non structural protein 1 (NS1) based rapid diagnostic test (RDT) for use in tribal and difficult to reach areas for early dengue (DEN) diagnosis in acute phase patients and evaluate its sensitivity and specificity against DENV NS1 enzyme linked immune sorbent assay (ELISA) and real time reverse transcriptase polymerase chain reaction (qRT-PCR). The DENV NS1 RDT was used for preliminary diagnosis during outbreaks in difficult to reach rural and tribal areas. The diagnosis was confirmed by DENV NS1 ELISA in the laboratory. The samples were also tested and serotyped by qRT-PCR. The results were evaluated using statistical tests. The DENV NS1 RDT showed 99.2% sensitivity and 96.0% specificity when analyzed using DENV NS1 ELISA as standard. The specificity and sensitivity of the RDT when compared with qRT-PCR was 93.6% and 91.1%, respectively. The serotype specific evaluation showed more than 90% sensitivity and specificity for DENV-1, 2, and 3. The RDT proved a good diagnostic tool in difficult to reach rural and tribal areas. Further evaluation studies with different commercially available RDTs in different field conditions are essential, that will help clinicians and patients for treatment and programme managers for timely intervention. © 2017 Wiley Periodicals, Inc.

76 FR 22938 - Submission for Review: RI 25-37, Evidence To Prove Dependency of a Child

Science.gov (United States)

2011-04-25

... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: RI 25-37, Evidence To Prove Dependency of a..., Evidence to Prove Dependency of a Child. As required by the Paperwork Reduction Act of 1995 (Pub. L. 104-13... Dependency of a Child, is designed to collect sufficient information for the Office of Personnel Management...

Difficult physician-patient relationships.

Science.gov (United States)

Reifsteck, S W

1998-01-01

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

Formal Analysis of Soft Errors using Theorem Proving

Directory of Open Access Journals (Sweden)

Sofiène Tahar

2013-07-01

Full Text Available Modeling and analysis of soft errors in electronic circuits has traditionally been done using computer simulations. Computer simulations cannot guarantee correctness of analysis because they utilize approximate real number representations and pseudo random numbers in the analysis and thus are not well suited for analyzing safety-critical applications. In this paper, we present a higher-order logic theorem proving based method for modeling and analysis of soft errors in electronic circuits. Our developed infrastructure includes formalized continuous random variable pairs, their Cumulative Distribution Function (CDF properties and independent standard uniform and Gaussian random variables. We illustrate the usefulness of our approach by modeling and analyzing soft errors in commonly used dynamic random access memory sense amplifier circuits.

Evidence-based recommendations for the therapeutic management of angioedema owing to hereditary C1 inhibitor deficiency: consensus report of an International Working Group

NARCIS (Netherlands)

Cicardi, M.; Bork, K.; Caballero, T.; Craig, T.; Li, H. H.; Longhurst, H.; Reshef, A.; Zuraw, B.; Werner, Aberer; Aygören-Pürsün, Emel; Banerji, Aleena; Bjorkander, Janne; Boccon-Gibod, Isabelle; Konrad, Bork; Bouillet, Laurence; Bova, Maria; Bowen, Tom; Branco Ferreira, Manuel; Bygum, Anette; Caballero, Teresa; Cancian, Mauro; Castel-Branco, Maria Graça; Cicardi, Marco; Craig, Timothy; de Carolis, Caterina; Mihály, Enikö; Josè, Fabiani; Farkas, Henriette; Gompels, Mark; Gower, Richard; Groffik, Adriane; Grumach, Anete; Guillarte, Mar; Hernandez Landeros, Maria Esthela; Kaplan, Allen; Leibovich, Iris; Li, Henry; Lock, Bob; Longhurst, Hilary; Lumry, William; Malbran, Alejandro; Martinez-Saguer, Immaculada; Campos, Matta; Maurer, Marcus; Moldovan, Dumitru; Montinaro, Vincenzo; Nieto, Sandra; Nordenfelt, Patrik; Obtulovicz, Krystana; Zeerleder, Sacha

2012-01-01

Angioedema owing to hereditary deficiency of C1 inhibitor (HAE) is a rare, life-threatening, disabling disease. In the last 2 years, the results of well-designed and controlled trials with existing and new therapies for this condition have been published, and new treatments reached the market.

Difficult management of posterior urethra gunshot wound combined ...

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2017-09-01

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

Difficult to control atopic dermatitis

Science.gov (United States)

2013-01-01

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

Proving Test on the Reliability for Reactor Containment Vessel

International Nuclear Information System (INIS)

Takumi, K.; Nonaka, A.

1988-01-01

NUPEC (Nuclear Power Engineering Test Center) has started an eight-year project of Proving Test on the Reliability for Reactor Containment Vessel since June 1987. The objective of this project is to confirm the integrity of containment vessels under severe accident conditions. This paper shows the outline of this project. The test Items are (1) Hydrogen mixing and distribution test, (2) Hydrogen burning test, (3) Iodine trapping characteristics test, and (4) Structural behavior test. Based on the test results, computer codes are verified and as the results of analysis and evaluation by the computer codes, containment integrity is to be confirmed

On proving confluence modulo equivalence for Constraint Handling Rules

DEFF Research Database (Denmark)

Christiansen, Henning; Kirkeby, Maja Hanne

2017-01-01

-logical built-in predicates such as var/1 and incomplete ones such as is/2, that are ignored in previous work on confluence. To this end, a new operational semantics for CHR is developed which includes such predicates. In addition, this semantics differs from earlier approaches by its simplicity without loss......Previous results on proving confluence for Constraint Handling Rules are extended in two ways in order to allow a larger and more realistic class of CHR programs to be considered confluent. Firstly, we introduce the relaxed notion of confluence modulo equivalence into the context of CHR: while...

PROVE Land Cover and Leaf Area of Jornada Experimental Range, New Mexico, 1997

Data.gov (United States)

National Aeronautics and Space Administration — ABSTRACT: Field measurement of shrubland ecological properties is important for both site monitoring and validation of remote-sensing information. During the PROVE...

How many gay men owe their sexual orientation to fraternal birth order?

Science.gov (United States)

Cantor, James M; Blanchard, Ray; Paterson, Andrew D; Bogaert, Anthony F

2002-02-01

In men, sexual orientation correlates with the number of older brothers, each additional older brother increasing the odds of homosexuality by approximately 33%. However, this phenomenon, the fraternal birth order effect, accounts for the sexual orientation of only a proportion of gay men. To estimate the size of this proportion, we derived generalized forms of two epidemiological statistics, the attributable fraction and the population attributable fraction, which quantify the relationship between a condition and prior exposure to an agent that can cause it. In their common forms, these statistics are calculable only for 2 levels of exposure: exposed versus not-exposed. We developed a method applicable to agents with multiple levels of exposure--in this case, number of older brothers. This noniterative method, which requires the odds ratio from a prior logistic regression analysis, was then applied to a large contemporary sample of gay men. The results showed that roughly 1 gay man in 7 owes his sexual orientation to the fraternal birth order effect. They also showed that the effect of fraternal birth order would exceed all other causes of homosexuality in groups of gay men with 3 or more older brothers and would precisely equal all other causes in a theoretical group with 2.5 older brothers. Implications are suggested for the gay sib-pair linkage method of identifying genetic loci for homosexuality.

Comparison of different tests to determine difficult intubation in pediatric patients

Directory of Open Access Journals (Sweden)

Mehmet Turan Inal

2014-12-01

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

PROVE Land Cover and Leaf Area of Jornada Experimental Range, New Mexico, 1997

Data.gov (United States)

National Aeronautics and Space Administration — Field measurement of shrubland ecological properties is important for both site monitoring and validation of remote-sensing information. During the PROVE exercise on...

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

African Journals Online (AJOL)

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

Proving termination of graph transformation systems using weighted type graphs over semirings

NARCIS (Netherlands)

Bruggink, H.J.S.; König, B.; Nolte, D.; Zantema, H.; Parisi-Presicce, F.; Westfechtel, B.

2015-01-01

We introduce techniques for proving uniform termination of graph transformation systems, based on matrix interpretations for string rewriting. We generalize this technique by adapting it to graph rewriting instead of string rewriting and by generalizing to ordered semirings. In this way we obtain a

Users manual on database of the Piping Reliability Proving Tests at the Japan Atomic Energy Research Institute

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-09-01

Japan Atomic Energy Research Institute(JAERI) conducted Piping Reliability Proving Tests from 1975 to 1992 based upon the contracts between JAERI and Science and Technology Agency of Japan under the auspices of the special account law for electric power development promotion. The purposes of those tests are to prove the structural reliability of the primary cooling piping constituting a part of the pressure boundary in the water reactor power plants. The tests with large experimental facilities had ended already in 1990. After that piping reliability analysis by the probabilistic method followed until 1992. This report describes the users manual on databases about the test results using the large experimental facilities. Objectives of the piping reliability proving tests are to prove that the primary piping of the water reactor (1) be reliable throughout the service period, (2) have no possibility of rupture, (3) bring no detrimental influence on the surrounding instrumentations or equipments near the break location. The research activities using large scale piping test facilities are described. The present report does the database about the test results pairing the former report. With these two reports, all the feature of Piping Reliability Proving Tests is made clear. Briefings of the tests are described also written in Japanese or English. (author)

Difficult airway management patterns among anesthesiologists practicing in Cairo University Hospitals

Directory of Open Access Journals (Sweden)

Neamat I. Abdel rahman

2016-01-01

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

Maxillofacial trauma patient: coping with the difficult airway

Directory of Open Access Journals (Sweden)

Barak Michal

2009-05-01

Full Text Available Abstract Establishing a secure airway in a trauma patient is one of the primary essentials of treatment. Any flaw in airway management may lead to grave morbidity and mortality. Maxillofacial trauma presents a complex problem with regard to the patient's airway. By definition, the injury compromises the patient's airway and it is, therefore, must be protected. In most cases, the patient undergoes surgery for maxillofacial trauma or for other, more severe, life-threatening injuries, and securing the airway is the first step in the introduction of general anaesthesia. In such patients, we anticipate difficult endotracheal intubation and, often, also difficult mask ventilation. In addition, the patient is usually regarded as having a "full stomach" and has not been cleared of a C-spine injury, which may complicate airway management furthermore. The time available to accomplish the task is short and the patient's condition may deteriorate rapidly. Both decision-making and performance are impaired in such circumstances. In this review, we discuss the complexity of the situation and present a treatment approach.

Case report 486: Spondyloepiphyseal dysplasia tarda (SDT) (presumptively proved)

International Nuclear Information System (INIS)

Brown, D.D.; Childress, M.H.

1988-01-01

A 51 year old man with severe degenerative joint disease, short stature, barrel chest deformity, platyspondyly, a narrow pelvis, small iliac bones, dysplastic femoral heads and necks, notching of the patellae and flattening of the femoral intercondylar notches has been described as an example of Spondyloepiphyseal dysplasia tarda SDT. The entity was discussed in detail. The notching of the patellae has not been reported in association with SDT to the authors' knowledge. Characteristic features of SDT allow it to be differentiated from other arthropathies and dysplasias and these distinctions have been emphasized in the discussion. The diagnosis in this case can only be considered presumptively proved. (orig./MG)

Ecological survey of M-Field, Edgewood Area Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Downs, J.L.; Eberhardt, L.E.; Fitzner, R.E.; Rogers, L.E.

1991-12-01

An ecological survey was conducted on M-Field, at the Edgewood Area, Aberdeen Proving Ground, Maryland. M-Field is used routinely to test army smokes and obscurants, including brass flakes, carbon fibers, and fog oils. The field has been used for testing purposes for the past 40 years, but little documented history is available. Under current environmental regulations, the test field must be assessed periodically to document the presence or potential use of the area by threatened and endangered species. The M-Field area is approximately 370 acres and is part of the US Army's Edgewood Area at Aberdeen Proving Ground in Harford County, Maryland. The grass-covered field is primarily lowlands with elevations from about 1.0 to 8 m above sea level, and several buildings and structures are present on the field. The ecological assessment of M-Field was conducted in three stages, beginning with a preliminary site visit in May to assess sampling requirements. Two field site visits were made June 3--7, and August 12--15, 1991, to identify the biota existing on the site. Data were gathered on vegetation, small mammals, invertebrates, birds, large mammals, amphibians, and reptiles.

Ecological survey of M-Field, Edgewood Area Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Downs, J.L.; Eberhardt, L.E.; Fitzner, R.E.; Rogers, L.E.

1991-12-01

An ecological survey was conducted on M-Field, at the Edgewood Area, Aberdeen Proving Ground, Maryland. M-Field is used routinely to test army smokes and obscurants, including brass flakes, carbon fibers, and fog oils. The field has been used for testing purposes for the past 40 years, but little documented history is available. Under current environmental regulations, the test field must be assessed periodically to document the presence or potential use of the area by threatened and endangered species. The M-Field area is approximately 370 acres and is part of the US Army`s Edgewood Area at Aberdeen Proving Ground in Harford County, Maryland. The grass-covered field is primarily lowlands with elevations from about 1.0 to 8 m above sea level, and several buildings and structures are present on the field. The ecological assessment of M-Field was conducted in three stages, beginning with a preliminary site visit in May to assess sampling requirements. Two field site visits were made June 3--7, and August 12--15, 1991, to identify the biota existing on the site. Data were gathered on vegetation, small mammals, invertebrates, birds, large mammals, amphibians, and reptiles.

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

Directory of Open Access Journals (Sweden)

Gernot Horstmann

2016-08-01

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

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

Science.gov (United States)

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

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

Sirvinskiene Giedre

2012-04-01

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

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

Science.gov (United States)

Fiester, Autumn

2012-01-01

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

The GOES-R Proving Ground: 2012 Update

Science.gov (United States)

Gurka, J.; Goodman, S. J.; Schmit, T.; Demaria, M.; Mostek, A.; Siewert, C.; Reed, B.

2011-12-01

The Geostationary Operational Environmental Satellite (GOES)-R will provide a great leap forward in observing capabilities, but will also offer a significant challenge to ensure that users are ready to exploit the vast improvements in spatial, spectral, and temporal resolutions. To ensure user readiness, forecasters and other users must have access to prototype advanced products well before launch, and have the opportunity to provide feedback to product developers and computing and communications managers. The operational assessment is critical to ensure that the end products and NOAA's computing and communications systems truly meet their needs in a rapidly evolving environment. The GOES-R Proving Ground (PG) engages the National Weather Service (NWS) forecast, watch and warning community and other agency users in pre-operational demonstrations of select products with GOES-R attributes (enhanced spectral, spatial, and temporal resolution). In the PG, developers and forecasters test and apply algorithms for new GOES-R satellite data and products using proxy and simulated data sets, including observations from current and future satellite instruments (MODIS, AIRS, IASI, SEVIRI, NAST-I, NPP/VIIRS/CrIS, LIS), lightning networks, and computer simulated products. The complete list of products to be evaluated in 2012 will be determined after evaluating results from experiments in 2011 at the NWS' Storm Prediction Center, National Hurricane Center, Aviation Weather Center, Ocean Prediction Center, Hydrometeorological Prediction Center, and from the six NWS regions. In 2012 and beyond, the PG will test and validate data processing and distribution systems and the applications of these products in operational settings. Additionally developers and forecasters will test and apply display techniques and decision aid tools in operational environments. The PG is both a recipient and a source of training. Training materials are developed using various distance training tools in

Difficult factors in Management of Impacted Dental Prosthesis in Esophagus

Directory of Open Access Journals (Sweden)

Efiaty A. Soepardi

2005-03-01

Full Text Available A dental prosthesis which ingested and impacted in esophagus, is an emergency case and life threatening, so require immediate esophagoscopy intervention for removing. The objective of this study is to assess some factors can caused dtfficulties in diagnosing and treating the ingested and impacted dental prosthesis in the esophagus and their complications. This retrospective study analyzed patient’s chart whose underwent esophagoscopy for removing the impacted dental prosthesis in Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia during a period between January 1997 and December 2003. Neck-chest X-ray and esophagoscopy were performed in all patients to identify the existence of the dental prosthesis as a diagnostic and treatment procedure. The length of time for removing the dental prosthesis was recorded and stated as a less difficult esophagoscopy when it takes time less than 60 minutes and as a difficult  esophagoscopy takes 60 minutes or longer. Some risk difficulties factors were statistically analyzed. There were 53 patients of ingested dental prosthesis in esophagus. Only 51 cases were analyzed According to the length of time for removing the dental prosthesis by esophagoscopy, 22 patients were recorded as less difficult cases and 29 patients as difficult cases. Two cases among the cases needed cervicotomy after unsuccessful esophagoscopy removal. The difficulties to diagnose an impacted dental prosthesis in the esophagus caused by unreliable clinical history, unclear signs and symptoms, unable to be detected by X-ray and was not found during esophagoscopy. The difficulties in treating due to mucosal laceration, edema, bleeding, failure of the first extraction and conformity with the size and shape, the wire outside the dental prosthesis and the length of time stayed in the esophagus. (Med J Indones 2005; 14: 33-6Keywords: ingested dental prosthesis, radioluscent foreign body, length of time of esophagoscopy

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

Science.gov (United States)

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

2010-07-01

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

Com aplicar les proves paramètriques bivariades t de Student i ANOVA en SPSS. Cas pràctic

Directory of Open Access Journals (Sweden)

María-José Rubio-Hurtado

2012-07-01

Full Text Available Les proves paramètriques són un tipus de proves de significació estadística que quantifiquen l'associació o independència entre una variable quantitativa i una categòrica. Les proves paramètriques són exigents amb certs requisits previs per a la seva aplicació: la distribució Normal de la variable quantitativa en els grups que es comparen, l'homogeneïtat de variàncies en les poblacions de les quals procedeixen els grups i una n mostral no inferior a 30. El seu no compliment comporta la necessitat de recórrer a proves estadístiques no paramètriques. Les proves paramètriques es classifiquen en dos: prova t (per a una mostra o per a dues mostres relacionades o independents i prova ANOVA (per a més de dues mostres independents.

An Archeological Overview and Management Plan for the Dugway Proving Ground.

Science.gov (United States)

1984-03-29

niches, particulary the lacustrine environment of the Great Basin (Baumhoff and Heizer 1965, Butler 1978, Heizer and Krieger 1956, Heizer and Harper...power that would capture the animals souls, rendering them docile and stupid (Steward 1970:34). Other large game was present, but were not numerous...uni versity. Baum, Bernard. 1947. Dugway Proving Ground. Aberdeen: U.S. Army Chemical Corps.* Bailmhoff, W.A. and R.F. Heizer . 1965. Postglacial

Difficult airway in a patient with Coffin-Siris syndrome.

Science.gov (United States)

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

2001-02-01

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

A Hybrid Approach to Proving Memory Reference Monotonicity

KAUST Repository

Oancea, Cosmin E.

2013-01-01

Array references indexed by non-linear expressions or subscript arrays represent a major obstacle to compiler analysis and to automatic parallelization. Most previous proposed solutions either enhance the static analysis repertoire to recognize more patterns, to infer array-value properties, and to refine the mathematical support, or apply expensive run time analysis of memory reference traces to disambiguate these accesses. This paper presents an automated solution based on static construction of access summaries, in which the reference non-linearity problem can be solved for a large number of reference patterns by extracting arbitrarily-shaped predicates that can (in)validate the reference monotonicity property and thus (dis)prove loop independence. Experiments on six benchmarks show that our general technique for dynamic validation of the monotonicity property can cover a large class of codes, incurs minimal run-time overhead and obtains good speedups. © 2013 Springer-Verlag.

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

Science.gov (United States)

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

2007-01-01

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

Research Objectives for Human Missions in the Proving Ground of Cis-Lunar Space

Science.gov (United States)

Spann, James; Niles, Paul; Eppler, Dean; Kennedy, Kriss; Lewis, Ruthan; Sullivan, Thomas

2016-07-01

Introduction: This talk will introduce the preliminary findings in support of NASA's Future Capabilities Team. In support of the ongoing studies conducted by NASA's Future Capabilities Team, we are tasked with collecting re-search objectives for the Proving Ground activities. The objectives could include but are certainly not limited to: demonstrating crew well being and performance over long duration missions, characterizing lunar volatiles, Earth monitoring, near Earth object search and identification, support of a far-side radio telescope, and measuring impact of deep space environment on biological systems. Beginning in as early as 2023, crewed missions beyond low Earth orbit will be enabled by the new capabilities of the SLS and Orion vehicles. This will initiate the "Proving Ground" phase of human exploration with Mars as an ultimate destination. The primary goal of the Proving Ground is to demonstrate the capability of suitably long dura-tion spaceflight without need of continuous support from Earth, i.e. become Earth Independent. A major component of the Proving Ground phase is to conduct research activities aimed at accomplishing major objectives selected from a wide variety of disciplines including but not limited to: Astronomy, Heliophysics, Fun-damental Physics, Planetary Science, Earth Science, Human Systems, Fundamental Space Biology, Microgravity, and In Situ Resource Utilization. Mapping and prioritizing the most important objectives from these disciplines will provide a strong foundation for establishing the architecture to be utilized in the Proving Ground. Possible Architectures: Activities and objectives will be accomplished during the Proving Ground phase using a deep space habitat. This habitat will potentially be accompanied by a power/propulsion bus capable of moving the habitat to accomplish different objectives within cis-lunar space. This architecture can also potentially support stag-ing of robotic and tele-robotic assets as well as

Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones

DEFF Research Database (Denmark)

Stage, J G; Moesgaard, F; Grønvall, S

1998-01-01

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

Is the greenhouse effect proving a pitfall in France?

International Nuclear Information System (INIS)

Godard, O.

1998-01-01

After Rio and Kyoto, the Buenos-Aires environmental summit comes nearer. The agreements to reduce the production of greenhouse effect gases have failed. The next step might be negotiable and transferable licences with the setting of a quota system. The discussions are expected to be difficult. This new compelling regulation could force some industrial countries to introduce green fiscal reforms. France with its 75% energy coming from nuclear plants has a reduced margin to manage. France cannot accept to be deprived of its right to abandon nuclear energy because of the imposed no-rising of greenhouse effect gases production. (A.C.)

Telomerase-Deficient Mice Exhibit Bone Loss Owing to Defects in Osteoblasts and Increased Osteoclastogenesis by Inflammatory Microenvironment

DEFF Research Database (Denmark)

Saeed, H.; Abdallah, B. M.; Ditzel, N.

2011-01-01

Telomere shortening owing to telomerase deficiency leads to accelerated senescence of human skeletal (mesenchymal) stem cells (MSCs) in vitro, whereas overexpression leads to telomere elongation, extended life span, and enhanced bone formation. To study the role of telomere shortening in vivo, we...... studied the phenotype of telomerase-deficient mice (Terc(-/-)).Terc(-/-) mice exhibited accelerated age-related bone loss starting at 3 months of age and during 12 months of follow-up revealed by dual-energy X-ray absorptiometric (DXA) scanning and by micro-computed tomography (mu CT). Bone...... histomorphometry revealed decreased mineralized surface and bone-formation rate as well as increased osteoclast number and size in Terc(-/-) mice. Also, serum total deoxypyridinoline (tDPD) was increased in Terc(-/-) mice. MSCs and osteoprogenitors isolated from Terc(-l-) mice exhibited intrinsic defects...

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2015-07-01

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

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

Science.gov (United States)

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

2018-01-01

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

Reasoning by analogy as an aid to heuristic theorem proving.

Science.gov (United States)

Kling, R. E.

1972-01-01

When heuristic problem-solving programs are faced with large data bases that contain numbers of facts far in excess of those needed to solve any particular problem, their performance rapidly deteriorates. In this paper, the correspondence between a new unsolved problem and a previously solved analogous problem is computed and invoked to tailor large data bases to manageable sizes. This paper outlines the design of an algorithm for generating and exploiting analogies between theorems posed to a resolution-logic system. These algorithms are believed to be the first computationally feasible development of reasoning by analogy to be applied to heuristic theorem proving.

[A Case of Pyoderma Gangrenosum of the Penis Difficult to Distinguish from Fournier Gangrene].

Science.gov (United States)

Taguchi, Makoto; Inoue, Takaaki; Nishida, Teruhisa; Kawabata, Takashi; Kawakita, Shigenari; Muguruma, Kouei; Murota, Takashi; Kinoshita, Hidefumi; Matsuda, Tadashi

2015-11-01

Here, we report a case of pyoderma gangrenosum of the penis which was difficult to distinguish from Fournier gangrene. The patient was a 54-year-old male who was aware of redness and swelling of the glanspenis for 1 month prior to a consultation at our department. Although he was diagnosed with herpes and treated at a nearby hospital, his symptoms did not improve. Subsequently, the patient visited our department following the onset of pain and fever. During his initial consultation, he had a fever of 39 °C as well as redness and swelling of the glans penis with partial spontaneous purulent discharge. His blood test revealed an elevated white blood cell count (20, 000/μl) and C-reactive protein (19.1 mg/dl). Because Fournier gangrene was suspected, administration of broad-spectrum antimicrobial agents was initiated but proved to be ineffective. An abscess (2 cm in diameter) was also noted in the umbilical region.Enterococcus faecalis was detected by the bacterial culture ; and therefore, Fournier gangrene was diagnosed. A partial penectomy was performed to control the infection. Pathological findings showed only non-specific inflammation ; however, fever persisted postoperatively and blood test results showed no improvement. Furthermore, new abscess lesions emerged on the right heel and back. Because the re-performed abscess bacterial culture test result was negative, pyoderma gangrenosum was suspected, and he was started on oral prednisolone (20 mg/day). On the following day, his fever subsided and his blood test results also showed improvement. A final diagnosis of pyoderma gangrenosum was ultimately made.

Chernobyl: Chronicle of difficult weeks [videorecording

Energy Technology Data Exchange (ETDEWEB)

Volodymyr, S

1987-07-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

1995-05-01

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

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

Directory of Open Access Journals (Sweden)

Tomislav Svoboda

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

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

Science.gov (United States)

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

2018-01-01

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

GOES-R Proving Ground Activities at the NASA Short-Term Prediction Research and Transition (SPoRT) Center

Science.gov (United States)

Molthan, Andrew

2011-01-01

SPoRT is actively involved in GOES-R Proving Ground activities in a number of ways: (1) Applying the paradigm of product development, user training, and interaction to foster interaction with end users at NOAA forecast offices national centers. (2) Providing unique capabilities in collaboration with other GOES-R Proving Ground partners (a) Hybrid GOES-MODIS imagery (b) Pseudo-GLM via regional lightning mapping arrays (c) Developing new RGB imagery from EUMETSAT guidelines

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

NARCIS (Netherlands)

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

2009-01-01

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

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

NARCIS (Netherlands)

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

2009-01-01

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

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

Science.gov (United States)

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

1986-09-01

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

Depleted uranium risk assessment at Aberdeen Proving Ground

International Nuclear Information System (INIS)

Ebinger, M.H.; Myers, O.B.; Kennedy, P.L.; Clements, W.H.

1993-01-01

The Environmental Science Group at Los Alamos and the Test and Evaluation Command (TECOM) are assessing the risk of depleted uranium (DU) testing at Aberdeen Proving Ground (APG). Conceptual and mathematical models of DU transfer through the APG ecosystem have been developed in order to show the mechanisms by which DU migrates or remains unavailable to different flora and fauna and to humans. The models incorporate actual rates of DU transfer between different ecosystem components as much as possible. Availability of data on DU transport through different pathways is scarce and constrains some of the transfer rates that can be used. Estimates of transfer rates were derived from literature sources and used in the mass-transfer models when actual transfer rates were unavailable. Objectives for this risk assessment are (1) to assess if DU transports away from impact areas; (2) to estimate how much, if any, DU migrates into Chesapeake Bay; (3) to determine if there are appreciable risks to the ecosystems due to DU testing; (4) to estimate the risk to human health as a result of DU testing

What's 'difficult'? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms.

Science.gov (United States)

Maatz, Anke; Wainwright, Megan; Russell, Andrew J; Macnaughton, Jane; Yiannakou, Yan

2016-11-01

The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term 'difficult'. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored. Three NHS trust secondary care hospitals in North-East England. 17 senior clinicians from seven medical and two surgical specialities. Unsolicited use of the term 'difficult' was common. 'Difficult' was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used 'difficult' to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of 'difficult'. Participants also reported experiences that were rewarding and positive. This study shows that blanket statements such as 'difficult patients' mask the complexity of doctors' experiences in the context of MUS. Our nuanced analysis of the use of 'difficult' challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS. Copyright © 2016 Elsevier Inc. All rights reserved.

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

DEFF Research Database (Denmark)

Lauridsen, Karen M.; Madsen, Henning

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

Z problematyki polskich i słoweńskich analityzmów kauzatywnych z parafrazą przymiotnikową

Directory of Open Access Journals (Sweden)

Agnieszka Zatorska

2015-12-01

Full Text Available Some remarks on Polish and Slovene analytic causatives paraphrased by adjectives The article is devoted to the analytic causative predicates. The data is collected from Polish and Slovene. The basic methodological device is a paraphrase which obligatorily includes an adjective. Special attention is paid to operator verbs, which often have their own semantic features. Some of them are verbs of transfer, others – verbs of motion. In most cases, however, they are causatives which denote change of features. Apart from the basic causative category, the material is classified according to its semantic features, including especially inchoativeness, terminativeness and restorativeness. In conclusion it is emphasized that analytic causatives show their semantic parameters more explicitly than is the case with verbal units and that they demonstrate considerable semantic condensity.   Z problematyki polskich i słoweńskich analityzmów kauzatywnych z parafrazą przymiotnikową Artykuł dotyczy analitycznych realizacji predykatu kauzatywnego. Materiał obejmuje przykłady z języków polskiego i słoweńskiego. Podstawowym narzędziem badawczym jest parafraza, która obligatoryjnie zawiera przymiotnik. Szczególną uwagę zwrócono na czasowniki operatorowe, które często mają samodzielne zna­czenie. Niektóre z nich są czasownikami transferu, inne – czasownikami ruchu. Jednakże wiele z nich to także kauzatywa, określające zmianę cechy. Oprócz nadrzędnej kategorii kauzatywnej badane kauzatywa zostały poklasyfikowane ze względu na kategorię inchoatywności, terminatywności, restauratywności. We wnioskach podkreślono, że konstrukcje analityczne bardziej eksplicytnie niż jednostki werbalne ujawniają w swej budowie parametry semantyczne, jak również to, że charakterystyczna jest dla nich duża kondensacja semantyczna.

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

Science.gov (United States)

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

2014-01-01

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

a Test to Prove Cloud Whitening THEORY!

Science.gov (United States)

Buttram, J. W.

2011-12-01

Climate science researchers believe our planet can possibly tolerate twice the present carbon dioxide levels with no upwards temperature change, IF we could increase the amount of energy reflected back out into space by about 2.0%. (c)Cloudtec basically alters a blend of seawater and applies heat derived from magma to it at a temperature exceeding 2,000 degrees F. The interaction of seawater and magma displaces the oxygen, causing the volume of water to vaporize and expand over 4,000 times - transforming billions of tons of seawater into thousands of cubic miles of white, maritime, stratocumulus clouds to reflect the incident Sun's rays back out into space. A 6 month test to prove Cloud Whitening Theory will cost 6 million dollars. (No profit added.) This study will enable everyone on the planet with a computer the transparency to use satellite imagery and check out for themselves - if and when Cloud Whitening is occurring. If Cloud Whitening Theory is validated, (c)Cloudtec's innovation can strategically create the clouds we need to reflect the Sun's rays back out into space and help neutralize the projected 3.6 degrees F rise in temperature. Based on reasonable calculations of anthropogenic global warming: this one move alone would be comparable to slashing global carbon dioxide emissions by over 60% over the next 40 years.

Why reference to the past is difficult for agrammatic speakers

NARCIS (Netherlands)

Bastiaanse, Roelien

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

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

International Nuclear Information System (INIS)

Durante, S; Comoglio, M; Rostagno, M

2011-01-01

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

NASA SPoRT GOES-R Proving Ground Activities

Science.gov (United States)

Stano, Geoffrey T.; Fuell, Kevin K.; Jedloec, Gary J.

2010-01-01

The NASA Short-term Prediction Research and Transition (SPoRT) program is a partner with the GOES-R Proving Ground (PG) helping prepare forecasters understand the unique products to come from the GOES-R instrument suite. SPoRT is working collaboratively with other members of the GOES-R PG team and Algorithm Working Group (AWG) scientists to develop and disseminate a suite of proxy products that address specific forecast problems for the WFOs, Regional and National Support Centers, and other NOAA users. These products draw on SPoRT s expertise with the transition and evaluation of products into operations from the MODIS instrument and the North Alabama Lightning Mapping Array (NALMA). The MODIS instrument serves as an excellent proxy for the Advanced Baseline Imager (ABI) that will be aboard GOES-R. SPoRT has transitioned and evaluated several multi-channel MODIS products. The true and false color products are being used in natural hazard detection by several SPoRT partners to provide better observation of land features, such as fires, smoke plumes, and snow cover. Additionally, many of SPoRT s partners are coastal offices and already benefit from the MODIS sea surface temperature composite. This, along with other surface feature observations will be developed into ABI proxy products for diagnostic use in the forecast process as well as assimilation into forecast models. In addition to the MODIS instrument, the NALMA has proven very valuable to WFOs with access to these total lightning data. These data provide situational awareness and enhanced warning decision making to improve lead times for severe thunderstorm and tornado warnings. One effort by SPoRT scientists includes a lightning threat product to create short-term model forecasts of lightning activity. Additionally, SPoRT is working with the AWG to create GLM proxy data from several of the ground based total lightning networks, such as the NALMA. The evaluation will focus on the vastly improved spatial

The Secret Prover : Proving Possession of Arbitrary Files While not Giving Them Away

NARCIS (Netherlands)

Teepe, Wouter

2005-01-01

The Secret Prover is a Java application which allows a user (A) to prove to another user (B), that A possesses a file. If B also possesses this file B will get convinced, and if B does not possess this file B will gain no information on (the contents of) this file. This is the first implementation

Impact of cooking, proving, and baking on the (poly)phenol content of wild blueberry.

Science.gov (United States)

Rodriguez-Mateos, Ana; Cifuentes-Gomez, Tania; George, Trevor W; Spencer, Jeremy P E

2014-05-07

Accumulating evidence suggests that diets rich in (poly)phenols may have positive effects on human health. Currently there is limited information regarding the effects of processing on the (poly)phenolic content of berries, in particular in processes related to the baking industry. This study investigated the impact of cooking, proving, and baking on the anthocyanin, procyanidin, flavonol, and phenolic acid contents of wild blueberry using HPLC with UV and fluorescence detection. Anthocyanin levels decreased during cooking, proving, and baking, whereas no significant changes were observed for total procyanidins. However, lower molecular weight procyanidins increased and high molecular weight oligomers decreased during the process. Quercetin and ferulic and caffeic acid levels remained constant, whereas increases were found for chlorogenic acid. Due to their possible health benefits, a better understanding of the impact of processing is important to maximize the retention of these phytochemicals in berry-containing products.

Conceptualizing reasoning-and-proving opportunities in textbook expositions : Cases from secondary calculus

OpenAIRE

Bergwall, Andreas

2017-01-01

Several recent textbook studies focus on opportunities to learn reasoning-and-proving. They typically investigate the extent to which justifications are general proofs and what opportunities exist for learning important elements of mathematical reasoning. In this paper, I discuss how a particular analytical framework for this might be refined. Based on an in-depth analysis of certain textbook passages in upper secondary calculus textbooks, I make an account for analytical issues encountered d...

The effects of GeoGebra software on pre-service mathematics teachers' attitudes and views toward proof and proving

Science.gov (United States)

Zengin, Yılmaz

2017-11-01

The purpose of this study is to determine the effect of GeoGebra software on pre-service mathematics teachers' attitudes towards proof and proving and to determine pre-service teachers' pre- and post-views regarding proof. The study lasted nine weeks and the participants of the study consisted of 24 pre-service mathematics teachers. The study used the 'Attitude Scale Towards Proof and Proving' and an open-ended questionnaire that were administered before and after the intervention as data collection tools. Paired samples t-test analysis was used for the analysis of quantitative data and content and descriptive analyses were utilized for the analysis of qualitative data. As a result of the data analysis, it was determined that GeoGebra software was an effective tool in increasing pre-service teachers' attitudes towards proof and proving.

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

DEFF Research Database (Denmark)

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

2013-01-01

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

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

Science.gov (United States)

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

2018-05-10

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

Environmental risk evaluation of difficult substances in USES 2.0

NARCIS (Netherlands)

Beelen P van; ECO

1998-01-01

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

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

African Journals Online (AJOL)

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

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

Science.gov (United States)

Heybach Vivirito, Jessica A.

2012-01-01

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

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

Science.gov (United States)

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

2000-01-01

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

Difficult weaning in delayed onset diaphragmatic hernia

Directory of Open Access Journals (Sweden)

Ahmed Syed

2009-01-01

Full Text Available Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support.

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

Science.gov (United States)

Anbar, Ran D; Sachdeva, Shagun

2011-07-01

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

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

Science.gov (United States)

Engelhardt, Thomas; Weiss, Markus

2012-06-01

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

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

Science.gov (United States)

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

2017-10-01

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

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

Science.gov (United States)

Connor, Christopher W; Segal, Scott

2014-02-01

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

Geophysics: Building E5481 decommissioning, Aberdeen Proving Ground

International Nuclear Information System (INIS)

Thompson, M.D.; McGinnis, M.G.; McGinnis, L.D.; Miller, S.F.

1992-11-01

Building E5481 is one of ten potentially contaminated sites in the Canal Creek and Westwood areas of the Edgewood section of Aberdeen Proving Ground examined by a geophysical team from Argonne National Laboratory in April and May of 1992. Noninvasive geophysical surveys, including magnetics, electrical resistivity, and ground-penetrating radar, were conducted around the perimeter of the building to guide a sampling program prior to decommissioning and dismantling. The building is located on the northern margin of a landfill that was sited in a wetland. The large number of magnetic sources surrounding the building are believed to be contained in construction fill that had been used to raise the grade. The smaller anomalies, for the most part, are not imaged with ground radar or by electrical profiling. A conductive zone trending northwest to southeast across the site is spatially related to an old roadbed. Higher resistivity areas in the northeast and east are probably representive of background values. Three high-amplitude, positive, rectangular magnetic anomalies have unknown sources. The features do not have equivalent electrical signatures, nor are they seen with radar imaging

Geophysics: Building E5375 decommissioning, Aberdeen Proving Ground

International Nuclear Information System (INIS)

McGinnis, M.G.; McGinnis, L.D.; Miller, S.F.; Thompson, M.D.

1992-08-01

Building E5375 was one of ten potentially contaminated sites in the Canal Creek area of the Edgewood section of Aberdeen Proving Ground examined by a geophysical team from Argonne National Laboratory in April and May 1992. Noninvasive geophysical surveys, including magnetics, electrical resistivity, and ground-penetrating radar (GPR), were conducted around the perimeter of the building to guide a sampling program prior to decommissioning and dismantling. Several anomalies wear, noted: (1) An underground storage tank located 25 ft east of Building E5375 was identified with magnetic, resistivity, and GPR profiling. (2) A three-point resistivity anomaly, 12 ft east of the northeast comer of Building E5374 (which borders Building E5375) and 5 ft south of the area surveyed with the magnetometer, may be caused by another underground storage tank. (3) A 2,500-gamma magnetic anomaly near the northeast corner of the site has no equivalent resistivity anomaly, although disruption in GPR reflectors was observed. (4) A one-point magnetic anomaly was located at the northeast comer, but its source cannot be resolved. A chaotic reflective zone to the east represents the radar signature of Building E5375 construction fill

Hemolytic disease of the fetus and newborn owing to anti-U, successfully treated with repeated intrauterine transfusions.

Science.gov (United States)

Strindberg, Johanna; Lundahl, Joachim; Ajne, Gunilla

2013-01-01

Hemolytic disease of the fetus and newborn (HDFN) owing to anti-U has rarely been reported. U is part of the MNS system.M and N glycoproteins are located on glycophorin A (GPA); Sand s antigens are on glycophorin B (GPB). Individuals who lack GPB are S- and s- and also lack U. The U- phenotype occurs almost exclusively in the African population and has a very low frequency (0.25%). Anti-U is of immunoglobulin G class and can cause hemolytic transfusion reaction and HDFN. In this report we present the use of a noninvasive method to detect anemia in the fetus and the subsequent use of intrauterine transfusion(IUT) with blood of a very rare phenotype. For the first time, we used deglycerolized and 3-week-old red blood cell units for IUT without signs of adverse reactions and with the expected effect on the hemoglobin value. We conclude that this transfusion strategy could be applied safely.

Do Australian Fire Brigades Owe a Common Law Duty of Care? A Review of Three Recent Cases

Directory of Open Access Journals (Sweden)

Michael Eburn

2013-12-01

Full Text Available The law regarding the fire service’s liability for alleged negligence in the way they plan for or respond to a fire is reasonably untested. This paper reports on three cases that were decided in 2012 by the Supreme Courts of New South Wales, Tasmania and the Australian Capital Territory. It is argued that the weight of authority is that the fire brigades are established to provide fire services for the common good, not for individual benefit, and the financial burden of unfortunate operational decisions should be borne by insurers or by the uninsured. Even so, two Supreme Courts have arrived at different conclusions with respect to the question of whether or not the NSW Rural Fire Service owes a common law duty of care to those at risk from bushfire. It is therefore argued that the issue of duty of care would benefit from a determination by the High Court of Australia.

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

Science.gov (United States)

Wolke, Dieter; St. James-Roberts, Ian

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

Information-Limited Parallel Processing in Difficult Heterogeneous Covert Visual Search

Science.gov (United States)

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

2010-01-01

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

Effective Climate Communication with Difficult Audiences

Science.gov (United States)

Denning, S.

2015-12-01

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

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

African Journals Online (AJOL)

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

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

Science.gov (United States)

Jarvie, Scott; Burke, Kevin

2015-01-01

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

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

CERN Document Server

Shaw, Peter J A

2010-01-01

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

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

Directory of Open Access Journals (Sweden)

Fabíola Maria Sabino Meireles

2013-03-01

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

The effect of herbal formula PROVE 1 and Stevia levels in diets on diet utilization of growing pigs

Directory of Open Access Journals (Sweden)

Kooprasert, S.

2007-05-01

Full Text Available The objective of this experiment was to study the effect of 0.2% antibiotic (ascomix-s®, one kilogram of which contains lincomycin hydrochloride 44 g and sulfamethazine 110 g or 0.25% herbal formulaPROVE 1, combined with five levels of Stevia supplementation in the diets on digestibility of pigs. Two factors; 1 type of drug (0.2% antibiotic and 0.25% herbal formula PROVE 1 and 2 five Stevia levels (0,0.2, 0.4, 0.6 and 0.8% were investigated and 10 dietary treatments were used in this study. Ten related growing crossbred (Large White x Landrace barrow pigs (30±1.5 kg body weight were raised in individualmetabolism cages for three collecting periods (30, 40 and 50 kg body weight, each pig was fed one experimental diet throughout the collecting period.The results showed that pigs fed diet with either 0.2% antibiotic or 0.25% herbal formula PROVE 1 had similar digestibility of diet, crude protein (CP, fiber, ash and nitrogen free extract (NFE (89.01 vs 87.83,94.96 vs 94.23, 60.73 vs 59.03, 61.22 vs 60.44 and 93.28 vs 92.03%, respectively. Negligible differences were observed between 0 and 0.4% Stevia supplementation in diet, but levels showed better digestibility than the other levels of Stevia supplementation, and the diet with 0.4% Stevia supplementation had the highestdigestibility of diet, CP, fiber, ash and NFE (91.04, 96.43, 69.48, 70.47 and 94.07%, respectively. The diet with antibiotic combined with 0.4% Stevia had digestibility of diet, CP, fat and fiber better than the otherlevels of Stevia supplementation, especially digestibility of ash, which was significantly higher than that of diet with 0.2% Stevia, but not significantly different from the other levels of Stevia supplementation. A partof herbal formula PROVE1 combined with 0% Stevia had the highest digestibility of ash (72.90%, significantly higher than the other levels of Stevia supplementation, except the diet with herbal formula PROVE 1combined with 0.4% Stevia supplementation

Safety objectives for next generation reactors: proving their achievement

International Nuclear Information System (INIS)

Tanguy, P.Y.

1996-01-01

Assuming that there is a consensus between regulatory bodies and nuclear operating organizations on safety objectives for future plants, how are we going to demonstrate that they have been achieved, with a reasonable certainty? Right from the beginning, I would like to underline the importance of convincing the public that high level safety objectives will be effectively achieved in future nuclear power plants. The mere fulfillment of administrative requirements might not be sufficient to obtain public acceptance. One has to take into account the changes that have occurred in the public preception of nuclear risks in the wake of the Chernobyl accident. Today public opinion rules out the possibility not only that such a catastrophic accident could recur, but also that any accident with detrimental health consequences off-site could occur. The nuclear industry has to reflect this concern in its safety demonstration, independently of proving the achievement of technical safety goals. The public opinion issue will be readdressed at the end of this paper. (orig.)

Why prove it again? alternative proofs in mathematical practice

CERN Document Server

Dawson, Jr , John W

2015-01-01

This monograph considers several well-known mathematical theorems and asks the question, “Why prove it again?” while examining alternative proofs.   It  explores the different rationales mathematicians may have for pursuing and presenting new proofs of previously established results, as well as how they judge whether two proofs of a given result are different.  While a number of books have examined alternative proofs of individual theorems, this is the first that presents comparative case studies of other methods for a variety of different theorems. The author begins by laying out the criteria for distinguishing among proofs and enumerates reasons why new proofs have, for so long, played a prominent role in mathematical practice.  He then outlines various purposes that alternative proofs may serve.  Each chapter that follows provides a detailed case study of alternative proofs for particular theorems, including the Pythagorean Theorem, the Fundamental Theorem of Arithmetic, Desargues’ Theorem, the...

“The most important is the most difficult to describe”. On Bohdan Zadura’s “Płyn Lugola”

Directory of Open Access Journals (Sweden)

Danuta Opacka-Walasek

2012-01-01

Full Text Available The starting point for the interpretation of the poem Płyn Lugola, [Lugol’s solution] written by B. Zadura, is the rift between the classical form of the sonnet and the title that prompts the interventionist character of the poem and that indicates journalistic involvement in and the implications of the events in Chernobyl. This in turn leads to identification of further structural tensions and dissonances (in the verse course, at the level of imaging and in shaping the mood of the poem. The descriptive category for the essence of the composition and underlined overtones of the work is the sublime, in particular as it is viewed by modern aesthetics (proposed by Lyotard, Derrida, but also Burke. What surfaces is the microscale of imaging clashed with the macroscale phenomena formalized in lyrical situation, violation of the substance of the world, stability encroached by liquidity. A particularly validated layer of the work is the sound structure of the poem: in the finely and precisely controlled instrumental line, almost equivalent to the anagram, connotes the word “Chernobyl”, though the word is not expressed explicitly in the text. The interpretation intends to prove that the stake here is the articulation of sublimity charged and permeated with a metapoetic reflection – and that “the most important is, at the same time, the most difficult to describe”.

Improving Biometric-Based Authentication Schemes with Smart Card Revocation/Reissue for Wireless Sensor Networks.

Science.gov (United States)

Moon, Jongho; Lee, Donghoon; Lee, Youngsook; Won, Dongho

2017-04-25

User authentication in wireless sensor networks is more difficult than in traditional networks owing to sensor network characteristics such as unreliable communication, limited resources, and unattended operation. For these reasons, various authentication schemes have been proposed to provide secure and efficient communication. In 2016, Park et al. proposed a secure biometric-based authentication scheme with smart card revocation/reissue for wireless sensor networks. However, we found that their scheme was still insecure against impersonation attack, and had a problem in the smart card revocation/reissue phase. In this paper, we show how an adversary can impersonate a legitimate user or sensor node, illegal smart card revocation/reissue and prove that Park et al.'s scheme fails to provide revocation/reissue. In addition, we propose an enhanced scheme that provides efficiency, as well as anonymity and security. Finally, we provide security and performance analysis between previous schemes and the proposed scheme, and provide formal analysis based on the random oracle model. The results prove that the proposed scheme can solve the weaknesses of impersonation attack and other security flaws in the security analysis section. Furthermore, performance analysis shows that the computational cost is lower than the previous scheme.

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

Energy Technology Data Exchange (ETDEWEB)

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

2017-05-15

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

Determination of difficult to measure actinides in radioactive liquid waste

International Nuclear Information System (INIS)

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

2014-01-01

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

Initial building investigations at Aberdeen Proving Ground, Maryland: Objectives and methodology

Energy Technology Data Exchange (ETDEWEB)

Brubaker, K.L.; Dougherty, J.M.; McGinnis, L.D.

1994-12-01

As part of an environmental-contamination source-definition program at Aberdeen Proving Ground, detailed internal and external inspections of 23 potentially contaminated buildings are being conducted to describe and characterize the state of each building as it currently exists and to identify areas potentially contaminated with toxic or other hazardous substances. In addition, a detailed geophysical investigation is being conducted in the vicinity of each target building to locate and identify subsurface structures, associated with former building operations, that are potential sources of contamination. This report describes the objectives of the initial building inspections, including the geophysical investigations, and discusses the methodology that has been developed to achieve these objectives.

Divide and conquer method for proving gaps of frustration free Hamiltonians

DEFF Research Database (Denmark)

Kastoryano, Michael J.; Lucia, Angelo

2018-01-01

Providing system-size independent lower bounds on the spectral gap of local Hamiltonian is in general a hard problem. For the case of finite-range, frustration free Hamiltonians on a spin lattice of arbitrary dimension, we show that a property of the ground state space is sufficient to obtain...... such a bound. We furthermore show that such a condition is necessary and equivalent to a constant spectral gap. Thanks to this equivalence, we can prove that for gapless models in any dimension, the spectral gap on regions of diameter $n$ is at most $o\\left(\\frac{\\log(n)^{2+\\epsilon}}{n}\\right)$ for any...... positive $\\epsilon$....

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

LENUS (Irish Health Repository)

Walsh, K

2012-02-03

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

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

Science.gov (United States)

DiMaio, Frank

2017-01-01

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

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

Science.gov (United States)

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

2015-11-01

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

High Metal Removal Rate Process for Machining Difficult Materials

Energy Technology Data Exchange (ETDEWEB)

Bates, Robert; McConnell, Elizabeth

2016-06-29

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

[Inadequate management of a difficult airway. Case SENSAR of the trimester].

Science.gov (United States)

2015-01-01

A clinical case reported to SENSAR is presented (www.sensar.org). A patient came to the operating room for surgery for parathyroidectomy. She had several predictors of difficult airway management, including a story of difficulties in previous intubations in other hospitals, as the patient reported. Therefore, after evaluation in preoperative consultation, fibreoptic bronchoscopy intubation was recommended. The day of surgery after induction of general anesthesia direct laryngoscopy was performed, without recognizing any glottic structure (Cormack-Lehane grade iv). Conventional laryngoscope was changed to a videolaryngoscope (Airtraq(®)) to try to improve the laryngoscopic view, but there were difficulties with handling and insertion of it, causing minor injuries to the lingual mucosa. Finally, tracheal intubation was achieved after several attempts. Analysis of the incident revealed the active error due to lack of experience of the professional who performed intubation maneuvers, favored by latent factors or contributors as were the complex pathology of the patient and the absence of protocols to difficult airway management in the hospital. Communication and analysis of this incident served to highlight the importance of the security protocols in Anesthesia, and as a result a working group that conducted the current algorithm approach to a difficult airway management was formed, established guidelines for further information patient and deals since clinical training and professional practice for the management of airway devices availables in the hospital. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Acceptance issues for large items and difficult waste

International Nuclear Information System (INIS)

Palmer, J.; Lock, Peter

2002-01-01

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

Difficultés scolaires et séparation des parents

OpenAIRE

Henri-Panabière, Gaële

2011-01-01

Répartition des collégiens dans les classes de difficultés scolaires selon que les parents vivent ensemble ou non… …dans la population d’ensemble (N=629 sans les non-réponses) …et dans la sous-population des parents diplômé(s) du supérieur (N=251 sans les non-réponses)

A difficult decision: what should we do when malignant tumours are diagnosed in patients supported by left ventricular assist devices?

Science.gov (United States)

Smail, Hassiba; Pfister, Christian; Baste, Jean-Marc; Nafeh-Bizet, Catherine; Gay, Arnaud; Barbay, Virginie; Bessou, Jean-Paul; Peillon, Christophe; Litzler, Pierre-Yves

2015-09-01

Left ventricular assist devices (LVADs) are used as a bridge to heart transplantation. During the preimplantation or pretransplantation screening, malignant tumours can be discovered. Owing to the lack of guidelines, the management is difficult. We describe our perioperative approach and the patients' outcomes. Between 2006 and 2014, 55 patients underwent implantation of HeartMate II LVAD. Five were diagnosed with malignant tumours: 2 renal, 2 lung and 1 breast tumours. The renal tumours were diagnosed during the preimplantation screening. An LVAD was implanted in both followed by partial nephrectomies 8 and 9 months later. The lung cancers were diagnosed after device implantation, a left pulmonary segmentectomy and a right upper sleeve lobectomy were performed. The breast cancer was diagnosed few months after support and a tumourectomy with lymphadenectomy was performed. Tumour resection was performed successfully in all patients. Prior to surgery haemostasis, device and heart function were evaluated. During surgery, haemodynamics and anticoagulation were monitored. Reoperations were necessary to evacuate haemothorax after lobectomy and an abdominal haematoma post-nephrectomy. After discussion with oncologists, 3 patients were relisted for heart transplantation. Two were successfully transplanted 2 and 3 years after partial nephrectomy with an actual survival of 56 and 59 months after the cancer diagnosis. The follow-up revealed no cancer recurrences. Malignant tumours during support with LVAD can be successfully resected. A multidisciplinary evaluation in these high-risk patients is mandatory. After careful evaluation, regaining the patient's heart transplant candidacy is possible. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

JPSS Preparations at the Satellite Proving Ground for Marine, Precipitation, and Satellite Analysis

Science.gov (United States)

Folmer, Michael J.; Berndt, E.; Clark, J.; Orrison, A.; Kibler, J.; Sienkiewicz, J.; Nelson, J.; Goldberg, M.; Sjoberg, W.

2016-01-01

The ocean prediction center at the national hurricane center's tropical analysis and forecast Branch, the Weather Prediction center and the Satellite analysis branch of NESDIS make up the Satellite Proving Ground for Marine, Precipitation and Satellite Analysis. These centers had early exposure to JPSS products using the S-NPP Satellite that was launched in 2011. Forecasters continue to evaluate new products in anticipation for the launch of JPSS-1 sometime in 2017.

Research in advanced formal theorem-proving techniques. [design and implementation of computer languages

Science.gov (United States)

Raphael, B.; Fikes, R.; Waldinger, R.

1973-01-01

The results are summarised of a project aimed at the design and implementation of computer languages to aid in expressing problem solving procedures in several areas of artificial intelligence including automatic programming, theorem proving, and robot planning. The principal results of the project were the design and implementation of two complete systems, QA4 and QLISP, and their preliminary experimental use. The various applications of both QA4 and QLISP are given.

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

Science.gov (United States)

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

2010-10-01

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

Proving Continuity of Coinductive Global Bisimulation Distances: A Never Ending Story

Directory of Open Access Journals (Sweden)

David Romero-Hernández

2015-12-01

Full Text Available We have developed a notion of global bisimulation distance between processes which goes somehow beyond the notions of bisimulation distance already existing in the literature, mainly based on bisimulation games. Our proposal is based on the cost of transformations: how much we need to modify one of the compared processes to obtain the other. Our original definition only covered finite processes, but a coinductive approach allows us to extend it to cover infinite but finitary trees. After having shown many interesting properties of our distance, it was our intention to prove continuity with respect to projections, but unfortunately the issue remains open. Nonetheless, we have obtained several partial results that are presented in this paper.

Foreign body aspiration masquerading as difficult asthma

Directory of Open Access Journals (Sweden)

Rai S

2007-01-01

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

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

DEFF Research Database (Denmark)

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

2012-01-01

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

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

International Nuclear Information System (INIS)

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

2007-01-01

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

Underuse of brachytherapy for the treatment of dysphagia owing to esophageal cancer. An Italian survey.

Science.gov (United States)

Fuccio, Lorenzo; Guido, Alessandra; Hassan, Cesare; Frazzoni, Leonardo; Arcelli, Alessandra; Farioli, Andrea; Giaccherini, Lucia; Galuppi, Andrea; Mandolesi, Daniele; Cellini, Francesco; Mantello, Giovanna; Macchia, Gabriella; de Bortoli, Nicola; Repici, Alessandro; Valentini, Vincenzo; Bazzoli, Franco; Morganti, Alessio Giuseppe

2016-10-01

International guidelines strongly recommend brachytherapy as valid alternative or in addition to stenting in patients with dysphagia owing to esophageal cancer. However, for not well understood reasons, brachytherapy is definitively underused for the palliative treatment of malignant dysphagia. Aim of the current survey was to investigate the use of brachytherapy for the treatment of malignant dysphagia in Italy. A structured questionnaire was submitted to the 1510 members of the Italian Association of Radiation Oncologists (AIRO). These members refer to 177 centres of radiotherapy across Italy and in 68 (38.4%) of them brachytherapy is routinely performed. Of the 1510 invited members, 178 completed the survey (11.7%). The answers provided by the 178 participants allowed to get information on 40 out of 68 brachytherapy centres (58.8%). Seven out of 40 (17.5%) centres perform brachytherapy of the oesophagus, in 3 out of 40 (7.5%) centres brachytherapy represents the first line of treatment. The main reason why brachytherapy is not routinely performed is the lack of experience. Despite the strong recommendations of the international guidelines and the wide diffusion of brachytherapy centres across Italy, only very few of them routinely considered brachytherapy for the treatment of dysphagia due to esophageal cancer. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

Homa, Donald; Viera, Cynthia

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

Geophysics: Building E5476 decommissiong, Aberdeen Proving Ground

International Nuclear Information System (INIS)

Miller, S.F.; Thompson, M.D.; McGinnis, M.G.; McGinnis, L.D.

1992-11-01

Building E5476 was one of ten potentially contaminated sites in the Canal Creek and Westwood areas of the Edgewood section of Aberdeen Proving Ground examined by a geophysical team from Argonne National Laboratory in April and May of 1992. Noninvasive geophysical surveys, including magnetics, electrical resistivity, and ground-penetrating radar, were conducted around the perimeter of the building to guide a sampling program prior to decommissioning and dismantling. The large number of magnetic sources surrounding the building are believed to be contained in construction fill. The smaller anomalies, for the most part, were not imaged with ground radar or by electrical profiling. Large magnetic anomalies near the southwest comer of the building are due to aboveground standpipes and steel-reinforced concrete. Two high-resistivity areas, one projecting northeast from the building and another south of the original structure, may indicate the presence of organic pore fluids in the subsurface. A conductive lineament protruding from the south wall that is enclosed by the southem, high-resistivity feature is not associated with an equivalent magnetic anomaly. Magnetic and electrical anomalies south of the old landfill boundary are probably not associated with the building. The boundary is marked by a band of magnetic anomalies and a conductive zone trending northwest to southeast. The cause of high resistivities in a semicircular area in the southwest comer, within the landfill area, is unexplained

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

Science.gov (United States)

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

2011-01-01

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

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

Directory of Open Access Journals (Sweden)

Bensghir Mustapha

2011-01-01

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

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

Science.gov (United States)

Goldberg, Tsafrir

2017-01-01

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

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

Science.gov (United States)

Bautista, Debbie; Mulligan, Joanne

2010-01-01

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

Hemorrhagic herpes encephalitis: A difficult diagnosis in computed tomography

International Nuclear Information System (INIS)

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

1982-01-01

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

20 CFR 416.1603 - How to prove you are a resident of the United States.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How to prove you are a resident of the United States. 416.1603 Section 416.1603 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... as— (1) Property, income, or other tax forms or receipts; (2) Utility bills, leases or rent payment...

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

Science.gov (United States)

Pritchard, Joy; Upjohn, Melissa; Hirson, Tamsin

2018-01-01

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

Using aetnanova to formally prove that the Davis-Putnam satisfiability test is correct

Directory of Open Access Journals (Sweden)

Eugenio G. Omodeo

2008-05-01

Full Text Available This paper reports on using the ÆtnaNova/Referee proof-verification system to formalize issues regarding the satisfiability of CNF-formulae of propositional logic. We specify an “archetype” version of the Davis-Putnam-Logemann-Loveland algorithm through the THEORY of recursive functions based on a well-founded relation, and prove it to be correct.Within the same framework, and by resorting to the Zorn lemma, we develop a straightforward proof of the compactness theorem.

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

Science.gov (United States)

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

2016-01-01

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

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

DEFF Research Database (Denmark)

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

2018-01-01

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

Potential Cislunar and Interplanetary Proving Ground Excursion Trajectory Concepts

Science.gov (United States)

McGuire, Melissa L.; Strange, Nathan J.; Burke, Laura M.; MacDonald, Mark A.; McElrath, Timothy P.; Landau, Damon F.; Lantoine, Gregory; Hack, Kurt J.; Lopez, Pedro

2016-01-01

NASA has been investigating potential translunar excursion concepts to take place in the 2020s that would be used to test and demonstrate long duration life support and other systems needed for eventual Mars missions in the 2030s. These potential trajectory concepts could be conducted in the proving ground, a region of cislunar and near-Earth interplanetary space where international space agencies could cooperate to develop the technologies needed for interplanetary spaceflight. Enabled by high power Solar Electric Propulsion (SEP) technologies, the excursion trajectory concepts studied are grouped into three classes of increasing distance from the Earth and increasing technical difficulty: the first class of excursion trajectory concepts would represent a 90-120 day round trip trajectory with abort to Earth options throughout the entire length, the second class would be a 180-210 day round trip trajectory with periods in which aborts would not be available, and the third would be a 300-400 day round trip trajectory without aborts for most of the length of the trip. This paper provides a top-level summary of the trajectory and mission design of representative example missions of these three classes of excursion trajectory concepts.

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

Science.gov (United States)

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

2017-08-01

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

Fractal geometry as a new approach for proving nanosimilarity: a reflection note.

Science.gov (United States)

Demetzos, Costas; Pippa, Natassa

2015-04-10

Nanosimilars are considered as new medicinal outcomes combining the generic drugs and the nanocarrier as an innovative excipient, in order to evaluate them as final products. They belong to the grey area - concerning the evaluation process - between generic drugs and biosimilar medicinal products. Generic drugs are well documented and a huge number of them are in market, replacing effectively the off-patent drugs. The scientific approach for releasing them to the market is based on bioequivalence studies, which are well documented and accepted by the regulatory agencies. On the other hand, the structural complexity of biological/biotechnology-derived products demands a new approach for the approval process taking into consideration that bioequivalence studies are not considered as sufficient as in generic drugs, and new clinical trials are needed to support their approval process of the product to the market. In proportion, due to technological complexity of nanomedicines, the approaches for proving the statistical identity or the similarity for generic and biosimilar products, respectively, with those of prototypes, are not considered as effective for nanosimilar products. The aim of this note is to propose a complementary approach which can provide realistic evidences concerning the nanosimilarity, based on fractal analysis. This approach is well fit with the structural complexity of nanomedicines and smooths the difficulties for proving the similarity between off-patent and nanosimilar products. Fractal analysis could be considered as the approach that completely characterizes the physicochemical/morphological characteristics of nanosimilar products and could be proposed as a start point for a deep discussion on nanosimilarity. Copyright © 2015 Elsevier B.V. All rights reserved.

Seismic proving test of ultimate piping strength (current status of preliminary tests)

International Nuclear Information System (INIS)

Suzuki, K.; Namita, Y.; Abe, H.; Ichihashi, I.; Suzuki, K.; Ishiwata, M.; Fujiwaka, T.; Yokota, H.

2001-01-01

In 1998 Fiscal Year, the 6 year program of piping tests was initiated with the following objectives: i) to clarify the elasto-plastic response and ultimate strength of nuclear piping, ii) to ascertain the seismic safety margin of the current seismic design code for piping, and iii) to assess new allowable stress rules. In order to resolve extensive technical issues before proceeding on to the seismic proving test of a large-scale piping system, a series of preliminary tests of materials, piping components and simplified piping systems is intended. In this paper, the current status of the material tests and the piping component tests is reported. (author)

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

Science.gov (United States)

Tingley, Suzanne Capek

2012-01-01

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

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

OpenAIRE

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

2017-01-01

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

Real life study of three years omalizumab in patients with difficult-to-control asthma.

Science.gov (United States)

López Tiro, J Jesús; Contreras, E Angélica Contreras; del Pozo, M Elena Ramírez; Gómez Vera, J; Larenas Linnemann, D

2015-01-01

Even though there are multiple options for the treatment of asthma, there still exists a fair group of patients with difficult-to-control asthma. We describe for the first time the real-world effects of three-year omalizumab treatment on patients with difficult-to-control asthma, seen in a social security hospital in a Latin American country. Difficult-to-control asthmatic patients from the out-patient clinic of a regional hospital were recruited to receive a three-year omalizumab course. Efficacy parameters were asthma control test (ACT) score; FEV1; daily beclomethasone maintenance dose; and unplanned visits for asthma exacerbations (emergency room (ER), hospitalisations, intensive care). 52 patients were recruited, 47 completed the three-year treatment (42 female, 15-67 years, mean age 43.5). Comparing efficacy parameters of the year before omalizumab with the 3rd year of omalizumab: mean ACT improved from 12.4 to 20.5, mean FEV1 from 66.3% (standard deviation (SD) 19.1%) to 88.4% (SD 16.2%) of predicted, while mean beclomethasone dose reduced from 1750 to 766 mcg/day and there was a significant reduction in patients experiencing ER visits (from 95% to 19%, pomalizumab, two because of an adverse event (anaphylaxis, severe headache, both resolved without sequelae). Omalizumab improved most clinical parameters of Mexican patients with difficult-to-control asthma. Especially the rates of ER visits and hospitalisation were significantly reduced, thus reducing costs. Omalizumab was generally well tolerated. Copyright © 2013 SEICAP. Published by Elsevier Espana. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Teena Bansal

2016-04-01

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

Le rôle de l'information en droit des entreprises en difficulté

OpenAIRE

Ould Eba, Moussa

2013-01-01

L’information est un moyen de gestion fiable et une garantie indispensable pour la protection des intérêts des acteurs de l’activité économique. Elle joue un rôle important dans la prévention et le traitement des difficultés des entreprises. En effet, à la lumière des informations comptables, financières et sociales, les dirigeants peuvent prévenir les difficultés et prendre les décisions adaptées à la situation de l’entreprise. Toutefois, en cas de procédures collectives, le besoin de protec...

The Neural Bases of Difficult Speech Comprehension and Speech Production: Two Activation Likelihood Estimation (ALE) Meta-Analyses

Science.gov (United States)

Adank, Patti

2012-01-01

The role of speech production mechanisms in difficult speech comprehension is the subject of on-going debate in speech science. Two Activation Likelihood Estimation (ALE) analyses were conducted on neuroimaging studies investigating difficult speech comprehension or speech production. Meta-analysis 1 included 10 studies contrasting comprehension…

Wind tunnel experiments to prove a hydraulic passive torque control concept for variable speed wind turbines

NARCIS (Netherlands)

Diepeveen, N.F.B.; Jarquin-Laguna, A.

2014-01-01

In this paper the results are presented of experiments to prove an innovative concept for passive torque control of variable speed wind turbines using fluid power technology. It is demonstrated that by correctly configuring the hydraulic drive train, the wind turbine rotor operates at or near

20 CFR 1002.33 - Does the employee have to prove that the employer discriminated against him or her in order to be...

Science.gov (United States)

2010-04-01

... employer discriminated against him or her in order to be eligible for reemployment? 1002.33 Section 1002.33... have to prove that the employer discriminated against him or her in order to be eligible for reemployment? No. The employee is not required to prove that the employer discriminated against him or her...

Vulnerability as a Key Concept in Museum Pedagogy on Difficult Matters

Science.gov (United States)

Tinning, Katrine

2018-01-01

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

Ploughs for difficult seams of Bergbau AG Niederrhein

Energy Technology Data Exchange (ETDEWEB)

Klimek, K.-H.

1989-06-29

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

Management of difficult airway in intratracheal tumor surgery

Directory of Open Access Journals (Sweden)

Agarwal Surendra K

2005-06-01

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

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

Science.gov (United States)

Simmonds Patience L.; Ingold, Jane L.

2002-01-01

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

Performance specifications: the nearly impossible versus the merely difficult

Science.gov (United States)

Hopper, Darrel G.

2000-08-01

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

Decline of the self-focusing of a pulsed high intensity electron beam owing to gas breakdown

International Nuclear Information System (INIS)

Hotta, H.; Arai, H.

1977-01-01

The self-focusing of a pulsed high-intensity electron beam in a gas declines in the intermediate pressure region owing to gas breakdown. The degree of the self-focusing of a beam from a Febetron 706 in monatomic gases increases by increasing the breakdown time (t/sub B/), which is defined as the time when the plasma conductivity becomes 10 mho/cm. Secondary electrons are consumed appreciably in polyatomic gases after t/sub B/ through their reactions with ions and neutral molecules. Therefore, in such gases, the amount of the consumption must be estimated to analyze the self-focusing. For the estimation of the consumption, we must remark that the mean energy of secondary electrons is quite different between before and after t/sub B/ because of the different strength of induced longitudinal electric field. As a result of the numerical analyses, we obtain the equation t/sub B/-t/sub N/ =12/w (α-eta) (t/sub N/ is neutralization time, w is electron drift velocity, α is the first Townsend ionization coefficient, and eta is the electron attachment coefficient). Since eta is usually negligibly small before t/sub B/ and t/sub N/ is also negligibly small above a certain pressure, t/sub B/ is approximately inversely proportional to wα. The t/sub B/ in polyatomic gases, however, must be corrected for the consumption described above

Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine.

Science.gov (United States)

Sawyer, Taylor; White, Marjorie; Zaveri, Pavan; Chang, Todd; Ades, Anne; French, Heather; Anderson, JoDee; Auerbach, Marc; Johnston, Lindsay; Kessler, David

2015-08-01

Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.

Betel quid, chewing habits and difficult intubation: A case report and critical appraisal of evidence for practice.

Science.gov (United States)

Narendra, P L; Hegde, Harihar V; Vijaykumar, T K; Nallamilli, Samson

2015-01-01

Betel quid is used by 10-20% of world of population. Oral submucus fibrosis (OSF) is a chronic premalignant disease common in South Asian countries where betel quid is chewed. It is characterized by juxtaepithelial fibrosis of oral cavity and limited mouth opening, which can cause difficult intubation. A recent study in Taiwan has revealed long-term betel nut chewing is not predictor of difficult intubation. We describe two cases of OSF and critically analyze this study and its implications for clinical practice. OSF is now seen in Saudi Arabia and western countries with use of commercial betel quid substitutes. Although betel quid without tobacco is used in Taiwan, available evidence suggests rapid and early development of OSF where commercial chewing products like Pan Masala are used in India. Effects of betel quid may vary depending on the composition of quid and chewing habits. Studies where personal habits are involved must be analyzed carefully for external validity. Even though, Taiwan study is controlled, its validity outside Taiwan is highly questionable. Since OSF can cause unanticipated difficult intubation, thus during preanesthetic assessment, history of betel quid chewing, more importantly use of commercial chewing products is more likely to give clues to severity of OSF and possible difficult intubation. Further controlled trails in populations where commercial chewing products are used is necessary to detect association of chewing habits and difficult intubation.

Seismic proving tests on the reliability for large components and equipment of nuclear power plants

International Nuclear Information System (INIS)

Ohno, Tokue; Tanaka, Nagatoshi

1988-01-01

Since Japan has destructive earthquakes frequently, the structural reliability for large components and equipment of nuclear power plants are rigorously required. They are designed using sophisticated seismic analyses and have not yet encountered a destructive earthquake. When nuclear power plants are planned, it is very important that the general public understand the structural reliability during and after an earthquake. Seismic Proving Tests have been planned by Ministry of International Trade and Industry (Miti) to comply with public requirement in Japan. A large-scale high-performance vibration table was constructed at Tasted Engineering Laboratory of Nuclear Power Engineering Test Center (NU PEC), in order to prove the structural reliability by vibrating the test model (of full scale or close to the actual size) in the condition of a destructive earthquake. As for the test models, the following four items were selected out of large components and equipment important to the safety: Reactor Containment Vessel; Primary Coolant Loop or Primary Loop Recirculation System; Reactor Pressure Vessel; and Reactor Core Internals. Here is described a brief of the vibration table, the test method and the results of the tests on PWR Reactor Containment Vessel and BWR Primary Loop Recirculation System (author)

Mites (Acari, Mesostigmata from rock cracks and crevices in rock labirynths in the Stołowe Mountains National Park (SW Poland

Directory of Open Access Journals (Sweden)

KAMCZYC JACEK

2014-06-01

Full Text Available The aim of this study was to recognize the species composition of soil mites of the order Mesostigmata in the soil/litter collected from rock cracks and crevices in Szczeliniec Wielki and Błędne Skały rock labirynths in the area of the Stołowe Mountains National Park (part of the Sudetes in SW Poland. Overall, 27 species were identified from 41 samples collected between September 2001 and August 2002. The most numerous species in this study were Veigaia nemorensis, Leptogamasus cristulifer, and Gamasellus montanus. Our study has also confirmed the occurrence or rare mite species, such as Veigaia mollis and Paragamasus insertus. Additionally, 5 mite species were recorded as new to the fauna of this Park: Vulgarogamasus remberti, Macrocheles tardus, Pachylaelaps vexillifer, Iphidosoma physogastris, and Dendrolaelaps (Punctodendrolaelaps eichhorni.

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

DEFF Research Database (Denmark)

Witt, Flemming; Nielsen, Jørn Flohr

The employee empowerment literature promises better organizational performance as well as more motivated and satisfied employees. However, this literature often neglects the specific context of public services in general, or the health care sector, hospitals, and nursing in particular. Nurses...... in Danish public hospitals work in a unique situation that makes the uncritical transfer of empowerment interventions intended to redesign their work difficult or even unfeasible. Analysis from an institutional perspective of the ongoing power struggle between agens of change at several levels in the Danish...

Pediatric Trainees Managing a Difficult Airway: Comparison of Laryngeal Mask Airway, Direct, and Video-Assisted Laryngoscopy

Directory of Open Access Journals (Sweden)

Art Ambrosio MD

2017-05-01

Full Text Available Objective Difficult airway management is a key skill required by all pediatric physicians, yet training on multiple modalities is lacking. The objective of this study was to compare the rate of, and time to, successful advanced infant airway placement with direct laryngoscopy, video-assisted laryngoscopy, and laryngeal mask airway (LMA in a difficult airway simulator. This study is the first to compare the success with 3 methods for difficult airway management among pediatric trainees. Study Design Randomized crossover pilot study. Setting Tertiary academic medical center. Methods Twenty-two pediatric residents, interns, and medical students were tested. Participants were provided 1 training session by faculty using a normal infant manikin. Subjects then performed all 3 of the aforementioned advanced airway modalities in a randomized order on a difficult airway model of a Robin sequence. Success was defined as confirmed endotracheal intubation or correct LMA placement by the testing instructor in ≤120 seconds. Results Direct laryngoscopy demonstrated a significantly higher placement success rate (77.3% than video-assisted laryngoscopy (36.4%, P = .0117 and LMA (31.8%, P = .0039. Video-assisted laryngoscopy required a significantly longer amount of time during successful intubations (84.8 seconds; 95% CI, 59.4-110.1 versus direct laryngoscopy (44.9 seconds; 95% CI, 33.8-55.9 and LMA placement (36.6 seconds; 95% CI, 24.7-48.4. Conclusions Pediatric trainees demonstrated significantly higher success using direct laryngoscopy in a difficult airway simulator model. However, given the potential lifesaving implications of advanced airway adjuncts, including video-assisted laryngoscopy and LMA placement, more extensive training on adjunctive airway management techniques may be useful for trainees.

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

Science.gov (United States)

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

2018-04-01

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

Post analysis simulated correlation of the El-Ganzouri airway difficulty score with difficult airway.

Science.gov (United States)

Corso, Ruggero M; Cattano, Davide; Buccioli, Matteo; Carretta, Elisa; Maitan, Stefano

2016-01-01

Difficult airway (DA) occurs frequently (5-15%) in clinical practice. The El-Ganzouri Risk Index (EGRI) has a high sensitivity for predicting a difficult intubation (DI). However difficult mask ventilation (DMV) was never included in the EGRI. Since DMV was not included in the EGRI assessment, and obstructive sleep apnea (OSA) is also correlated with DMV, a study correlating the prediction of DA and OSA (identified by STOP-Bang questionnaire, SB) seemed important. We accessed a database previously collected for a post analysis simulation of the airway difficulty predictivity of the EGRI, associated with normal and difficult airway, particularly DMV. As secondary aim, we measured the correlation between the SB prediction system and DA, compared to the EGRI. A total of 2747 patients were included in the study. The proportion of patients with DI was 14.7% (95% CI 13.4-16) and the proportion of patients with DMV was 3.42% (95% CI 2.7-4.1). The incidence of DMV combined with DI was (2.3%). The optimal cutoff value of EGRI was 3. EGRI registered also an higher ability to predict DMV (AUC=0.76 (95% CI 0.71-0.81)). Adding the SB variables in the logistic model, the AUC increases with the inclusion of "observed apnea" variable (0.83 vs. 0.81, p=0.03). The area under the ROC curve for the patients with DI and DMV was 0.77 (95% CI 0.72-0.83). This study confirms that the incidence of DA is not negligible and suggests the use of the EGRI as simple bedside predictive score to improve patient safety. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[Post analysis simulated correlation of the El-Ganzouri airway difficulty score with difficult airway].

Science.gov (United States)

Corso, Ruggero M; Cattano, Davide; Buccioli, Matteo; Carretta, Elisa; Maitan, Stefano

2016-01-01

Difficult airway (DA) occurs frequently (5-15%) in clinical practice. The El-Ganzouri Risk Index (EGRI) has a high sensitivity for predicting a difficult intubation (DI). However difficult mask ventilation (DMV) was never included in the EGRI. Since DMV was not included in the EGRI assessment, and obstructive sleep apnea (OSA) is also correlated with DMV, a study correlating the prediction of DA and OSA (identified by STOP-Bang questionnaire, SB) seemed important. We accessed a database previously collected for a post analysis simulation of the airway difficulty predictivity of the EGRI, associated with normal and difficult airway, particularly DMV. As secondary aim, we measured the correlation between the SB prediction system and DA, compared to the EGRI. A total of 2747 patients were included in the study. The proportion of patients with DI was 14.7% (95% CI 13.4-16) and the proportion of patients with DMV was 3.42% (95% CI 2.7-4.1). The incidence of DMV combined with DI was (2.3%). The optimal cutoff value of EGRI was 3. EGRI registered also an higher ability to predict DMV (AUC=0.76 (95% CI 0.71-0.81)). Adding the SB variables in the logistic model, the AUC increases with the inclusion of "observed apnea" variable (0.83 vs. 0.81, p=0.03). The area under the ROC curve for the patients with DI and DMV was 0.77 (95% CI 0.72-0.83). This study confirms that the incidence of DA is not negligible and suggests the use of the EGRI as simple bedside predictive score to improve patient safety. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

"Difficult-to treat" ulcers management: use of pulse dose radiofrequency.

Science.gov (United States)

Quarto, Gennaro; Solimeno, G; Furino, E; Sivero, Luigi; Bucci, Luigi; Massa, Salvatore; Benassai, Giacomo; Apperti, M

2013-01-01

In this paper we wanted to evaluate the impact of pain reduction on the evolution of "difficult-to treat" ulcers, using Radiofrequency analgesia in pulse-dose modality. We have performed a randomized trial to evaluate the efficacy of the RF in PD mode to reduce the healing time of ulcers of difficult management as outpatient for spontaneous and provoked pain. We enrolled 23 patients, including 7 males (30%) and 16 females (70%), aged between 53 and 79 years (mean age = 67.2) sorted according to the first letter of the last name in ascending order and assigned alternately to one or another group. In Group A healing was obtained in 33% of patients (4/12), with an average healing time of 6 months while in Group B healing has been obtained in 81% of patients (9/11) with an average time of 3 months (range 1-5 months) Student's T was performed to compare the average recovery time among the two groups; moreover we have analyzed the proportions of healed patients in the group A and B. Healing time significantly decreased in group B (p = 0,013079). Even the cure rate has changed favorably, in a statistically significant way. According to the literature related to the use of the RF pulse dose, there is a greater effectiveness of this technique in respect of the classical PRF, in terms of immediate and long-term reduction of pain and this impacts positively on the course of ulcer healing.

Co-operative projects with AECL in the fields of hydrogeology and geochemistry

International Nuclear Information System (INIS)

1985-01-01

The report covers collaborative study with Atomic Energy of Canada Limited on geological aspects of waste disposal in crystalline rocks. A field test of the sinusoidal hydraulic pressure pulse method was carried out at the URL site to try to define hydraulic properties of major horizontal fractures. The trials were generally successful and observable sine and square wave signals were transmitted. Owing to the limited scale of the programme, and some equipment problems, the results proved difficult to interpret, although the speed and flexibility of the method was demonstrated. A second aspect of collaboration was to be the field comparison of the AECL and NERC/BGS borehole geochemical probes. In the event, the AECL probe development programme was curtailed and a Swedish design selected for purchase. Effort thus switched to technical comparison of the SGAB probe with the NERC/BGS design. Since both are still at various development points the collaboration was limited to technical exchange. The results are presented. (author)

A general relationship between disorder, aggregation and charge transport in conjugated polymers

KAUST Repository

Noriega, Rodrigo; Rivnay, Jonathan; Vandewal, Koen; Koch, Felix P. V.; Stingelin, Natalie; Smith, Paul; Toney, Michael F.; Salleo, Alberto

2013-01-01

Conjugated polymer chains have many degrees of conformational freedom and interact weakly with each other, resulting in complex microstructures in the solid state. Understanding charge transport in such systems, which have amorphous and ordered phases exhibiting varying degrees of order, has proved difficult owing to the contribution of electronic processes at various length scales. The growing technological appeal of these semiconductors makes such fundamental knowledge extremely important for materials and process design. We propose a unified model of how charge carriers travel in conjugated polymer films. We show that in high-molecular-weight semiconducting polymers the limiting charge transport step is trapping caused by lattice disorder, and that short-range intermolecular aggregation is sufficient for efficient long-range charge transport. This generalization explains the seemingly contradicting high performance of recently reported, poorly ordered polymers and suggests molecular design strategies to further improve the performance of future generations of organic electronic materials. © 2013 Macmillan Publishers Limited. All rights reserved.

A general relationship between disorder, aggregation and charge transport in conjugated polymers

KAUST Repository

Noriega, Rodrigo

2013-08-04

Conjugated polymer chains have many degrees of conformational freedom and interact weakly with each other, resulting in complex microstructures in the solid state. Understanding charge transport in such systems, which have amorphous and ordered phases exhibiting varying degrees of order, has proved difficult owing to the contribution of electronic processes at various length scales. The growing technological appeal of these semiconductors makes such fundamental knowledge extremely important for materials and process design. We propose a unified model of how charge carriers travel in conjugated polymer films. We show that in high-molecular-weight semiconducting polymers the limiting charge transport step is trapping caused by lattice disorder, and that short-range intermolecular aggregation is sufficient for efficient long-range charge transport. This generalization explains the seemingly contradicting high performance of recently reported, poorly ordered polymers and suggests molecular design strategies to further improve the performance of future generations of organic electronic materials. © 2013 Macmillan Publishers Limited. All rights reserved.

Machining of Some Difficult-to-Cut Materials with Rotary Cutting Tools

OpenAIRE

Stjernstoft, Tero

2004-01-01

Automobile and aero industries have an increasing interestin materials with improved mechanical properties. However, manyof these new materials are classified as difficult-to-cut withconventional tools. It is obvious that tools, cutting processesand cutting models has to be devel-oped parallel to materialsscience. In this thesis rotary cutting tools are tested as analternative toexpensive diamond or cubic bore nitridetools. Metal matrix composites mostly consist of a light metalalloy (such as...

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

Science.gov (United States)

Immerwahr, John

2009-01-01

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

How cytogenetical methods help victims prove radiation exposure and claim right for social support: NCERM experience

International Nuclear Information System (INIS)

Aleksanin, S.; Slozina, N.; Neronova, E.; Smoliakov, E.

2011-01-01

Russian citizens who were irradiated because of radiation disasters, nuclear weapons testing and some other sources have a right to some social support and financial compensation. In order to get this compensation people have to prove that they were irradiated. As it is, not all victims for a variety of reasons have formal documents. Thus they apply for cytogenetic investigation to prove irradiation months, years and even decades after irradiation. Since 1992 the cytogenetic investigations related to radiation exposure were performed in NRCERM for more than 700 people. At the beginning of this investigation FISH method was not certified as a biodosimenty test in Russia. Only dicentric analysis was approved as a proof of irradiation. It is known that the rate of dicentrics decrease in time, but the residual level of cytogenetical markers could be revealed a long time after a radiation accident. Thus the dicentric analysis was performed for the people who applied for biological indication of radiation exposure at that time. Rates of dicentrics exceeding control levels were revealed in half the people who applied for radiation conformation. Now FISH method is certified in Russia and both cytogenetic tests of biodosimetry (dicentrics and FISH) are available for all comers. Increased levels of translocations were found in 8 cases (the dose rate from 0.16 to 0.64 Gy). On the basis of the results of cytogenetic tests official documents were supplied to these people and they were entitled to apply for radiation exposure compensation. Thus cytogenetic tests are very effective and in some cases the only possible way for the victims to prove irradiation exposure and to apply for radiation exposure compensation a long time after an accident.

How cytogenetical methods help victims prove radiation exposure and claim right for social support: NCERM experience

Energy Technology Data Exchange (ETDEWEB)

Aleksanin, S., E-mail: Aleksanin@arcerm.spb.ru [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation); Slozina, N., E-mail: NataliaSlozina@peterlink.ru [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation); Neronova, E.; Smoliakov, E. [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation)

2011-09-15

Russian citizens who were irradiated because of radiation disasters, nuclear weapons testing and some other sources have a right to some social support and financial compensation. In order to get this compensation people have to prove that they were irradiated. As it is, not all victims for a variety of reasons have formal documents. Thus they apply for cytogenetic investigation to prove irradiation months, years and even decades after irradiation. Since 1992 the cytogenetic investigations related to radiation exposure were performed in NRCERM for more than 700 people. At the beginning of this investigation FISH method was not certified as a biodosimenty test in Russia. Only dicentric analysis was approved as a proof of irradiation. It is known that the rate of dicentrics decrease in time, but the residual level of cytogenetical markers could be revealed a long time after a radiation accident. Thus the dicentric analysis was performed for the people who applied for biological indication of radiation exposure at that time. Rates of dicentrics exceeding control levels were revealed in half the people who applied for radiation conformation. Now FISH method is certified in Russia and both cytogenetic tests of biodosimetry (dicentrics and FISH) are available for all comers. Increased levels of translocations were found in 8 cases (the dose rate from 0.16 to 0.64 Gy). On the basis of the results of cytogenetic tests official documents were supplied to these people and they were entitled to apply for radiation exposure compensation. Thus cytogenetic tests are very effective and in some cases the only possible way for the victims to prove irradiation exposure and to apply for radiation exposure compensation a long time after an accident.

Depleted uranium risk assessment for Jefferson Proving Ground using data from environmental monitoring and site characterization. Final report

International Nuclear Information System (INIS)

Ebinger, M.H.; Hansen, W.R.

1996-10-01

This report documents the third risk assessment completed for the depleted uranium (DU) munitions testing range at Jefferson Proving Ground (JPG), Indiana, for the U.S. Army Test and Evaluation command. Jefferson Proving Ground was closed in 1995 under the Base Realignment and Closure Act and the testing mission was moved to Yuma Proving Ground. As part of the closure of JPG, assessments of potential adverse health effects to humans and the ecosystem were conducted. This report integrates recent information obtained from site characterization surveys at JPG with environmental monitoring data collected from 1983 through 1994 during DU testing. Three exposure scenarios were evaluated for potential adverse effects to human health: an occasional use scenario and two farming scenarios. Human exposure was minimal from occasional use, but significant risk were predicted from the farming scenarios when contaminated groundwater was used by site occupants. The human health risk assessments do not consider the significant risk posed by accidents with unexploded ordnance. Exposures of white-tailed deer to DU were also estimated in this study, and exposure rates result in no significant increase in either toxicological or radiological risks. The results of this study indicate that remediation of the DU impact area would not substantially reduce already low risks to humans and the ecosystem, and that managed access to JPG is a reasonable model for future land use options

How do patients come to be seen as 'difficult'?: a mixed-methods study in community mental health care

NARCIS (Netherlands)

Koekkoek, B.; Hutschemaekers, G.; van Meijel, B.; Schene, A.

2011-01-01

Across all health care settings, certain patients are perceived as 'difficult' by clinicians. This paper's aim is to understand how certain patients come to be perceived and labelled as 'difficult' patients in community mental health care, through mixed-methods research in The Netherlands between

Taking a holistic approach to managing difficult stress fractures.

Science.gov (United States)

Miller, Timothy L; Best, Thomas M

2016-09-09

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

Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

Directory of Open Access Journals (Sweden)

Osman Karakus

2015-04-01

Full Text Available BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS system Class 4 (50%, Cormack-Lehane classification (CLS Grade 4 (95.7%, previous knowledge of difficult airway (86.2%, restricted neck movements (cervical ROM (75.8%, short thyromental distance (TMD (81.6%, vocal cord mass (49.5% as indicated in parentheses (p < 0.0001. MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

[Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery].

Science.gov (United States)

Karakus, Osman; Kaya, Cengiz; Ustun, Faik Emre; Koksal, Ersin; Ustun, Yasemin Burcu

2015-01-01

Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack-Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p<0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Yehia Khalil

2012-07-01

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

Teaching Vacancies and Difficult-to-Staff Teaching Positions in Public Schools. Stats in Brief. NCES 2015-065

Science.gov (United States)

Malkus, Nat; Hoyer, Kathleen Mulvaney; Sparks, Dinah

2015-01-01

This brief investigates teaching vacancies and difficult-to-staff teaching positions (i.e., positions for which the principals reported that it was very difficult to fill a vacancy or that they could not fill a vacancy in a specific subject area) in public schools in four school years (1999-2000, 2003-04, 2007-08, and 2011-12). This Statistics in…

Seeing a Colleague Encourage a Student to Make an Assumption while Proving: What Teachers Put in Play when Casting an Episode of Instruction

Science.gov (United States)

Nachlieli, Talli; Herbst, Patricio

2009-01-01

This article reports on an investigation of how teachers of geometry perceived an episode of instruction presented to them as a case of engaging students in proving. Confirming what was hypothesized, participants found it remarkable that a teacher would allow a student to make an assumption while proving. But they perceived this episode in various…

Seismic test facilities at the ENEA Casaccia Research Center; Prove sismiche con le tavole vibranti al centro ricerche Enea Casaccia

Energy Technology Data Exchange (ETDEWEB)

De Canio, G. [ENEA, Divisione Servizi Tecnologici, Centro Ricerche Casaccia, Rome (Italy)

2000-07-01

The main experimental facilities for seismic tests at the ENEA C.R. Casaccia laboratories consist of two high performance shake table for three axial seismic tests of structures up to 10 ton mass and 3g acceleration applied at the Center of Gravity at 1m from the base table. The activities are principally devoted to the dynamic characterization and vibration tests for mechanical and aero spatial structures, and the experimental analysis of innovative systems for the seismic isolation and retrofitting of civil, industrial, and historical buildings; together with the seismic tests of sub-structures and scaled mock-ups, in order to evaluate the isolation/dissipation performance of the anti-seismic devices, and the failure modes of the structural parts of the building. [Italian] Le principali attrezzature per le prove sismiche presso i laboratori del C.R. Casaccia consistono di due tavole vibranti triassali per prove su strutture fino a 10t di peso con una accelerazione di 3g applicata al centro di gravita' posto ad 1 m di altezza dal piano della tavola. Le principali attivita' riguardano: (a) test di caratterizzazione dinamica e prove di vibrazioni per strutture meccaniche ed aerospaziali; (b) l'analisi sperimentale di sistemi innovativi per l'isolamento sismico ed il consolidamento di strutture civili, industriali e storico monumentali, e le prove sismiche di elementi strutturali e di modelli in scala per la valutazione della capacita' di dissipazione dei dispositivi antisismici e le modalita' di formazione delle fratture.

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

OpenAIRE

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

2015-01-01

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

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

Directory of Open Access Journals (Sweden)

Joy Pritchard

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

Why behavior change is difficult to sustain.

Science.gov (United States)

Bouton, Mark E

2014-11-01

Unhealthy behavior is responsible for much human disease, and a common goal of contemporary preventive medicine is therefore to encourage behavior change. However, while behavior change often seems easy in the short run, it can be difficult to sustain. This article provides a selective review of research from the basic learning and behavior laboratory that provides some insight into why. The research suggests that methods used to create behavior change (including extinction, counterconditioning, punishment, reinforcement of alternative behavior, and abstinence reinforcement) tend to inhibit, rather than erase, the original behavior. Importantly, the inhibition, and thus behavior change more generally, is often specific to the "context" in which it is learned. In support of this view, the article discusses a number of lapse and relapse phenomena that occur after behavior has been changed (renewal, spontaneous recovery, reinstatement, rapid reacquisition, and resurgence). The findings suggest that changing a behavior can be an inherently unstable and unsteady process; frequent lapses should be expected. In the long run, behavior-change therapies might benefit from paying attention to the context in which behavior change occurs. Copyright © 2014 Elsevier Inc. All rights reserved.

Remedial investigation report for J-Field, Aberdeen Proving Ground, Maryland. Volume 3: Ecological risk assessment

Energy Technology Data Exchange (ETDEWEB)

Hlohowskyj, I.; Hayse, J.; Kuperman, R.; Van Lonkhuyzen, R.

2000-02-25

The Environmental Management Division of the U.S. Army Aberdeen Proving Ground (APG), Maryland, is conducting a remedial investigation (RI) and feasibility study (FS) of the J-Field area at APG, pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended. As part of that activity, Argonne National Laboratory (ANL) conducted an ecological risk assessment (ERA) of the J-Field site. This report presents the results of that assessment.

Remedial investigation report for J-Field, Aberdeen Proving Ground, Maryland. Volume 3: Ecological risk assessment

International Nuclear Information System (INIS)

Hlohowskyj, I.; Hayse, J.; Kuperman, R.; Van Lonkhuyzen, R.

2000-01-01

The Environmental Management Division of the U.S. Army Aberdeen Proving Ground (APG), Maryland, is conducting a remedial investigation (RI) and feasibility study (FS) of the J-Field area at APG, pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended. As part of that activity, Argonne National Laboratory (ANL) conducted an ecological risk assessment (ERA) of the J-Field site. This report presents the results of that assessment

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

Science.gov (United States)

Silberman, Mel

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

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

DEFF Research Database (Denmark)

Halttunen, Jorma; Meisner, Søren; Aabakken, Lars

2014-01-01

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

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

Science.gov (United States)

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

2015-04-01

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

[Anaesthetic management in a paediatric patient with a difficult airway due to epidermolysis bullosa dystrophica].

Science.gov (United States)

Blázquez Gómez, E; Garcés Aletá, A; Monclus Diaz, E; Manen Berga, F; García-Aparicio, L; Ontanilla López, A

2015-05-01

Dystrophic epidermolysis bullosa (DEB) is a rare inherited disorder characterized by blistering after minimal trauma. These blisters tend to form dystrophic scars, leading to limiting and life-threatening sequelae. The anaesthetic management of patients with DEB is a challenge, even for the most experienced anaesthesiologists, but basic principles can help us prepare the plan of care. The main goals are to prevent trauma/infection of skin/mucous, and to establish a secure airway without causing bullae. Patient positioning and the instruments used to monitor vital signs and administering anaesthetic agents can cause new lesions. It is advisable to lubricate the instruments and to avoid adhesive material and shearing forces on the skin. Besides the implications of the comorbidities, there is a potential difficult intubation and difficult vascular access. Acute airway obstruction can occur due to airway instrumentation. We report the case of a patient diagnosed with EBD difficult airway and undergoing correction of syndactylyl and dental extractions. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Walid Kerkeni

2015-06-01

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

The Difficult Chore of Measuring Coordination by EXAFS

International Nuclear Information System (INIS)

Ravel, B.; Kelly, S. D.

2007-01-01

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

Radon mitigation experience in difficult-to-mitigate schools

International Nuclear Information System (INIS)

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

1990-01-01

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

Cylindrical plunge grinding of difficult to grind materials

International Nuclear Information System (INIS)

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

1983-01-01

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

Fake News: A Technological Approach to Proving the Origins of Content, Using Blockchains.

Science.gov (United States)

Huckle, Steve; White, Martin

2017-12-01

In this article, we introduce a prototype of an innovative technology for proving the origins of captured digital media. In an era of fake news, when someone shows us a video or picture of some event, how can we trust its authenticity? It seems that the public no longer believe that traditional media is a reliable reference of fact, perhaps due, in part, to the onset of many diverse sources of conflicting information, via social media. Indeed, the issue of "fake" reached a crescendo during the 2016 U.S. Presidential Election, when the winner, Donald Trump, claimed that The New York Times was trying to discredit him by pushing disinformation. Current research into overcoming the problem of fake news does not focus on establishing the ownership of media resources used in such stories-the blockchain-based application introduced in this article is technology that is capable of indicating the authenticity of digital media. Put simply, using the trust mechanisms of blockchain technology, the tool can show, beyond doubt, the provenance of any source of digital media, including images used out of context in attempts to mislead. Although the application is an early prototype and its capability to find fake resources is somewhat limited, we outline future improvements that would overcome such limitations. Furthermore, we believe that our application (and its use of blockchain technology and standardized metadata) introduces a novel approach to overcoming falsities in news reporting and the provenance of media resources used therein. However, while our application has the potential to be able to verify the originality of media resources, we believe that technology is only capable of providing a partial solution to fake news. That is because it is incapable of proving the authenticity of a news story as a whole. We believe that takes human skills.

Navigating diversity with nursing students through difficult dialogues: A qualitative study

Directory of Open Access Journals (Sweden)

Deirdre E. van Jaarsveldt

2015-01-01

Full Text Available The Difficult Dialogues project is an international initiative that promotes the development of the art and skill of civil discourse as an essential outcome of higher education. At the University of the Free State, South Africa, the project is implemented by the Centre for Teaching and Learning. When intergroup conflict started disrupting the academic performance of first year nursing students, the School of Nursing consulted with the centre to facilitate a Difficult Dialogues session. This article describes the engineering of a session programme to facilitate learning about navigating diversity and responding to conflict in a constructive way. The rich data of a qualitative inquiry conducted via the Critical Incident Questionnaire are triangulated with literature and other feedback provided to describe to what extent the session contributed towards student learning. A number of participants indicated that they had learnt to respect diversity and had realised that they could co-operate as a team in spite of individual differences. As additional evidence, the students listed specific skills that could aid them in navigating diversity and conflict in future. Considering that the School strives to establish inclusion during the orientation of students, this case raises questions about the sufficiency of such endeavours. In conclusion it is asked to what extent nurse educators should be expected to implement strategies to address issues of diversity in the classroom on a continuous basis.

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

Science.gov (United States)

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

2017-02-01

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

Seismic proving test of process computer systems with a seismic floor isolation system

International Nuclear Information System (INIS)

Fujimoto, S.; Niwa, H.; Kondo, H.

1995-01-01

The authors have carried out seismic proving tests for process computer systems as a Nuclear Power Engineering Corporation (NUPEC) project sponsored by the Ministry of International Trade and Industry (MITI). This paper presents the seismic test results for evaluating functional capabilities of process computer systems with a seismic floor isolation system. The seismic floor isolation system to isolate the horizontal motion was composed of a floor frame (13 m x 13 m), ball bearing units, and spring-damper units. A series of seismic excitation tests was carried out using a large-scale shaking table of NUPEC. From the test results, the functional capabilities during large earthquakes of computer systems with a seismic floor isolation system were verified

Combined precut in difficult biliary cannulation

Directory of Open Access Journals (Sweden)

Jesús Espinel-Díez

2013-06-01

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

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

Science.gov (United States)

Shapiro, Johanna; Rakhra, Pavandeep; Wong, Adrianne

2016-10-01

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

Predicting difficult laryngoscopy in acromegalic patients undergoing surgery for excision of pituitary tumors: A comparison of extended Mallampati score with modified Mallampati classification

Directory of Open Access Journals (Sweden)

Ashish Bindra

2013-01-01

Full Text Available Background: There are numerous reports of difficult laryngoscopy and intubation in patients with acromegaly. To date, no study has assessed the application of extended Mallampati score (EMS for predicting difficult intubation in acromegalics. The primary aim of this study was to compare EMS with modified Mallampati classification (MMP in predicting difficult laryngoscopy in acromegalic patients. We hypothesized that since EMS has been reported to be more specific and better predictor than MMP, it may be superior to the MMP to predict difficult laryngoscopy in acromegalic patients. Materials and Methods: For this prospective cohort study with matched controls, acromegalic patients scheduled to undergo pituitary surgery over a period of 3 years (January 2008-December 2010 were enrolled. Preoperative airway assessment was performed by experienced anesthesiologists and involved a MMP and the EMS. Under anesthesia, laryngoscopic view was assessed using Cormack-Lehane (CL grading. MMP and CL grades of I and II were defined "easy" and III and IV as "difficult". EMS grade of I and II were defined "easy" and III as "difficult". Data were used to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MMP and EMS in predicting difficult laryngoscopy. Results: Seventy eight patients participated in the study (39 patients in each group. Both MMP and EMS failed to detect difficult laryngoscopy in seven patients. Only one laryngoscopy was predicted to be difficult by both tests which was in fact, difficult. Conclusion: We found that addition of neck extension did not improve the predictive value of MMP.

A Comparison of Cormeck-Lehane and Mallampati Tests with Mandibular and Neck Measurements for Predicting Difficult Intubation

Directory of Open Access Journals (Sweden)

Niyazi Acer

2011-06-01

Full Text Available Objective: Various prediction tests were formulated to forecast difficult intubation. The Mallampati test, Wilson score, Cormack-Lehane test and thyromental distance are the most commonly used tests pre-operatively to assess the airway. The objective of the present study was to investigate whether a combination of the Mallampati and Cormack-Lehane’s classification to predict difficult intubation compared with sternomental and thyromental distances, mandibular length, width and neck length and circumference. Material and Methods: Two hundred twenty seven cases between 17 and 70 years old undergoing elective surgery were included in the study. Age, gender, body weight, body height and BMI were noted preoperatively. The pharyngeal structures were examined before the operation. At the time of intubation, laryngoscopic evaluation was performed according to the Cormack-Lehane’s laryngoscopic classification.Results: For analysis, Mallampati and Cormack-Lehane’s laryngoscopic classification were grouped as difficult (grades III and IV or easy (grades I and II. Whereas Mallampati scoring were class 1 and 2 (easy in 72.7% cases, Cormack-Lehane’s laryngoscopic scoring 90.7% of the cases were in class 1 and 2. The combination of the Cormeck-Lehane classification with neck circumference had the highest sensitivity (94.74%, but this combination decreased the positive predictive value. The combination of the Mallampati classification with neck length had the highest sensitivity (67.86%, but this combination decreased the positive predictive value.Conclusion: The findings suggest that the Mallampati and Cormeck-Lehane classification by itself is insufficient for predicting difficult intubation so should be used in conjunction with measurement of neck circumference and Cormeck-lehane test. Mallampati test with sternomental and thyromental distances in addition with neck length may be useful in routine test for preoperative prediction of difficult

Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Science.gov (United States)

Paolini, Jean-Baptiste; Donati, François; Drolet, Pierre

2013-02-01

An adequate airway management plan is essential for patient safety. Recently, new tools have been developed as alternatives to direct laryngoscopy and intubation. Among these, video-laryngoscopy has enjoyed a rapid increase in popularity and is now considered by many as the first-line technique in airway management. This paradigm shift may have an impact on patient safety. Studies show that video-laryngoscopes are associated with better glottic visualization, a higher success rate for difficult airways, and a faster learning curve, resulting in a higher success rate for intubations by novice physicians. Thus, unanticipated difficult intubations may be less frequent if video-laryngoscopy is used as the first-line approach. In addition, on-screen viewing by the operator creates a new dynamic interaction during airway management. The entire operating room team can assess progress in real time, which enhances communication and improves teaching. However, if video-laryngoscopes become standard tools for tracheal intubation, these more costly devices will need to be widely available in all locations where airway management is conducted. Furthermore, algorithms for difficult intubation will require modification, and the question of selecting alternate devices will arise. If the incidence of difficult intubation decreases, the lack of motivation to teach and learn the use of alternative devices might adversely impact patient safety. The greater effectiveness of video-laryngoscopes associated with multi-person visualization could enhance overall patient safety during airway management. However, the routine use of video-laryngoscopy also introduces some issues that need to be addressed to avoid potentially dangerous pitfalls.

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

Science.gov (United States)

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

2006-01-01

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

Meeting on Solute/Solvent Interactions Held in Aberdeen Proving Ground, Maryland on May 29-30, 1991

Science.gov (United States)

1992-01-01

the magnitudes of the nuclear charges and therefore cannot be assumed to indicate relative reactivities toward nucleophiles. There is accordingly no...APPENDIX 3 ORGANIZATIONS OF AUTHORS IN THESE PROCEEDINGS Central Michigan University 49 Instituto de Quimica Fisica 33 La Sierra University, Riverside 71...Aberdeen Proving Gd, MD Joxe-Luis Abbud Christopher Cramer Instituto de Quimica Fisica SMCCR-RSP-C "Rocasolano" U.S. Army Chemical RD&E Center Conajo

Environmental geophysics at J-Field, Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Daudt, C.R.; McGinnis, L.D.; Miller, S.F.; Thompson, M.D.

1994-11-01

Geophysical data collected at J-Field, Aberdeen Proving Ground, Maryland, were used in the characterization of the natural hydrogeologic framework of the J-Field area and in the identification of buried disturbances (trenches and other evidences of contamination). Seismic refraction and reflection data and electrical resistivity data have aided in the characterization of the leaky confining unit at the base of the surficial aquifer (designated Unit B of the Tertiary Talbot Formation). Excellent reflectors have been observed for both upper and lower surfaces of Unit B that correspond to stratigraphic units observed in boreholes and on gamma logs. Elevation maps of both surfaces and an isopach map of Unit B, created from reflection data at the toxic burning pits site, show a thickening of Unit B to the east. Abnormally low seismic compressional-wave velocities suggest that Unit B consists of gassy sediments whose gases are not being flushed by upward or downward moving groundwater. The presence of gases suggests that Unit B serves as an efficient aquitard that should not be penetrated by drilling or other activities. Electromagnetic, total-intensity magnetic, and ground-penetrating radar surveys have aided in delineating the limits of two buried trenches, the VX burning pit and the liquid smoke disposal pit, both located at the toxic burning pits site. The techniques have also aided in determining the extent of several other disturbed areas where soils and materials were pushed out of disposal pits during trenching activities. Surveys conducted from the Prototype Building west to the Gunpowder River did not reveal any buried trenches.

Use of Adult Fibreoptic Bronchoscope for Difficult Paediatric Intubation: A Case Report

Directory of Open Access Journals (Sweden)

Kundan Sandugir Gosavi

2015-06-01

Full Text Available Difficult airway management in paediatric patients may require a technique different from the standard one. We report the use of an adult fibreoptic bronchoscope and J tipped guidewire to intubate a child having temporo-mandibular joint ankylosis. Spontaneous respiration was maintained and local anaesthesia was provided to the upper airway during the procedure and the successful use of this technique avoided the requirement of surgical airway.

Methods to ease the release of thin polydimethylsiloxane films from difficult substrates

DEFF Research Database (Denmark)

Vudayagiri, Sindhu; Skov, Anne Ladegaard

2014-01-01

permissible thickness is around 25–50 µm. The relatively small Young's modulus for these elastomers is a requirement for actuation capabilities. However, peeling and release of such films during manufacture processes are very difficult. To ease the release of the films, techniques such as the use of release....... Polysorbate-20, a non-ionic surfactant, fulfills all requirements and gives the lowest peel forces for the films....

Tectonique globale. Quelques difficultés Global Tectonics. a Few Problems

Directory of Open Access Journals (Sweden)

Vitart M. J.

2006-11-01

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

How Spoken Language Comprehension is Achieved by Older Listeners in Difficult Listening Situations.

Science.gov (United States)

Schneider, Bruce A; Avivi-Reich, Meital; Daneman, Meredyth

2016-01-01

Comprehending spoken discourse in noisy situations is likely to be more challenging to older adults than to younger adults due to potential declines in the auditory, cognitive, or linguistic processes supporting speech comprehension. These challenges might force older listeners to reorganize the ways in which they perceive and process speech, thereby altering the balance between the contributions of bottom-up versus top-down processes to speech comprehension. The authors review studies that investigated the effect of age on listeners' ability to follow and comprehend lectures (monologues), and two-talker conversations (dialogues), and the extent to which individual differences in lexical knowledge and reading comprehension skill relate to individual differences in speech comprehension. Comprehension was evaluated after each lecture or conversation by asking listeners to answer multiple-choice questions regarding its content. Once individual differences in speech recognition for words presented in babble were compensated for, age differences in speech comprehension were minimized if not eliminated. However, younger listeners benefited more from spatial separation than did older listeners. Vocabulary knowledge predicted the comprehension scores of both younger and older listeners when listening was difficult, but not when it was easy. However, the contribution of reading comprehension to listening comprehension appeared to be independent of listening difficulty in younger adults but not in older adults. The evidence suggests (1) that most of the difficulties experienced by older adults are due to age-related auditory declines, and (2) that these declines, along with listening difficulty, modulate the degree to which selective linguistic and cognitive abilities are engaged to support listening comprehension in difficult listening situations. When older listeners experience speech recognition difficulties, their attentional resources are more likely to be deployed to

Improving working equine welfare in ‘hard-win’ situations, where gains are difficult, expensive or marginal

Science.gov (United States)

Pritchard, Joy; Hirson, Tamsin

2018-01-01

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

Nuclear energy and public opinion - a difficult relationship

International Nuclear Information System (INIS)

Kaase, M.

1990-01-01

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

Prediction of difficult mask ventilation using a systematic assessment of risk factors vs. existing practice - a cluster randomised clinical trial in 94,006 patients

DEFF Research Database (Denmark)

Nørskov, A K; Wetterslev, J; Rosenstock, C V

2017-01-01

We compared implementation of systematic airway assessment with existing practice of airway assessment on prediction of difficult mask ventilation. Twenty-six departments were cluster-randomised to assess eleven risk factors for difficult airway management (intervention) or to continue with their......We compared implementation of systematic airway assessment with existing practice of airway assessment on prediction of difficult mask ventilation. Twenty-six departments were cluster-randomised to assess eleven risk factors for difficult airway management (intervention) or to continue...... with their existing airway assessment (control). In both groups, patients predicted as a difficult mask ventilation and/or difficult intubation were registered in the Danish Anaesthesia Database, with a notational summary of airway management. The trial's primary outcome was the respective incidence of unpredicted...... difficult and easy mask ventilation in the two groups. Among 94,006 patients undergoing mask ventilation, the incidence of unpredicted difficult mask ventilation in the intervention group was 0.91% and 0.88% in the control group; (OR) 0.98 (95% CI 0.66-1.44), p = 0.90. The incidence of patients predicted...

Dealing with difficult deformations: Construction of a knowledge-based deformation atlas

DEFF Research Database (Denmark)

Thorup, Signe Strann; Darvann, T.A.; Hermann, N.V.

2010-01-01

from pre- to post-surgery using thin-plate spline warping. The registration results are convincing and represent a first move towards an automatic registration method for dealing with difficult deformations due to this type of surgery. New or breakthrough work to be presented: The method provides...... was needed. We have previously demonstrated that non-rigid registration using B-splines is able to provide automated determination of point correspondences in populations of infants without cleft lip. However, this type of registration fails when applied to the task of determining the complex deformation...

The Potential of Supplemental Instruction in Engineering Education: Creating Additional Peer-Guided Learning Opportunities in Difficult Compulsory Courses for First-Year Students

Science.gov (United States)

Malm, Joakim; Bryngfors, Leif; Mörner, Lise-Lotte

2016-01-01

Supplemental Instruction (SI) can be an efficient way of improving student success in difficult courses. Here, a study is made on SI attached to difficult first-year engineering courses. The results show that both the percentage of students passing a difficult first-year engineering course, and scores on the course exams are considerably higher…

Defense Waste Management Plan for buried transuranic-contaminated waste, transuranic-contaminated soil, and difficult-to-certify transuranic waste

International Nuclear Information System (INIS)

1987-06-01

GAO recommended that DOE provide specific plans for permanent disposal of buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste; cost estimates for permanent disposal of all TRU waste, including the options for the buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste; and specific discussions of environmental and safety issues for the permanent disposal of TRU waste. Purpose of this document is to respond to the GAO recommendations by providing plans and cost estimates for the long-term isolation of the buried TRU-contaminated waste, TRU-contaminated soil, and difficult-to-certify TRU waste. This report also provides cost estimates for processing and certifying stored and newly generated TRU waste, decontaminating and decommissioning TRU waste processing facilities, and interim operations

A practical approach to proving waste metals suitable for consignment as radiologically exempt materials - 59266

International Nuclear Information System (INIS)

Carvel, Iain; Gunn, Richard D.; Orr, Christopher H.; Strange, Robin

2012-01-01

Building 220 at Harwell was built by the Ministry of Works as a Radiochemical Research and Development facility in the latter part of the 1940's. The facility has been operational since 1949 and has been extended several times, most notably the Plutonium Glove Box Wing in the 1950's and the Remote Handling Wing in the 1980's. Only the Remote Handling wing remains operational, processing Historic Waste which is being recovered from storage holes elsewhere on site. The remainder of the facility is undergoing progressive strip out and decommissioning. In the Plutonium Wing and associated areas the waste 'fingerprint' (nuclide vector) consists predominately of alpha emitting radionuclides. Decommissioning and Decontamination (D and D) operations often result in the production of large volumes of scrap metal waste with little or no radioactive contamination. Proving that the waste is clean can be costly and time consuming, as the shape and size of the metallic waste items often means that it is difficult or impossible to monitor all surfaces using conventional hand-held survey meters. This is a particular problem for alpha contamination measurement. Traditional radiological surveying techniques are very labour intensive and involve surveyors checking every surface using hand held instruments and smear sampling the hard to access areas. Even then 100% monitoring cannot be guaranteed. An alternative to traditional methods is the Long Range Alpha Detection (LRAD) technique which remotely detects and measures secondary ionization created in air by alpha particle interactions, allowing extremely low levels of alpha contamination to be measured. A survey system, IonSens R , using the LRAD technique, was developed by BNFL Instruments Ltd (now Babcock Nuclear) which allows rapid surveying of scrap metal for alpha contamination at very low levels. Two versions of this system exist but both essentially comprise a measurement chamber into which scrap metal is placed and sealed

Automated Theorem Proving in High-Quality Software Design

Science.gov (United States)

Schumann, Johann; Swanson, Keith (Technical Monitor)

2001-01-01

The amount and complexity of software developed during the last few years has increased tremendously. In particular, programs are being used more and more in embedded systems (from car-brakes to plant-control). Many of these applications are safety-relevant, i.e. a malfunction of hardware or software can cause severe damage or loss. Tremendous risks are typically present in the area of aviation, (nuclear) power plants or (chemical) plant control. Here, even small problems can lead to thousands of casualties and huge financial losses. Large financial risks also exist when computer systems are used in the area of telecommunication (telephone, electronic commerce) or space exploration. Computer applications in this area are not only subject to safety considerations, but also security issues are important. All these systems must be designed and developed to guarantee high quality with respect to safety and security. Even in an industrial setting which is (or at least should be) aware of the high requirements in Software Engineering, many incidents occur. For example, the Warshaw Airbus crash, was caused by an incomplete requirements specification. Uncontrolled reuse of an Ariane 4 software module was the reason for the Ariane 5 disaster. Some recent incidents in the telecommunication area, like illegal "cloning" of smart-cards of D2GSM handies, or the extraction of (secret) passwords from German T-online users show that also in this area serious flaws can happen. Due to the inherent complexity of computer systems, most authors claim that only a rigorous application of formal methods in all stages of the software life cycle can ensure high quality of the software and lead to real safe and secure systems. In this paper, we will have a look, in how far automated theorem proving can contribute to a more widespread application of formal methods and their tools, and what automated theorem provers (ATPs) must provide in order to be useful.

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

Science.gov (United States)

Fiester, Autumn

2015-01-01

Mediators utilize a wide range of skills in the process of facilitating dialogue and resolving conflicts. Among the most useful techniques for clinical ethics consultants (CECs)-and surely the least discussed-are those employed in acrimonious, hostile conversations between stakeholders. In the context of clinical ethics disputes or other bedside conflicts, good mediation skills can reverse the negative interactions that have prevented the creation of workable treatment plans or ethical consensus. This essay lays out the central framework mediators use in distinguishing positions from interests and describes a set of strategies for managing contentious ethics consultations or working with "difficult" patients, families, or patient-careprovider interactions. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Tropospheric ozone and its precursors from the urban to the global scale from air quality to short-lived climate forcer

Science.gov (United States)

Monks, P. S.; Archibald, A. T.; Colette, A.; Cooper, O.; Coyle, M.; Derwent, R.; Fowler, D.; Granier, C.; Law, K. S.; Mills, G. E.; Stevenson, D. S.; Tarasova, O.; Thouret, V.; von Schneidemesser, E.; Sommariva, R.; Wild, O.; Williams, M. L.

2015-08-01

Ozone holds a certain fascination in atmospheric science. It is ubiquitous in the atmosphere, central to tropospheric oxidation chemistry, yet harmful to human and ecosystem health as well as being an important greenhouse gas. It is not emitted into the atmosphere but is a byproduct of the very oxidation chemistry it largely initiates. Much effort is focused on the reduction of surface levels of ozone owing to its health and vegetation impacts, but recent efforts to achieve reductions in exposure at a country scale have proved difficult to achieve owing to increases in background ozone at the zonal hemispheric scale. There is also a growing realisation that the role of ozone as a short-lived climate pollutant could be important in integrated air quality climate change mitigation. This review examines current understanding of the processes regulating tropospheric ozone at global to local scales from both measurements and models. It takes the view that knowledge across the scales is important for dealing with air quality and climate change in a synergistic manner. The review shows that there remain a number of clear challenges for ozone such as explaining surface trends, incorporating new chemical understanding, ozone-climate coupling, and a better assessment of impacts. There is a clear and present need to treat ozone across the range of scales, a transboundary issue, but with an emphasis on the hemispheric scales. New observational opportunities are offered both by satellites and small sensors that bridge the scales.

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

DEFF Research Database (Denmark)

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

2017-01-01

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

Wire-guided (Seldinger technique intubation through a face mask in urgent, difficult and grossly distorted airways

Directory of Open Access Journals (Sweden)

Jake M Heier

2012-01-01

Full Text Available We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

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

Directory of Open Access Journals (Sweden)

Ravi Bhat

2014-01-01

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

Impedance-Based Stability Analysis in Grid Interconnection Impact Study Owing to the Increased Adoption of Converter-Interfaced Generators

Directory of Open Access Journals (Sweden)

Youngho Cho

2017-09-01

Full Text Available This study investigates the emerging harmonic stability concerns to be addressed by grid planners in generation interconnection studies, owing to the increased adoption of renewable energy resources connected to the grid via power electronic converters. The wideband and high-frequency electromagnetic transient (EMT characteristics of these converter-interfaced generators (CIGs and their interaction with the grid impedance are not accurately captured in the typical dynamic studies conducted by grid planners. This paper thus identifies the desired components to be studied and subsequently develops a practical process for integrating a new CIG into a grid with the existing CIGs. The steps of this process are as follows: the impedance equation of a CIG using its control dynamics and an interface filter to the grid, for example, an LCL filter (inductor-capacitor-inductor type, is developed; an equivalent impedance model including the existing CIGs nearby and the grid observed from the point of common coupling are derived; the system stability for credible operating scenarios is assessed. Detailed EMT simulations validate the accuracy of the impedance models and stability assessment for various connection scenarios. By complementing the conventional EMT simulation studies, the proposed analytical approach enables grid planners to identify critical design parameters for seamlessly integrating a new CIG and ensuring the reliability of the grid.

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

Directory of Open Access Journals (Sweden)

Surendra Kumar Sethi

2017-04-01

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

The existence of propagated sensation along the meridian proved by neuroelectrophysiology

Science.gov (United States)

Xu, Jinsen; Zheng, Shuxia; Pan, Xiaohua; Zhu, Xiaoxiang; Hu, Xianglong

2013-01-01

Propagated sensation along the meridian can occur when acupoints are stimulated by acupuncture or electrical impulses. In this study, participants with notable propagated sensation along the dian were given electro-acupuncture at the Jianyu (LI15) acupoint of the large intestine meridian. When participants stated that the sensation reached the back of their hand, regular nervous system action discharge was examined using a physiological recording electrode placed on the superficial branch of the radial nerve. The topographical maps of brain-evoked potential in the primary cortical somatosensory area were also detected. When Guangming (GB37) acupoint in the lower limb and Hegu (LI4) acupoint in the upper limb were stimulated, subjects without propagated sensation along the meridian exhibited a high potential reaction in the corresponding area of the brain cortical so-matosensory area. For subjects with a notable propagated sensation along the meridian, the tion area was larger and extended into the face representative area. These electrophysiological measures directly prove the existence of propagated sensation along the meridian, and the pheral stimulated site is consistent with the corresponding primary cortical somatosensory area, which presents a high potential reaction. PMID:25206574

History Matters: What Happens When African Americans Confront Their Difficult Past.

Science.gov (United States)

Seitz, Phillip

2016-05-01

History and Reconstruction is an interdisciplinary project to assess the impact of African American history education for black men. Under the theory of trauma recovery, leading scholars of African American history worked with a group of ten ex-offenders, supported by the services of a psychologist and an African American cultural expert and storyteller. Results based on psychological testing and qualitative feedback showed that history can be a catalyst for personal development and transformation. It also demonstrated that difficult history can be taught and assimilated for audience benefit. History and Reconstruction was supported by the Pew Center for Arts and Heritage.

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

Science.gov (United States)

Keller, Eric

2010-01-01

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

Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study

Directory of Open Access Journals (Sweden)

Basak Ceyda Meco

Full Text Available BACKGROUND AND OBJECTIVES: Preoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions. METHODS: Fifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software. RESULTS: The mean thyroid volume of the patients was 26.38 ± 14 mL. The median intubation difficulty scale was 1 (0-2. Thyromental distance (p = 0.011; r = 0.36; 95% CI 0.582-0.088, Mallampati score (p = 0.041; r = 0.29; 95% CI 0.013-0.526, compression or invasion signs (p = 0.041; r = 0.28; 95% CI 0.006-0.521 and tracheal deviation on chest X-ray (p = 0.041; r = 0.52; 95% CI 0.268-0.702 were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n = 19: intubation difficulty scale = 0; Group II, n = 31: 1 < intubation difficulty scale ≤ 5 and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (p = 0.025. CONCLUSION: The thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation.

Improving oncology nurses' communication skills for difficult conversations.

Science.gov (United States)

Baer, Linda; Weinstein, Elizabeth

2013-06-01

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

An infant presenting with failure to thrive and hyperkalaemia owing to transient pseudohypoaldosteronism: case report.

Science.gov (United States)

De Clerck, Marieke; Vande Walle, Johan; Dhont, Evelyn; Dehoorne, Joke; Keenswijk, Werner

2017-05-30

A 3-month-old boy presented with failure to thrive and a history of a prenatally detected unilateral hydroureteronephrosis which was confirmed after birth. His growth and developmental milestones had been normal during the first 2 months but in the third month his appetite was poor with reduced intake but no vomiting. At presentation, his temperature was normal, there was mild dehydration and there was weight loss (his weight had decreased by 270 g in the past month). Haemoglobin was 11.9 g/dL, total white cell count 20.2 × 10 9 /L (7-15) [neutrophils 30% (39-75) and lymphocytes 61% (16-47)], platelets 702 × 10 9 /L (150-450), BUN12.1 mmol/L (2.1-16.1), serum creatinine 35.4 μmol/L (15.0-37.1), sodium 126 mmol/L (135-144), potassium 6.8 mmol/L (3.6-4.8), chloride 88 mmol/L (98-106) and bicarbonate 14 mmol/L (19-24). Intravenous rehydration with sodium chloride 0.9% solution was commenced and he was transferred to the paediatric intensive care unit. A salt-wasting syndrome was suspected and a differential diagnosis included adrenal insufficiency, pseudohypoaldosteronism and congenital adrenal hyperplasia (owing to 21-hydroxylase deficiency). Urinalysis confirmed a urinary tract infection. Serum aldosterone was 3608 ng/dL (3.7-43.2), plasma renin activity > 38.9 pmol/L (<0.85), random cortisol 459 nmol/L (74-289), adrenocorticotropic hormone (ACTH) 6.01 pmol/L (1.32-6.60) and 17-hydroxyprogesterone 4.01 nmol/L (<3.2). Treatment of the urinary tract infection was followed by normalisation of serum electrolytes and other biochemical abnormalities, return of appetite and normal growth, which confirmed the diagnosis of transient pseudohypoaldosteronsim (TPHA). TPHA is discussed and insight provided to enable early recognition and adequate treatment of this rare clinical entity.

The palm print as a sensitive predictor of difficult laryngoscopy in diabetics: a comparison with other airway evaluation indices.

Directory of Open Access Journals (Sweden)

Vani V

2000-04-01

Full Text Available AIMS: To evaluate the ink impression made by the palm of the dominant hand as a screening tool for difficult laryngoscopy in diabetic patients. SUBJECTS AND METHODS: In this prospective study, airway of 50 adult diabetic patients, undergoing elective surgery under general anaesthesia, was assessed preoperatively using the common clinical indices such as Modified Mallampati test, thyromental distance, degree of head extension and a specific index- the palm print test. Following induction of anaesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index were calculated. RESULTS: The incidence of difficult laryngoscopy was 16%. The palm print test had the highest sensitivity (75% of all the indices. The thyromental distance less than six cm had the highest specificity (95.2% but was least sensitive (25%. 87% of patients with difficult laryngoscopy had two or more indices abnormal. CONCLUSION: Though the palm print test was the most sensitive index of the four indices studied, a better prediction of difficult laryngoscopy can be achieved by evaluating all the four airway indices preoperatively.

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

LENUS (Irish Health Repository)

Malik, M A

2009-11-01

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

Exploitation of Self Organization in UAV Swarms for Optimization in Combat Environments

Science.gov (United States)

2008-03-01

to thank my three kids , to whom I owe thanks for the gift of perspective. Next, I would like to thank my mother who had the tedious task of proof... pedagogical problems, but does not scale well. A GA proved more efficient and effective, solving to the sub-optimal levels outside the peda- gogical... pedagogical limits. Despite the fact that this mapping approaches more of a set covering problem than a POMDP [41], its mapping proves very insightful

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

DEFF Research Database (Denmark)

Skak, Morten; Bloze, Gintautas

2013-01-01

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

Percutaneous sonographically assisted endoscopic gastrostomy for difficult cases with interposed organs.

Science.gov (United States)

Moriwaki, Yoshihiro; Otani, Jun; Okuda, Junzo; Zotani, Hitomi; Kasuga, So

2018-03-27

The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound. Twenty-one patients (95.5%) successfully underwent PSEGD. Early complications (more than grade 2 in Clavien-Dindo classification) just after the procedure occurred in one case (active oozing). We did not encounter a case with mispuncture of the intraperitoneal organs and tissues. Delayed complications occurring within 1 mo were pneumonia in five patients, including death in three cases; bleeding from puncture site in two patients; and atrial fibrilation in one patient. PSEGD using the introduction method is a useful procedure for difficult patients in whom intraperitoneal organ or tissue is suspected to be interposed between the abdominal wall and stomach. Copyright © 2018 Elsevier Inc. All rights reserved.

Categories children find easy and difficult to process in figural analogies

Directory of Open Access Journals (Sweden)

Claire E Stevenson

2014-08-01

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

Formal Security-Proved Mobile Anonymous Authentication Protocols with Credit-Based Chargeability and Controllable Privacy

Directory of Open Access Journals (Sweden)

Chun-I Fan

2016-06-01

Full Text Available Smart mobile phones are widely popularized and advanced mobile communication services are provided increasingly often, such that ubiquitous computing environments will soon be a reality. However, there are many security threats to mobile networks and their impact on security is more serious than that in wireline networks owing to the features of wireless transmissions and the ubiquity property. The secret information which mobile users carry may be stolen by malicious entities. To guarantee the quality of advanced services, security and privacy would be important issues when users roam within various mobile networks. In this manuscript, an anonymous authentication scheme will be proposed to protect the security of the network system and the privacy of users. Not only does the proposed scheme provide mutual authentication between each user and the system, but also each user’s identity is kept secret against anyone else, including the system. Although the system anonymously authenticates the users, it can still generate correct bills to charge these anonymous users via a credit-based solution instead of debit-based ones. Furthermore, our protocols also achieve fair privacy which allows the judge to revoke the anonymity and trace the illegal users when they have misused the anonymity property, for example, if they have committed crimes. Finally, in this paper, we also carry out complete theoretical proofs on each claimed security property.

The cause of fever and pulmonary infiltrate: a difficult etiological diagnosis

Directory of Open Access Journals (Sweden)

Bahjat Barakat

2017-04-01

Full Text Available Adult-onset Still’s disease is a rare condition that typically presents itself with intermittent fever, arthralgia and salmon colored rash. The involvement of the in lung is less common and very rare. Diagnosis is relatively difficult because of the presence of non-specific symptoms and the lack of serological markers specific to the disease. We report the case of a patient having a pulmonary infiltrate/infiltration compatible with pneumonia, cutaneous/skin rash and persistence of fever with multiple admissions to the Emergency Room due to the failure of treatment with antibiotics. After an appropriate work-up, a diagnosis of adult-onset Still’s disease was made.

Correlation of Fault Size, Moment Magnitude, and Tsunami Height to Proved Paleo-tsunami Data in Sulawesi Indonesia

Science.gov (United States)

Julius, A. M.; Pribadi, S.

2016-02-01

Sulawesi (Indonesia) island is located in the meeting of three large plates i.e. Indo-Australia, Pacific, and Eurasia. This configuration surely make high risk on tsunami by earthquake and by sea floor landslide. NOAA and Russia Tsunami Laboratory show more than 20 tsunami data recorded in Sulawesi since 1820. Based on this data, determine of correlation between all tsunami parameter need to be done to proved all event in the past. Complete data of magnitudes, fault sizes and tsunami heights in this study sourced from NOAA and Russia Tsunami database and completed with Pacific Tsunami Warning Center (PTWC) catalog. This study aims to find correlation between fault area, moment magnitude, and tsunami height by simple regression in Sulawesi. The step of this research are data collect, processing, and regression analysis. Result shows very good correlation, each moment magnitude, tsunami heights, and fault parameter i.e. long, wide, and slip are correlate linier. In increasing of fault area, the tsunami height and moment magnitude value also increase. In increasing of moment magnitude, tsunami height also increase. This analysis is enough to proved all Sulawesi tsunami parameter catalog in NOAA, Russia Tsunami Laboratory and PTWC are correct. Keyword: tsunami, magnitude, height, fault

Infrared spectrum of an extremely cool white-dwarf star

Science.gov (United States)

Hodgkin; Oppenheimer; Hambly; Jameson; Smartt; Steele

2000-01-06

White dwarfs are the remnant cores of stars that initially had masses of less than 8 solar masses. They cool gradually over billions of years, and have been suggested to make up much of the 'dark matter' in the halo of the Milky Way. But extremely cool white dwarfs have proved difficult to detect, owing to both their faintness and their anticipated similarity in colour to other classes of dwarf stars. Recent improved models indicate that white dwarfs are much more blue than previously supposed, suggesting that the earlier searches may have been looking for the wrong kinds of objects. Here we report an infrared spectrum of an extremely cool white dwarf that is consistent with the new models. We determine the star's temperature to be 3,500 +/- 200 K, making it the coolest known white dwarf. The kinematics of this star indicate that it is in the halo of the Milky Way, and the density of such objects implied by the serendipitous discovery of this star is consistent with white dwarfs dominating the dark matter in the halo.

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

Directory of Open Access Journals (Sweden)

Katharina eScheiter

2014-03-01

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

The written mathematical communication profile of prospective math teacher in mathematical proving

Science.gov (United States)

Pantaleon, K. V.; Juniati, D.; Lukito, A.; Mandur, K.

2018-01-01

Written mathematical communication is the process of expressing mathematical ideas and understanding in writing. It is one of the important aspects that must be mastered by the prospective math teacher as tool of knowledge transfer. This research was a qualitative research that aimed to describe the mathematical communication profile of the prospective mathematics teacher in mathematical proving. This research involved 48 students of Mathematics Education Study Program; one of them with moderate math skills was chosen as the main subject. Data were collected through tests, assignments, and task-based interviews. The results of this study point out that in the proof of geometry, the subject explains what is understood, presents the idea in the form of drawing and symbols, and explains the content/meaning of a representation accurately and clearly, but the subject can not convey the argument systematically and logically. Whereas in the proof of algebra, the subject describes what is understood, explains the method used, and describes the content/meaning of a symbolic representation accurately, systematically, logically, but the argument presented is not clear because it is insufficient detailed and complete.

Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study

Science.gov (United States)

Lim, Chor-Kuan; Ruan, Sheng-Yuan; Lin, Feng-Ching; Wu, Chao-Ling; Chang, Hou-Tai; Jerng, Jih-Shuin; Wu, Huey-Dong; Yu, Chong-Jen

2015-01-01

Background and Objective Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients. Methods In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes. Results A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (Δ) = 4.4, 95% CI, 2.7 to 6.1, Ptracheostomy than those who were unsuccessfully weaned. Conclusions In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning. Trial Registration ClinicalTrials.gov NCT01312142 PMID:26379127

To compare the accuracy of Prayer's sign and Mallampatti test in predicting difficult intubation in Diabetic patients

International Nuclear Information System (INIS)

Baig, M. M. A.; Khan, F. H.

2014-01-01

Objective: To determine the accuracy of Prayer's sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients. Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer's sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS 15 was used for statistical analysis. Results: Of the 357 patients, 125(35%) were classified as difficult to intubate. Prayer's sign showed significantly lower accuracy, positive and negative predictive values than Mallampatti test. The sensitivity of Prayer's sign was lower 29.6 (95% Confidence Interval, 21.9-38.5) than Mallampatti test 79.3 (95% confidence interval, 70.8-85.7) while specificity of both the tests was not found to be significantly different. Conclusion: Prayer's sign is not acceptable as a single best bedside test for prediction of difficult intubation. (author)

Non-linear quenching of current fluctuations in a self-exciting homopolar dynamo, proved by feedback system theory

OpenAIRE

A. M. de Paor

1998-01-01

International audience; Hide (Nonlinear Processes in Geophysics, 1998) has produced a new mathematical model of a self-exciting homopolar dynamo driving a series- wound motor, as a continuing contribution to the theory of the geomagnetic field. By a process of exact perturbation analysis, followed by combination and partial solution of differential equations, the complete nonlinear quenching of current fluctuations reported by Hide in the case that a parameter ? has the value 1 is proved via ...

Conference Scene: Recent advancements in immunopotentiators for modern vaccines

NARCIS (Netherlands)

Harandi, A.M.; Schijns, V.E.J.C.

2011-01-01

Vaccines have proved to be the most successful preventive measure against a variety of infectious diseases. Owing to the potential safety concerns associated with the use of live-attenuated or killed pathogens, there is currently a drive to discover defined subunits of pathogens or recombinant

Nostalgia: retreat or support in difficult times?

Science.gov (United States)

Batcho, Krystine Irene

2013-01-01

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

Simultaneous Optimization of Tallies in Difficult Shielding Problems

International Nuclear Information System (INIS)

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

2008-01-01

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

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

Directory of Open Access Journals (Sweden)

Adel Salah Bediwy

2014-01-01

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

Application of proving-ring technology to measure thermally induced displacements in large boreholes in rock

International Nuclear Information System (INIS)

Patrick, W.C.; Reactor, N.L.; Butkovich, T.R.

1984-03-01

A strain-gauged proving-ring transducer was designed and deployed to measure small diametral displacements in 0.61-m diameter boreholes in rock. The rock surrounding the boreholes was previously heated by storage of spent nuclear fuel assemblies and measurements during post-retrieval cooling of the rock were made. To accomplish this, a transducer was designed to measure displacements in the range of 10 to 100 μm, to function in a time-varying temperature regime of 30 0 to 60 0 C at a relative humidity of 100%, to be of low stiffness, and to be easily and quickly installed. 7 references, 6 figures, 1 table

Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session.

Science.gov (United States)

Borges, Bruno C R; Boet, Sylvain; Siu, Lyndon W; Bruppacher, Heinz R; Naik, Viren N; Riem, Nicole; Joo, Hwan S

2010-07-01

Although guidelines for difficult airway management have been published, the extent to which consultant anesthesiologists follow these guidelines has not been determined. The purpose of this study is to observe how consultant anesthesiologists manage a "cannot intubate, cannot ventilate" (CICV) scenario in a high-fidelity simulator and to evaluate whether a simulation teaching session improves their adherence to the American Society of Anesthesiologists (ASA) difficult airway algorithm. With Ethics Board approval and informed consent, all staff anesthesiologists in a single tertiary care institution were invited to enrol in this study where they managed a simulated unanticipated CICV scenario in a high-fidelity simulator. The scenario involved a patient with a difficult airway whose trachea could not be intubated and where it was impossible to ventilate the patient's lungs. Airway management options, including laryngeal mask airway, a fibreoptic bronchoscope, and a Glidescope were available for use but scripted to fail. A percutaneous cricothyroidotomy was required to re-establish adequate ventilation. Following the scenario, there was a personalized one-hour video-assisted expert debriefing focusing on the ASA difficult airway guidelines and "hands-on" cricothyroidotomy teaching. The second scenario followed immediately with an identical CICV scenario. The content to either scenario was not revealed beforehand. Outcome measures included: 1) major deviations from the ASA difficult airway guidelines; 2) time to start cricothyroidotomy; and 3) time to achieve ventilation. Thirty-eight anesthesiologists agreed to participate. The number of major deviations from the ASA algorithm was similar in the first and second sessions. These deviations included: multiple laryngoscopies (0 vs 2 pre-post; P = 0.49), use of fibreoptic bronchoscope (8 vs 7 pre-post; P = 1.0), bypass of laryngeal mask airway attempt (7 vs 13 pre-post; P = 0.19), and failure to call for anesthetic help

980nm laser for difficult-to-treat basal cell carcinoma

Science.gov (United States)

Derjabo, A. D.; Cema, I.; Lihacova, I.; Derjabo, L.

2013-06-01

Begin basal cell carcinoma (BCC) is most common skin cancer over the world. There are around 20 modalities for BCC treatment. Laser surgery is uncommon option. We demonstrate our long term follow up results. Aim: To evaluate long term efficacy of a 980nm diode laser for the difficult-to-treat basal cell carcinoma. Materials and Methods: 167 patients with 173 basal cell carcinoma on the nose were treated with a 980 nm diode laser from May 1999 till May 2005 at Latvian Oncology center. All tumors were morphologically confirmed. 156 patients were followed for more than 5 years. Results: The lowest recurrence rate was observed in cases of superficial BCC, diameterConclusions: 980 nm diode laser is useful tool in dermatology with high long term efficacy, good acceptance by the patients and good cosmetics results.

Safety and risk factors for difficult endoscopist-directed ERCP sedation in daily practice: a hospital-based case-control study

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Enrique Pérez-Cuadrado-Robles

Full Text Available Background: There are limited data concerning endoscopist-directed endoscopic retrograde cholangiopancreatography deep sedation. The aim of this study was to establish the safety and risk factors for difficult sedation in daily practice. Patients and methods: Hospital-based, frequency matched case-control study. All patients were identified from a database of 1,008 patients between 2014 and 2015. The cases were those with difficult sedations. This concept was defined based on the combination of the receipt of high-doses of midazolam or propofol, poor tolerance, use of reversal agents or sedation-related adverse events. The presence of different factors was evaluated to determine whether they predicted difficult sedation. Results: One-hundred and eighty-nine patients (63 cases, 126 controls were included. Cases were classified in terms of high-dose requirements (n = 35, 55.56%, sedation-related adverse events (n = 14, 22.22%, the use of reversal agents (n = 13, 20.63% and agitation/discomfort (n = 8, 12.7%. Concerning adverse events, the total rate was 1.39%, including clinically relevant hypoxemia (n = 11, severe hypotension (n = 2 and paradoxical reactions to midazolam (n = 1. The rate of hypoxemia was higher in patients under propofol combined with midazolam than in patients with propofol alone (2.56% vs. 0.8%, p < 0.001. Alcohol consumption (OR: 2.674 [CI 95%: 1.098-6.515], p = 0.030, opioid consumption (OR: 2.713 [CI 95%: 1.096-6.716], p = 0.031 and the consumption of other psychoactive drugs (OR: 2.015 [CI 95%: 1.017-3.991], p = 0.045 were confirmed to be independent risk factors for difficult sedation. Conclusions: Endoscopist-directed deep sedation during endoscopic retrograde cholangiopancreatography is safe. The presence of certain factors should be assessed before the procedure to identify patients who are high-risk for difficult sedation.

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study.

Science.gov (United States)

Liaskou, Chara; Chara, Liaskou; Vouzounerakis, Eleftherios; Eleftherios, Vouzounerakis; Moirasgenti, Maria; Maria, Moirasgenti; Trikoupi, Anastasia; Anastasia, Trikoupi; Staikou, Chryssoula; Chryssoula, Staikou

2014-03-01

Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study. We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.

Deep Help in Complex Project Work: Guiding and Path-Clearing Across Difficult Terrain

OpenAIRE

Fisher, Colin M.; Pillemer, Julianna; Amabile, Teresa M.

2017-01-01

How do teams working on complex projects get the help they need? Our qualitative investigation of the help provided to project teams at a prominent design firm revealed two distinct helping processes, both characterized by deep, sustained engagement that far exceeds the brief interactions described in the helping literature. Such deep help consisted of (1) guiding a team through a difficult juncture by working with its members in several prolonged, tightly clustered sessions, or (2) path-clea...

Facilitation de l'accès des personnes aux prises avec des difficultés ...

International Development Research Centre (IDRC) Digital Library (Canada)

... sont en outre à l'origine de frictions inutiles dans les interactions sociales. ... de sérieuses difficultés grâce à l'utilisation judicieuse des TIC et, dans la foulée, de ... long-term climate action to reduce social inequality, promote greater gender ...

Strategies for the capillary electrophoretic separation of indole alkaloids in Psilocybe semilanceata.

Science.gov (United States)

Pedersen-Bjergaard, S; Rasmussen, K E; Sannes, E

1998-01-01

While the hallucinogenic mushrooms Psilocybe semilanceata have previously been analyzed for the indole alkaloids psilocybin and baeocystin by capillary zone electrophoresis (CZE) at pH 11.5, the present work focused on the development of an alternative and complementary capillary electrophoretic method for their identification. Owing to their structural similarity and zwitterionic nature, the compounds were difficult to resolve based on different interactions with cationic or anionic micelles. However, while the attempts with micellar electrokinetic chromatography (MEKC) were unsuccessful, rapid derivatization with propyl chloroformate and reanalysis by CZE at pH 11.5 was effective to support identification of the two indole alkaloids. Psilocin was difficult to analyze by CZE at pH 11.5 owing to comigration with the electroosmotic flow. For this compound, the pH of the running buffer was reduced to 7.2 to effectively enhance the electrophoretic mobility.

Isolation of nucleic acids and cultures from fossil ice and permafrost

DEFF Research Database (Denmark)

Willerslev, E.; Hansen, Anders J.; Poinar, H. N.

2004-01-01

Owing to their constant low temperatures, glacial ice and permafrost might contain the oldest nucleic acids and microbial cells on Earth, which could prove key to reconstructing past ecosystems and for the planning of missions to other planets. However, recent claims concerning viable cells and m...

[Effectiveness of the GlideScope video laryngoscope in a case of unexpected difficult airway due to lingual tonsil hypertrophy].

Science.gov (United States)

Cruz, P; Alarcón, L; Del Castillo, T; Cabrerizo, P; Díaz, S

2015-05-01

Lingual tonsil hypertrophy can cause varying degrees of airway obstruction and is considered a risk factor for difficult mask ventilation and tracheal intubation. We report a case of unexpected difficult airway in a patient with unknown lingual tonsil hypertrophy that was solved with the use of the GlideScope video laryngoscope. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

JPSS Proving Ground Activities with NASA's Short-term Prediction Research and Transition (SPoRT) Center

Science.gov (United States)

Schultz, L. A.; Smith, M. R.; Fuell, K.; Stano, G. T.; LeRoy, A.; Berndt, E.

2015-12-01

Instruments aboard the Joint Polar Satellite System (JPSS) series of satellites will provide imagery and other data sets relevant to operational weather forecasts. To prepare current and future weather forecasters in application of these data sets, Proving Ground activities have been established that demonstrate future JPSS capabilities through use of similar sensors aboard NASA's Terra and Aqua satellites, and the S-NPP mission. As part of these efforts, NASA's Short-term Prediction Research and Transition (SPoRT) Center in Huntsville, Alabama partners with near real-time providers of S-NPP products (e.g., NASA, UW/CIMSS, UAF/GINA, etc.) to demonstrate future capabilities of JPSS. This includes training materials and product distribution of multi-spectral false color composites of the visible, near-infrared, and infrared bands of MODIS and VIIRS. These are designed to highlight phenomena of interest to help forecasters digest the multispectral data provided by the VIIRS sensor. In addition, forecasters have been trained on the use of the VIIRS day-night band, which provides imagery of moonlit clouds, surface, and lights emitted by human activities. Hyperspectral information from the S-NPP/CrIS instrument provides thermodynamic profiles that aid in the detection of extremely cold air aloft, helping to map specific aviation hazards at high latitudes. Hyperspectral data also support the estimation of ozone concentration, which can highlight the presence of much drier stratospheric air, and map its interaction with mid-latitude or tropical cyclones to improve predictions of their strengthening or decay. Proving Ground activities are reviewed, including training materials and methods that have been provided to forecasters, and forecaster feedback on these products that has been acquired through formal, detailed assessment of their applicability to a given forecast threat or task. Future opportunities for collaborations around the delivery of training are proposed

[Management of difficult-to-treat asthma using a flow sheet for systematic evaluation and therapeutic intervention].

Science.gov (United States)

Wakayama, Hisashi; Ogasawara, Tomohiko; Sato, Ai; Honda, Mamiko; Sakurai, Keiko; Uemura, Takehiro; Kasai, Daishi; Kato, Hisaaki; Tomita, Yuka; Park, Jangchul; Mizuno, Akiko; Suzuki, Masayuki

2008-11-01

Although most patients of asthma can be controlled by inhaled corticosteroid (ICS), some patients remain uncontrolled even after the introduction of ICS treatment. In management of such difficult-to-treat asthma, systematic review including additional differential diagnosis and avoidance of exacerbating factors is very important. Here we postulate a flow sheet presenting an algorithm which intends to achieve better asthma control following ATS refractory asthma guidance. For patients with poor controlled asthma even after using ICS more than moderate dose, we used the sheet in our daily outpatient management and investigated whether we could improve the control in such patients. The sheet was constructed by an algorithm which included (1) reevaluation of inhalation technique of ICS; (2) additional differential diagnosis of COPD and other similar diseases; and (3) reevaluation of presence of exacerbating factors. In our outpatient department, seven clinicians managed 22 difficult-to-treat asthma patients using this sheet. Additional factors which might worsen asthma control could be detected in 21 patients (95.5%). Firstly, smoking was disclosed in 8 patients (36.4%). Secondly, keeping pets was identified in 7 patients (31.8%). 5 patients (22.7%) were diagnosed as COPD rather than asthma and 4 patients (18.2%) were diagnosed as having rhinosinusitis. Some improvement of asthma control was achieved in 9 patients (40.9%). Reevaluation of refractory asthma patients using our newly developed flow sheet is essential and it may facilitate understanding of management of difficult-to-treat asthma.

The Effects of GeoGebra Software on Pre-Service Mathematics Teachers' Attitudes and Views toward Proof and Proving

Science.gov (United States)

Zengin, Yilmaz

2017-01-01

The purpose of this study is to determine the effect of GeoGebra software on pre-service mathematics teachers' attitudes towards proof and proving and to determine pre-service teachers' pre- and post-views regarding proof. The study lasted nine weeks and the participants of the study consisted of 24 pre-service mathematics teachers. The study used…

Non-linear quenching of current fluctuations in a self-exciting homopolar dynamo, proved by feedback system theory

Science.gov (United States)

de Paor, A. M.

Hide (Nonlinear Processes in Geophysics, 1998) has produced a new mathematical model of a self-exciting homopolar dynamo driving a series- wound motor, as a continuing contribution to the theory of the geomagnetic field. By a process of exact perturbation analysis, followed by combination and partial solution of differential equations, the complete nonlinear quenching of current fluctuations reported by Hide in the case that a parameter ɛ has the value 1 is proved via the Popov theorem from feedback system stability theory.

Jungle Giants: Assessing Sustainable Harvesting in a Difficult-to-Survey Species (Python reticulatus.

Directory of Open Access Journals (Sweden)

Daniel J D Natusch

Full Text Available Sustainability of wildlife harvests is critical but difficult to assess. Evaluations of sustainability typically combine modelling with the measurement of underlying abundances. For many taxa harvested in developing countries, however, abundances are near-impossible to survey and a lack of detailed ecological information impedes the reliability of models. In such cases, repeated surveys of the attributes of harvested individuals may provide more robust information on sustainability. If the numbers, sizes and other demographic attributes of animals taken for the commercial trade do not change over biologically significant time intervals (decades, there is a prima facie case that the harvest is indeed sustainable. Here, we report the results of examinations of > 4,200 reticulated pythons (Python reticulatus taken for the commercial leather industry in northern and southern Sumatra, Indonesia. The numbers, mean body sizes, clutch sizes, sizes at maturity and proportion of giant specimens have not decreased between our first surveys (1995 and repeat surveys (2015. Thus, despite assumptions to the contrary, the harvest appears to be sustainable. We use our data to inform the design of future monitoring programs for this species. Our study underpins the need for robust science to inform wildlife trade policy and decision-making, and urges wildlife managers to assess sustainability of difficult-to-survey terrestrial wildlife by drawing inferences directly from the harvest itself.

Jungle Giants: Assessing Sustainable Harvesting in a Difficult-to-Survey Species (Python reticulatus).

Science.gov (United States)

Natusch, Daniel J D; Lyons, Jessica A; Mumpuni; Riyanto, Awal; Shine, Richard

2016-01-01

Sustainability of wildlife harvests is critical but difficult to assess. Evaluations of sustainability typically combine modelling with the measurement of underlying abundances. For many taxa harvested in developing countries, however, abundances are near-impossible to survey and a lack of detailed ecological information impedes the reliability of models. In such cases, repeated surveys of the attributes of harvested individuals may provide more robust information on sustainability. If the numbers, sizes and other demographic attributes of animals taken for the commercial trade do not change over biologically significant time intervals (decades), there is a prima facie case that the harvest is indeed sustainable. Here, we report the results of examinations of > 4,200 reticulated pythons (Python reticulatus) taken for the commercial leather industry in northern and southern Sumatra, Indonesia. The numbers, mean body sizes, clutch sizes, sizes at maturity and proportion of giant specimens have not decreased between our first surveys (1995) and repeat surveys (2015). Thus, despite assumptions to the contrary, the harvest appears to be sustainable. We use our data to inform the design of future monitoring programs for this species. Our study underpins the need for robust science to inform wildlife trade policy and decision-making, and urges wildlife managers to assess sustainability of difficult-to-survey terrestrial wildlife by drawing inferences directly from the harvest itself.

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

Science.gov (United States)

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

2018-01-01

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

How to prove the Earth's daily and annual direction of its spinning

Directory of Open Access Journals (Sweden)

Drago Špoljarić

2014-12-01

Full Text Available Every day, we can observe the Sun's apparent motion around the sky. It rises in the east, gets to its highest point above the horizon at noon, and sets in the west. The stars appear to be fixed on the sky and move around apparently together with the Sun. We have daytime1 and night. The apparent annual motion of the Sun results in seasons when we can see different stars. These directly visible daily and annual changes result from real Earth’s motions – the Earth’s daily and annual spinning (rotation and revolution and they are not easily explainable without understanding the Earth’s motions. In order to understand the apparent daily and annual motions and motion direction of the Sun and stars (night sky, it is very important to know where we are on the Earth, what is our geographic position, i.e. to know the cardinal points. At the same time, one should take into consideration also the direction of the Earth’s rotation and revolution. What is the Earth’s daily or annual direction of spinning as related to the direction of clock hands, and how do we prove it?

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

Energy Technology Data Exchange (ETDEWEB)

Kingston, J

1979-07-15

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

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

Science.gov (United States)

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

2005-11-01

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

Quality Assurance in the National Tests of English: Investigating What Makes Reading Difficult

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Angela Hasselgreen

2017-09-01

Full Text Available This article presents a piece of research, conducted in order to validate the claims made in test results, concerning what it means – in terms of reading ability – to be placed at a particular mastery level. It will consider the question of what makes reading tasks difficult, and whether data from the National Tests of English (NTE supports the progression of subskills/reading operations as presented in the mastery level descriptors, which are the basis of test results

Spectroscopy of heavy fissionable nuclei

Indian Academy of Sciences (India)

2015-08-05

Aug 5, 2015 ... Nuclei in the actinide chain and beyond are prone to fission owing to ... mass nuclei are typically more difficult, because the intensity is .... j15/2 neutron alignments in a region where shell stablization effects are crucial.

The language of modern medicine: it's all Greek to me.

Science.gov (United States)

Lewis, Kristopher N

2004-01-01

The Greek language has shaped and formed the lexicon of modern medicine. Although medical terminology may seem complex and difficult to master, the clarity and functionality of this language owe a great debt to the tongue of the classical Greeks.

When care situations evoke difficult emotions in nursing staff members: an ethnographic study in two Norwegian nursing homes.

Science.gov (United States)

Sandvoll, Anne Marie; Grov, Ellen Karine; Kristoffersen, Kjell; Hauge, Solveig

2015-01-01

Caring practice in nursing homes is a complex topic, especially the challenges of meeting the basic needs of residents when their behaviour evokes difficult emotions. Cognitive and physical changes related to aging and disability can contribute to behaviours considered to be unacceptable. For example, resident behaviours such as spitting, making a mess with food or grinding teeth are behaviours that most people do not want to see, hear or experience. The aim of this study was to gain a deeper understanding of how nursing home staff members deal with such behaviours in care situations. This article draws on ethnographic data to describe how nursing home staff members manage unpleasant resident behaviours. The study was based on two long-term units in two Norwegian public nursing homes. The Region's Medical Ethics Committee and the Norwegian Social Science Data Services granted approval. In total, 45 participants (37 nursing aides and eight nurses) agreed to participate in this study. Ten of the participants were interviewed at the end of the field study. This study indicates that nursing home staff members experience difficult emotions related to some residents' behaviours. However, they found these feelings difficult to express and rarely verbalized them openly. In addition, they were characterized by a strong obligation to help all residents, despite their own feelings. Therefore, it appears that an inner struggle occurs as a part of everyday practice. Despite these difficult emotions, nursing staff members believed that they needed to manage their responses and continued to offer good care to all residents. These findings extend our understanding of this unarticulated part of nursing home practice.

Non-linear quenching of current fluctuations in a self-exciting homopolar dynamo, proved by feedback system theory

Directory of Open Access Journals (Sweden)

A. M. de Paor

1998-01-01

Full Text Available Hide (Nonlinear Processes in Geophysics, 1998 has produced a new mathematical model of a self-exciting homopolar dynamo driving a series- wound motor, as a continuing contribution to the theory of the geomagnetic field. By a process of exact perturbation analysis, followed by combination and partial solution of differential equations, the complete nonlinear quenching of current fluctuations reported by Hide in the case that a parameter ε has the value 1 is proved via the Popov theorem from feedback system stability theory.

They're Suing Us? Liability and Risk Management.

Science.gov (United States)

Hollander, Patricia A.

1982-01-01

Legal issues in liability for and prevention of injuries through negligence are discussed: proving negligence, who is owed a duty of care, who may be sued, remedies, risk management (shifting risk, insurance, indemnification, waivers and releases), and preventing claims (warning of known danger, proper supervision, school maintenance, security,…

Multimodal treatment in difficult sialolithiasis: Role of extracorporeal shock-wave lithotripsy and intraductal pneumatic lithotripsy.

Science.gov (United States)

Koch, Michael; Schapher, Mirco; Mantsopoulos, Konstantinos; von Scotti, Felix; Goncalves, Miguel; Iro, Heinrich

2017-12-15

To assess results after treatment of difficult/complex sialolithiasis with extracorporeal shock-wave lithotripsy (ESWL) and intraductal pneumatic lithotripsy (IPL). Retrospective study in a tertiary referral center. Altogether, 63 stones were diagnosed in 38 patients with difficult/complex sialolithiasis. Forty-nine stones were treated with fragmentation using both ESWL and IPL. Stones accessible with the sialendoscope were treated primarily with IPL in multiple sialolithiasis. Seventy-one ESWL procedures and 57 IPL were performed in our patients. Forty-nine stones were treated by 67 ESWL procedures and 52 IPL. ESWL converted sialoliths from sialendoscopically untreatable into sialendoscopically treatable cases in 94.7%; the treatment then was completed by a total of 52 IPL procedures. ESWL was performed before IPL (81.6%), in combination with IPL (7.9%) and after (10.5%). Complete fragmentation was achieved in 97.9%. Four stones each were treated with ESWL and IPL alone in multiple sialolithiasis. Altogether, 53 stones were treated by 57 IPL procedures. Complete fragmentation was achieved in 98.1% of the 53 stones. ESWL and IPL were the dominant treatment modalities in 84.1% of all 63 stones treated. Of all 38 patients, 92.1% became stone-free and all became symptom-free. All the glands were preserved. Multiple stones were treated in 34.2% of the patients; of these, 92.3% became stone-free. These results show that patients with difficult and complex sialolithiasis can be treated with high success rates of > 90% using a multimodal, minimally invasive, and gland-preserving treatment approach. ESWL and IPL played a key role in this multimodal treatment regime in > 80% of stones. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Techniques for assisting difficult delivery at caesarean section.

Science.gov (United States)

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

2016-01-31

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

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

Science.gov (United States)

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

2014-01-01

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

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

International Nuclear Information System (INIS)

Kitagawa, Takeaki; Maekawa, Katsuhiro; Kubo, Akihiko

1987-01-01

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

Combustion-assisted laser cutting of a difficult-to-machine superalloy

International Nuclear Information System (INIS)

Molian, P.A.

1992-01-01

In laser cutting, the largest single application of lasers in manufacturing, the assist gas plays an important role in affecting the cutting performance. The assist gas is usually oxygen or an inert gas. In this paper acetylene and oxygen was employed to create combustion reactions during CO 2 laser cutting that enabled an improvement in the cutting speed, and cut quality of a difficult-to-machine superalloy. A comparison with laser cutting of a plain carbon steel under identical conditions was also made to determine the usefulness of combustion energy. Results indicate that both cutting speed and quality are enhanced by the reduction in the viscosity of slag formed during cutting (which assisted in ejection of the slag through the bottom of the kerf) due to the heat released by the acetylene burning inside the kerf. Correlations of experimental data with a theoretical model provided the influence of combustion power and gas-flow power on the cutting phenomena

Penile Corporeal Reconstruction during Difficult Placement of a Penile Prosthesis

Directory of Open Access Journals (Sweden)

Viet Q. Tran

2008-01-01

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

Serial Cases of Combining ESWL and ERCP Procedures in Management Chronic Pancreatitis and Difficult Bile Duct Stones

OpenAIRE

Fauzi, Achmad; Rasyid, Nur; Syam, Ari Fahrial; Abdullah, Murdani; Makmun, Dadang; Simadibrata, Marcellus; Manan, Chudahman; Rani, Abdul Aziz; Daldiyono, Daldiyono

2009-01-01

Extracorporeal shock wave lithotripsy (ESWL) has an established role in the management of pancreaticductalcalculiandasfurthertreatmentmodalityforlargeordifficultcomplicatedcommon bile duct(CBD)stones. Combinedwithminimally invasive endoscopic procedure suchasendoscopic retrogradecholangio-pancreatography(ERCP),it has replaced open surgeryas theinitial form of therapy. ESWL has also proved to bean effective therapyin treating intrahepaticstones that are refractory toroutine endoscopic extracti...

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

Science.gov (United States)

Segall, Avner

2014-01-01

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

Why do young adults with Type 1 diabetes find it difficult to manage diabetes in the workplace?

Science.gov (United States)

Balfe, Myles; Brugha, Ruairi; Smith, Diarmuid; Sreenan, Seamus; Doyle, Frank; Conroy, Ronan

2014-03-01

This article explores how and why workplace environments impact diabetes management for adults people with Type 1 diabetes, 23-30 years of age. Interviews were conducted with 35 young adults, 29 women and 6 men. The majority of these interviewees worked in sectors such as banking, technology and administration. Young adults found it difficult to manage diabetes in the workplace for two main reasons: work-related time pressures and the non-routine nature of interviewees' work and working environment. Young adults also found it difficult to get the time to exercise both inside and outside of work. Young adults with Type 1 diabetes need to be provided with the tools and technologies that they need to manage diabetes in modern flexible workplaces. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pepino mosaic virus: an endemic pathogen of tomato crops

NARCIS (Netherlands)

Hanssen, I.M.

2010-01-01

Owing to their large population size and short generation time, viruses generally have a huge potential to evolve and adapt under natural selection pressure. Despite tremendous efforts in human, animal and plant health management, viral diseases remain difficult to control and eradicate. Moreover,

Bronchoscopic diagnostic procedures and microbiological examinations in proving endobronchial tuberculosis

Directory of Open Access Journals (Sweden)

Abdullah Şimşek

Full Text Available ABSTRACT Objective: To determine the proportional distribution of endobronchial tuberculosis (EBTB subtypes and to evaluate the types of bronchoscopic diagnostic procedures that can prove granulomatous inflammation. Methods: This was a retrospective study of 18 HIV-negative patients with biopsy-proven EBTB treated between 2010 and 2014. Results: The most common EBTB subtypes, as classified by the bronchoscopic features, were tumorous and granular (in 22.2% for both. Sputum smear microscopy was performed in 11 patients and was positive for AFB in 4 (36.3%. Sputum culture was also performed in 11 patients and was positive for Mycobacterium tuberculosis in 10 (90.9%. Smear microscopy of BAL fluid (BALF was performed in 16 patients and was positive for AFB in 10 (62.5%. Culture of BALF was also performed in 16 patients and was positive for M. tuberculosis in 15 (93.7%. Culture of BALF was positive for M. tuberculosis in 93.7% of the 16 patients tested. Among the 18 patients with EBTB, granulomatous inflammation was proven by the following bronchoscopic diagnostic procedures: bronchial mucosal biopsy, in 8 (44.4%; bronchial brushing, in 7 (38.8%; fine-needle aspiration biopsy, in 2 (11.1%; and BAL, in 2 (11.1%. Bronchial anthracofibrosis was observed in 5 (27.7% of the 18 cases evaluated. Conclusions: In our sample of EBTB patients, the most common subtypes were the tumorous and granular subtypes. We recommend that sputum samples and BALF samples be evaluated by smear microscopy for AFB and by culture for M. tuberculosis, which could increase the rates of early diagnosis of EBTB. We also recommend that bronchial brushing be employed together with other bronchoscopic diagnostic procedures in patients suspected of having EBTB.

Contamination source review for Building E2370, Edgewood Area, Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

O`Reilly, D.P.; Glennon, M.A.; Draugelis, A.K.; Rueda, J.; Zimmerman, R.E.

1995-09-01

The US Army Aberdeen Proving Ground (APG) commissioned Argonne National Laboratory (ANL) to conduct a contamination source review to identify and define areas of toxic or hazardous contaminants and to assess the physical condition and accessibility of APG buildings. The information obtained from this review may be used to assist the US Army in planning for the future use or disposition of the buildings. The contamination source review consisted of the following tasks: historical records search, physical inspection, photographic documentation, and geophysical investigation. This report provides the results of the contamination source review for Building E2370. Many of the APG facilities constructed between 1917 and the 1960s are no longer used because of obsolescence and their poor state of repair. Because many of these buildings were used for research, development, testing, and/or pilot-scale production of chemical warfare agents and other military substances, the potential exists for portions of the buildings to be contaminated with these substances, their degradation products, and other laboratory or industrial chemicals. These buildings and associated structures or appurtenances may contribute to environmental concerns at APG.

Prediction is Difficult, Especially the Future: A Progress Report

Directory of Open Access Journals (Sweden)

Andrew Booth

2007-03-01

Full Text Available Objective This paper reviews developments in the consolidation and diversification of the evidence based library and information practice (EBLIP paradigm since publication of the authors’ book Evidence Based Practice for Information Professionals: a Handbook in 2004.Methods The authors provide an updated narrative review of key themes in the development of evidence based librarianship within the context of the new consensual term ‘EBLIP.’ Sources for this thematic framework included professional literature, Internet searches, and the authors’ personal experiences.Results ‐ While considerable achievements have been realized within a three‐year period, most notably the instigation of the journal known as EBLIP, a broadening of the paradigm to other library sectors, and increased availability of implementation studies, many challenges remain. Of particular concern is the lack of international strategic foresight in determining rotation of the biennial international conferences and distribution of influential EBLIP infrastructures and initiatives.Conclusion ‐ While the enthusiasms and energies of individual practitioners and work teams have made considerable progress in meeting short‐term objectives, uncertainty remains concerning how longer‐term objectives requiring infrastructure and resources might be realized. From its faltering steps as a toddler EBLIP has developed to a ‘prepubescent’ stage with the promise of ‘growth spurts’ and ‘emotional crises.’ The next three years should prove both challenging and demanding.

Why are the Mathematics National Examination Items Difficult and What Is Teachers’ Strategy to Overcome It?

Directory of Open Access Journals (Sweden)

Heri Retnawati

2017-07-01

Full Text Available The quality of national examination items plays an enormous role in identifying students’ competencies mastery and their difficulties. This study aims to identify the difficult items in the Junior High School Mathematics National Examination, to find the factors that cause students’ difficulty and to reveal the strategies that the teachers and the students might implement in order to overcome them. The study is phenomenological research with the mixed methods. The data were collected using documentation of students’ responses and focus group discussion (FGD of teachers. The data analysis was conducted using Milles & Hubberman steps. The results of the study showed that there were 4 difficult items of the 40 test items for the students. The students’ difficulties were the lack of concept understanding, difficulties in calculating, difficulties in selecting information, being deceived by the distractors, being unaccustomed to completing complex and non-integers test items, and completing contextual test items that have been presented in the form of figures or narrative texts.

Environmental geophysics at the Southern Bush River Peninsula, Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Davies, B.E.; Miller, S.F.; McGinnis, L.D. [and others

1995-05-01

Geophysical studies have been conducted at five sites in the southern Bush River Peninsula in the Edgewood Area of Aberdeen Proving Ground, Maryland. The goals of the studies were to identify areas containing buried metallic objects and to provide diagnostic signatures of the hydrogeologic framework of the site. These studies indicate that, during the Pleistocene Epoch, alternating stands of high and low sea level resulted in a complex pattern of channel-fill deposits. Paleochannels of various sizes and orientations have been mapped throughout the study area by means of ground-penetrating radar and EM-31 techniques. The EM-31 paleochannel signatures are represented onshore either by conductivity highs or lows, depending on the depths and facies of the fill sequences. A companion study shows the features as conductivity highs where they extend offshore. This erosional and depositional system is environmentally significant because of the role it plays in the shallow groundwater flow regime beneath the site. Magnetic and electromagnetic anomalies outline surficial and buried debris throughout the areas surveyed. On the basis of geophysical measurements, large-scale (i.e., tens of feet) landfilling has not been found in the southern Bush River Peninsula, though smaller-scale dumping of metallic debris and/or munitions cannot be ruled out.

Cricotracheostomy for a patient with difficult airway access for an aberrant common carotid artery: A case report

Directory of Open Access Journals (Sweden)

Hiroshi Hasegawa

2017-03-01

Although there is a need to resolve the long-term sequelae, we believe that cricotracheostomy is likely to be as useful for establishment of an open airway as tracheostomy or cricothyrotomy, especially in emergency or difficult situations.

Il Servizio Nazionale di Valutazione e le prove Invalsi. Stato dell’arte e proposte per una valutazione come agente di cambiamento

Directory of Open Access Journals (Sweden)

Roberto Trinchero

2014-12-01

Full Text Available Qual è la funzione del Servizio Nazionale di Valutazione formativa degli istituti scolastici? A cosa servono davvero le prove Invalsi? Le critiche che spesso vengono mosse a queste prove sono veramente fondate? Come può la valutazione dell’offerta formativa scolastica costituire davvero un agente di miglioramento? Il presente articolo intende fornire alcune risposte a queste domande, partendo dalle istanze che hanno ispirato l’autonomia scolastica e offrendo spunti per un utilizzo non fazioso della valutazione. La valutazione può essere davvero agente di cambiamento a patto che: i sia attribuito ai dati il corretto significato; ii la scuola sia in grado di comprendere i potenziali suggerimenti che la valutazione può dare e si apra al cambiamento positivo. La valutazione applicata ad una “scuola che si difende” non può che provocare inutili esiti di facciata. La valutazione applicata ad una “scuola che apprende” può davvero aiutarla ad esplicare appieno tutte le proprie potenzialità.

Effects on crystal structure of CZTS thin films owing to deionized water and sulfurization treatment

Energy Technology Data Exchange (ETDEWEB)

Nadi, Samia Ahmed; Chelvanathan, Puvaneswaran; Islam, M. A.; Sopian, Kamruzzaman [Solar Energy Research Institute (SERI), Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor (Malaysia); Yusoff, Yulisa [Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor (Malaysia); Amin, Nowshad [Solar Energy Research Institute (SERI), Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor (Malaysia); Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor (Malaysia); College of Sciences, King Saud University, Riyadh 11451 (Saudi Arabia)

2015-05-15

To condense the cost and increase the production, using abundantly obtainable non-toxic elements, Cu{sub 2}ZnSnS{sub 4} (CZTS) seem to be a strong contender among the photovoltaic thin film technologies. Cu{sub 2}ZnSnS{sub 4} thin films were fabricated by RF magnetron sputtering system. CZTS were sputtered on Molybdenum (Mo) coated soda lime glass (SLG) using a single target sputtering technique. The sputtering parameters (base pressure, working pressure, Argon (Ar) flow rate, RF power and sputtering time) were kept same for all three types of films. For sulfurization, the temperature used was 500 °C. Finally, As-deposited film was immersed in DIW before undergoing identical sulfurization profile. As-deposited film (Sample A), sulfurized films (Sample B) and sulfurized plus DIW treated (Sample C) were compared in terms of their structural properties by means of X-Ray Diffraction (XRD) measurement and Atomic Force Microscopy (AFM). Sample B and C showed peak of (1 1 2) planes of CZTS which are characteristics of stannite structure. Post deposition treatment on CZTS films proved to be beneficial as evident from the observed enhancement in the crystallinity and grain growth. Significant difference on grain size and area roughness could be observed from the AFM measurement. The roughness of Sample A, B and C increased from 5.007 nm to 20.509 nm and 14.183 nm accordingly. From XRD data secondary phases of Cu{sub x}MoS{sub x} could be observed.

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

Energy Technology Data Exchange (ETDEWEB)

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

1997-05-27

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

The effects of sexism, psychological distress, and difficult sexual situations on U.S. women's sexual risk behaviors.

Science.gov (United States)

Choi, Kyung-Hee; Bowleg, Lisa; Neilands, Torsten B

2011-10-01

Women represent almost half of the people living with HIV worldwide. Although social discrimination has been recognized as a major obstacle to HIV prevention, few empirical studies have examined the effects of sexism on women's HIV sexual risk behaviors. We analyzed data collected from an ethnically diverse sample of 754 women attending family planning clinics in the San Francisco Bay Area. A majority of respondents reported lifetime experiences of sexism (e.g., 94% reported sexual harassment). Structural equation modeling results demonstrated that experiences of sexism and reports of recent unprotected sex with a primary or a secondary sexual partner were linked through psychological distress and difficult sexual situations. Our results suggest the need to develop HIV prevention strategies for women that address two mechanisms-psychological distress and difficult sexual situations-that link social discrimination to women's sexual risk for HIV.

Anesthetic considerations and difficult airway management in a case of Noonan syndrome

Directory of Open Access Journals (Sweden)

Sukhminder Jit Singh Bajwa

2011-01-01

Full Text Available Noonan syndrome is a genetically transmitted autosomal dominant disorder characterized by various anatomic anomalies and pathophysiologic derangements. Anesthetic management in such cases poses a multitude of challenges, especially related to the airway management and maintenance of cardiovascular stability. We report a case of a 9-year-old male child weighing 24 kg, who was diagnosed as a case of Noonan syndrome and had undergone ligation of patent ductus arteriosus during early childhood. The child was operated on for release of bilateral neck bands under general anesthesia. The case report pertains to the successful airway and anesthetic management in the background of difficult airway and existence of various cardiac lesions.

Virtual Drive Testing of Adaptive Antenna Systems in Dynamic Propagation Scenarios for Vehicle Communications

DEFF Research Database (Denmark)

Fan, Wei; Hentilä, Lassi; Zhang, Fengchun

2018-01-01

Virtual drive testing (VDT) has gained great interest from both industry and academia, owing to its promise to replay field trials in a controllable laboratory condition. VDT is especially appealing for vehicle communication scenarios, where actual field trials can be difficult to carry out...

Maltose-neopentyl glycol (MNG) amphiphiles for solubilization, stabilization and crystallization of membrane proteins

DEFF Research Database (Denmark)

Chae, Pil Seok; Rasmussen, Søren G F; Rana, Rohini R

2010-01-01

proteins remain difficult to study owing to a lack of suitable detergents. We introduce a class of amphiphiles, each built around a central quaternary carbon atom derived from neopentyl glycol, with hydrophilic groups derived from maltose. Representatives of this maltose-neopentyl glycol (MNG) amphiphile...

Ultra-early tranexamic acid after subarachnoid hemorrhage (ULTRA): study protocol for a randomized controlled trial

NARCIS (Netherlands)

Germans, Menno R.; Post, René; Coert, Bert A.; Rinkel, Gabriël J. E.; Vandertop, W. Peter; Verbaan, Dagmar

2013-01-01

A frequent complication in patients with subarachnoid hemorrhage (SAH) is recurrent bleeding from the aneurysm. The risk is highest within the first 6 hours after the initial hemorrhage. Securing the aneurysm within this timeframe is difficult owing to logistical delays. The rate of recurrent

Continuous residual reinforcement learning for traffic signal control optimization

NARCIS (Netherlands)

Aslani, Mohammad; Seipel, Stefan; Wiering, Marco

2018-01-01

Traffic signal control can be naturally regarded as a reinforcement learning problem. Unfortunately, it is one of the most difficult classes of reinforcement learning problems owing to its large state space. A straightforward approach to address this challenge is to control traffic signals based on

Potential health impacts from range fires at Aberdeen Proving Ground, Maryland

International Nuclear Information System (INIS)

Willians, G.P.; Hermes, A.M.; Policastro, A.J.; Hartmann, H.M.; Tomasko, D.

1998-03-01

This study uses atmospheric dispersion computer models to evaluate the potential for human health impacts from exposure to contaminants that could be dispersed by fires on the testing ranges at Aberdeen Proving Ground, Maryland. It was designed as a screening study and does not estimate actual human health risks. Considered are five contaminants possibly present in the soil and vegetation from past human activities at APG--lead, arsenic, trichloroethylene (TCE), depleted uranium (DU), and dichlorodiphenyltrichloroethane (DDT); and two chemical warfare agents that could be released from unexploded ordnance rounds heated in a range fire--mustard and phosgene. For comparison, dispersion of two naturally occurring compounds that could be released by burning of uncontaminated vegetation--vinyl acetate and 2-furaldehyde--is also examined. Data from previous studies on soil contamination at APG are used in conjunction with conservative estimates about plant uptake of contaminants, atmospheric conditions, and size and frequency of range fires at APG to estimate dispersion and possible human exposure. The results are compared with US Environmental Protection Agency action levels. The comparisons indicate that for all of the anthropogenic contaminants except arsenic and mustard, exposure levels would be at least an order of magnitude lower than the corresponding action levels. Because of the compoundingly conservative nature of the assumptions made, they conclude that the potential for significant human health risks from range fires is low. The authors recommend that future efforts be directed at fire management and control, rather than at conducting additional studies to more accurately estimate actual human health risk from range fires

Potential health impacts from range fires at Aberdeen Proving Ground, Maryland.

Energy Technology Data Exchange (ETDEWEB)

Willians, G.P.; Hermes, A.M.; Policastro, A.J.; Hartmann, H.M.; Tomasko, D.

1998-03-01

This study uses atmospheric dispersion computer models to evaluate the potential for human health impacts from exposure to contaminants that could be dispersed by fires on the testing ranges at Aberdeen Proving Ground, Maryland. It was designed as a screening study and does not estimate actual human health risks. Considered are five contaminants possibly present in the soil and vegetation from past human activities at APG--lead, arsenic, trichloroethylene (TCE), depleted uranium (DU), and dichlorodiphenyltrichloroethane (DDT); and two chemical warfare agents that could be released from unexploded ordnance rounds heated in a range fire--mustard and phosgene. For comparison, dispersion of two naturally occurring compounds that could be released by burning of uncontaminated vegetation--vinyl acetate and 2-furaldehyde--is also examined. Data from previous studies on soil contamination at APG are used in conjunction with conservative estimates about plant uptake of contaminants, atmospheric conditions, and size and frequency of range fires at APG to estimate dispersion and possible human exposure. The results are compared with US Environmental Protection Agency action levels. The comparisons indicate that for all of the anthropogenic contaminants except arsenic and mustard, exposure levels would be at least an order of magnitude lower than the corresponding action levels. Because of the compoundingly conservative nature of the assumptions made, they conclude that the potential for significant human health risks from range fires is low. The authors recommend that future efforts be directed at fire management and control, rather than at conducting additional studies to more accurately estimate actual human health risk from range fires.

Multi-Stream Saline-Jet Dissection Using a Simple Irrigation System Defines Difficult Tissue Planes

Science.gov (United States)

Ng, Philip CH

2010-01-01

Introduction: Single-stream hydro-jet dissection is increasingly used in various laparoscopic procedures, but its use requires special equipment. We describe a simple method for using an irrigation system for saline-jet tissue dissection as a useful adjunct prior to adhesiolysis. Material and Methods: Intraabdominal adhesions prolong laparoscopic procedures, because tissue planes are difficult to identify. We performed multi-jet saline dissection (MSSJ) between 2000 and 2009 in more than 500 patients during laparoscopy involving hernias, gallbladders, appendices, and intestinal obstructions. We use a standard suction irrigation probe, which is attached to a 1-liter saline bag with an inflatable cuff around to create a pressure of 250mm Hg to 300mm Hg. In effect, this is the standard setup generally used for irrigation. After using saline dissection, tissue planes can be better defined and the structures can then be separated. Result and Discussion: Using this method, we have successfully identified tissue planes in spite of dense adhesions, and our conversion rates to open have been reduced dramatically. This method is relatively safer than other modalities of tissue dissection, such as diathermy, ultrasonic, blunt or sharp dissection. The disadvantage is that with tissues saturated with saline it becomes more difficult to use diathermy hemostasis. Care has to be exercised in monitoring the temperature and volume of the fluid used. PMID:20529528

Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship

Science.gov (United States)

Lamba, Sangeeta; Nagurka, Roxanne; Offin, Michael; Scott, Sandra R.

2015-01-01

Introduction The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM) clerkship. Methods We supplemented two case-based simulated resuscitation scenarios (cardiac arrest and blunt trauma) with role-play in order to teach medical students how to deliver news of death and poor prognosis to family of the critically ill or injured simulated patient. Quantitative outcomes were assessed with pre and post-clerkship surveys. Secondarily, students completed a written self-reflection (things that went well and why; things that did not go well and why) to further explore learner experiences with communication around resuscitation. Qualitative analysis identified themes from written self-reflections. Results A total of 120 medical students completed the pre and post-clerkship surveys. Majority of respondents reported that they had witnessed or role-played the delivery of difficult news, but only few had real-life experience of delivering news of death (20/120, 17%) and poor prognosis (34/120, 29%). This communication module led to statistically significant increased scores for comfort, confidence, and knowledge with communicating difficult news of death and poor prognosis. Pre-post scores increased for those agreeing with statements (somewhat/very much) for delivery of news of poor prognosis: comfort 69% to 81%, confidence 66% to 81% and knowledge 76% to 90% as well as for statements regarding delivery of news of death: comfort 52% to 68%, confidence 57% to 76% and knowledge 76% to 90%. Respondents report that patient resuscitations (simulated and/or real) generated a variety of strong emotional responses such as anxiety, stress, grief and feelings of loss and failure. Conclusion A structured communication module supplements simulated resuscitation training in an EM clerkship and leads to a self-reported increase in knowledge, comfort, and

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

Science.gov (United States)

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

2015-01-01

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

Laparoendoscopic Rendezvous for Concomitant Cholecystocholedocholithiasis: A Successful Modality Even in the Most Difficult Presentations Including Pregnancy.

Science.gov (United States)

Shirah, Bader Hamza; Mikwar, Zaher Abdulaziz; Ahmad, Akram Neyaz; Dahlan, Yaser Mohammed

2016-01-01

Background . Laparoendoscopic rendezvous (LERV) technique is emerging as an attractive treatment option for concomitant cholecystocholedocholithiasis. In this paper, we report our experience in performing the LERV technique in patients with unusual presentations in terms of anatomical difficulty, pregnancy, multiple comorbid diseases, and postlaparotomy. We aim to highlight the effectiveness of the LERV technique in some clinical situations where conventional methods would fail or carry high risks in adequately managing concomitant cholecystocholedocholithiasis. Methods . Four patients diagnosed to have concomitant cholecystocholedocholithiasis with associated difficult presentation or comorbid diseases were treated using the LERV technique. One patient presented with difficult anatomy where ERCP failed at initial attempts. Another patient was pregnant (first trimester). A third patient had complex comorbid diseases (bronchial asthma, hypertension, congestive heart failure, and end-stage renal disease on regular hemodialysis). A fourth patient had previous laparotomy and sigmoidectomy for diverticular disease and had severe hospital phobia. Results . All patients tolerated the LERV technique very well; no intraoperative occurrence was reported. The mean operative time was 86.3 ± 17.2 minutes; mean time of the endoscopic part was 29.4 ± 3.57 minutes. The mean blood loss was 44.3 ± 18.2 mL (range 20-85). Residual stone, postoperative complications, postoperative morbidity, and postoperative mortality were 0 (0%). Postoperative short hospital stay was reported in all patients, average 3 days (range 2-4). Conclusion . LERV procedure is a safe and effective treatment option for the management of concomitant cholecystocholedocholithiasis, even in difficult situations where other methods would fail or carry high risks, or in patients presenting with severe comorbid diseases or pregnancy. This procedure may emerge as an attractive alternative option for high

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

Science.gov (United States)

Mintz, Avi I.

2010-01-01

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

Contamination source review for Building E3236, Edgewood Area, Aberdeen Proving Ground, Maryland

Energy Technology Data Exchange (ETDEWEB)

Zellmer, S.D.; Smits, M.P.; Draugelis, A.K.; Glennon, M.A.; Rueda, J.; Zimmerman, R.E.

1995-09-01

The US Army Aberdeen Proving Ground (APG) commissioned Argonne National Laboratory (ANL) to conduct a contamination source review to identify and define areas of toxic or hazardous contaminants and to assess the physical condition and accessibility of APG buildings. The information obtained from the review may be used to assist the US Army in planning for the future use or disposition of the buildings. The contamination source review consisted of the following tasks: historical records search, physical inspection, photographic documentation, geophysical investigation, and review of available records regarding underground storage tanks associated with each building. This report provides the results of the contamination source review for Building E3236. Many of the APG facilities constructed between 1917 and the 1960s are no longer used because of obsolescence and their poor state of repair. Because many of these buildings were used for research, development, testing, and/or pilot- scale production of chemical warfare agents and other military substances, the potential exists for portions of the buildings to be contaminated with these substances, their degradation products, and other laboratory or industrial chemicals. These buildings and associated structures or appurtenances may contribute to environmental concerns at APG.

Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.

LENUS (Irish Health Repository)

Maharaj, C H

2008-02-01

The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.

Health activism: the way forward to improve health in difficult times.

Science.gov (United States)

Laverack, Glenn

2013-09-01

Health activism is an action on behalf of a cause, action that goes beyond what is conventional or routine in society. It involves a challenge to the existing order whenever it is perceived to lead to a social injustice or inequality. Today social injustice is killing people on a grand scale and it is timely for health activism to be used as a way forward to improve health during difficult economic and political times. Health activism is essential because it can create the necessary conditions for people to take control over their own lives when others cannot or will not act on their behalf. Health promotion agencies and the practitioners that they employ, professional organisations and researchers can also play an important role. What is clear is that if greedy corporations and complacent governments are not challenged, we will continue to have limited success in improving health.

The effect of characterisation training on the congruence of ...

African Journals Online (AJOL)

Background. Incongruence of standardised patient (SP) portrayals is worsened when SPs are given basic scenarios and too little background information on short notice. Consequently, SPs are confronted with questions they find difficult to answer owing to a lack of insight, internalisation and association with the role.

Sub-optimal patient and physician communication in primary care consultations: its relation to severe and difficult asthma

NARCIS (Netherlands)

Moffat, M.; Cleland, J.; Van der Molen, T.; Price, D.

2006-01-01

Introduction: Asthma control can be influenced by a range of non-medical issues, including psychosocial factors. Little is known about the views of patients, particularly those with severe and/or difficult asthma, towards their asthma control and their asthma-related primary care consultations. Aims

Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult.

Science.gov (United States)

Etherton, Hayley; Blunden, Sarah; Hauck, Yvonne

2016-11-15

The majority of behavioral sleep interventions for young children involve extinction procedures where parents must ignore their child's cries for a period. Many parents have difficulties with this, contributing to attrition, non-compliance, and treatment avoidance. Yet why these methods are difficult to implement has rarely been addressed in the literature. This paper discusses seven potential reasons why parents may find extinction sleep interventions difficult: enduring crying, practical considerations, fear of repercussions, misinformation, incongruence with personal beliefs, different cultural practices, and parent wellness. These reasons are discussed in relation to the current literature. Practicing health professionals and sleep researchers could benefit from an awareness of these issues when suggesting extinction interventions and offering alternatives which may be more appropriate for family circumstances and facilitate parental informed choice. © 2016 American Academy of Sleep Medicine

Laryngeal mask placement in a teaching institution: analysis of difficult placements [version 1; referees: 2 approved, 1 approved with reservations

Directory of Open Access Journals (Sweden)

Anastasia D Katsiampoura

2015-04-01

Full Text Available Background: Laryngeal mask airway (LMA placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees. In our retrospective analysis we tried to identify predictive factors of difficult LMA placement in an academic training program. Methods: This retrospective analysis was derived from a research airway database, where data were collected prospectively at the Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA, from 2008 to 2010. All non-obstetric adult patients presenting for elective surgery requiring general anesthesia, were enrolled in this study: anesthesiology residents primarily managed the airways. The level of difficulty, number of attempts, and type of the extraglottic device placement were retrieved. Results: Sixty-nine unique Laryngeal Mask Airways (uLMAs were utilized as a primary airway device. Two independent predictors for difficult LMA placement were identified: gender and neck circumference. The sensitivity for one factor is 87.5% with a specificity of 50%. However with two risk factors, the specificity increases to the level of 93% and the sensitivity is 63%. Conclusion: In a large academic training program, besides uLMA not been used routinely, two risk factors for LMA difficulty were identified, female gender and large neck circumference. Neck circumference is increasingly being recognized as a significant predictor across the spectrum of airway management difficulties while female gender has not been previously reported as a risk factor for difficult LMA placement.

Depleted uranium human health risk assessment, Jefferson Proving Ground, Indiana

International Nuclear Information System (INIS)

Ebinger, M.H.; Hansen, W.R.

1994-01-01

The risk to human health from fragments of depleted uranium (DU) at Jefferson Proving Ground (JPG) was estimated using two types of ecosystem pathway models. A steady-state, model of the JPG area was developed to examine the effects of DU in soils, water, and vegetation on deer that were hunted and consumed by humans. The RESRAD code was also used to estimate the effects of farming the impact area and consuming the products derived from the farm. The steady-state model showed that minimal doses to humans are expected from consumption of deer that inhabit the impact area. Median values for doses to humans range from about 1 mrem (±2.4) to 0.04 mrem (±0.13) and translate to less than 1 x 10 -6 detriments (excess cancers) in the population. Monte Carlo simulation of the steady-state model was used to derive the probability distributions from which the median values were drawn. Sensitivity analyses of the steady-state model showed that the amount of DU in airborne dust and, therefore, the amount of DU on the vegetation surface, controlled the amount of DU ingested by deer and by humans. Human doses from the RESRAD estimates ranged from less than 1 mrem/y to about 6.5 mrem/y in a hunting scenario and subsistence fanning scenario, respectively. The human doses exceeded the 100 mrem/y dose limit when drinking water for the farming scenario was obtained from the on-site aquifer that was presumably contaminated with DU. The two farming scenarios were unrealistic land uses because the additional risk to humans due to unexploded ordnance in the impact area was not figured into the risk estimate. The doses estimated with RESRAD translated to less than 1 x 10 -6 detriments to about 1 x 10 -3 detriments. The higher risks were associated only with the farming scenario in which drinking water was obtained on-site

[Ischemic Changes in the Electrocardiogram and Circulatory Collapse Accompanied by Severe Anemia Owing to the Delay of Red Blood Cell Concentrate Transfusion in Two Patients with Intraoperative Massive Bleeding].

Science.gov (United States)

Horiuchi, Toshinori; Noguchi, Teruo; Kurita, Naoko; Yamaguchi, Ayako; Takeda, Masafumi; Sha, Keiichi; Nagahata, Toshihiro

2016-01-01

We present two patients developing intraoperative massive bleeding and showed ischemic changes in the electrocardiogram and circulatory collapse accompanied by severe anemia owing to the delay of red blood cell concentrate transfusion. One patient underwent hepatectomy and the other pancreaticoduodenectomy. Their lowest hemoglobin concentration was around 2 g x dl(-1), and they showed ischemic changes in the electrocardiogram and severe decreases in blood pressure. The former received compatible red blood cell concentrate and the latter received uncrossmatched same blood group red blood cell concentrate immediately, and their electrocardiogram and blood pressure quickly improved. To avoid life-threatening anemia, emergency red blood cell concentrate transfusion including compatible different blood group transfusion should be applied for intraoperative massive bleeding.

Shift, Interrupted: Strategies for Managing Difficult Patients Including Those with Personality Disorders and Somatic Symptoms in the Emergency Department.

Science.gov (United States)

Moukaddam, Nidal; AufderHeide, Erin; Flores, Araceli; Tucci, Veronica

2015-11-01

Difficult patients are often those who present with a mix of physical and psychiatric symptoms, and seem refractory to usual treatments or reassurance. such patients can include those with personality disorders, those with somatization symptoms; they can come across as entitled, drug-seeking, manipulative, or simply draining to the provider. Such patients are often frequent visitors to Emergency Departments. Other reasons for difficult encounters could be rooted in provider bias or countertransference, rather than sole patient factors. Emergency providers need to have high awareness of these possibilities, and be prepared to manage such situations, otherwise workup can be sub-standard and dangerous medical mistakes can be made. Copyright © 2015 Elsevier Inc. All rights reserved.

A case difficult to diagnose in adults: High sinus venous atrial septal defect

Directory of Open Access Journals (Sweden)

Ozge Cetinarslan

2018-01-01

Full Text Available Sinus venous atrial septal defect (SVD is highly difficult to diagnose because of its location. Below, we report a case of SVD which is misdiagnosed as pulmonary hypertension and anomalous pulmonary venous return. A 57-year-old female patient was referred to congenital disease outpatient clinic of a tertiary center. She was admitted to the hospital with complaints of fatigue and exercise dyspnea which had started a year ago. She had transthoracic echocardiography (TTE examination done in another hospital which showed dilated right heart chambers and pulmonary hypertension. She underwent transesophageal echocardiography (TEE examination with the suspicion of atrial septal defect (ASD, but no defect was seen. As her symptoms persisted, we repeated the TTE and TEE examination in our center. TEE revealed 0.6 cm ASD on the upper side of the interatrial septum. All four pulmonary veins were draining into the left atrium. Right heart catheterization (RHC confirmed the diagnosis. A left-to-right shunt was detected and localized by a significant step-up in blood oxygen saturation found between mid and upper segments of the right atrium. According to our TEE and RHC results, we planned the surgical closure of the defect. Sinus venous ASD is deficiency of the superior portion of atrial septum adjacent to superior vena cava. Diagnosis of SVD is often more difficult than other forms of ASD and may require special imaging such as TEE, magnetic resonance imaging, or computed tomographic scanning. In conclusion, cardiologists must be aware about the possibility of SVD patients who have unexplained exertional dyspnea and fatigue, dilated right atrium and ventricle, pulmonary hypertension, paradoxical embolism, or atrial arrhythmias in their respective populations.

Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

DEFF Research Database (Denmark)

Nørskov, A K; Wetterslev, J; Rosenstock, C V

2016-01-01

departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34). CONCLUSIONS: Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations. CLINICAL TRIAL REGISTRATION: NCT01718561.......BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI...

Radionuclides difficult to measure in waste packages. Final report

Energy Technology Data Exchange (ETDEWEB)

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

1995-11-01

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

Protection of mineral deposits - a way towards difficult compromises

Science.gov (United States)

Radwanek-Bąk, Barbara; Nieć, Marek

2014-05-01

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

Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios

DEFF Research Database (Denmark)

Jepsen, Cecilie H; Gätke, Mona R; Thøgersen, Bente

2014-01-01

Grath videolaryngoscope and FFE. The participants then performed tracheal intubation on a SimMan manikin once with the McGrath videolaryngoscope and once with the FFE in three difficult airway scenarios: (1) pharyngeal obstruction; (2) pharyngeal obstruction and cervical rigidity; (3) tongue oedema. MAIN OUTCOME MEASURES...

The treatment of 'difficult' patients in a secure unit of a specialized psychiatric hospital : The patient's perspective

NARCIS (Netherlands)

N. Kool-Goudzwaard; Bauke van Koekkoek; C.J. Gamel; M. Bos; B. Meijel

2012-01-01

The aim of this study is to obtain insight, from a patient's perspective, into the results and essential components of treatment in specialist settings for so-called 'difficult' patients in mental health care. In cases where usual hospital treatment is not successful, a temporary transfer to

Acute cholecystitis: comparing clinical outcomes with TG13 severity and intended laparoscopic versus open cholecystectomy in difficult operative cases.

Science.gov (United States)

Gerard, Justin; Luu, Minh B; Poirier, Jennifer; Deziel, Daniel J

2018-03-09

The revised Tokyo Guidelines include criteria for determining the severity of acute cholecystitis with treatment algorithms based on severity. The aim of this study was to investigate the relationship of the revised Tokyo Guidelines severity grade to clinical outcomes of cholecystectomy for acute cholecystitis. We identified 66 patients with acute cholecystitis from a prior study of difficult cholecystectomy cases. We examined the relationship between severity grade and multiple variables related to perioperative and postoperative outcomes. A more severe revised Tokyo Guidelines grade was associated with a higher number of complications (p = 0.03) and a higher severity of complications (p = 0.01). Severity grade did not predict operative time, estimated blood loss, intensive care unit admission or length of stay. Compared to planned open cholecystectomy, intended laparoscopic cholecystectomy was associated with significantly fewer total and Clavien-Dindo grade 3 complications, fewer intensive care unit admissions, and shorter length of stay (p values range from 0.03 to < 0.0001). In technically difficult operations for acute cholecystitis, the revised Tokyo guidelines severity grade correlates with the number and severity of complications. However, intended performance of laparoscopic cholecystectomy rather than open cholecystectomy in difficult operations predicts broader beneficial outcomes than severity grade.

Jałowe martwice kości, charakterystyka choroby i postępowanie fizykalne – przegląd literatury = Sterile necrosis of bone, the characteristics of the illness and physical examination - a literature review

OpenAIRE

Radzimińska, Agnieszka; Zimmermann, Agnieszka Anna; Weber-Rajek, Magdalena; Strojek, Katarzyna; Bułatowicz, Irena; Goch, Aleksander; Zukow, Walery

2015-01-01

Radzimińska Agnieszka, Zimmermann Agnieszka Anna, Weber-Rajek Magdalena, Strojek Katarzyna, Bułatowicz Irena, Goch Aleksander, Zukow Walery. Jałowe martwice kości, charakterystyka choroby i postępowanie fizykalne – przegląd literatury = Sterile necrosis of bone, the characteristics of the illness and physical examination - a literature review. Journal of Education, Health and Sport. 2015;5(10):108-120. ISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.32518 http://ojs.ukw.edu.pl/index....

Decreasing the cost of ground grid installations under difficult environmental conditions

International Nuclear Information System (INIS)

Miranda, E.P.

1992-01-01

The purpose of a ground grid is to provide a means to carry and dissipate electrical currents into ground under normal and fault conditions. In some cases, especially in dry rock terrain, the soil resistivity can be very high, making it difficult and very expensive to install an acceptable ground grid. Usually a soil resistivity above 200 ohm-meter is considered high. This paper discusses and provides design calculations for a successful ground grid installation in a distribution substation located in one of the worst soil conditions encountered in the industry; a very rocky terrain where the resistivity is 1800 ohm-m. It is a practical application of the theories presented in ANSI/IEEE Std. 80-1986. The design application consists of bare copper combined with conventional and a new type of ground rod. The installation cost for this application was much less than the cost associated with that of a conventional installation

A distributed supervisor synthesis approach based on weak bisimulation

NARCIS (Netherlands)

Su, Rong; Thistle, J.G.; Lafortune, S.; Lin, F.; Tilbury, D.

2006-01-01

It is well known that space and time complexity is one of the main bottlenecks of supervisor synthesis. The model of a large system is usually too big to be explicitly expressed, owing to composition of local components’ models, making supervisor synthesis difficult, if still possible. In this paper

Echinococcal cyst of the pancreas with Cystopancreatic duct fistula ...

African Journals Online (AJOL)

The primary pancreatic hydatid (echinococcal) cyst is extremely rare with a reported incidence of <1%. Owing to its rareness and a considerable overlap of imaging features, a preoperative diagnosis is usually difficult. The dilemma in confirming this benign diagnosis has often questioned the extent of radical pancreatic ...

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

Directory of Open Access Journals (Sweden)

Cai-neng Wu

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

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

Science.gov (United States)

Fugazza, G; Bona, F

1996-03-01

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

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

Science.gov (United States)

Bickel, Janet; Rosenthal, Susan L

2011-10-01

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

A Mechanically Proved and an Incremental Development of the Session Initiation Protocol INVITE Transaction

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Rajaa Filali

2014-01-01

Full Text Available The Session Initiation Protocol (SIP is an application layer signaling protocol used to create, manage, and terminate sessions in an IP based network. SIP is considered as a transactional protocol. There are two main SIP transactions, the INVITE transaction and the non-INVITE transaction. The SIP INVITE transaction specification is described in an informal way in Request for Comments (RFC 3261 and modified in RFC 6026. In this paper we focus on the INVITE transaction of SIP, over reliable and unreliable transport mediums, which is used to initiate a session. In order to ensure the correctness of SIP, the INVITE transaction is modeled and verified using event-B method and its Rodin platform. The Event-B refinement concept allows an incremental development by defining the studied system at different levels of abstraction, and Rodin discharges almost all proof obligations at each level. This interaction between modeling and proving reduces the complexity and helps in assuring that the INVITE transaction SIP specification is correct, unambiguous, and easy to understand.

A study of organic binding of incorporated tritium by means of the organic components of human urine

International Nuclear Information System (INIS)

Szilagyi, M.

1976-01-01

The change in tritium activity of metabolytic fractions of urine of persons working in the production of tritium labelled compounds was studied. The radioactivity of the separated fractions was measured during a 20 day period. A carbamide fraction proved to be the most sensitive to incorporative cases owing to its organic component fractioned together with the carbamide. (K.A.)

Hydrogeologic and chemical data for the O-Field area, Aberdeen Proving Ground, Maryland

International Nuclear Information System (INIS)

Nemoff, P.R.; Vroblesky, D.A.

1989-01-01

O-Field, located at the Edgewood area of Aberdeen Proving Ground, Maryland, was periodically used for disposal of munitions, waste chemicals, and chemical-warfare agents from World War II through the 1950's. This report includes various physical, geologic, chemical, and hydrologic data obtained from well-core, groundwater, surface water, and bottom-sediment sampling sites at and near the O-Field disposal area. The data are presented in tables and hydrographs. Three site-location maps are also included. Well-core data include lithologic logs for 11 well-cluster sites, grain-size distributions, various chemical characteristics, and confining unit characteristics. Groundwater data include groundwater chemistry, method blanks for volatile organic carbon, available data on volatile and base/neutral organics, and compilation of corresponding method blanks, chemical-warfare agents, explosive-related products, radionuclides, herbicides, and groundwater levels. Surface-water data include field-measured characteristics; concentrations of various inorganic constituents including arsenic; selected organic constituents with method blanks; detection limits of organics; and a compilation of information on corresponding acids, volatiles, and semivolatiles; and method blanks corresponding to acids, volatiles, and semivolatiles. A set of 15 water-level hydrographs for the period March 1986 through September 1987 also is included in the report. 3 refs., 18 figs., 24 tabs

Ecological risk assessment of depleted uranium in the environment at Aberdeen Proving Ground

International Nuclear Information System (INIS)

Clements, W.H.; Kennedy, P.L.; Myers, O.B.

1993-01-01

A preliminary ecological risk assessment was conducted to evaluate the effects of depleted uranium (DU) in the Aberdeen Proving Ground (APG) ecosystem and its potential for human health effects. An ecological risk assessment of DU should include the processes of hazard identification, dose-response assessment, exposure assessment, and risk characterization. Ecological risk assessments also should explicitly examine risks incurred by nonhuman as well as human populations, because risk assessments based only on human health do not always protect other species. To begin to assess the potential ecological risk of DU release to the environment we modeled DU transport through the principal components of the aquatic ecosystem at APG. We focused on the APG aquatic system because of the close proximity of the Chesapeake Bay and concerns about potential impacts on this ecosystem. Our objective in using a model to estimate environmental fate of DU is to ultimately reduce the uncertainty about predicted ecological risks due to DU from APG. The model functions to summarize information on the structure and functional properties of the APG aquatic system, to provide an exposure assessment by estimating the fate of DU in the environment, and to evaluate the sources of uncertainty about DU transport

Difficult mask ventilation in general surgical population: observation of risk factors and predictors [v1; ref status: indexed, http://f1000r.es/47z

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Davide Cattano

2014-08-01

Full Text Available Background: There are few predictors of difficult mask ventilation and a simple, objective, predictive system to identify patients at risk of difficult mask ventilation does not currently exist. We present a retrospective - subgroup analysis aimed at identifying predictive factors for difficult mask ventilation (DMV in patients undergoing pre-operative airway assessment before elective surgery at a major teaching hospital. Methods: Data for this retrospective analysis were derived from a database of airway assessments, management plans, and outcomes that were collected prospectively from August 2008 to May 2010 at a Level 1 academic trauma center. Patients were stratified into two groups based on the difficulty of mask ventilation and the cohorts were analyzed using univariate analysis and stepwise selection method. Results: A total of 1399 pre-operative assessments were completed with documentation stating that mask ventilation was attempted. Of those 1399, 124 (8.9% patients were found to be difficult to mask ventilate. A comparison of patients with and without difficult mask ventilation identified seven risk factors for DMV: age, body mass index (BMI, neck circumference, history of difficult intubation, presence of facial hair, perceived short neck and obstructive sleep apnea. Although seven risk factors were identified, no individual subject had more than four risk factors. Conclusion: The results of this study confirm that in a real world clinical setting, the incidence of DMV is not negligible and suggest the use of a simple bedside predictive score to improve the accuracy of DMV prediction, thereby improving patient safety. Further prospective studies to validate this score would be useful.

Methodology of proving long-term safety of a salt dome repository with existing insecurities forming the background

International Nuclear Information System (INIS)

Storck, R.

1992-01-01

Existing methods to prove safety can consider the insecurities of input data within the framework of probabilistic analyses. The results of application calculations show that inspite of considerable band widths of input data the scattering widths of radiation exposures are comparably limited, and calculated radiation exposures are clearly below acceptable limits. Moreover it can be demonstrated that in the event of an assumed brine influx into the repository radionuclides are released only if parameter combinations are unfavourable. Therefore such incident in general does not have any radiological consequences. Insecurities in model approaches can be taken into consideration only partly so far by using alternative models, or indirectly through data insecurities. (orig./DG) [de

Cell-Free Systems Based on CHO Cell Lysates: Optimization Strategies, Synthesis of "Difficult-to-Express" Proteins and Future Perspectives.

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Lena Thoring

Full Text Available Nowadays, biotechnological processes play a pivotal role in target protein production. In this context, Chinese Hamster Ovary (CHO cells are one of the most prominent cell lines for the expression of recombinant proteins and revealed as a safe host for nearly 40 years. Nevertheless, the major bottleneck of common in vivo protein expression platforms becomes obvious when looking at the production of so called "difficult-to-express" proteins. This class of proteins comprises in particular several ion channels and multipass membrane proteins as well as cytotoxic proteins. To enhance the production of "difficult-to-express" proteins, alternative technologies were developed, mainly based on translationally active cell lysates. These so called "cell-free" protein synthesis systems enable an efficient production of different classes of proteins. Eukaryotic cell-free systems harboring endogenous microsomal structures for the synthesis of functional membrane proteins and posttranslationally modified proteins are of particular interest for future applications. Therefore, we present current developments in cell-free protein synthesis based on translationally active CHO cell extracts, underlining the high potential of this platform. We present novel results highlighting the optimization of protein yields, the synthesis of various "difficult-to-express" proteins and the cotranslational incorporation of non-standard amino acids, which was exemplarily demonstrated by residue specific labeling of the glycoprotein Erythropoietin and the multimeric membrane protein KCSA.

Genetic evidence of multiple loci in dystocia - difficult labour

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Westgren Magnus

2010-06-01

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

Genetic evidence of multiple loci in dystocia - difficult labour

Science.gov (United States)

2010-01-01

Background Dystocia, difficult labour, is a common but also complex problem during childbirth. It can be attributed to either weak contractions of the uterus, a large infant, reduced capacity of the pelvis or combinations of these. Previous studies have indicated that there is a genetic component in the susceptibility of experiencing dystocia. The purpose of this study was to identify susceptibility genes in dystocia. Methods A total of 104 women in 47 families were included where at least two sisters had undergone caesarean section at a gestational length of 286 days or more at their first delivery. Study of medical records and a telephone interview was performed to identify subjects with dystocia. Whole-genome scanning using Affymetrix genotyping-arrays and non-parametric linkage (NPL) analysis was made in 39 women exhibiting the phenotype of dystocia from 19 families. In 68 women re-sequencing was performed of candidate genes showing suggestive linkage: oxytocin (OXT) on chromosome 20 and oxytocin-receptor (OXTR) on chromosome 3. Results We found a trend towards linkage with suggestive NPL-score (3.15) on chromosome 12p12. Suggestive linkage peaks were observed on chromosomes 3, 4, 6, 10, 20. Re-sequencing of OXT and OXTR did not reveal any causal variants. Conclusions Dystocia is likely to have a genetic component with variations in multiple genes affecting the patient outcome. We found 6 loci that could be re-evaluated in larger patient cohorts. PMID:20587075

A technical solution to a difficult problem - An update

International Nuclear Information System (INIS)

Asselstine, J.K.

1985-01-01

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

A technical solution to a difficult problem - An update

Energy Technology Data Exchange (ETDEWEB)

Asselstine, J K

1985-07-01

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

Laparoendoscopic Rendezvous for Concomitant Cholecystocholedocholithiasis: A Successful Modality Even in the Most Difficult Presentations Including Pregnancy

Directory of Open Access Journals (Sweden)

Bader Hamza Shirah

2016-01-01

Full Text Available Background. Laparoendoscopic rendezvous (LERV technique is emerging as an attractive treatment option for concomitant cholecystocholedocholithiasis. In this paper, we report our experience in performing the LERV technique in patients with unusual presentations in terms of anatomical difficulty, pregnancy, multiple comorbid diseases, and postlaparotomy. We aim to highlight the effectiveness of the LERV technique in some clinical situations where conventional methods would fail or carry high risks in adequately managing concomitant cholecystocholedocholithiasis. Methods. Four patients diagnosed to have concomitant cholecystocholedocholithiasis with associated difficult presentation or comorbid diseases were treated using the LERV technique. One patient presented with difficult anatomy where ERCP failed at initial attempts. Another patient was pregnant (first trimester. A third patient had complex comorbid diseases (bronchial asthma, hypertension, congestive heart failure, and end-stage renal disease on regular hemodialysis. A fourth patient had previous laparotomy and sigmoidectomy for diverticular disease and had severe hospital phobia. Results. All patients tolerated the LERV technique very well; no intraoperative occurrence was reported. The mean operative time was 86.3±17.2 minutes; mean time of the endoscopic part was 29.4±3.57 minutes. The mean blood loss was 44.3±18.2 mL (range 20–85. Residual stone, postoperative complications, postoperative morbidity, and postoperative mortality were 0 (0%. Postoperative short hospital stay was reported in all patients, average 3 days (range 2–4. Conclusion. LERV procedure is a safe and effective treatment option for the management of concomitant cholecystocholedocholithiasis, even in difficult situations where other methods would fail or carry high risks, or in patients presenting with severe comorbid diseases or pregnancy. This procedure may emerge as an attractive alternative option for high

METHODOLOGY OF DETERMINATION OF ADMISSIBLE SPEEDS OF TRAIN MOVEMENT ON DIFFICULT SECTIONS OF RAILROAD PLAN

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M. B. Kurhan

2014-03-01

Full Text Available Purpose. Determination of improvement ways of admissible speeds of train movement on the difficult sections of а railroad plan. Methodology. Mathematical modeling of the train traffic is used to achieve the purpose of research. The average weighted speed and elevation of outer rail is predicted on this basis. Findings. The case analysis of the speeds determination in curved sections of track was carried out. The above mentioned track sections adversely affect the ride comfort and the intensity of the way disorder, as well as the reasons that contribute to the speed limits traffic on the railways of Ukraine. The technique of performing the calculations for determining the permissible train speeds was developed and tested on real curves of railways, were the accelerated movement of trains was introduced. Proposals on automate calculations in distances and services by way of determining the permissible speeds in curves were developed. Originality. Methodology of determining the permissible motion speeds and elevation of outer rails on the difficult sections of the railway plan was developed. This approach allows you to get a rational decisions on reorganization of plan based on local conditions. Practical value. The developed technique of definition of admissible speeds of motion in curves was implemented as a program DopShvid. The program was tested on real railway sections, where the accelerated train motion was introduced.

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

International Nuclear Information System (INIS)

Di Lucia, Lorenzo

2013-01-01

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

The Effects of Sexism, Psychological Distress, and Difficult Sexual Situations on U.S. Women’s Sexual Risk Behaviors

Science.gov (United States)

Choi, Kyung-Hee; Bowleg, Lisa; Neilands, Torsten B.

2011-01-01

Women represent almost half of the people living with HIV worldwide. Although social discrimination has been recognized as a major obstacle to HIV prevention, few empirical studies have examined the effects of sexism on women’s HIV sexual risk behaviors. We analyzed data collected from an ethnically diverse sample of 754 women attending family planning clinics in the San Francisco Bay Area. A majority of respondents reported lifetime experiences of sexism (e.g., 94% reported sexual harassment). Structural equation modeling results demonstrated that experiences of sexism and reports of recent unprotected sex with a primary or a secondary sexual partner were linked through psychological distress and difficult sexual situations. Our results suggest the need to develop HIV prevention strategies for women that address two mechanisms ---psychological distress and difficult sexual situations --- that link social discrimination to women’s sexual risk for HIV. PMID:22010804

The use of 65Zn for estimating group size of brown hyaenas Hyaena ...

African Journals Online (AJOL)

MacDonald 1983), is influenced by the quality of resources within a territory (Mills 1982). Group size is, however, difficult to determine accurately using routine methods (i.e., direct counts and mark recapture techniques) owing to the shy, elusive and nocturnal habits of brown hyaenas and the physiognomic characteristics of ...

Remediation application strategies for depleted uranium contaminated soils at the US Army Yuma Proving Ground

International Nuclear Information System (INIS)

Vandel, D.S.; Medina, S.M.; Weidner, J.R.

1994-03-01

The US Army Yuma Proving Ground (YPG), located in the southwest portion of Arizona conducts firing of projectiles into the Gunpoint (GP-20) firing range. The penetrators are composed of titanium and DU. The purpose of this project was to determine feasible cleanup technologies and disposal alternatives for the cleanup of the depleted uranium (DU) contaminated soils at YPG. The project was split up into several tasks that include (a) collecting and analyzing samples representative of the GP-20 soils, (b) evaluating the data results, (c) conducting a literature search of existing proven technologies for soil remediation, and (0) making final recommendations for implementation of this technology to the site. As a result of this study, several alternatives for the separation, treatment, and disposal procedures are identified that would result in meeting the cleanup levels defined by the Nuclear Regulatory Commission for unrestricted use of soils and would result in a significant cost savings over the life of the firing range

[Facing the difficult experience even with support: the underage adolescent experiencing motherhood].

Science.gov (United States)

Andrade, Paula Rosenberg de; Ohara, Conceição Vieira da Silva; Borba, Regina Issuzu Hirooka de; Ribeiro, Circéa Amalia

2015-01-01

To understand the meaning of childcare for the underage adolescent mother, to reveal the demands of care and to build a theoretical model based on this experience. Qualitative research with symbolic interactionism as the theoretical framework and the grounded theory as the methodological framework; nine adolescents participated in the study. The semi-structured interview was used to collect data from September 2008 to September 2011, during paediatric nursing consultation at the Centro Assistencial Cruz de Malta, a philanthropic institution in the city of São Paulo/Brazil. Data analysis led to the construction of the theoretical model,Facing a difficult experience even with support. The experience shows that the difficulties to care for a child, even with help, are not met, only mitigated, and that underage adolescents do not have the maturity to cope with this experience.

The Difficult Airway Society 'ADEPT' guidance on selecting airway devices: the basis of a strategy for equipment evaluation.

Science.gov (United States)

Pandit, J J; Popat, M T; Cook, T M; Wilkes, A R; Groom, P; Cooke, H; Kapila, A; O'Sullivan, E

2011-08-01

Faced with the concern that an increasing number of airway management devices were being introduced into clinical practice with little or no prior evidence of their clinical efficacy or safety, the Difficult Airway Society formed a working party (Airway Device Evaluation Project Team) to establish a process by which the airway management community within the profession could itself lead a process of formal device/equipment evaluation. Although there are several national and international regulations governing which products can come on to the market and be legitimately sold, there has hitherto been no formal professional guidance relating to how products should be selected (i.e. purchased). The Airway Device Evaluation Project Team's first task was to formulate such advice, emphasising evidence-based principles. Team discussions led to a definition of the minimum level of evidence needed to make a pragmatic decision about the purchase or selection of an airway device. The Team concluded that this definition should form the basis of a professional standard, guiding those with responsibility for selecting airway devices. We describe how widespread adoption of this professional standard can act as a driver to create an infrastructure in which the required evidence can be obtained. Essential elements are that: (i) the Difficult Airway Society facilitates a coherent national network of research-active units; and (ii) individual anaesthetists in hospital trusts play a more active role in local purchasing decisions, applying the relevant evidence and communicating their purchasing decisions to the Difficult Airway Society. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study.

Science.gov (United States)

Lee, Tae Hoon; Hwang, Soon Oh; Choi, Hyun Jong; Jung, Yunho; Cha, Sang Woo; Chung, Il-Kwun; Moon, Jong Ho; Cho, Young Deok; Park, Sang-Heum; Kim, Sun-Joo

2014-02-17

Numerous clinical trials to improve the success rate of biliary access in difficult biliary cannulation (DBC) during ERCP have been reported. However, standard guidelines or sequential protocol analysis according to different methods are limited in place. We planned to investigate a sequential protocol to facilitate selective biliary access for DBC during ERCP. This prospective clinical study enrolled 711 patients with naïve papillae at a tertiary referral center. If wire-guided cannulation was deemed to have failed due to the DBC criteria, then according to the cannulation algorithm early precut fistulotomy (EPF; cannulation time > 5 min, papillary contacts > 5 times, or hook-nose-shaped papilla), double-guidewire cannulation (DGC; unintentional pancreatic duct cannulation ≥ 3 times), and precut after placement of a pancreatic stent (PPS; if DGC was difficult or failed) were performed sequentially. The main outcome measurements were the technical success, procedure outcomes, and complications. Initially, a total of 140 (19.7%) patients with DBC underwent EPF (n = 71) and DGC (n = 69). Then, in DGC group 36 patients switched to PPS due to difficulty criteria. The successful biliary cannulation rate was 97.1% (136/140; 94.4% [67/71] with EPF, 47.8% [33/69] with DGC, and 100% [36/36] with PPS; P EPF, 314.8 (65.2) seconds in DGC, and 706.0 (469.4) seconds in PPS (P EPF, DGC, and PPS may be safe and feasible for DBC. The use of EPF in selected DBC criteria, DGC in unintentional pancreatic duct cannulations, and PPS in failed or difficult DGC may facilitate successful biliary cannulation.

Origin of optical non-linear response in TiN owing to excitation dynamics of surface plasmon resonance electronic oscillations

Science.gov (United States)

Divya, S.; Nampoori, V. P. N.; Radhakrishnan, P.; Mujeeb, A.

2014-08-01

TiN nanoparticles of average size 55 nm were investigated for their optical non-linear properties. During the experiment the irradiated laser wavelength coincided with the surface plasmon resonance (SPR) peak of the nanoparticle. The large non-linearity of the nanoparticle was attributed to the plasmon resonance, which largely enhanced the local field within the nanoparticle. Both open and closed aperture Z-scan experiments were performed and the corresponding optical constants were explored. The post-excitation absorption spectra revealed the interesting phenomenon of photo fragmentation leading to the blue shift in band gap and red shift in the SPR. The results are discussed in terms of enhanced interparticle interaction simultaneous with size reduction. Here, the optical constants being intrinsic constants for a particular sample change unusually with laser power intensity. The dependence of χ(3) is discussed in terms of the size variation caused by photo fragmentation. The studies proved that the TiN nanoparticles are potential candidates in photonics technology offering huge scope to study unexplored research for various expedient applications.

Brachytherapy for the palliation of dysphagia owing to esophageal cancer: A systematic review and meta-analysis of prospective studies.

Science.gov (United States)

Fuccio, Lorenzo; Mandolesi, Daniele; Farioli, Andrea; Hassan, Cesare; Frazzoni, Leonardo; Guido, Alessandra; de Bortoli, Nicola; Cilla, Savino; Pierantoni, Chiara; Violante, Francesco Saverio; Bazzoli, Franco; Repici, Alessandro; Morganti, Alessio Giuseppe

2017-03-01

The management of dysphagia owing to esophageal cancer is challenging. Brachytherapy has been proposed as an alternative option to stent placement. We performed a systematic review to examine its efficacy and safety in the resolution of dysphagia. Prospective studies recruiting at least 20 patients with malignant dysphagia and published up to April 2016 were eligible. The dysphagia-free survival (DFS) and adverse event rates were pooled by means of a random effect model. Six studies for a total of 9 treatment arms (623 patients) were eligible for inclusion. After 1month since treatment, the DFS rate was 86.9% [95%CI: 76.0-93.3%]; after 3months, it was 67.2% [95%CI: 56.1-76.7%]; after 6months, it was 47.4% [95%CI: 38.5-56.5%]; after 9months, it was 37.6% [95%CI:30.0-45.9%]; and, finally, after 12months, it was 29.4% [95%CI: 21.6-38.7%]. The heterogeneity between studies was high at 1-, 3- and 6-month assessment; the values of I 2 were 86.3%, 80.0% and 57.8%, respectively. The meta-regression analysis showed total radiation dose and number of fractions as the only positively influencing factors. Severe adverse event rate was 22.6% (95%CI 19.4-26.3). The main reported adverse events were brachytherapy-related stenosis (12.2%) and fistula development (8.3%). Two cases (0.3%) of deaths were reported due to esophageal perforation. Brachytherapy is a highly effective and relatively safe treatment option therefore its underuse is no longer justified. Further studies should investigate the optimal radiation dose and number of fractions able to achieve the highest DFS rates. Copyright © 2017 Elsevier B.V. All rights reserved.

The use of peracetic acid in drinking water systems: flow tests; L'acido peracetico in potabilizzazione: prove in flusso

Energy Technology Data Exchange (ETDEWEB)

Ragazzo, P. [Consorzio per l' Acquedotto del Basso Piave, San Dona' di Piave, VE (Italy); Navazio, G. [Padua Univ., Padua (Italy). Dipt. dei Processi Chimici dell' Ingegneria; Cavadone, A. [Solvay Chimica Italia S.p.A., Milan (Italy)

2000-09-01

In a previous research, a preliminary study was carried out on the disinfection efficiency of peracetic acid (PAA), comparing it to that of other disinfectants that are typically used, in batch tests with dosage values ranging from 0.5 to 5 ppm. The study was carried out on samples of water collected from several significant points of the treatment process at the main water treatment plant in Jesolo (Venice, Italy). On the basis of results (basically positive at that time) obtained from these tests, a 400 litre/hour pilot plant was built, as a lower scale reproduction of the drink water treatment system mentioned earlier, in order to study the characteristics of PAA even in tests that could more realistically simulate the flow of water along the process. These tests essentially confirmed the kinetics of the spontaneous hydrolysis to CH{sub 3} COOH+H{sub 2}O{sub 2} and those of dismutation to CH{sub 3}COOH+O{sub 2}, with half-life time values ranging from 3 to 12 hours, depending on the characteristics of the water (especially the pH factor) and the PAA concentration values. [Italian] In un precedente lavoro e' stato effettuato un preventivo studio sull'efficienza disinfettiva dell'acido peracetico, anche in confronto con gli altri piu' usuali disinfettanti, in prove condotte in batch, con dosaggi compresi tra 0.5 e 5 ppm, su campioni di acqua prelevati dai diversi punti significativi della linea di trattamento della centrale di Jesolo (Torre Caligo), gestita dal Consorzio Acquedottistico del Basso Piave di S. Dona' di Piave (Venezia). Sulla base dei risultati, sostanzialmente positivi, e' stato costruito un impianto pilota da 400l/h, riproducente, in scala, la linea di potabilizzazione su ricordata, per studiare le caratteristiche del PAA anche in prove piu' probanti condotte in flusso. In tali prove sono state sostanzialmente riconfermate le cinetiche delle reazioni spontanee di dirolisi a CH{sub 3}COOH+H{sub 2}O{sub 2} e di

Long-term fate of depleted uranium at Aberdeen and Yuma Proving Grounds: Human health and ecological risk assessments

Energy Technology Data Exchange (ETDEWEB)

Ebinger, M.H.; Beckman, R.J.; Myers, O.B. [Los Alamos National Lab., NM (United States); Kennedy, P.L.; Clements, W.; Bestgen, H.T. [Colorado State Univ., Ft. Collins, CO (United States). Dept. of Fishery and Wildlife Biology

1996-09-01

The purpose of this study was to evaluate the immediate and long-term consequences of depleted uranium (DU) in the environment at Aberdeen Proving Ground (APG) and Yuma Proving Ground (YPG) for the Test and Evaluation Command (TECOM) of the US Army. Specifically, we examined the potential for adverse radiological and toxicological effects to humans and ecosystems caused by exposure to DU at both installations. We developed contaminant transport models of aquatic and terrestrial ecosystems at APG and terrestrial ecosystems at YPG to assess potential adverse effects from DU exposure. Sensitivity and uncertainty analyses of the initial models showed the portions of the models that most influenced predicted DU concentrations, and the results of the sensitivity analyses were fundamental tools in designing field sampling campaigns at both installations. Results of uranium (U) isotope analyses of field samples provided data to evaluate the source of U in the environment and the toxicological and radiological doses to different ecosystem components and to humans. Probabilistic doses were estimated from the field data, and DU was identified in several components of the food chain at APG and YPG. Dose estimates from APG data indicated that U or DU uptake was insufficient to cause adverse toxicological or radiological effects. Dose estimates from YPG data indicated that U or DU uptake is insufficient to cause radiological effects in ecosystem components or in humans, but toxicological effects in small mammals (e.g., kangaroo rats and pocket mice) may occur from U or DU ingestion. The results of this study were used to modify environmental radiation monitoring plans at APG and YPG to ensure collection of adequate data for ongoing ecological and human health risk assessments.

Long-term fate of depleted uranium at Aberdeen and Yuma Proving Grounds: Human health and ecological risk assessments

International Nuclear Information System (INIS)

Ebinger, M.H.; Beckman, R.J.; Myers, O.B.; Kennedy, P.L.; Clements, W.; Bestgen, H.T.

1996-09-01

The purpose of this study was to evaluate the immediate and long-term consequences of depleted uranium (DU) in the environment at Aberdeen Proving Ground (APG) and Yuma Proving Ground (YPG) for the Test and Evaluation Command (TECOM) of the US Army. Specifically, we examined the potential for adverse radiological and toxicological effects to humans and ecosystems caused by exposure to DU at both installations. We developed contaminant transport models of aquatic and terrestrial ecosystems at APG and terrestrial ecosystems at YPG to assess potential adverse effects from DU exposure. Sensitivity and uncertainty analyses of the initial models showed the portions of the models that most influenced predicted DU concentrations, and the results of the sensitivity analyses were fundamental tools in designing field sampling campaigns at both installations. Results of uranium (U) isotope analyses of field samples provided data to evaluate the source of U in the environment and the toxicological and radiological doses to different ecosystem components and to humans. Probabilistic doses were estimated from the field data, and DU was identified in several components of the food chain at APG and YPG. Dose estimates from APG data indicated that U or DU uptake was insufficient to cause adverse toxicological or radiological effects. Dose estimates from YPG data indicated that U or DU uptake is insufficient to cause radiological effects in ecosystem components or in humans, but toxicological effects in small mammals (e.g., kangaroo rats and pocket mice) may occur from U or DU ingestion. The results of this study were used to modify environmental radiation monitoring plans at APG and YPG to ensure collection of adequate data for ongoing ecological and human health risk assessments

Characteristics of Difficult-to-Place Youth in State Custody: A Profile of the Exceptional Care Pilot Project Population

Science.gov (United States)

Armour, Marilyn P.; Schwab, James

2007-01-01

This study examines the characteristics of Texas youth designated as "most difficult to place" recipients of service under the "Exceptional Care Pilot Project" (N = 46). Findings include, among others, high levels of comorbid psychiatric disturbance (greater than 3 diagnostic groupings), physical (78.3%) and sexual (88%)…

Easy and difficult performance-approach goals : Their moderating effect on the link between task interest and performance attainment

NARCIS (Netherlands)

Blaga, Monica; Van Yperen, N.W.

2008-01-01

The purpose of this study was to demonstrate that the positive link between task interest and performance attainment can he negatively affected by the pursuit of difficult performance-approach goals. This was tested in a sample of 60 undergraduate Students at a Dutch university, In line with

An expert panel-based study on recognition of gastro-esophageal reflux in difficult esophageal pH-impedance tracings

NARCIS (Netherlands)

Smits, M. J.; Loots, C. M.; van Wijk, M. P.; Bredenoord, A. J.; Benninga, M. A.; Smout, A. J. P. M.

2015-01-01

Despite existing criteria for scoring gastro-esophageal reflux (GER) in esophageal multichannel pH-impedance measurement (pH-I) tracings, inter- and intra-rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH-I patterns and

The "enemies within": regions of the genome that are inherently difficult to replicate [version 1; referees: 2 approved

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Rahul Bhowmick

2017-05-01

Full Text Available An unusual feature of many eukaryotic genomes is the presence of regions that appear intrinsically difficult to copy during the process of DNA replication. Curiously, the location of these difficult-to-replicate regions is often conserved between species, implying a valuable role in some aspect of genome organization or maintenance. The most prominent class of these regions in mammalian cells is defined as chromosome fragile sites, which acquired their name because of a propensity to form visible gaps/breaks on otherwise-condensed chromosomes in mitosis. This fragility is particularly apparent following perturbation of DNA replication—a phenomenon often referred to as “replication stress”. Here, we review recent data on the molecular basis for chromosome fragility and the role of fragile sites in the etiology of cancer. In particular, we highlight how studies on fragile sites have provided unexpected insights into how the DNA repair machinery assists in the completion of DNA replication.

Les difficultés de la replantation. Quel avenir pour le cacao en Côte d’Ivoire ?

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Ruf François

2001-11-01

Full Text Available La conférence internationale sur le thème « Quel avenir pour les cultures pérennes ? » est née de deux préoccupations. La première recouvre le champ des difficultés de la replantation, difficultés techniques, économiques mais aussi environnementales, sociales et politiques : comment replanter 1 ? La seconde est la baisse des cours, probablement structurelle, de la plupart des matières premières agricoles, notamment de celles produites par des cultures pérennes. Si les prix restent aussi bas de façon aussi durable, pourquoi replanter ? De même qu’il est toujours de bon aloi d’acheter des actions quand la bourse s’écroule, les économistes recommandent de planter quand les cours des matières premières sont à leur plancher. Toutefois, si des centaines de milliers d’hectares sont plantés par des producteurs qui anticipent une remontée des cours, celle-ci peut alors être fort retardée. Cette capacité à anticiper un retour à des prix élevés est ainsi une des causes du prolongement de la phase des très bas prix du cacao jusqu’en 2001, ce qui semble bien relever d’un échec du marché 2. Le pourquoi et le comment de la replantation sont bien indissociables. Face aux enjeux, de nombreux pays détenteurs du patrimoine « cultures pérennes tropicales » ne manquent-ils pas d’une véritable politique de replantation prenant acte des changements nécessaires dans les conditions de production, se remettant en cause, tout en faisant face aux difficultés à interpréter les marchés ? Les problèmes de replantation ne peuvent se surmonter qu’à partir d’une compréhension des processus en œuvre, sur le terrain, en commençant par les décisions des producteurs. Les exemples, les études de cas, par village, par région, restent donc des fondamentaux pour une réflexion globale, pour une anticipation des problèmes, une action nationale, voire internationale, sur la replantation. En même temps, la question de

Anterior cysts of the spine: a difficult differential diagnosis to amyotrophic lateral sclerosis.

Science.gov (United States)

Schmalbach, S; Petri, S; Götz, F; Dengler, R; Krampfl, K

2008-11-01

We describe three patients referred to our ALS/MND clinic with suspected diagnosis of amyotrophic lateral sclerosis (ALS). The patients were all male, middle aged, and their initial symptoms were weakness and fasciculations in upper limb muscles. Results of clinical and electrophysiological examination in all cases were in accordance with possible ALS according to the revised El Escorial criteria. Other conditions mimicking ALS appeared to be excluded by extensive technical examinations and laboratory tests. Only repeated MRI examinations revealed anterior spinal cysts several years after symptom onset. This report intends to highlight this rare and difficult differential diagnosis of ALS and underlines the value of the revised El Escorial criteria in conjunction with electrophysiology to asses the certainty of the diagnosis ALS.

Does ego development increase during midlife? The effects of openness and accommodative processing of difficult events.

Science.gov (United States)

Lilgendahl, Jennifer Pals; Helson, Ravenna; John, Oliver P

2013-08-01

Although Loevinger's model of ego development is a theory of personality growth, there are few studies that have examined age-related change in ego level over developmentally significant periods of adulthood. To address this gap in the literature, we examined mean-level change and individual differences in change in ego level over 18 years of midlife. In this longitudinal study, participants were 79 predominantly White, college-educated women who completed the Washington University Sentence Completion Test in early (age 43) and late (age 61) midlife as well as measures of the trait of Openness (ages 21, 43, 52, and 61) and accommodative processing (assessed from narratives of difficult life events at age 52). As hypothesized, the sample overall showed a mean-level increase in ego level from age 43 to age 61. Additionally, a regression analysis showed that both the trait of Openness at age 21 and accommodative processing of difficult events that occurred during (as opposed to prior to) midlife were each predictive of increasing ego level from age 43 to age 61. These findings counter prior claims that ego level remains stable during adulthood and contribute to our understanding of the underlying processes involved in personality growth in midlife. © 2012 Wiley Periodicals, Inc.

Detecting Latent Prints on Stone and Other Difficult Porous Surfaces via Indanedione/Zinc Chloride and Laser

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Shiquan LIU

2016-01-01

Full Text Available Lasers and alternate light sources have been recognized as effective tools for latent print detection for over three decades. Luminescence often increases friction ridge contrast to reveal impressions otherwise undetectable. Indanedione/zinc chloride excited by a forensic light source is widely recognized as an effective process for developing latent prints on porous surfaces. This study was designed to evaluate the use of a combination of luminescence excitation and indanedione with zinc chloride to detect latent prints on stones, bricks, and similar difficult porous surfaces. The wavelengths evaluated included 400 nm (violet, 447 nm (blue, 532 nm (green, and 645 nm (red. Latent prints were deposited on a variety of porous surfaces including bricks, cement stones, wood, and cotton fabric, all commonly encountered at crime scenes in China. The surfaces were examined using white light (light-emitting diode flashlight and laser light sources separately, both before and after treatment with indanedione/zinc chloride. The goal of this study was to evaluate various light sources for their effectiveness in detecting impressions developed by indanedione/zinc chloride on difficult porous surfaces. Results indicated that latent prints on some brick and cement stone surfaces may be effectively detected using 532 nm laser excitation after indanedione/zinc chloride processing.

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

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Garrett Joanne M

2006-10-01

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

The three-photon vertex

International Nuclear Information System (INIS)

Delbourgo, R.

1976-01-01

Owing to weak interactions, the three-photon vertex is non-zero. From gauge invariance and symmetry requirements, it is proved that the C = -1P = - 1 vertex amplitudes are at least of order q 7 in the limit of soft photon momentum q and that if any two photons are placed on mass shell the form factors vanish identically. (author)

Rules and technical tricks in extremely difficult laparoscopic cholecystectomies

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Liviu Drăghici

2017-11-01

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

Effect of Ultrasound-Guided Placement of Difficult-to-Place Peripheral Venous Catheters

DEFF Research Database (Denmark)

Partovi-Deilami, Kohyar; Nielsen, Jesper K.; Møller, Ann M.

2016-01-01

operated by nurse anesthetists for these patients. This prospective observational study with a pre/post design focused on inpatients with DIVA referred for PVC placement, a service provided by nurse anesthetists in most Scandinavian hospitals. The rate of success, procedure time, number of skin punctures......) with ultrasound. Procedure time was reduced from 20 to 10 minutes, discomfort was unchanged, and the median number of skin punctures decreased from 3 to 2. The incidence of central venous catheter placement dropped from 34% to 7%. Implementation of a training program and a mobile service in which nurse......, discomfort, catheter size, location, and incidence of central venous catheter placement are reported before and after implementation of a training program and a mobile service using ultrasound to place difficult-to-place PVCs. The success rate increased from 0% (0 of 33 patients) to 83% (58 of 70 patients...

Undergoing an immunization is effortlessly, manageable or difficult according to five-year-old children.

Science.gov (United States)

Harder, Maria; Christensson, Kyllike; Söderbäck, Maja

2015-06-01

To prevent diseases among children they regularly undergo immunizations. Previous research show different approaches available to facilitate immunization-procedures for children to protect them from harm. To complement this research and provide care suited for children, research recognizing their perceptions of undergoing such a procedure is needed. The aim of this study was to describe 5-year-old children's perceptions of undergoing an immunization. A phenomenographic approach and analysis was used to describe the children's (n = 21) various perceptions. The data-collection was accomplished directly after the immunization to grasp the children's immediate perceptions. Drawings and reflective talks were used as they are considered as suitable methods when involving young children in research. The right to conduct research with children was approved by the appropriate research ethics committee and also by each child and the parents. The findings show that children's perceptions of an immunization-procedure may vary from effortlessly, to manageable or difficult. Regardless of how the child perceive the immunization-procedure each perception embrace the children's descriptions of actors and articles in the situation, their feelings in the situation and also their actions to deal with the immunization. Nevertheless, these descriptions vary according to how the children perceive the immunization as effortlessly, manageable or difficult. Children's and adults' perceptions of medical procedures may differ and children need guidance, time and space to deal with them. Recognizing children's perceptions of undergoing an immunization contributes to the promotion of their right to be involved in their own health care and towards the development of child-centred care. © 2014 Nordic College of Caring Science.

An expert panel-based study on recognition of gastro-esophageal reflux in difficult esophageal pH-impedance tracings.

Science.gov (United States)

Smits, M J; Loots, C M; van Wijk, M P; Bredenoord, A J; Benninga, M A; Smout, A J P M

2015-05-01

Despite existing criteria for scoring gastro-esophageal reflux (GER) in esophageal multichannel pH-impedance measurement (pH-I) tracings, inter- and intra-rater variability is large and agreement with automated analysis is poor. To identify parameters of difficult to analyze pH-I patterns and combine these into a statistical model that can identify GER episodes with an international consensus as gold standard. Twenty-one experts from 10 countries were asked to mark GER presence for adult and pediatric pH-I patterns in an online pre-assessment. During a consensus meeting, experts voted on patterns not reaching majority consensus (>70% agreement). Agreement was calculated between raters, between consensus and individual raters, and between consensus and software generated automated analysis. With eight selected parameters, multiple logistic regression analysis was performed to describe an algorithm sensitive and specific for detection of GER. Majority consensus was reached for 35/79 episodes in the online pre-assessment (interrater κ = 0.332). Mean agreement between pre-assessment scores and final consensus was moderate (κ = 0.466). Combining eight pH-I parameters did not result in a statistically significant model able to identify presence of GER. Recognizing a pattern as retrograde is the best indicator of GER, with 100% sensitivity and 81% specificity with expert consensus as gold standard. Agreement between experts scoring difficult impedance patterns for presence or absence of GER is poor. Combining several characteristics into a statistical model did not improve diagnostic accuracy. Only the parameter 'retrograde propagation pattern' is an indicator of GER in difficult pH-I patterns. © 2015 John Wiley & Sons Ltd.

Supporting clinical management of the difficult-to-treat TB cases: the ERS-WHO TB Consilium

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Lia D’Ambrosio

2015-03-01

The primary objective of the ERS/WHO TB Consilium is to provide clinical consultation for drug-resistant TB and other difficult-to-treat TB cases, including co-infection with HIV and paediatric cases. Through technical guidance to clinicians managing complex TB cases, the main contribution and outcome of the initiative will be a public health response aimed at achieving correct treatment of affected patients and preventing further development of drug resistance. The Consilum's secondary objective is to ensure monitoring and evaluation of clinical practices on the ground (diagnosis, treatment and prevention.

Determination of difficult concepts in the interpretation of musculoskeletal radiographs using a web-based learning/teaching tool

International Nuclear Information System (INIS)

Nunn, Heidi; Nunn, David L.

2011-01-01

Aim: To identify which aspects of musculoskeletal radiograph image interpretation users of a web-based learning resource found to be most difficult. Method: The resource provides modular online training, based on twelve musculoskeletal anatomical and pathological areas. At the end of each module is a multiple choice self-test, which users can utilize to consolidate their learning. There are 217 questions within the tests. The results for all questions answered on or before 1st February 2011 were analyzed, and the lowest scoring 25% of questions subsequently reviewed. A low-scoring question implies that the subject was difficult. Results: Users provided a total of 117,097 answers. The range of scores provided by the test questions varied significantly (P < 0.0001), from 15.8% to 93.8%. Topics appearing in the lowest quartile were analyzed in detail. They included interpretation of paediatric radiographs, the Salter-Harris classification, soft-tissue signs and the identification of multiple injuries. The lowest scoring modules were the shoulder and ankle. Conclusion: The results of this study will help to guide educators both within radiography and other health professions in providing more targeted teaching in musculoskeletal image interpretation.

Storms, channel changes, and a sediment budget for an urban-suburban stream, Difficult Run, Virginia, USA

Science.gov (United States)

Gellis, Allen C.; Myers, Michael; Noe, Gregory; Hupp, Cliff R.; Shenk, Edward; Myers, Luke

2017-01-01

Determining erosion and deposition rates in urban-suburban settings and how these processes are affected by large storms is important to understanding geomorphic processes in these landscapes. Sediment yields in the suburban and urban Upper Difficult Run are among the highest ever recorded in the Chesapeake Bay watershed, ranging from 161 to 376 Mg/km2/y. Erosion and deposition of streambanks, channel bed, and bars and deposition of floodplains were monitored between 1 March 2010 and 18 January 2013 in Upper Difficult Run, Virginia, USA. We documented the effects of two large storms, Tropical Storm Lee (September 2011), a 100-year event, and Super Storm Sandy (October 2012) a 5-year event, on channel erosion and deposition. Variability in erosion and deposition rates for all geomorphic features, temporally and spatially, are important conclusions of this study. Tropical Storm Lee was an erosive event, where erosion occurred on 82% of all streambanks and where 88% of streambanks that were aggrading before Tropical Storm Lee became erosional. Statistical analysis indicated that drainage area explains linear changes (cm/y) in eroding streambanks and that channel top width explains cross-sectional area changes (cm2/y) in eroding streambanks and floodplain deposition (mm/y). A quasi-sediment budget constructed for the study period using the streambanks, channel bed, channel bars, and floodplain measurements underestimated the measured suspended-sediment load by 61% (2130 Mg/y). Underestimation of the sediment load may be caused by measurement errors and to contributions from upland sediment sources, which were not measured but estimated at 36% of the gross input of sediment. Eroding streambanks contributed 42% of the gross input of sediment and accounted for 70% of the measured suspended-sediment load. Similar to other urban watersheds, the large percentage of impervious area in Difficult Run and direct runoff of precipitation leads to increased streamflow and