Severe childhood malnutrition.

Science.gov (United States)

Bhutta, Zulfiqar A; Berkley, James A; Bandsma, Robert H J; Kerac, Marko; Trehan, Indi; Briend, André

2017-09-21

The main forms of childhood malnutrition occur predominantly in children malnutrition. Here, we use the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.

Severe Aplastic Anemia (SAA)

Science.gov (United States)

... page Print this page My Cart Severe aplastic anemia (SAA) Severe aplastic anemia (SAA) is a disease ... leukemia (ALL) Other diseases What is severe aplastic anemia (SAA)? SAA is a bone marrow disease. The ...

The Airway Microbiome in Severe Asthma: Associations with Disease Features and Severity

Science.gov (United States)

Huang, Yvonne J.; Nariya, Snehal; Harris, Jeffrey M.; Lynch, Susan V.; Choy, David F.; Arron, Joseph R.; Boushey, Homer

2015-01-01

Background Asthma is heterogeneous, and airway dysbiosis is associated with clinical features in mild-moderate asthma. Whether similar relationships exist among patients with severe asthma is unknown. Objective To evaluate relationships between the bronchial microbiome and features of severe asthma. Methods Bronchial brushings from 40 participants in the BOBCAT study (Bronchoscopic Exploratory Research Study of Biomarkers in Corticosteroid-refractory Asthma) were evaluated using 16S rRNA-based methods. Relationships to clinical and inflammatory features were analyzed among microbiome-profiled subjects. Secondarily, bacterial compositional profiles were compared between severe asthmatics, and previously studied healthy controls (n=7), and mild-moderate asthma subjects (n=41). Results In severe asthma, bronchial bacterial composition was associated with several disease-related features, including body-mass index (BMI; Bray-Curtis distance PERMANOVA, p < 0.05), changes in Asthma Control Questionnaire (ACQ) scores (p < 0.01), sputum total leukocytes (p = 0.06) and bronchial biopsy eosinophils (per mm2; p = 0.07). Bacterial communities associated with worsening ACQ and sputum total leukocytes (predominantly Proteobacteria) differed markedly from those associated with BMI (Bacteroidetes/Firmicutes). In contrast, improving/stable ACQ and bronchial epithelial gene expression of FKBP5, an indicator of steroid responsiveness, correlated with Actinobacteria. Mostly negative correlations were observed between biopsy eosinophils and Proteobacteria. No taxa were associated with a T-helper type 2-related epithelial gene expression signature, but expression of Th17-related genes was associated with Proteobacteria. Severe asthma subjects, compared to healthy controls or mild-moderate asthmatics, were significantly enriched in Actinobacteria, although the largest differences observed involved a Klebsiella genus member (7.8 fold-increase in severe asthma, padj < 0.001) Conclusions

Severe childhood malnutrition

DEFF Research Database (Denmark)

Bhutta, Zulfiqar A; Berkley, James A; Bandsma, Robert H J

2017-01-01

The main forms of childhood malnutrition occur predominantly in children malnutrition. Here, we use...... the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal...... nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide...

De-severing distance

DEFF Research Database (Denmark)

Jensen, Hanne Louise; de Neergaard, Maja

2016-01-01

De-severing Distance This paper draws on the growing body of mobility literature that shows how mobility can be viewed as meaningful everyday practices (Freudendal –Pedersen 2007, Cresswell 2006) this paper examines how Heidegger’s term de-severing can help us understand the everyday coping with ...

Heartburn Severity Does Not Predict Disease Severity in Patients With Erosive Esophagitis

Science.gov (United States)

Fennerty, M. Brian; Johnson, David A.

2006-01-01

Background For patients with gastroesophageal reflux disease (GERD), it is often assumed by treating physicians that the severity of heartburn correlates with the severity of erosive esophagitis (EE). Objective This is a post hoc analysis of data from 5 clinical trials that investigate the relationship between the baseline severity of heartburn and the baseline severity of EE. Methods Patients with endoscopically confirmed EE were assessed for heartburn symptoms with a 4-point scale at baseline and during treatment for 8 weeks with various proton pump inhibitors in 5 double-blind trials in which esomeprazole was the common comparator. EE was graded with the Los Angeles (LA) classification system. In these trials, healing and symptom response were evaluated by endoscopy and questionnaire after 4 weeks of treatment. Patients who were not healed were treated for an additional 4 weeks and reevaluated. Results A total of 11,945 patients with endoscopically confirmed EE participated in the 5 trials, with patients receiving esomeprazole 40 mg (n = 5068), esomeprazole 20 mg (n = 1243), omeprazole 20 mg (n = 3018), or lansoprazole 30 mg (n = 2616). Approximately one quarter of the 11,945 GERD patients in these 5 trials had severe EE (defined as LA grades C or D), regardless of their baseline heartburn severity. Conclusion The severity of GERD symptoms does not correlate well with disease severity. These findings indicate that endoscopy may have value in GERD patients in identifying those with EE, and if empirical therapy is chosen, then longer courses (4-8 weeks) of antisecretory therapy may be necessary to ensure healing of unrecognized esophagitis. PMID:16926745

Currency flaw severity. [Banknotes

Energy Technology Data Exchange (ETDEWEB)

Johnson, C.; Burnett, M.; Goodman, C.; Sherrod, R.; Schmoyer, R.; Harrison, C.; Uppuluri, R.

1986-01-01

A survey of currency flaw severity was carried out using 300 banknotes and 37 judges. Each judge assigned each note to one of five flaw severity categories. These categories correspond to severity grades of 1 to 5 with 1 equivalent to ''always accepted'' and 5 ''never accepted.'' An average flaw severity grade for each note was obtained by taking the mean of the severity grades assigned to that note by the 37 judges. Thus, each note has a single numerical real-number flaw grade between 1 and 5. Mathematical modeling of the currency flaw survey results is continuing with some very promising initial results. Our present model handles common excess ink and missing ink flaw types quite well. We plan to extend the model to ink level, mash, setoff and blanket impression flaw types.

Congenital Anorectal Malformation Severity Does Not Predict Severity of Congenital Heart Defects.

Science.gov (United States)

Jonker, Jara E; Liem, Eryn T; Elzenga, Nynke J; Molenbuur, Bouwe; Trzpis, Monika; Broens, Paul M A

2016-12-01

To determine the prevalence of congenital heart defects (CHDs) in patients with mild or severe congenital anorectal malformations (CARMs), and whether all patients with CARM need pediatric cardiology screening. We included 129 patients with CARM born between 2004 and 2013, and referred to University Medical Center Groningen. Recto-perineal and recto-vestibular fistulas were classified as mild CARMs, all others as severe. Significant patent foramen ovale, secundum atrial septal defect, and small ventricular septum defect were classified as minor CHDs, all others as major. Of 129 patients with CARM, 67% had mild CARM, 33% severe CARM, and 17% were additionally diagnosed with CHD. CHDs were distributed equally in patients with mild or severe CARMs. Patients with multiple congenital abnormalities were more frequently diagnosed with CHD (n = 16, 36%) than patients without multiple congenital malformations (n = 5, 9%, P = .001). Patients with CARM diagnosed with CHD using pediatric cardiac echo screening were younger than 3 months of age at diagnosis. Earlier general pediatric examinations missed 7 (50%) children with mild and 4 (50%) with severe CHDs. The severity of CARM could predict neither prevalence nor severity of CHD. More than one-half of CHDs were missed during the first physical examination. No new CHDs were found in patients older than 3 months of age at the time CARMs were diagnosed. We recommend screening all patients with CARM younger than 3 months of age for CHD at the time CARM is diagnosed. Preoperative echocardiography should be the rule in children younger than 3 months of age and with multiple congenital anomalies. Copyright © 2016 Elsevier Inc. All rights reserved.

Allergy in severe asthma.

Science.gov (United States)

Del Giacco, S R; Bakirtas, A; Bel, E; Custovic, A; Diamant, Z; Hamelmann, E; Heffler, E; Kalayci, Ö; Saglani, S; Sergejeva, S; Seys, S; Simpson, A; Bjermer, L

2017-02-01

It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Cost per severe accident as an index for severe accident consequence assessment and its applications

International Nuclear Information System (INIS)

Silva, Kampanart; Ishiwatari, Yuki; Takahara, Shogo

2014-01-01

The Fukushima Accident emphasizes the need to integrate the assessments of health effects, economic impacts, social impacts and environmental impacts, in order to perform a comprehensive consequence assessment of severe accidents in nuclear power plants. “Cost per severe accident” is introduced as an index for that purpose. The calculation methodology, including the consequence analysis using level 3 probabilistic risk assessment code OSCAAR and the calculation method of the cost per severe accident, is proposed. This methodology was applied to a virtual 1,100 MWe boiling water reactor. The breakdown of the cost per severe accident was provided. The radiation effect cost, the relocation cost and the decontamination cost were the three largest components. Sensitivity analyses were carried out, and parameters sensitive to cost per severe accident were specified. The cost per severe accident was compared with the amount of source terms, to demonstrate the performance of the cost per severe accident as an index to evaluate severe accident consequences. The ways to use the cost per severe accident for optimization of radiation protection countermeasures and for estimation of the effects of accident management strategies are discussed as its applications. - Highlights: • Cost per severe accident is used for severe accident consequence assessment. • Assessments of health, economic, social and environmental impacts are included. • Radiation effect, relocation and decontamination costs are important cost components. • Cost per severe accident can be used to optimize radiation protection measures. • Effects of accident management can be estimated using the cost per severe accident

Severity parameters for steam cracking

NARCIS (Netherlands)

Golombok, M.; Bijl, J.L.M.; Kornegoor, M.

2001-01-01

There are several ways to measure severity in steam cracking which are all a function of residence time, temperature, and pressure. Many measures of severity are not practicable for experimental purposes. Our experimental study shows that methane make is the best measure of severity because it is an

Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery.

Science.gov (United States)

Na, Boo Suk; Cho, Jin Whan; Park, Kwan; Kwon, Soonwook; Kim, Ye Sel; Kim, Ji Sun; Youn, Jinyoung

2018-04-27

Hemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD). We enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups. The severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD. Spasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD. Copyright © 2018 Korean Neurological Association.

Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis

Directory of Open Access Journals (Sweden)

Jin Hwan Kim

2017-12-01

Full Text Available Severe osteoporosis is classified as those with a bone mineral density (BMD T-score of −2.5 or lower, and demonstrate one or more of osteoporotic, low-trauma, fragility fractures. According to the general principle of surgical approach, patients with severe osteoporosis require not only more thorough pre- and postoperative treatment plans, but improvements in surgical fixtures and techniques such as the concept of a locking plate to prevent bone deformity and maximizing the blood flow to the fracture site by using a minimally invasive plate osteosynthesis. Arthroplasty is often performed in cases of displaced femoral neck fracture. Otherwise internal fixation for the goal of bone union is the generally accepted option for intertrochanteric, subtrochanteric, and femoral shaft fractures. Most of osteoporotic spine fracture is stable compression fracture, but vertebroplasty or kyphoplasty may be performed some selective patients. If neurological paralysis, severe spinal instability, or kyphotic deformity occurs, open decompression or fusion surgery may be considered. In order to overcome shortcomings of the World Health Organization definition of osteoporosis, we proposed a concept of ‘advanced severe osteoporosis,’ which is defined by the presence of proximal femur fragility fracture or two or more fragility fractures in addition to BMD T-score of −2.5 or less. In conclusion, we need more meticulous approach for surgical treatment of severe osteoporosis who had fragility fracture. In cases of advanced severe osteoporosis, we recommend more aggressive managements using parathyroid hormone and receptor activator of nuclear factor kappa-B ligand monoclonal antibody.

Severe malaria in Europe

DEFF Research Database (Denmark)

Kurth, Florian; Develoux, Michel; Mechain, Matthieu

2017-01-01

BACKGROUND: Malaria remains one of the most serious infections for travellers to tropical countries. Due to the lack of harmonized guidelines a large variety of treatment regimens is used in Europe to treat severe malaria. METHODS: The European Network for Tropical Medicine and Travel Health (Trop......Net) conducted an 8-year, multicentre, observational study to analyse epidemiology, treatment practices and outcomes of severe malaria in its member sites across Europe. Physicians at participating TropNet centres were asked to report pseudonymized retrospective data from all patients treated at their centre...... for microscopically confirmed severe Plasmodium falciparum malaria according to the 2006 WHO criteria. RESULTS: From 2006 to 2014 a total of 185 patients with severe malaria treated in 12 European countries were included. Three patients died, resulting in a 28-day survival rate of 98.4%. The majority of infections...

Several real variables

CERN Document Server

Kantorovitz, Shmuel

2016-01-01

This undergraduate textbook is based on lectures given by the author on the differential and integral calculus of functions of several real variables. The book has a modern approach and includes topics such as: •The p-norms on vector space and their equivalence •The Weierstrass and Stone-Weierstrass approximation theorems •The differential as a linear functional; Jacobians, Hessians, and Taylor's theorem in several variables •The Implicit Function Theorem for a system of equations, proved via Banach’s Fixed Point Theorem •Applications to Ordinary Differential Equations •Line integrals and an introduction to surface integrals This book features numerous examples, detailed proofs, as well as exercises at the end of sections. Many of the exercises have detailed solutions, making the book suitable for self-study. Several Real Variables will be useful for undergraduate students in mathematics who have completed first courses in linear algebra and analysis of one real variable.

Severe Bleeding: First Aid

Science.gov (United States)

... 12, 2017. Jevon P, et al. Part 5 — First-aid treatment for severe bleeding. Nursing Times. 2008;104:26. Oct. 19, 2017 Original article: http://www.mayoclinic.org/first-aid/first-aid-severe-bleeding/basics/ART-20056661 . Mayo ...

Palmer Drought Severity Index

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — PDSI from the Dai dataset. The Palmer Drought Severity Index (PDSI) is devised by Palmer (1965) to represent the severity of dry and wet spells over the U.S. based...

Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study.

Directory of Open Access Journals (Sweden)

Mohammod Jobayer Chisti

Full Text Available In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children.In this retrospective case-control study SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50 with those without severe sepsis (controls = 354. Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline.The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001. In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons.We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.

Needs of Persons with Severe Intellectual Disabilities: A Q-Methodological Study of Clients with Severe Behavioural Disorders and Severe Intellectual Disabilities

Science.gov (United States)

Kreuger, Linda; van Exel, Job; Nieboer, Anna

2008-01-01

Background: A demand-oriented approach is becoming increasingly important in care provision. The purpose of this study was to identify the primary needs of clients with Severe Behavioural Disorders and Severe Intellectual Disabilities. Materials and Methods: We used the theory of Social Production Function and Maslow's hierarchy of needs to…

Current concepts of severe asthma

Science.gov (United States)

Raundhal, Mahesh; Oriss, Timothy B.; Ray, Prabir; Wenzel, Sally E.

2016-01-01

The term asthma encompasses a disease spectrum with mild to very severe disease phenotypes whose traditional common characteristic is reversible airflow limitation. Unlike milder disease, severe asthma is poorly controlled by the current standard of care. Ongoing studies using advanced molecular and immunological tools along with improved clinical classification show that severe asthma does not identify a specific patient phenotype, but rather includes patients with constant medical needs, whose pathobiologic and clinical characteristics vary widely. Accordingly, in recent clinical trials, therapies guided by specific patient characteristics have had better outcomes than previous therapies directed to any subject with a diagnosis of severe asthma. However, there are still significant gaps in our understanding of the full scope of this disease that hinder the development of effective treatments for all severe asthmatics. In this Review, we discuss our current state of knowledge regarding severe asthma, highlighting different molecular and immunological pathways that can be targeted for future therapeutic development. PMID:27367183

The airway microbiome in patients with severe asthma: Associations with disease features and severity.

Science.gov (United States)

Huang, Yvonne J; Nariya, Snehal; Harris, Jeffrey M; Lynch, Susan V; Choy, David F; Arron, Joseph R; Boushey, Homer

2015-10-01

Asthma is heterogeneous, and airway dysbiosis is associated with clinical features in patients with mild-to-moderate asthma. Whether similar relationships exist among patients with severe asthma is unknown. We sought to evaluate relationships between the bronchial microbiome and features of severe asthma. Bronchial brushings from 40 participants in the Bronchoscopic Exploratory Research Study of Biomarkers in Corticosteroid-refractory Asthma (BOBCAT) study were evaluated by using 16S ribosomal RNA-based methods. Relationships to clinical and inflammatory features were analyzed among microbiome-profiled subjects. Secondarily, bacterial compositional profiles were compared between patients with severe asthma and previously studied healthy control subjects (n = 7) and patients with mild-to-moderate asthma (n = 41). In patients with severe asthma, bronchial bacterial composition was associated with several disease-related features, including body mass index (P PERMANOVA), changes in Asthma Control Questionnaire (ACQ) scores (P < .01), sputum total leukocyte values (P = .06), and bronchial biopsy eosinophil values (per square millimeter, P = .07). Bacterial communities associated with worsening ACQ scores and sputum total leukocyte values (predominantly Proteobacteria) differed markedly from those associated with body mass index (Bacteroidetes/Firmicutes). In contrast, improving/stable ACQ scores and bronchial epithelial gene expression of FK506 binding protein (FKBP5), an indicator of steroid responsiveness, correlated with Actinobacteria. Mostly negative correlations were observed between biopsy eosinophil values and Proteobacteria. No taxa were associated with a TH2-related epithelial gene expression signature, but expression of TH17-related genes was associated with Proteobacteria. Patients with severe asthma compared with healthy control subjects or patients with mild-to-moderate asthma were significantly enriched in Actinobacteria, although the largest differences

[Severe depression : psychoanalysis].

Science.gov (United States)

Bouvet de la Maisonneuve, O

2009-12-01

The indication for psychoanalysis in severe depression is not clear. And yet, demands for this type of intervention are increasing, despite the absence of any form of consensus on the subject. Freud considered depression as a failure of analytical efforts and, based on this observation, revised his theory, in particular to include the notions of narcissism and the death drive. Many analysts have been reluctant to follow his teachings on this last point and provide depressed patients with analytical-type therapies aimed at restoring narcissism. Melanie Klein pushed Freud's ideas about depression even further and brought such therapies back to the heart of analytical practice. Jacques Lacan took the debate to another level by proposing an overhaul of the principles on which analysis has been based. Today, while following certain precautionary rules, true psychoanalyses can be proposed to patients with severe depression, whether of the bipolar, recurring or even neurotic type that can reach this level of severity. Copyright 2009 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

Allergy in severe asthma

NARCIS (Netherlands)

Del Giacco, Stefano R.; Bakirtas, A.; Bel, E.; Custovic, A.; Diamant, Z.; Hamelmann, E.; Heffler, E.; Kalayci, O.; Saglani, S.; Sergejeva, S.; Seys, S.; Simpson, A.; Bjermer, Leif

It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps

Severe accident behavior

International Nuclear Information System (INIS)

Denning, R.S.

1986-01-01

The purpose of this paper is to provide an overview of severe accident behavior. The term source term is defined and a brief history of the regulatory use of source term is presented. The processes in severe accidents in light water reactors are described with particular emphasis on the relationships between accident thermal-hydraulics and chemistry. Those factors which have the greatest impact on predicted source terms are identified. Design differences between plants that affect source term estimation are also described. The principal unresolved issues are identified that are the focus of ongoing research and debate in the technical community

Severe fire weather and intensive forest management increase fire severity in a multi-ownership landscape.

Science.gov (United States)

Zald, Harold S J; Dunn, Christopher J

2018-04-26

Many studies have examined how fuels, topography, climate, and fire weather influence fire severity. Less is known about how different forest management practices influence fire severity in multi-owner landscapes, despite costly and controversial suppression of wildfires that do not acknowledge ownership boundaries. In 2013, the Douglas Complex burned over 19,000 ha of Oregon & California Railroad (O&C) lands in Southwestern Oregon, USA. O&C lands are composed of a checkerboard of private industrial and federal forestland (Bureau of Land Management, BLM) with contrasting management objectives, providing a unique experimental landscape to understand how different management practices influence wildfire severity. Leveraging Landsat based estimates of fire severity (Relative differenced Normalized Burn Ratio, RdNBR) and geospatial data on fire progression, weather, topography, pre-fire forest conditions, and land ownership, we asked (1) what is the relative importance of different variables driving fire severity, and (2) is intensive plantation forestry associated with higher fire severity? Using Random Forest ensemble machine learning, we found daily fire weather was the most important predictor of fire severity, followed by stand age and ownership, followed by topographic features. Estimates of pre-fire forest biomass were not an important predictor of fire severity. Adjusting for all other predictor variables in a general least squares model incorporating spatial autocorrelation, mean predicted RdNBR was higher on private industrial forests (RdNBR 521.85 ± 18.67 [mean ± SE]) vs. BLM forests (398.87 ± 18.23) with a much greater proportion of older forests. Our findings suggest intensive plantation forestry characterized by young forests and spatially homogenized fuels, rather than pre-fire biomass, were significant drivers of wildfire severity. This has implications for perceptions of wildfire risk, shared fire management responsibilities, and developing

Severe Accident Research Program plan update

International Nuclear Information System (INIS)

1992-12-01

In August 1989, the staff published NUREG-1365, ''Revised Severe Accident Research Program Plan.'' Since 1989, significant progress has been made in severe accident research to warrant an update to NUREG-1365. The staff has prepared this SARP Plan Update to: (1) Identify those issues that have been closed or are near completion, (2) Describe the progress in our understanding of important severe accident phenomena, (3) Define the long-term research that is directed at improving our understanding of severe accident phenomena and developing improved methods for assessing core melt progression, direct containment heating, and fuel-coolant interactions, and (4) Reflect the growing emphasis in two additional areas--advanced light water reactors, and support for the assessment of criteria for containment performance during severe accidents. The report describes recent major accomplishments in understanding the underlying phenomena that can occur during a severe accident. These include Mark I liner failure, severe accident scaling methodology, source term issues, core-concrete interactions, hydrogen transport and combustion, TMI-2 Vessel Investigation Project, and direct containment heating. The report also describes the major planned activities under the SARP over the next several years. These activities will focus on two phenomenological issues (core melt progression, and fuel-coolant interactions and debris coolability) that have significant uncertainties that impact our understanding and ability to predict severe accident phenomena and their effect on containment performance SARP will also focus on severe accident code development, assessment and validation. As the staff completes the research on severe accident issues that relate to current generation reactors, continued research will focus on efforts to independently evaluate the capability of new advanced light water reactor designs to withstand severe accidents

Seizure Severity Is Correlated With Severity of Hypoxic-Ischemic Injury in Abusive Head Trauma.

Science.gov (United States)

Dingman, Andra L; Stence, Nicholas V; O'Neill, Brent R; Sillau, Stefan H; Chapman, Kevin E

2017-12-12

The objective of this study was to characterize hypoxic-ischemic injury and seizures in abusive head trauma. We performed a retrospective study of 58 children with moderate or severe traumatic brain injury due to abusive head trauma. Continuous electroencephalograms and magnetic resonance images were scored. Electrographic seizures (51.2%) and hypoxic-ischemic injury (77.4%) were common in our cohort. Younger age was associated with electrographic seizures (no seizures: median age 13.5 months, interquartile range five to 25 months, versus seizures: 4.5 months, interquartile range 3 to 9.5 months; P = 0.001). Severity of hypoxic-ischemic injury was also associated with seizures (no seizures: median injury score 1.0, interquartile range 0 to 3, versus seizures: 4.5, interquartile range 3 to 8; P = 0.01), but traumatic injury severity was not associated with seizures (no seizures: mean injury score 3.78 ± 1.68 versus seizures: mean injury score 3.83 ± 0.95, P = 0.89). There was a correlation between hypoxic-ischemic injury severity and seizure burden when controlling for patient age (r s =0.61, P interquartile range 0 to 0.23 on magnetic resonance imaging done within two days versus median restricted diffusion ratio 0.13, interquartile range 0.01 to 0.43 on magnetic resonance imaging done after two days, P = 0.03). Electrographic seizures are common in children with moderate to severe traumatic brain injury from abusive head trauma, and therefore children with suspected abusive head trauma should be monitored with continuous electroencephalogram. Severity of hypoxic-ischemic brain injury is correlated with severity of seizures, and evidence of hypoxic-ischemic injury on magnetic resonance imaging may evolve over time. Therefore children with a high seizure burden should be reimaged to evaluate for evolving hypoxic-ischemic injury. Published by Elsevier Inc.

Severe accident management guidelines tool

International Nuclear Information System (INIS)

Gutierrez Varela, Javier; Tanarro Onrubia, Augustin; Martinez Fanegas, Rafael

2014-01-01

Severe Accident is addressed by means of a great number of documents such as guidelines, calculation aids and diagnostic trees. The response methodology often requires the use of several documents at the same time while Technical Support Centre members need to assess the appropriate set of equipment within the adequate mitigation strategies. In order to facilitate the response, TECNATOM has developed SAMG TOOL, initially named GGAS TOOL, which is an easy to use computer program that clearly improves and accelerates the severe accident management. The software is designed with powerful features that allow the users to focus on the decision-making process. Consequently, SAMG TOOL significantly improves the severe accident training, ensuring a better response under a real situation. The software is already installed in several Spanish Nuclear Power Plants and trainees claim that the methodology can be followed easier with it, especially because guidelines, calculation aids, equipment information and strategies availability can be accessed immediately (authors)

Severe asthma in childhood

International Nuclear Information System (INIS)

Ciznar, P.

2013-01-01

Patients with severe asthma are clinically, physiologically and biologically a heterogeneous group. About half of children referred for medical examination for severe asthma have true severe, therapy resistant asthma. The rest of referred patients have difficult to treat asthma. Symptoms persist mostly due to drug non-compliance, inappropriate inhalation technique, persistent environmental exposures or co-morbid conditions. Compared with adults have children more frequently atopic form of severe asthma. This is associated with eosinophilia in peripheral blood and sensitization to inhaled allergens. The IgE levels are high. Therapy of co-morbidities and improvement of treatment compliance lead in most cases to full asthma control. Proportion of children will benefit from biologics like anti-IgE monoclonal antibody, administered by subcutaneous injections in 2 to 4 week intervals. By this therapy it is not only possible to suppress symptoms, but also decrease the total steroid dose and the risk of adverse effects associated with its long-term administration. By achieving a full asthma control we lower future risk of exacerbations and probably improve long-term prognosis of disease, frequently persisting for the rest of life. (author)

Severe anemia in Malawian children.

Science.gov (United States)

Calis, Job Cj; Phiri, Kamija S; Faragher, E Brian; Brabin, Bernard J; Bates, Imelda; Cuevas, Luis E; de Haan, Rob J; Phiri, Ajib I; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul Jm; van Lieshout, Lisette; Beld, Marcel Ghm; Teo, Yik Y; Rockett, Kirk A; Richardson, Anna; Kwiatkowski, Dominic P; Molyneux, Malcolm E; van Hensbroek, Michaël Boele

2016-09-01

Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors previously associated with severe anemia were studied. The data were examined by multivariate analysis and structural equation modeling. Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI], 2.6 to 10.9), malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3), hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8), human immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI, 1.0 to 3.8), the G6PD -202/-376 genetic disorder (adjusted odds ratio, 2.4; 95% CI, 1.3 to 4.4), vitamin A deficiency (adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.8), and vitamin B 12 deficiency (adjusted odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe anemia. Folate deficiency, sickle cell disease, and laboratory signs of an abnormal inflammatory response were uncommon. Iron deficiency was not prevalent in case patients (adjusted odds ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with bacteremia. Malaria was associated with severe anemia in the urban site (with seasonal transmission) but not in the rural site (where malaria was holoendemic). Seventy-six percent of hookworm infections were found in children under 2 years of age. There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered.

Accident management for severe accidents

International Nuclear Information System (INIS)

Bari, R.A.; Pratt, W.T.; Lehner, J.; Leonard, M.; Disalvo, R.; Sheron, B.

1988-01-01

The management of severe accidents in light water reactors is receiving much attention in several countries. The reduction of risk by measures and/or actions that would affect the behavior of a severe accident is discussed. The research program that is being conducted by the US Nuclear Regulatory Commission focuses on both in-vessel accident management and containment and release accident management. The key issues and approaches taken in this program are summarized. 6 refs

Co-morbidities in severe asthma

DEFF Research Database (Denmark)

Porsbjerg, Celeste; Menzies-Gow, Andrew

2017-01-01

Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma...... to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical...... impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD...

CE/Bechtel design containment response to severe accident phenomenology: A comparison among several combustion engineering plants

International Nuclear Information System (INIS)

Khalil, Y.F.; Schneider, R.E.

1995-01-01

The objectives of this paper are to: (1) discuss the types of severe accident phenomena that drive containment failure modes in CE plants and (2) contribute to the current state of knowledge of CE/Bechtel-design containment response to severe accident phenomenology. The second objective is addressed by providing a comparative study of containment response to severe accidents among several CE plants including Millstone Unit 2 (MP2), Palisades (Consumers Power), Calvert Cliffs (Baltimore Gas and Electric Company), Palo Verde (Arizona Public Service), and SONGS Units 2 and 3 (Southern California Edison). The motivation for addressing the second objective is based on the current lack of comprehensive literature on CE/Bechtel design containment failure modes and mechanisms for accidents that progress beyond the design basis limits. The first part of this paper addresses severe accident phenomena-related failure mechanisms in CE/Bechtel-designed containments. The second part of this work provides a comparative study of containment response among several CE plants

A discussion on disease severity index values: using the disease severity index for null hypothesis testing

Science.gov (United States)

A disease severity index (DSI) is a single number for summarizing a large amount of information on disease severity. It has been used to indicate the performance of a cultivar in regard to disease resistance at a particular location, to relate disease severity to yield loss, to determine the effecti...

Severe Weather Data Inventory (SWDI)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Severe Weather Data Inventory (SWDI) is an integrated database of severe weather records for the United States. SWDI enables a user to search through a variety...

Severe rosacea: A case report

Directory of Open Access Journals (Sweden)

Ebrahim Shirzadeh

2017-01-01

Conclusion: Rosacea can be extremely severe and disfiguring, and it can be misdiagnosed as the pathognomonic butterfly rash of LE. Demodex carriage in rosacea is consistent and may play a significant role in the severe forms.

Gene Expression Correlated with Severe Asthma Characteristics Reveals Heterogeneous Mechanisms of Severe Disease.

Science.gov (United States)

Modena, Brian D; Bleecker, Eugene R; Busse, William W; Erzurum, Serpil C; Gaston, Benjamin M; Jarjour, Nizar N; Meyers, Deborah A; Milosevic, Jadranka; Tedrow, John R; Wu, Wei; Kaminski, Naftali; Wenzel, Sally E

2017-06-01

Severe asthma (SA) is a heterogeneous disease with multiple molecular mechanisms. Gene expression studies of bronchial epithelial cells in individuals with asthma have provided biological insight and underscored possible mechanistic differences between individuals. Identify networks of genes reflective of underlying biological processes that define SA. Airway epithelial cell gene expression from 155 subjects with asthma and healthy control subjects in the Severe Asthma Research Program was analyzed by weighted gene coexpression network analysis to identify gene networks and profiles associated with SA and its specific characteristics (i.e., pulmonary function tests, quality of life scores, urgent healthcare use, and steroid use), which potentially identified underlying biological processes. A linear model analysis confirmed these findings while adjusting for potential confounders. Weighted gene coexpression network analysis constructed 64 gene network modules, including modules corresponding to T1 and T2 inflammation, neuronal function, cilia, epithelial growth, and repair mechanisms. Although no network selectively identified SA, genes in modules linked to epithelial growth and repair and neuronal function were markedly decreased in SA. Several hub genes of the epithelial growth and repair module were found located at the 17q12-21 locus, near a well-known asthma susceptibility locus. T2 genes increased with severity in those treated with corticosteroids but were also elevated in untreated, mild-to-moderate disease compared with healthy control subjects. T1 inflammation, especially when associated with increased T2 gene expression, was elevated in a subgroup of younger patients with SA. In this hypothesis-generating analysis, gene expression networks in relation to asthma severity provided potentially new insight into biological mechanisms associated with the development of SA and its phenotypes.

Severe hypertriglyceridemia-related acute pancreatitis.

Science.gov (United States)

Stefanutti, Claudia; Labbadia, Giancarlo; Morozzi, Claudia

2013-04-01

Acute pancreatitis is a potentially life-threatening complication of severe hypertriglyceridemia. In some cases, inborn errors of metabolism such as lipoprotein lipase deficiency, apoprotein C-II deficiency, and familial hypertriglyceridemia have been reported as causes of severe hypertriglyceridemia. More often, severe hypertriglyceridemia describes various clinical conditions characterized by high plasma levels of triglycerides (>1000 mg/dL), chylomicron remnants, or intermediate density lipoprotein like particles, and/or chylomicrons. International guidelines on the management of acute pancreatitis are currently available. Standard therapeutic measures are based on the use of lipid-lowering agents (fenofibrate, gemfibrozil, niacin, Ω-3 fatty acids), low molecular weight heparin, and insulin in diabetic patients. However, when standard medical therapies have failed, non-pharmacological approaches based upon the removal of triglycerides with therapeutic plasma exchange can also provide benefit to patients with severe hypertriglyceridemia and acute pancreatitis. Plasma exchange could be very helpful in reducing triglycerides levels during the acute phase of hyperlipidemic pancreatitis, and in the prevention of recurrence. The current evidence on management of acute pancreatitis and severe hypertriglyceridemia, focusing on symptoms, treatment and potential complications is reviewed herein. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns

Directory of Open Access Journals (Sweden)

Ohsfeldt Robert L

2011-10-01

Full Text Available Abstract Background It is well known that older adults figure prominently in the use of emergency departments (ED across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates. Methods Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen's behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects. Results We identified 948 individuals (17.2% of the entire sample who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5% who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52, men (AOR 1.28, current smokers (AOR 1.60, experience diabetes (AOR (AOR 1.80, heart disease (AOR 1.70, hypertension (AOR 1.32 and have a greater amount of

Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns.

Science.gov (United States)

Kaskie, Brian; Obrizan, Maksym; Jones, Michael P; Bentler, Suzanne; Weigel, Paula; Hockenberry, Jason; Wallace, Robert B; Ohsfeldt, Robert L; Rosenthal, Gary E; Wolinsky, Fredric D

2011-10-21

It is well known that older adults figure prominently in the use of emergency departments (ED) across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates. Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen's behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects. We identified 948 individuals (17.2% of the entire sample) who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5%) who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52), men (AOR 1.28), current smokers (AOR 1.60), experience diabetes (AOR (AOR 1.80), heart disease (AOR 1.70), hypertension (AOR 1.32) and have a greater amount of morbidity (AOR 1.48) than those who persistently

Severe accidents in nuclear reactors

International Nuclear Information System (INIS)

Ohai, Dumitru; Dumitrescu, Iulia; Tunaru, Mariana

2004-01-01

The likelihood of accidents leading to core meltdown in nuclear reactors is low. The consequences of such an event are but so severe that developing and implementing of adequate measures for preventing or diminishing the consequences of such events are of paramount importance. The analysis of major accidents requires sophisticated computation codes but necessary are also relevant experiments for checking the accuracy of the predictions and capability of these codes. In this paper an overview of the severe accidents worldwide with definitions, computation codes and relating experiments is presented. The experimental research activity of severe accidents was conducted in INR Pitesti since 2003, when the Institute jointed the SARNET Excellence Network. The INR activity within SARNET consists in studying scenarios of severe accidents by means of ASTEC and RELAP/SCDAP codes and conducting bench-scale experiments

Several complex variables

International Nuclear Information System (INIS)

Field, M.J.

1976-01-01

Topics discussed include the elementary of holomorphic functions of several complex variables; the Weierstrass preparation theorem; meromorphic functions, holomorphic line bundles and divisors; elliptic operators on compact manifolds; hermitian connections; the Hodge decomposition theorem. ( author)

Severe congenital neutropenia (Kostmann Syndrome)

African Journals Online (AJOL)

Severe congenital neutropenia (SCN), Kostmann syndrome is a heterogenous disorder of myelopoiesis characterized by severe chronic ... erogenous hematological disorders, characterized by extremely low circu- lating neutrophils and ..... tic activation of STAT5 and stimulate. G-CSF-induced cell proliferation.26, 27.

Severe accident management guidelines

International Nuclear Information System (INIS)

Uhle, Jennifer

2014-01-01

The events at Fukushima Daiichi have highlighted the importance of Severe Accident Management Guidelines (SAMGs). As the world has learned from the catastrophe and countries are considering changes to their nuclear regulatory programs, the content of SAMGs and their regulatory control are being evaluated. This presentation highlights several factors that are being addressed in the United States as rulemaking is underway pertaining to SAMGs. The question of how to be prepared for the unexpected is discussed with specific insights gleaned from Fukushima. (author)

Severe Psychomotor Delay in a Severe Presentation of Cat-Eye Syndrome

Directory of Open Access Journals (Sweden)

Guillaume Jedraszak

2015-01-01

Full Text Available Cat-eye syndrome is a rare genetic syndrome of chromosomal origin. Individuals with cat-eye syndrome are characterized by the presence of preauricular pits and/or tags, anal atresia, and iris coloboma. Many reported cases also presented with variable congenital anomalies and intellectual disability. Most patients diagnosed with CES carry a small supernumerary bisatellited marker chromosome, resulting in partial tetrasomy of 22p-22q11.21. There are two types of small supernumerary marker chromosome, depending on the breakpoint site. In a very small proportion of cases, other cytogenetic anomalies are reportedly associated with the cat-eye syndrome phenotype. Here, we report a patient with cat-eye syndrome caused by a type 1 small supernumerary marker chromosome. The phenotype was atypical and included a severe developmental delay. The use of array comparative genomic hybridization ruled out the involvement of another chromosomal imbalance in the neurological phenotype. In the literature, only a few patients with cat-eye syndrome present with a severe developmental delay, and all of the latter carried an atypical partial trisomy 22 or an uncharacterized small supernumerary marker chromosome. Hence, this is the first report of a severe neurological phenotype in cat-eye syndrome with a typical type 1 small supernumerary marker chromosome. Our observation clearly complicates prognostic assessment, particularly when cat-eye syndrome is diagnosed prenatally.

Severe accident training simulator APROS SA

International Nuclear Information System (INIS)

Raiko, Eerikki; Salminen, Kai; Lundstroem, Petra; Harti, Mika; Routamo, Tomi

2003-01-01

APROS SA is a severe accident training simulator based on the APROS simulation environment. APROS SA has been developed in Fortum Nuclear Services Ltd to serve as a training tool for the personnel of the Loviisa NPP. Training with APROS SA gives the personnel a deeper understanding of the severe accident phenomena and thus it is an important part of the implementation of the severe accident management strategy. APROS SA consists of two parts, a comprehensive Loviisa plant model and an external severe accident model. The external model is an extension to the Loviisa plant model, which allows the simulation to proceed into the severe accident phase. The severe accident model has three submodels: the core melting and relocation model, corium pool model and fission product model. In addition to these, a new thermal-hydraulic solver is introduced to the core region of the Loviisa plant model to replace the more limited APROS thermal-hydraulic solver. The full APROS SA training simulator has a graphical user interface with visualizations of both severe accident management panels at the operator room and the important physical phenomena during the accident. This paper describes the background of the APROS SA training simulator, the severe accident submodels and the graphical user interface. A short description how APROS SA will be used as a training tool at the Loviisa NPP is also given

Severe Anemia in Malawian Children

NARCIS (Netherlands)

Calis, J.C.J.; Kamija, S.P.; Faragher, E.B.; Brabin, B.J.; Bates, I.; Cuevas, L.E.; Haan, de R.J.; Phiri, A.I.; Malange, P.; Khoka, M.; Hulshof, P.J.M.; Lieshout, L.; Beld, M.G.H.M.; Teo, Y.Y.; Rockett, K.A.; Richardson, A.; Kwiatkowski, D.P.; Molyneux, M.E.; Hensbroek, van M.B.

2008-01-01

Background Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. Methods We conducted a case¿control study of 381 preschool children with severe anemia (hemoglobin concentration,

Functional Limitations in Severe Haemophilia

NARCIS (Netherlands)

Genderen, F.R. van

2006-01-01

This thesis aims to describe the Disablement Process (DP) in Dutch adult patients with severe haemophilia, with specific focus on the domain of “Functional Limitations”. Four main questions underlie this thesis: How can Functional Limitations in severe haemophilia be investigated? Can the

Severe agitation in severe early-onset Alzheimer’s disease resolves with ECT

Directory of Open Access Journals (Sweden)

Aksay SS

2014-11-01

Full Text Available Suna Su Aksay, Lucrezia Hausner, Lutz Frölich, Alexander Sartorius Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Abstract: Dementia-related behavioral disturbances are mostly treated with antipsychotics; however, the observed beneficial effects are modest and the risk of serious adverse effects high. We report the case of a 57-year-old woman with severe early-onset Alzheimer’s disease and severe agitation, whom we treated with electroconvulsive therapy (ECT. A significant clinical improvement was achieved over eight ECT sessions, which were tolerated well without cognitive worsening, and lasted approximately 3 months. Our case demonstrates the safe and effective use of ECT in pharmacotherapy-resistant severe agitation in Alzheimer’s disease. The risk–benefit profile of ECT for dementia-related agitation should be further investigated in clinical trials. Keywords: dementia, electroconvulsive therapy, cognition, emotional distress, disinhibition.

Kiss-induced severe anaphylactic reactions

Directory of Open Access Journals (Sweden)

Atanasković-Marković Marina

2010-01-01

Full Text Available Introduction. Ingestion is the principal route for food allergens to trigger allergic reaction in atopic persons. However, in some highly sensitive patients severe symptoms may develop upon skin contact and by inhalation. The clinical spectrum ranges from mild facial urticaria and angioedema to life-threatening anaphylactic reactions. Outline of Cases. We describe cases of severe anaphylactic reactions by skin contact, induced by kissing in five children with prior history of severe anaphylaxis caused by food ingestion. These cases were found to have the medical history of IgE mediated food allergy, a very high total and specific serum IgE level and very strong family history of allergy. Conclusion. The presence of tiny particles of food on the kisser's lips was sufficient to trigger an anaphylactic reaction in sensitized children with prior history of severe allergic reaction caused by ingestion of food. Allergic reaction provoked with food allergens by skin contact can be a risk factor for generalized reactions. Therefore, extreme care has to be taken in avoiding kissing allergic children after eating foods to which they are highly allergic. Considering that kissing can be a cause of severe danger for the food allergic patient, such persons should inform their partners about the risk factor for causing their food hypersensitivity.

Uncertainties and severe-accident management

International Nuclear Information System (INIS)

Kastenberg, W.E.

1991-01-01

Severe-accident management can be defined as the use of existing and or alternative resources, systems, and actions to prevent or mitigate a core-melt accident. Together with risk management (e.g., changes in plant operation and/or addition of equipment) and emergency planning (off-site actions), accident management provides an extension of the defense-indepth safety philosophy for severe accidents. A significant number of probabilistic safety assessments have been completed, which yield the principal plant vulnerabilities, and can be categorized as (a) dominant sequences with respect to core-melt frequency, (b) dominant sequences with respect to various risk measures, (c) dominant threats that challenge safety functions, and (d) dominant threats with respect to failure of safety systems. Severe-accident management strategies can be generically classified as (a) use of alternative resources, (b) use of alternative equipment, and (c) use of alternative actions. For each sequence/threat and each combination of strategy, there may be several options available to the operator. Each strategy/option involves phenomenological and operational considerations regarding uncertainty. These include (a) uncertainty in key phenomena, (b) uncertainty in operator behavior, (c) uncertainty in system availability and behavior, and (d) uncertainty in information availability (i.e., instrumentation). This paper focuses on phenomenological uncertainties associated with severe-accident management strategies

Relationship of severity of depression, anxiety and stress with severity of fibromyalgia.

Science.gov (United States)

Alok, R; Das, S K; Agarwal, G G; Salwahan, L; Srivastava, R

2011-01-01

Negative affects like depression, anxiety and stress are frequently observed in patients with fibromyalgia (FMS). Understanding the association between FMS and negative affects is likely to help in deciding the choice of treatment. The aim of this study was to determine the correlation between the severity of FMS with the severity of depression, anxiety and stress. Sixty patients with fibromyalgia and 60 healthy controls were included in the study. Fibromyalgia Impact Questionnaire Revised (FIQR), and Depression, Anxiety and Stress Scale (DASS21) were administered to both the groups. The mean age of study population was 40.4±9.9 and 36±8.7 for FMS and control groups respectively. Most of the patients were females (93.3%). In subjects without FMS, depression was seen in 5% and was significantly associated with all three components of FIQR (pdepression, anxiety and stress were found significantly associated with the severity of all three components of FIQR, namely pain, function and symptoms (pdepression, anxiety and stress and in FMS magnitude of negative affects is significantly correlated with FIQR. However, depression alone in absence of FMS can also give rise to all three components of FIQR.

A Computer Adaptive Testing Version of the Addiction Severity Index-Multimedia Version (ASI-MV): The Addiction Severity CAT

Science.gov (United States)

Butler, Stephen F.; Black, Ryan A.; McCaffrey, Stacey A.; Ainscough, Jessica; Doucette, Ann M.

2017-01-01

The purpose of this study was to develop and validate a computer adaptive testing (CAT) version of the Addiction Severity Index-Multimedia Version (ASI-MV®), the Addiction Severity CAT. This goal was accomplished in four steps. First, new candidate items for Addiction Severity CAT domains were evaluated after brainstorming sessions with experts in substance abuse treatment. Next, this new item bank was psychometrically evaluated on a large non-clinical (n =4419) and substance abuse treatment sample (n =845). Based on these results, final items were selected and calibrated for the creation of the Addiction Severity CAT algorithms. Once the algorithms were developed for the entire assessment, a fully functioning prototype of an Addiction Severity CAT was created. CAT simulations were conducted and optimal termination criteria were selected for the Addiction Severity CAT algorithms. Finally, construct validity of the CAT algorithms was evaluated by examining convergent/discriminant validity and sensitivity to change. The Addiction Severity CAT was determined to be valid, sensitive to change, and reliable. Further, the Addiction Severity CAT’s time of administration was found to be significantly less than the average time of administration for the ASI-MV composite scores. This study represents the initial validation of an IRT-based Addiction Severity CAT, and further exploration of the Addiction Severity CAT is needed. PMID:28230387

A computer adaptive testing version of the Addiction Severity Index-Multimedia Version (ASI-MV): The Addiction Severity CAT.

Science.gov (United States)

Butler, Stephen F; Black, Ryan A; McCaffrey, Stacey A; Ainscough, Jessica; Doucette, Ann M

2017-05-01

The purpose of this study was to develop and validate a computer adaptive testing (CAT) version of the Addiction Severity Index-Multimedia Version (ASI-MV), the Addiction Severity CAT. This goal was accomplished in 4 steps. First, new candidate items for Addiction Severity CAT domains were evaluated after brainstorming sessions with experts in substance abuse treatment. Next, this new item bank was psychometrically evaluated on a large nonclinical (n = 4,419) and substance abuse treatment (n = 845) sample. Based on these results, final items were selected and calibrated for the creation of the Addiction Severity CAT algorithms. Once the algorithms were developed for the entire assessment, a fully functioning prototype of an Addiction Severity CAT was created. CAT simulations were conducted, and optimal termination criteria were selected for the Addiction Severity CAT algorithms. Finally, construct validity of the CAT algorithms was evaluated by examining convergent and discriminant validity and sensitivity to change. The Addiction Severity CAT was determined to be valid, sensitive to change, and reliable. Further, the Addiction Severity CAT's time of completion was found to be significantly less than the average time of completion for the ASI-MV composite scores. This study represents the initial validation of an Addiction Severity CAT based on item response theory, and further exploration of the Addiction Severity CAT is needed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Asthma Is More Severe in Older Adults

Science.gov (United States)

Dweik, Raed A.; Comhair, Suzy A.; Bleecker, Eugene R.; Moore, Wendy C.; Peters, Stephen P.; Busse, William W.; Jarjour, Nizar N.; Calhoun, William J.; Castro, Mario; Chung, K. Fan; Fitzpatrick, Anne; Israel, Elliot; Teague, W. Gerald; Wenzel, Sally E.; Love, Thomas E.; Gaston, Benjamin M.

2015-01-01

Background Severe asthma occurs more often in older adult patients. We hypothesized that the greater risk for severe asthma in older individuals is due to aging, and is independent of asthma duration. Methods This is a cross-sectional study of prospectively collected data from adult participants (N=1130; 454 with severe asthma) enrolled from 2002 – 2011 in the Severe Asthma Research Program. Results The association between age and the probability of severe asthma, which was performed by applying a Locally Weighted Scatterplot Smoother, revealed an inflection point at age 45 for risk of severe asthma. The probability of severe asthma increased with each year of life until 45 years and thereafter increased at a much slower rate. Asthma duration also increased the probability of severe asthma but had less effect than aging. After adjustment for most comorbidities of aging and for asthma duration using logistic regression, asthmatics older than 45 maintained the greater probability of severe asthma [OR: 2.73 (95 CI: 1.96; 3.81)]. After 45, the age-related risk of severe asthma continued to increase in men, but not in women. Conclusions Overall, the impact of age and asthma duration on risk for asthma severity in men and women is greatest over times of 18-45 years of age; age has a greater effect than asthma duration on risk of severe asthma. PMID:26200463

Pilot program: NRC severe reactor accident incident response training manual: Severe reactor accident overview

International Nuclear Information System (INIS)

McKenna, T.J.; Martin, J.A.; Miller, C.W.; Hively, L.M.; Sharpe, R.W.; Giitter, J.G.; Watkins, R.M.

1987-02-01

This pilot training manual has been written to fill the need for a general text on NRC response to reactor accidents. The manual is intended to be the foundation for a course for all NRC response personnel. Severe Reactor Accident Overview is the second in a series of volumes that collectively summarize the US Nuclear Regulatory Commission (NRC) emergency response during severe power reactor accidents and provide necessary background information. This volume describes elementary perspectives on severe accidents and accident assesment. Each volume serves, respectively, as the text for a course of instruction in a series of courses. Each volume is accompanied by an appendix of slides that can be used to present this material. The slides are called out in the text

[Severe hypertension: definition and patients profiles].

Science.gov (United States)

Mourad, Jean-Jacques

2013-05-01

Severe arterial hypertension gathers relatively different clinical situations explained by the heterogeneity of the definitions of this clinical setting. From a medical point of view, severe hypertension is a short course situation defined by very high values of blood pressure corresponding to grade 3 hypertension. In France, until 2011, the social security also included in the definition of severe HTA chronic situations characterized by moderate blood pressure values requiring at least triple anthihypertensive therapies associated with a clinical or infraclinical target organ damages. These clinical profiles, much more frequent than grade 3 hypertension, allowed the full reimbursement of care costs for these patients. In France, it is estimated that 10% of hypertensive patients present a severe form with an annual incidence of 50,000 patients. The patients with severe hypertension have an increased cardiovascular morbidity justifying a closer clinical monitoring. From an economic point of view, these severe forms of hypertension have a higher cost of care, explained primarily by a more frequent need of specialized referrals, radiological exams and hospitalizations. This excess cost justified the existence of a full coverage of induced costs by the social security, since the incidence of severe hypertension is more frequent in the low social categories, and in patients with economic fragility.

Severe anemia in Malawian children

NARCIS (Netherlands)

Calis, Job C. J.; Phiri, Kamija S.; Faragher, E. Brian; Brabin, Bernard J.; Bates, Imelda; Cuevas, Luis E.; de Haan, Rob J.; Phiri, Ajib I.; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul J. M.; van Lieshout, Lisette; Beld, Marcel G. H. M.; teo, Yik Y.; Rockett, Kirk A.; Richardson, Anna; Kwiatkowski, Dominic P.; Molyneux, Malcolm E.; Boele van Hensbroek, Michael

2008-01-01

Background Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. Methods We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and

Severe anemia in Malawian children

NARCIS (Netherlands)

Calis, Job Cj; Phiri, Kamija S.; Faragher, E. Brian; Brabin, Bernard J.; Bates, Imelda; Cuevas, Luis E.; de Haan, Rob J.; Phiri, Ajib I.; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul Jm; van Lieshout, Lisette; Beld, Marcel Ghm; teo, Yik Y.; Rockett, Kirk A.; Richardson, Anna; Kwiatkowski, Dominic P.; Molyneux, Malcolm E.; van Hensbroek, Michaël Boele

2016-01-01

Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool

Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma

NARCIS (Netherlands)

Verkleij, Marieke; van de Griendt, Erik-Jonas; Colland, Vivian; van Loey, Nancy; Beelen, Anita; Geenen, Rinie

2015-01-01

Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 +/- A 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups

Targeted treatment of severe head injury

African Journals Online (AJOL)

injury is not a homogeneous concept and is poorly classified for the purposes of treatment.1 The separation of patients into 3 categories of severity (mild, moderate and severe) remains a blunt measure used to guide therapy in individual patients. Patients with severe traumatic brain injury (TBI), i.e. a Glasgow Coma Score ...

Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma

NARCIS (Netherlands)

Verkleij, Marieke; van de Griendt, E-J.; Colland, V.; Van Loey, N.E.E.; Beelen, A.; Geenen, R.

2015-01-01

Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in

Prothrombin Time Prolongation was the Most Important Indicator of Severe Bleeding in Children with Severe Dengue Viral Infection.

Science.gov (United States)

Laoprasopwattana, Kamolwish; Binsaai, Jehrabeeyah; Pruekprasert, Pornpimol; Geater, Alan

2017-08-01

To determine the indicators of severe bleeding in children with severe dengue viral infection (DVI), the medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Severe-bleeding DVI was defined as needing blood products transfusion owing to DVI-caused bleeding. Of the 238 children with severe DVI according to the World Health Organization 2009 criteria, 44 (18.5%) had severe bleeding, of whom 28 (63.6%) died. The international normalized ratio (INR) had high correlations with both transaminase enzymes (Spearman correlation, rs = 0.67-0.69, p <0.01). Multivariate analysis found that patients who had dengue haemorrhagic fever (DHF) grade IV, platelets <20 000/mm3 and INR ≥ 1.5 had increased risk of severe bleeding with odds ratios (95% confidence intervals) of 3.4 (1.4, 8.6), 2.6 (1.1, 6.2) and 10.6 (4.0, 28.4), respectively. Blood products should be at hand in severe DHF children with high risk of severe bleeding. © The Author [2017]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Monitoring Severe Accidents Using AI Techniques

International Nuclear Information System (INIS)

No, Young Gyu; Kim, Ju Hyun; Na, Man Gyun; Ahn, Kwang Il

2011-01-01

It is very difficult for nuclear power plant operators to monitor and identify the major severe accident scenarios following an initiating event by staring at temporal trends of important parameters. The objective of this study is to develop and verify the monitoring for severe accidents using artificial intelligence (AI) techniques such as support vector classification (SVC), probabilistic neural network (PNN), group method of data handling (GMDH) and fuzzy neural network (FNN). The SVC and PNN are used for event classification among the severe accidents. Also, GMDH and FNN are used to monitor for severe accidents. The inputs to AI techniques are initial time-integrated values obtained by integrating measurement signals during a short time interval after reactor scram. In this study, 3 types of initiating events such as the hot-leg LOCA, the cold-leg LOCA and SGTR are considered and it is verified how well the proposed scenario identification algorithm using the GMDH and FNN models identifies the timings when the reactor core will be uncovered, when CET will exceed 1200 .deg. F and when the reactor vessel will fail. In cases that an initiating event develops into a severe accident, the proposed algorithm showed accurate classification of initiating events. Also, it well predicted timings for important occurrences during severe accident progression scenarios, which is very helpful for operators to perform severe accident management

Monitoring severe accidents using AI techniques

Energy Technology Data Exchange (ETDEWEB)

No, Young Gyu; Ahn, Kwang Il [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kim, Ju Hyun; Na, Man Gyun [Dept. of Nuclear Engineering, Chosun University, Gwangju (Korea, Republic of); Lim, Dong Hyuk [Korea Institute of Nuclear Nonproliferation and Control, Daejon (Korea, Republic of)

2012-05-15

After the Fukushima nuclear accident in 2011, there has been increasing concern regarding severe accidents in nuclear facilities. Severe accident scenarios are difficult for operators to monitor and identify. Therefore, accurate prediction of a severe accident is important in order to manage it appropriately in the unfavorable conditions. In this study, artificial intelligence (AI) techniques, such as support vector classification (SVC), probabilistic neural network (PNN), group method of data handling (GMDH), and fuzzy neural network (FNN), were used to monitor the major transient scenarios of a severe accident caused by three different initiating events, the hot-leg loss of coolant accident (LOCA), the cold-leg LOCA, and the steam generator tube rupture in pressurized water reactors (PWRs). The SVC and PNN models were used for the event classification. The GMDH and FNN models were employed to accurately predict the important timing representing severe accident scenarios. In addition, in order to verify the proposed algorithm, data from a number of numerical simulations were required in order to train the AI techniques due to the shortage of real LOCA data. The data was acquired by performing simulations using the MAAP4 code. The prediction accuracy of the three types of initiating events was sufficiently high to predict severe accident scenarios. Therefore, the AI techniques can be applied successfully in the identification and monitoring of severe accident scenarios in real PWRs.

Monitoring severe accidents using AI techniques

International Nuclear Information System (INIS)

No, Young Gyu; Ahn, Kwang Il; Kim, Ju Hyun; Na, Man Gyun; Lim, Dong Hyuk

2012-01-01

After the Fukushima nuclear accident in 2011, there has been increasing concern regarding severe accidents in nuclear facilities. Severe accident scenarios are difficult for operators to monitor and identify. Therefore, accurate prediction of a severe accident is important in order to manage it appropriately in the unfavorable conditions. In this study, artificial intelligence (AI) techniques, such as support vector classification (SVC), probabilistic neural network (PNN), group method of data handling (GMDH), and fuzzy neural network (FNN), were used to monitor the major transient scenarios of a severe accident caused by three different initiating events, the hot-leg loss of coolant accident (LOCA), the cold-leg LOCA, and the steam generator tube rupture in pressurized water reactors (PWRs). The SVC and PNN models were used for the event classification. The GMDH and FNN models were employed to accurately predict the important timing representing severe accident scenarios. In addition, in order to verify the proposed algorithm, data from a number of numerical simulations were required in order to train the AI techniques due to the shortage of real LOCA data. The data was acquired by performing simulations using the MAAP4 code. The prediction accuracy of the three types of initiating events was sufficiently high to predict severe accident scenarios. Therefore, the AI techniques can be applied successfully in the identification and monitoring of severe accident scenarios in real PWRs.

Reporting Severe Hypoglycemia in Type 1 Diabetes

DEFF Research Database (Denmark)

Pedersen-Bjergaard, Ulrik; Thorsteinsson, Birger

2017-01-01

PURPOSE OF REVIEW: To describe potential factors influencing reporting of severe hypoglycemia in adult patients with type 1 diabetes and to analyze their effect on reported rates of severe hypoglycemia. RECENT FINDINGS: Reported rates of severe hypoglycemia defined as need for third party...... by partners report higher rates of severe hypoglycemia. There is a large variation between studies reporting incidence and prevalence of severe hypoglycemia in patients with type 1 diabetes, mainly explained by definition of severity, methods of reporting, and patient selection. These findings call...... hypoglycemia are 0.02-0.5 events per patient-year and 1-29%, respectively. When subjects with recurrent severe hypoglycemia in the past or suffering from impaired hypoglycemia awareness are excluded from participation in studies, lower rates are reported. Studies applying anonymous reporting or reporting...

Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

Directory of Open Access Journals (Sweden)

Natasha Gupta

2014-01-01

Full Text Available Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term and was successfully treated with postpartum therapeutic plasma exchange. Patient also developed several other complications related to her substantial hypertriglyceridemia including preeclampsia, chylous ascites, retinal detachment, pleural effusion, and chronic pericarditis. This patient had no previous family or personal history of lipid abnormality and had four successful prior pregnancies without developing gestational hypertriglyceridemia. Such a severe hypertriglyceridemia is usually seen in patients with familial chylomicronemia syndromes where hypertriglyceridemia is exacerbated by the pregnancy, leading to fatal complications such as acute pancreatitis.

Severe accidents: in nuclear power plants

International Nuclear Information System (INIS)

1986-01-01

A ''severe'' nuclear accident refers to a reactor accident that could exceed reactor design specifications to such a degree as to prevent cooling of the reactor's core by normal means. This report summarizes the work of a NEA Senior Group of Experts who have studied the potential response of existing light-water reactors to severe accidents and have found that current designs of reactors are far more capable of coping with severe accidents than design specifications would suggest. The report emphasises the specific knowledge and means that can be used for diagnosing a severe accident and for managing its progression in order to prevent or mitigate its consequences

Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

OpenAIRE

Gupta, Natasha; Ahmed, Seema; Shaffer, Lemuel; Cavens, Paula; Blankstein, Josef

2014-01-01

Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term an...

State energy severance taxes, 1985-1993

International Nuclear Information System (INIS)

1995-09-01

This report analyzes changes in aggregate and State-level energy severance taxes for 1985 through 1993. Data are presented for crude oil, natural gas, and coal. The report highlights trends in severance tax receipts relative to energy prices and production, using severance tax data published by the Bureau of the Census of the US Department of Commerce and production data published by the Energy Information Administration

Severe forms of food allergy

Directory of Open Access Journals (Sweden)

Emanuel Sarinho

Full Text Available Abstract Objectives: To guide the diagnostic and therapeutic management of severe forms of food allergy. Data sources: Search in the Medline database using the terms “severe food allergy,” “anaphylaxis and food allergy,” “generalized urticaria and food allergy,” and “food protein-induced enterocolitis syndrome” in the last ten years, searching in the title, abstract, or keyword fields. Summary of data: Food allergy can be serious and life-threatening. Milk, eggs, peanuts, nuts, walnuts, wheat, sesame seeds, shrimp, fish, and fruit can precipitate allergic emergencies. The severity of reactions will depend on associated cofactors such as age, drug use at the onset of the reaction, history and persistence of asthma and/or severe allergic rhinitis, history of previous anaphylaxis, exercise, and associated diseases. For generalized urticaria and anaphylaxis, intramuscular epinephrine is the first and fundamental treatment line. For the treatment in acute phase of food-induced enterocolitis syndrome in the emergency setting, prompt hydroelectrolytic replacement, administration of methylprednisolone and ondansetron IV are necessary. It is important to recommend to the patient with food allergy to maintain the exclusion diet, seek specialized follow-up and, in those who have anaphylaxis, to emphasize the need to carry epinephrine. Conclusion: Severe food allergy may occur in the form of anaphylaxis and food-protein-induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment.

Severe forms of food allergy.

Science.gov (United States)

Sarinho, Emanuel; Lins, Maria das Graças Moura

To guide the diagnostic and therapeutic management of severe forms of food allergy. Search in the Medline database using the terms "severe food allergy," "anaphylaxis and food allergy," "generalized urticaria and food allergy," and "food protein-induced enterocolitis syndrome" in the last ten years, searching in the title, abstract, or keyword fields. Food allergy can be serious and life-threatening. Milk, eggs, peanuts, nuts, walnuts, wheat, sesame seeds, shrimp, fish, and fruit can precipitate allergic emergencies. The severity of reactions will depend on associated cofactors such as age, drug use at the onset of the reaction, history and persistence of asthma and/or severe allergic rhinitis, history of previous anaphylaxis, exercise, and associated diseases. For generalized urticaria and anaphylaxis, intramuscular epinephrine is the first and fundamental treatment line. For the treatment in acute phase of food-induced enterocolitis syndrome in the emergency setting, prompt hydroelectrolytic replacement, administration of methylprednisolone and ondansetron IV are necessary. It is important to recommend to the patient with food allergy to maintain the exclusion diet, seek specialized follow-up and, in those who have anaphylaxis, to emphasize the need to carry epinephrine. Severe food allergy may occur in the form of anaphylaxis and food-protein-induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Surviving severe traumatic brain injury in Denmark

DEFF Research Database (Denmark)

Odgaard, Lene; Poulsen, Ingrid; Kammersgaard, Lars Peter

2015-01-01

PURPOSE: To identify all hospitalized patients surviving severe traumatic brain injury (TBI) in Denmark and to compare these patients to TBI patients admitted to highly specialized rehabilitation (HS-rehabilitation). PATIENTS AND METHODS: Patients surviving severe TBI were identified from...... severe TBI were admitted to HS-rehabilitation. Female sex, older age, and non-working status pre-injury were independent predictors of no HS-rehabilitation among patients surviving severe TBI. CONCLUSION: The incidence rate of hospitalized patients surviving severe TBI was stable in Denmark...

Management of severe accidents

International Nuclear Information System (INIS)

Jankowski, M.W.

1987-01-01

The definition and the multidimensionality aspects of accident management have been reviewed. The suggested elements in the development of a programme for severe accident management have been identified and discussed. The strategies concentrate on the two tiered approaches. Operative management utilizes the plant's equipment and operators capabilities. The recovery managment concevtrates on preserving the containment, or delaying its failure, inhibiting the release, and on strategies once there has been a release. The inspiration for this paper was an excellent overview report on perspectives on managing severe accidents in commercial nuclear power plants and extending plant operating procedures into the severe accident regime; and by the most recent publication of the International Nuclear Safety Advisory Group (INSAG) considering the question of risk reduction and source term reduction through accident prevention, management and mitigation. The latter document concludes that 'active development of accident management measures by plant personnel can lead to very large reductions in source terms and risk', and goes further in considering and formulating the key issue: 'The most fruitful path to follow in reducing risk even further is through the planning of accident management.' (author)

Epidemiology of severe trauma.

Science.gov (United States)

Alberdi, F; García, I; Atutxa, L; Zabarte, M

2014-12-01

Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Management of severe accidents

International Nuclear Information System (INIS)

Jankowski, M.W.

1988-01-01

The definition and the multidimensionality aspects of accident management have been reviewed. The suggested elements in the development of a programme for severe accident management have been identified and discussed. The strategies concentrate on the two tiered approaches. Operative management utilizes the plant's equipment and operators capabilities. The recovery management concentrates on preserving the containment, or delaying its failure, inhibiting the release, and on strategies once there has been a release. The inspiration for this paper was an excellent overview report on perspectives on managing severe accidents in commercial nuclear power plants and extending plant operating procedures into the severe accident regime; and by the most recent publication of the International Nuclear Safety Advisory Group (INSAG) considering the question of risk reduction and source term reduction through accident prevention, management and mitigation. The latter document concludes that active development of accident management measures by plant personnel can lead to very large reductions in source terms and risk, and goes further in considering and formulating the key issue: The most fruitful path to follow in reducing risk even further is through the planning of accident management

Deterministic analyses of severe accident issues

International Nuclear Information System (INIS)

Dua, S.S.; Moody, F.J.; Muralidharan, R.; Claassen, L.B.

2004-01-01

Severe accidents in light water reactors involve complex physical phenomena. In the past there has been a heavy reliance on simple assumptions regarding physical phenomena alongside of probability methods to evaluate risks associated with severe accidents. Recently GE has developed realistic methodologies that permit deterministic evaluations of severe accident progression and of some of the associated phenomena in the case of Boiling Water Reactors (BWRs). These deterministic analyses indicate that with appropriate system modifications, and operator actions, core damage can be prevented in most cases. Furthermore, in cases where core-melt is postulated, containment failure can either be prevented or significantly delayed to allow sufficient time for recovery actions to mitigate severe accidents

Severe congenital neutropenia

DEFF Research Database (Denmark)

Borregaard, Niels

2014-01-01

In this issue of Blood, Tidwell et al1 demonstrate that mutations in the start codon (protein synthesis is initiated at the codon ATG) of neutrophil elastase (ELANE) result in the production of N-terminally truncated elastase, which mislocates to the nucleus and results in severe congenital neutr...... neutropenia (SCN)....

Severe combined immune deficiency syndrome

International Nuclear Information System (INIS)

Saleem, A.F.; Khawaja, R.D.A.; Shaikh, A.S.; Ali, S.A.; Zaidi, A.K.M.

2013-01-01

To determine the clinico-demographic features and laboratory parameters of children with severe combined immunodeficiency (SCID). Study Design: Case series. Place and Duration of Study: Department of Paediatrics and Child Health, the Aga Khan University, Karachi, from July 2006 to July 2011. Methodology: Thirteen infants who were discharged with a diagnosis of SCID were inducted in the study. Their clinicodemographic features and laboratory parameters were determined. Descriptive statistics has been used for computing frequency and percentage. Results: The median age at diagnosis was five months; 5 infants presented within 3 months of life. Three-fourth (77%) were males. Most of the infants were severely malnourished (85%) at the time of presentation. More than two-thirds (69%) were products of consanguineous marriages. All subjects had severe lymphopenia (absolute lymphocyte count (ALC) ranging between 170 – 2280) and low T and B lymphocyte counts. Conclusion: SCID should be considered in infants presenting with severe and recurrent infections. Low ALC (< 2500/mm3), is a reliable diagnostic feature of SCID. These infants should be promptly referred to a facility where stem cell transplant can be done. (author)

Bariatric surgery for severely obese adolescents.

Science.gov (United States)

Fitzgerald, Dominic A; Baur, Louise

2014-09-01

Severe obesity is increasing in adolescents and is associated with cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnoea, polycystic ovarian syndrome and a range of musculoskeletal problems. Premature death is the inevitable outcome of persistent severe obesity in adolescents. In adults with severe obesity, medical and lifestyle interventions have been shown to be expensive and less effective in terms of weight loss than has bariatric surgery. The single completed randomised controlled trial in adolescents shows the same outcome. This is supported by meta analyses of bariatric surgery in adolescent subjects. A more aggressive approach to severe obesity, utilising bariatric surgery in selected cases, within the context of a multi-disciplinary team, is required. Copyright © 2014. Published by Elsevier Ltd.

Cernavoda CANDU severe accident evaluation

International Nuclear Information System (INIS)

Negut, G.; Marin, A.

1997-01-01

The papers present the activities dedicated to Romania Cernavoda Nuclear Power Plant first CANDU Unit severe accident evaluation. This activity is part of more general PSA assessment activities. CANDU specific safety features are calandria moderator and calandria vault water capabilities to remove the residual heat in the case of severe accidents, when the conventional heat sinks are no more available. Severe accidents evaluation, that is a deterministic thermal hydraulic analysis, assesses the accidents progression and gives the milestones when important events take place. This kind of assessment is important to evaluate to recovery time for the reactor operators that can lead to the accident mitigation. The Cernavoda CANDU unit is modeled for the of all heat sinks accident and results compared with the AECL CANDU 600 assessment. (orig.)

Severe accident approach - final report. Evaluation of design measures for severe accident prevention and consequence mitigation

International Nuclear Information System (INIS)

Tentner, A.M.; Parma, E.; Wei, T.; Wigeland, R.

2010-01-01

An important goal of the US DOE reactor development program is to conceptualize advanced safety design features for a demonstration Sodium Fast Reactor (SFR). The treatment of severe accidents is one of the key safety issues in the design approach for advanced SFR systems. It is necessary to develop an in-depth understanding of the risk of severe accidents for the SFR so that appropriate risk management measures can be implemented early in the design process. This report presents the results of a review of the SFR features and phenomena that directly influence the sequence of events during a postulated severe accident. The report identifies the safety features used or proposed for various SFR designs in the US and worldwide for the prevention and/or mitigation of Core Disruptive Accidents (CDA). The report provides an overview of the current SFR safety approaches and the role of severe accidents. Mutual understanding of these design features and safety approaches is necessary for future collaborations between the US and its international partners as part of the GEN IV program. The report also reviews the basis for an integrated safety approach to severe accidents for the SFR that reflects the safety design knowledge gained in the US during the Advanced Liquid Metal Reactor (ALMR) and Integral Fast Reactor (IFR) programs. This approach relies on inherent reactor and plant safety performance characteristics to provide additional safety margins. The goal of this approach is to prevent development of severe accident conditions, even in the event of initiators with safety system failures previously recognized to lead directly to reactor damage.

Severe accident approach - final report. Evaluation of design measures for severe accident prevention and consequence mitigation.

Energy Technology Data Exchange (ETDEWEB)

Tentner, A. M.; Parma, E.; Wei, T.; Wigeland, R.; Nuclear Engineering Division; SNL; INL

2010-03-01

An important goal of the US DOE reactor development program is to conceptualize advanced safety design features for a demonstration Sodium Fast Reactor (SFR). The treatment of severe accidents is one of the key safety issues in the design approach for advanced SFR systems. It is necessary to develop an in-depth understanding of the risk of severe accidents for the SFR so that appropriate risk management measures can be implemented early in the design process. This report presents the results of a review of the SFR features and phenomena that directly influence the sequence of events during a postulated severe accident. The report identifies the safety features used or proposed for various SFR designs in the US and worldwide for the prevention and/or mitigation of Core Disruptive Accidents (CDA). The report provides an overview of the current SFR safety approaches and the role of severe accidents. Mutual understanding of these design features and safety approaches is necessary for future collaborations between the US and its international partners as part of the GEN IV program. The report also reviews the basis for an integrated safety approach to severe accidents for the SFR that reflects the safety design knowledge gained in the US during the Advanced Liquid Metal Reactor (ALMR) and Integral Fast Reactor (IFR) programs. This approach relies on inherent reactor and plant safety performance characteristics to provide additional safety margins. The goal of this approach is to prevent development of severe accident conditions, even in the event of initiators with safety system failures previously recognized to lead directly to reactor damage.

Several crimes solved

CERN Multimedia

Relations with the Host States Service

2007-01-01

A member of a contractor's personnel suspected of having committed several thefts in and around Building 180 has recently been questioned by the French police. He was immediately tried by the court in Bourg-en-Bresse and sentenced to six months in prison, with a requirement to serve at least three months. His arrest was facilitated, among other things, by a video recording, fast and detailed statements to the CERN Fire Brigade and close collaboration between the members of the personnel concerned, the Reception and Access Control Service and the police. Several laptops and other items of electronic equipment were seized during a search of the culprit's home. A stolen digital camera has yet to be returned to its owner as he has not reported the theft to the CERN Fire Brigade and the police. The person concerned is therefore requested to go to the Gendarmerie in Saint-Genis-Pouilly with the necessary proof of ownership. In addition, the French authorities have informed CERN that the presumed authors of the a...

Severity of Neuropsychiatric Symptoms in Nursing Home Residents

Directory of Open Access Journals (Sweden)

Anne-Sofie Helvik

2016-01-01

Full Text Available We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163 and 2010/2011 (n = 1,858. Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia.

Genetics Home Reference: severe congenital neutropenia

Science.gov (United States)

... A characteristic of X-linked inheritance is that fathers cannot pass X-linked traits to their sons. ... Genetic Testing Registry: Severe congenital neutropenia 2, autosomal dominant Genetic Testing Registry: Severe congenital neutropenia 3, autosomal ...

SAMEX: A severe accident management support expert

International Nuclear Information System (INIS)

Park, Soo-Yong; Ahn, Kwang-Il

2010-01-01

A decision support system for use in a severe accident management following an incident at a nuclear power plant is being developed which is aided by a severe accident risk database module and a severe accident management simulation module. The severe accident management support expert (SAMEX) system can provide the various types of diagnostic and predictive assistance based on the real-time plant specific safety parameters. It consists of four major modules as sub-systems: (a) severe accident risk data base module (SARDB), (b) risk-informed severe accident risk data base management module (RI-SARD), (c) severe accident management simulation module (SAMS), and (d) on-line severe accident management guidance module (on-line SAMG). The modules are integrated into a code package that executes within a WINDOWS XP operating environment, using extensive user friendly graphics control. In Korea, the integrated approach of the decision support system is being carried out under the nuclear R and D program planned by the Korean Ministry of Education, Science and Technology (MEST). An objective of the project is to develop the support system which can show a theoretical possibility. If the system is feasible, the project team will recommend the radiation protection technical support center of a national regulatory body to implement a plant specific system, which is applicable to a real accident, for the purpose of immediate and various diagnosis based on the given plant status information and of prediction of an expected accident progression under a severe accident situation.

Severe accidents in Nuclear Power Plants

International Nuclear Information System (INIS)

Valle Cepero, R.; Castillo Alvarez, J.; Ramon Fuente, J.

1996-01-01

For the assessment of the safety of nuclear power plants it is of great importance the analyses of severe accidents since they allow to estimate the possible failure models of the containment, and also permit knowing the magnitude and composition of the radioactive material that would be released to the environment in case of an accident upon population and the environment. This paper presents in general terms the basic principles for conducting the analysis of severe accidents, the fundamental sources in the generation of radionuclides and aerosols, the transportation and deposition processes, and also makes reference to de main codes used in the modulation of severe accidents. The final part of the paper contents information on how severe accidents are dialed with the regulatory point view in different countries

Thromboelastography in patients with severe sepsis

DEFF Research Database (Denmark)

Haase, Nicolai; Ostrowski, Sisse Rye; Wetterslev, Jørn

2015-01-01

PURPOSE: To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis. METHODS: Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156......) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer's acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox...... bleeding [HR 2.43 (1.16-5.07)] and possibly explained the excess bleeding with HES in the 6S trial. CONCLUSIONS: In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding....

SEVERITY CLASSIFICATION OF MICROANEURYSMS USING NEURAL NETWORK

Directory of Open Access Journals (Sweden)

Shree Divya R

2014-01-01

Full Text Available Diabetic Retinopathy is one of the most common causes of blindness that leads to the loss of vision to the human eye. Several methods have been proposed to detect several defects of the human eye like hemorrhages, exudates etc. which are to be considered as the major symptoms. Among them, Microaneurysms should be considered as one of the severe condition for the early blindness. Several techniques have been proposed based on this, but they have certain drawbacks. A new technique called neural network taken for presentation, helps to detect and determine the severity of Microaneurysms which would be able to give a better performance than the existing techniques.

Relationship of Heme Oxygenase-1 (HO-1 Level with Onset and Severity in Normotensive Pregnancy and Severe Preeclampsia

Directory of Open Access Journals (Sweden)

John Johannes Wantania

2016-08-01

Full Text Available Background: Preeclampsia still becomes a major problem in pregnancies. Various evidences showed that heme oxygenase-1 (HO-1 is very important in pregnancy. This study aims to understand the relationship of heme oxygenase-1 level with onset and severity in normotensive pregnancy and severe preeclampsia. Methods: This is a cross sectional analytic comparative study, the subjects consisted of 26 patients with normotensive pregnancies and 26 patients with severe preeclampsia. Blood samples from women with < 34 / ≥ 34 weeks’ normotensive pregnancies and women with severe preeclampsia were taken. HO-1 ELISA kit used to quantitate heme oxygenase-1 level in samples. Results: The level of heme oxygenase-1 in normotensive pregnant women < 34 weeks lower than severe preeclampsia pregnant women < 34 weeks (3.28 ± 0.46 ng/mL vs 4.20 ± 0.64 ng/mL, p=0.003, respectively. The median level of heme oxygenase-1 in normotensive pregnant women ≥ 34 weeks was 2.96 (2.41–4.39 ng/mL, while severe preeclampsia pregnant women ≥ 34 weeks was 3.52 (2.88–5.43 ng/mL, (p=0.040. The median level of heme oxygenase-1 in normotensive pregnant women was 3.04 (2.41–4.39 ng/mL, while severe preeclampsia pregnant women was 3.68 (2.88–5.67 ng/mL, (p=0.001. Conclusions: There is correlation between the incidence of severe preeclampsia with heme oxygenase-1 level in < 34 and ≥ 34 weeks of pregnancy. There is a significant difference between the level of heme oxygenase-1 in pregnant women with severe preeclampsia and in women with normotensive pregnancy. 

The influence of severe malnutrition on rehabilitation in patients with severe head injury.

Science.gov (United States)

Dénes, Zoltán

2004-10-07

The purpose of the study was to evaluate the consequences of severe malnutrition in patients with severe head injury during rehabilitation. The data were collected from medical records of patients admitted to the neurorehabilitation unit over the last 5 years. Twenty of 1850 patients had severe malnutrition, the body mass index (BMI) of these patients were under 15 (10-14) kg/m2. The majority of patients suffered traumatic brain damage (17/20). Thirteen patients arrived with percutaneous endoscopic gastrotomy /PEG, three nasogastric tube in 3 cases we placed PEG. The nutritional strategy included a high-calorie diet, by means of bolus feeding five times during the day, continuous feeding during the night; the daily intake target being more than 2500 kcal. During rehabilitation treatment the majority of patients (13/20) revealed weight gain with a rate of 0.5-2 kg/week. The following complications were treated during the rehabilitation phase: 20 pressure sores, 20 contractures, 11 urinal infections, 6 cases of pneumonia, 2 of purulent bronchitis, 6 of sepsis, 1 penoscrotal abscess, epidydymitis, and 1 case of purulent arthritis. The patients required total assistance at the time of admission. At discharge 10 patients remained completely dependent, 6 patients needed minimal assistance, and 4 patients could perform daily activities independently. The average length of stay in our unit was 78/6-150/days. Patients with head injury suffering from severe malnutrition exhibit serious complications at the time of admission as well as during rehabilitation treatment. The patients were very difficult to mobilize. The length of stay at the rehabilitation unit was 28 days longer when complicated by malnutrition, than head injuries showing normal nutritional status. These findings underline the importance of adequate nutrition in patients with head injury in both the acute ward and in the rehabilitation unit.

Severe ASR damaged concrete bridges

DEFF Research Database (Denmark)

Antonio Barbosa, Ricardo; Gustenhoff Hansen, Søren

2015-01-01

Technical University of Denmark (DTU) and University of Southern Denmark (SDU) have conducted several full-scale experiments with severe ASR deteriorated bridges. This paper presents few and preliminary results from both the shear tests and the measuring of the material properties. The shear test...... show that the shear capacity is almost unaffected of ASR despite significant reduction in compressive concrete strength. Furthermore, measurements show a significant tensile reinforcement strain developed due to ASR expansion....

Relationship between Affective Symptoms and Malnutrition Severity in Severe Anorexia Nervosa

Science.gov (United States)

Mattar, Lama; Huas, Caroline; group, EVHAN; Godart, Nathalie

2012-01-01

Background Very few studies have investigated the relationship between malnutrition and psychological symptoms in Anorexia Nervosa (AN). They have used only body weight or body mass index (BMI) for the nutritional assessment and did not always report on medication, or if they did, it was not included in the analysis of results, and they did not include confounding factors such as duration of illness, AN subtype or age. The present study investigates this relationship using indicators other than BMI/weight, among which body composition and biological markers, also considering potential confounders related to depression and anxiety. Methods 155 AN patients, (DSM-IV) were included consecutively upon admission to inpatient treatment. Depression, anxiety, obsessive behaviours and social functioning were measured using various scales. Nutritional status was measured using BMI, severity of weight loss, body composition, and albumin and prealbumin levels. Results No correlation was found between BMI at inclusion, fat-free mass index, fat mass index, and severity of weight loss and any of the psychometric scores. Age and medication are the only factors that affect the psychological scores. None of the psychological scores were explained by the nutritional indicators with the exception of albumin levels which was negatively linked to the LSAS fear score (p = 0.024; beta = −0.225). Only the use of antidepressants explained the variability in BDI scores (p = 0.029; beta = 0.228) and anxiolytic use explained the variability in HADs depression scores (p = 0.037; beta = 0.216). Conclusion The present study is a pioneer investigation of various nutritional markers in relation to psychological symptoms in severely malnourished AN patients. The clinical hypothesis that malnutrition partly causes depression and anxiety symptoms in AN in acute phase is not confirmed, and future studies are needed to back up our results. PMID:23185320

A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale.

Science.gov (United States)

Walker, Stephen L; Sales, Anna M; Butlin, C Ruth; Shah, Mahesh; Maghanoy, Armi; Lambert, Saba M; Darlong, Joydeepa; Rozario, Benjamin Jewel; Pai, Vivek V; Balagon, Marivic; Doni, Shimelis N; Hagge, Deanna A; Nery, José A C; Neupane, Kapil D; Baral, Suwash; Sangma, Biliom A; Alembo, Digafe T; Yetaye, Abeba M; Hassan, Belaynesh A; Shelemo, Mohammed B; Nicholls, Peter G; Lockwood, Diana N J

2017-07-01

We wished to validate our recently devised 16-item ENLIST ENL Severity Scale, a clinical tool for measuring the severity of the serious leprosy associated complication of erythema nodosum leprosum (ENL). We also wished to assess the responsiveness of the ENLIST ENL Severity Scale in detecting clinical change in patients with ENL. Participants, recruited from seven centres in six leprosy endemic countries, were assessed using the ENLIST ENL Severity Scale by two researchers, one of whom categorised the severity of ENL. At a subsequent visit a further assessment using the scale was made and both participant and physician rated the change in ENL using the subjective categories of "Much better", "somewhat better", "somewhat worse" and "much worse" compared with "No change" or "about the same". 447 participants were assessed with the ENLIST ENL Severity Scale. The Cronbach alpha of the scale and each item was calculated to determine the internal consistency of the scale. The ENLIST ENL Severity Scale had good internal consistency and this improved following removal of six items to give a Cronbach's alpha of 0.77. The cut off between mild ENL and more severe disease was 9 determined using ROC curves. The minimal important difference of the scale was determined to be 5 using both participant and physician ratings of change. The 10-item ENLIST ENL Severity Scale is the first valid, reliable and responsive measure of ENL severity and improves our ability to assess and compare patients and their treatments in this severe and difficult to manage complication of leprosy. The ENLIST ENL Severity Scale will assist physicians in the monitoring and treatment of patients with ENL. The ENLIST ENL Severity Scale is easy to apply and will be useful as an outcome measure in treatment studies and enable the standardisation of other clinical and laboratory ENL research.

United States position on severe accidents

International Nuclear Information System (INIS)

Ross, D.F.

1988-01-01

The United States policy on severe accidents was published in 1985 for both new plant applications and for existing plants. Implementation of this policy is in progress. This policy, aided by a related safety goal policy and by analysis capabilities emerging from improved understanding of accident phenomenology, is viewed as a logical development from the pioneering work in the WASH-1400 Reactor Safety Study published by the United States Nuclear Regulatory Commission (NRC) in 1975. This work provided an estimate of the probability and consequences of severe accidents which, prior to that time, had been mostly evaluated by somewhat arbitrary assumptions dating back 30 years. The early history of severe accident evaluation is briefly summarized for the period 1957-1979. Then, the galvanizing action of Three Mile Island Unit 2 (TMI-2) on severe accident analysis, experimentation and regulation is reviewed. Expressions of US policy in the form of rulemaking, severe accident policy, safety research, safety goal policy and court decisions (on adequacy of safety) are discussed. Finally, the NRC policy as of March 1988 is stated, along with a prospective look at the next few years. (author). 19 refs

Chemical phenomena under severe accident conditions

International Nuclear Information System (INIS)

Powers, D.A.

1988-01-01

A severe nuclear reactor accident is expected to involve a vast number of chemical processes. The chemical processes of major safety significance begin with the production of hydrogen during steam oxidation of fuel cladding. Physico-chemical changes in the fuel and the vaporization of radionuclides during reactor accidents have captured much of the attention of the safety community in recent years. Protracted chemical interactions of core debris with structural concrete mark the conclusion of dynamic events in a severe accident. An overview of the current understanding of chemical processes in severe reactor accident is provided in this paper. It is shown that most of this understanding has come from application of findings from other fields though a few areas have in the past been subject to in-depth study of a fundamental nature. Challenges in the study of severe accident chemistry are delineated

Function theory of several complex variables

CERN Document Server

Krantz, Steven G

2001-01-01

The theory of several complex variables can be studied from several different perspectives. In this book, Steven Krantz approaches the subject from the point of view of a classical analyst, emphasizing its function-theoretic aspects. He has taken particular care to write the book with the student in mind, with uniformly extensive and helpful explanations, numerous examples, and plentiful exercises of varying difficulty. In the spirit of a student-oriented text, Krantz begins with an introduction to the subject, including an insightful comparison of analysis of several complex variables with th

The American 'severe fuel damage program'

International Nuclear Information System (INIS)

Sdouz, G.

1982-03-01

The TMI-2 accident has initiated a new phase of safety research. It is necessary to consider severe accidents with degraded or molten core. For NRC there was a need for an improved understanding of this reactor behaviour and the 'Severe Fuel Dage Program' was initiated. Planned are in-pile experiments in PBF, NRU and ESSOR and in addition separate effects tests and results from TMI-2. The analytical component of the program is the development of different versions of the code SCDAP for the detailed analysis during severe accident transients. (Author) [de

Severe falciparum malaria: A case report

Science.gov (United States)

Arcelia, F.; Asymida, F.; Lubis, N. F. M.; Pasaribu, A. P.

2018-03-01

Plasmodium parasites caused Malaria. Indonesia is one of the countries in Southeast Asia that endemic to malaria. The burden of malaria is more in the eastern part of Indonesia than the Western part as well as the endemicity. Some cases of malaria will develop to severe form. Usually, the manifestation of children and adult are different. We reported a severe case of malaria in a 14-year-old boy who develops several manifestations such as anemia, hypoglycemia, sepsis and black water fever. We successfully treated the patient with Artesunate intravenous and continued with Dihydroartemisinin-piperaquine.

Decreased ADAMTS 13 Activity is Associated With Disease Severity and Outcome in Pediatric Severe Sepsis

Science.gov (United States)

Lin, Jainn-Jim; Chan, Oi-Wa; Hsiao, Hsiang-Ju; Wang, Yu; Hsia, Shao-Hsuan; Chiu, Cheng-Hsun

2016-01-01

Abstract Decreased ADAMTS 13 activity has been reported in severe sepsis and in sepsis-induced disseminated intravascular coagulation. This study aimed to investigate the role of ADAMTS 13 in different pediatric sepsis syndromes and evaluate its relationship with disease severity and outcome. We prospectively collected cases of sepsis treated in a pediatric intensive care unit, between July 2012 and June 2014 in Chang Gung Children's Hospital in Taoyuan, Taiwan. Clinical characteristics and ADAMTS-13 activity were analyzed. All sepsis syndromes had decreased ADAMTS 13 activity on days 1 and 3 of admission compared to healthy controls. Patients with septic shock had significantly decreased ADAMTS 13 activity on days 1 and 3 compared to those with sepsis and severe sepsis. There was a significant negative correlation between ADAMTS 13 activity on day 1 and day 1 PRISM-II, PELOD, P-MOD, and DIC scores. Patients with mortality had significantly decreased ADAMTS 13 activity on day 1 than survivors, but not on day 3. Different pediatric sepsis syndromes have varying degrees of decreased ADAMTS 13 activity. ADAMTS 13 activity is strongly negatively correlated with disease severity of pediatric sepsis syndrome, whereas decreased ADAMTS 13 activity on day 1 is associated with increased risk of mortality. PMID:27100422

[Predictive factors associated with severity of asthma exacerbations].

Science.gov (United States)

Atiş, Sibel; Kaplan, Eylem Sercan; Ozge, Cengiz; Bayindir, Suzan

2008-01-01

Several factors have been accused for asthma exacerbations, however, very few studies have evaluated whether different factors predict severity of asthma exacerbation. We aimed to determine the predictive factors for severity of asthma exacerbation. Retrospective analysis of data on 93 patients visited our emergency-department because of asthma exacerbation was reviewed. Hospitalization in intensive care unit and/or intubation because of asthma was accepted as the criteria for severe exacerbation. Logistic regression analysis estimated the strength of association of each variable, potentially related to severe asthmatic exacerbation, with severe/very severe as compared to mild/moderate asthmatic exacerbation. Independent variables included in the analysis were age, sex, smoking history, inhaler steroid using, compliance with medication, chronic asthma severity, presence of additional atopic diseases, prick test positivity, provocative factors, number of short-acting beta(2)-agonist using, number of visits to emergency department for asthma over one year period, previous severe exacerbation, pulmonary functions, and blood eosinophil count. 20 were severe/very severe and 73 mild/moderate asthmatic exacerbation. Frequent using of short-acting beta(2)-agonist (OR= 1.5, 95% CI= 1.08-5.3, p= 0.003), noncompliance with medication (OR= 3.6, 95% CI= 1.3-9.9, p= 0.013), previous severe asthmatic exacerbation (OR= 3.8, 95% CI= 1.48-10.01, p= 0.005) and recent admission to hospital (OR= 2.9, 95% CI= 1.07-8.09, p= 0.037) were found to be predictive factors for severe asthmatic exacerbation. Different predictive factors, in particular frequent using of short-acting beta(2)-agonist and noncompliance with medication may be associated with severe asthma exacerbations compared to milder exacerbations. This suggests different mechanisms are responsible for severity of asthma exacerbation.

Use of biologics in severe food allergies.

Science.gov (United States)

Fiocchi, Alessandro; Pecora, Valentina; Valluzzi, Rocco L; Fierro, Vincenzo; Mennini, Maurizio

2017-06-01

Severe cases of food allergy account for the majority of the burden in terms of risks, quality of life, and resource expenditure. The traditional approach to these forms has been strict avoidance. More recently, Oral ImmunoTherapy (OIT) has gained a role in their management. However, in severe food allergies OIT is often infeasible. Case reports, observational, and prospective studies have recently proposed different approaches to severe food allergy. The majority of them include the use of biologics. Omalizumab has been the most studied drug for severe food allergies, and its role as adjuvant treatment to OIT is well established. Interest has been raised on other biologics, as dupilumab, reslizumab, and mepolizumab. Toll-like receptor agonists, and gene therapy using adeno-associated virus coding for Omalizumab are promising alternatives. The recent studies are deeply influencing the clinical practice. We review the modifications of the clinical approach to severe food allergies so far available. We indicate the possible evolutions of treatment with biologics in severe food allergies.

Importance of passive diffusion in the uptake of polychlorinated biphenyls by phagotrophic protozoa

Energy Technology Data Exchange (ETDEWEB)

Kujawinski, E.B.; Farrington, J.W.; Moffett, J.W.

2000-05-01

Unicellular protozoan grazers represent a size class of organisms where a transition in the mechanism of chlorobiphenyl (CB) introduction, from diffusion through surface membranes to ingestion of contaminated prey, could occur. This study compares the relative importance of these two processes in the overall uptake of polychlorinated biphenyls by protists. Uptake rates and steady-state concentrations were compared in laboratory cultures of grazing and nongrazing protozoa. These experiments were conducted with a 10-{micro}m marine scuticociliate (Uronema sp.), bacterial prey (Halomonas halodurans), and a suite of 21 CB congeners spanning a range of aqueous solubilities. The dominant pathway of CB uptake by both grazing and nongrazing protozoa was diffusion. Organic-carbon-normalized CB concentrations (in the protozoan cell) were equivalent in grazing and nongrazing protozoa for all congeners studied. Rate constants for uptake into and loss from the protozoan cell were independently determined by using [3,3{prime}, 4,4{prime}-{sup 14}C]tetrachlorobiphenyl (IUPAC no. 77), 0.38 {+-} 0.03 min{sup {minus}1} and (1.1 {+-} 0.1) x 10{sup {minus}5} (g of organic carbon){minus}{sup {minus}1} min{sup {minus}1}, respectively. Magnitudes of the uptake and loss processes were calculated and compared by using a numerical model. The model result was consistent with data from the bioaccumulation experiment and supported the hypothesis that diffusive uptake is faster than ingestive uptake in phagotrophic unicellular protozoa.

Assessment of uncertainties in severe accident management strategies

International Nuclear Information System (INIS)

Kastenberg, W.E.; Apostolakis, G.; Catton, I.; Dhir, V.K.; Okrent, D.

1990-01-01

Recent progress on the development of Probabilistic Risk Assessment (PRA) as a tool for qualifying nuclear reactor safety and on research devoted to severe accident phenomena has made severe accident management an achievable goal. Severe accident management strategies may involve operational changes, modification and/or addition of hardware, and institutional changes. In order to achieve the goal of managing severe accidents, a method for assessment of strategies must be developed which integrates PRA methodology and our current knowledge concerning severe accident phenomena, including uncertainty. The research project presented in this paper is aimed at delineating uncertainties in severe accident progression and their impact on severe accident management strategies

Application Study of Fire Severity Classification

International Nuclear Information System (INIS)

Kim, In Hwan; Kim, Hyeong Taek; Jee, Moon Hak; Kim, Yun Jung

2013-01-01

This paper introduces the Fire Incidents Severity Classification Method for Korean NPPs that may be derived directly from the data fields and feasibility study for domestic uses. FEDB was characterized in more detail and assessed based on the significance of fire incidents in the updated database and five fire severity categories were defined. The logical approach to determine the fire severity starts from the most severe characteristics, namely challenging fires, and continues to define the less challenging and undetermined categories in progress. If the FEDB is utilized for Korean NPPs, the ways of Fire Severity Classification suggested in 2.4 above can be utilized for the quantitative fire risk analysis in future. The Fire Events Database (FEDB) is the primary source of fire data which are used for fire frequency in Fire PSA (Probabilistic Safety Assessment). The purpose of its development is to calculate the quantitative fire frequency at the comprehensive and consolidated source derived from the fire incident information available for Nuclear Power Plants (NPPs). Recently, the Fire Events Database (FEDB) was updated by Electric Power Research Institute (EPRI) and Nuclear Regulatory Commission (NRC) in U. S. The FEDB is intended to update the fire event history up to 2009. A significant enhancement to it is the reorganization and refinement of the database structure and data fields. It has been expanded and improved data fields, coding consistency, incident detail, data review fields, and reference data source traceability. It has been designed to better support several Fire PRA uses as well

Congenital Anorectal Malformation Severity Does Not Predict Severity of Congenital Heart Defects

NARCIS (Netherlands)

Jonker, Jara E.; Liem, Eryn T.; Elzenga, Nynke J.; Molenbuur, Bouwe; Trzpis, Monika; Broens, Paul M. A.

2016-01-01

Objective To determine the prevalence of congenital heart defects (CHDs) in patients with mild or severe congenital anorectal malformations (CARMs), and whether all patients with CARM need pediatric cardiology screening. Study design We included 129 patients with CARM born between 2004 and 2013, and

Severe hypothyroidism masquerading as renal impairment

DEFF Research Database (Denmark)

Bistrup, C; Jensen, Dorte Møller; Kvetny, J

1996-01-01

A case of severe hypothyroidism in a 51-year old male is presented. The patient was especially complaining of weakness, stiffness and moderate pain in the proximal muscle groups together with rhinorrhea and nasal stenosis. Because of severely elevated S-creatine-kinase combined with reduced...

Hepatitis E-induced severe myositis.

Science.gov (United States)

Mengel, Annerose M; Stenzel, Werner; Meisel, Andreas; Büning, Carsten

2016-02-01

Hepatitis E virus (HEV) is endemic in Asian and African countries but is rarely reported in Western countries. Although there are some prominent neurological manifestations, HEV is rarely recognized by neurologists. This is a case report of myositis induced by HEV. We report the life-threatening case of a 57-year-old man with flaccid tetraparesis due to myositis, acute hepatitis, and renal failure caused by HEV infection. Muscle biopsy revealed scattered myofiber necrosis with a diffuse, mild lymphomonocytic infiltrate in the endomysium and perimysium. Because the patient suffered from an acute HEV infection with a rapidly progressive course of severe myopathy, we started ribavirin treatment. He recovered partially within 3 weeks and recovered fully within 6 months. This case highlights a neurological manifestation of endemic HEV infection with severe myositis in a patient with alcoholic chronic liver disease. Ribavirin treatment is effective in severe HEV infection and may also lead to rapid neurological recovery. © 2015 Wiley Periodicals, Inc.

Hospital Management of Severe Hypertriglyceridemia in Children.

Science.gov (United States)

Valaiyapathi, Badhma; Ashraf, Ambika P

2017-01-01

Severe Hypertriglyceridemia (HTG), i.e., plasma triglyceride levels exceeding 1000 mg/dL, is one of the established causes of acute pancreatitis and severe abdominal pain. There are no established pediatric guidelines regarding treatment of children and adolescents with severe HTG. To review the pathophysiology and etiology of severe HTG in the pediatric age group, and to discuss management options. Severe HTG is usually due to deficient or absent Lipoprotein Lipase (LPL) activity, which can be due to primary genetic etiology or secondary causes triggering HTG in those with underlying genetic susceptibility. Hospitalization is indicated for patients with severe HTG who are symptomatic with abdominal pain or pancreatitis, in those with uncontrolled diabetes requiring insulin, or, in those with substantial elevations of plasma TG. Fasting followed by fat free diet until plasma TG declines to severe pancreatitis, shock or multi-organ failure. Medications such as fibrates and omega-3 fatty acids are not effective if LPL activity is absent or when plasma TG is >1800 mg/dL. Medications only have an adjunct role in the management. Low fat diet, lifestyle changes, weight loss, control of secondary causes, and patient education form the mainstay of management once the patient is discharged. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Development of Krsko Severe Accident Management Database (SAMD)

International Nuclear Information System (INIS)

Basic, I.; Kocnar, R.

1996-01-01

Severe Accident Management is a framework to identify and implement the Emergency Response Capabilities that can be used to prevent or mitigate severe accidents and their consequences. Krsko Severe Accident Management Database documents the severe accident management activities which are developed in the NPP Krsko, based on the Krsko IPE (Individual Plant Examination) insights and Generic WOG SAMGs (Westinghouse Owners Group Severe Accident Management Guidance). (author)

Air pollution and asthma severity in adults

Science.gov (United States)

Rage, Estelle; Siroux, Valérie; Künzli, Nino; Pin, Isabelle; Kauffmann, Francine

2009-01-01

Objectives There is evidence that exposure to air pollution affects asthma, but the effect of air pollution on asthma severity has not been addressed. The aim was to assess the relation between asthma severity during the past 12 months and home outdoor concentrations of air pollution. Methods Asthma severity over the last 12 months was assessed in two complementary ways among 328 adult asthmatics from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA) examined between 1991 and 1995. The 4-class severity score integrated clinical events and type of treatment. The 5-level asthma score is based only on the occurrence of symptoms. Nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) concentrations were assigned to each residence using two different methods. The first was based on the closest monitor data from 1991–1995. The second consisted in spatial models that used geostatistical interpolations and then assigned air pollutants to the geo-coded residences (1998). Results Higher asthma severity score was significantly related to the 8-hour average of ozone during April-September (O3-8hr) and the number of days (O3-days) with 8-hour ozone averages above 110 μg.m−3 (for a 36-day increase, equivalent to the inter quartile range, in O3-days, odds ratio (95% confidence interval) 2.22 (1.61–3.07) for one class difference in score). Adjustment for age, sex, smoking habits, occupational exposure, and educational level did not alter results. Asthma severity was unrelated to NO2. Both exposure assessment methods and severity scores resulted in very similar findings. SO2 correlated with severity but reached statistical significance only for the model based assignment of exposure. Conclusions The observed associations between asthma severity and air pollution, in particular O3, support the hypothesis that air pollution at levels far below current standards increases asthma severity. PMID:19017701

Personality dimensions and service failure severity

African Journals Online (AJOL)

kirstam

Dr L. Kruger is a senior lecturer in the Department of Marketing Management ... severity rather than possible individual consumer effects on service failure severity. ... When service failures occur, there is an imbalance in the relationship, because ... service recovery strategies may result in a successful recovery experience ( ...

NPP Krsko Severe Accident Management Guidelines Implementation

International Nuclear Information System (INIS)

Basic, I.; Krajnc, B.; Bilic-Zabric, T.; Spiler, J.

2002-01-01

Severe Accident Management is a framework to identify and implement the Emergency Response Capabilities that can be used to prevent or mitigate severe accidents and their consequences. The USA NRC has indicated that the development of a licensee plant specific accident management program will be required in order to close out the severe accident regulatory issue (Ref. SECY-88-147). Generic Letter 88-20 ties the Accident management Program to IPE for each plant. The SECY-89-012 defines those actions taken during the course of an accident by the plant operating and technical staff to: 1) prevent core damage, 2) terminate the progress of core damage if it begins and retain the core within the reactor vessel, 3) maintain containment integrity as long as possible, and 4) minimize offsite releases. The subject of this paper is to document the severe accident management activities, which resulted in a plant specific Severe Accident Management Guidelines implementation. They have been developed based on the Krsko IPE (Individual Plant Examination) insights, Generic WOG SAMGs (Westinghouse Owners Group Severe Accident Management Guidances) and plant specific documents developed within this effort. Among the required plant specific actions the following are the most important ones: Identification and documentation of those Krsko plant specific severe accident management features (which also resulted from the IPE investigations). The development of the Krsko plant specific background documents (Severe Accident Plant Specific Strategies and SAMG Setpoint Calculation). Also, paper discusses effort done in the areas of NPP Krsko SAMG review (internal and external ), validation on Krsko Full Scope Simulator (Severe Accident sequences are simulated by MAAP4 in real time) and world 1st IAEA Review of Accident Management Programmes (RAMP). (author)

Jose Cabrera NPP severe accident management activities

International Nuclear Information System (INIS)

Blanco, J.; Almeida, P.; Saiz, J.; Sastre, J.L.; Delgado, R.

1998-01-01

To prepare a common acting plan with respect to Severe Accident Management, in 1994 was founded the severe accident management ''ad-hoc'' working group from the Spanish Westinghouse PWR Nuclear Power Plant Owners Group. In this group actively collaborated the Jose Cabrera NPP Training Centre and the Department of Nuclear Engineering of UNION FENOSA. From this moment, Jose Cabrera NPP began the planning of its specific Severe Accident Management Program, which main point are Severe Accident Management Guidelines (SAMG). To elaborate this guidelines, the Spanish translation of Westinghouse Owners Group (WOG) Severe Accident Management Guidelines were considered the reference documents. The implementation of this Guidelines to Jose Cabrera NPP started on January 1997. Once the specific guidelines have been implemented to the plant, training activities for the personnel involved in severe accident issues will be developed. To prepare the training exercises MAAP4 code will be used, and with this intention, a specific Jose Cabrera NPP MAAP-GRAAPH screen has been developed. Furthermore, a wide selection of MAAP input files for the simulation of different scenarios and accidental events is available. (Author)

Conclusions on severe accident research priorities

International Nuclear Information System (INIS)

Klein-Heßling, W.; Sonnenkalb, M.; Jacquemain, D.; Clément, B.; Raimond, E.; Dimmelmeier, H.; Azarian, G.; Ducros, G.; Journeau, C.; Herranz Puebla, L.E.; Schumm, A.; Miassoedov, A.; Kljenak, I.; Pascal, G.; Bechta, S.; Güntay, S.; Koch, M.K.; Ivanov, I.; Auvinen, A.; Lindholm, I.

2014-01-01

Highlights: • Estimation of research priorities related to severe accident phenomena. • Consideration of new topics, partly linked to the severe accidents at Fukushima. • Consideration of results of recent projects, e.g. SARNET, ASAMPSA2, OECD projects. - Abstract: The objectives of the SARNET network of excellence are to define and work on common research programs in the field of severe accidents in Gen. II–III nuclear power plants and to further develop common tools and methodologies for safety assessment in this area. In order to ensure that the research conducted on severe accidents is efficient and well-focused, it is necessary to periodically evaluate and rank the priorities of research. This was done at the end of 2008 by the Severe Accident Research Priority (SARP) group at the end of the SARNET project of the 6th Framework Programme of European Commission (FP6). This group has updated this work in the FP7 SARNET2 project by accounting for the recent experimental results, the remaining safety issues as e.g. highlighted by Level 2 PSA national studies and the results of the recent ASAMPSA2 FP7 project. These evaluation activities were conducted in close relation with the work performed under the auspices of international organizations like OECD or IAEA. The Fukushima-Daiichi severe accidents, which occurred while SARNET2 was running, had some effects on the prioritization and definition of new research topics. Although significant progress has been gained and simulation models (e.g. the ASTEC integral code, jointly developed by IRSN and GRS) were improved, leading to an increased confidence in the predictive capabilities for assessing the success potential of countermeasures and/or mitigation measures, most of the selected research topics in 2008 are still of high priority. But the Fukushima-Daiichi accidents underlined that research efforts had to focus still more to improve severe accident management efficiency

Etiology, clinical profile, severity and outcome of acute pancreatitis in relation to bed side index for severity of acute pancreatitis bisap and CT severity index [CTSI] scores

Directory of Open Access Journals (Sweden)

Bezwada Srinivasa Rao, Matta SreeVani, V.Sarat Chandra

2014-11-01

Full Text Available Background: Acute pancreatitis is an inflammatory process of the pancreas with involvement of regional tissues or remote organ systems and with potentially devastating consequences. Early prediction of outcome of acute pancreatitis within 24 hrs by clinically based bed Side Index of Severity of Acute Pancreatitis [BISAP] Score and radiological based CT Severity Index [CTSI] later on being useful in initiation of early treatment, assessing severity, to prevent morbidity and mortality. In those who survive, it can progress to chronic pancreatitis resulting in malabsorption and permanent diabetes. Aim: The aim was to study aetiology, clinical profile, severity, outcome of acute pancreatitis in relation to BISAP Score and CTSI. Materials and Methods: This was an observational and prospective study. The present study enrolled 55 patients who were diagnosed as acute pancreatitis and patients with chronic pancreatitis were excluded from the study. Vital data like pulse rate, blood Pressure, temperature, respiratory rate, conscious level using Glasgow coma scale, serum amylase, lipase, Chest x-ray, US abdomen and CT abdomen [both CECT & NCCT] were done. BISAP Score was obtained at the time of presentation or within 24 hours of presentation and radiological based CT Severity Index [CTSI] was calculated using the Balthazar grading system and Necrosis Scoring system to assess the severity, morbidity and mortality. The results: In this study, the most common aetiology being alcohol intake followed by gall stones. BISAP Score 3 had organ dysfunction and Score 4 had 100% mortality. The relation between CTSI score and Organ dysfunction showed increased organic dysfunction and higher mortality with higher CTSI Scores. p value < 0.0001 was calculated using Pearson Chi-square test and found to be statistically significant. Conclusions: Both BISAP and CTSI scores had positive correlation with morbidity and mortality.

Therapy of moderate and severe psoriasis

Directory of Open Access Journals (Sweden)

Werfel, Thomas

2006-04-01

Full Text Available Objective and methods: This health technology assessment (HTA report synthesises systematically randomized controlled studies (RCT on the therapy of moderate and severe psoriasis vulgaris which were published between 1999 and 2004; it includes some important clinical studies which have been published after 2004 and thus updates the English HTA report by Griffiths et al. [1]. The major objective is the evaluation of the medical effectiveness of different therapeutical approaches and the cost effectiveness with relevance for Germany. Results: The major conclusions from the results of medical RCT on moderate and severe psoriasis vulgaris are: Oral fumarates are effective in the treatment of moderate to severe psoriasis vulgaris. However, fumarates quiet frequently cause moderate side effects. Cyclosporine and methotrexate are both effective in the treatment of severe psoriasis vulgaris. Both substances have a different spectrum of side effects which may limit the individual applicability. Acetritin is only moderately effective in the treatment of severe psoriasis of the plaque type. Calcipotriol or UV-radiation used at the same time can increase the clinical effectiveness of acetritin. Systemic PUVA, balneo-PUVA and UVB therapy are all effective for the treatment of severe psoriasis. The combination of UV therapy with vitamin D3 analogues or with topical steroids is more effective than the treatment with UV radiation alone. Saltwater baths increase the effectiveness of UVB therapy. No RCT on the therapeutical effects of topical tar or of dithranol in combination with UV therapy have been published so far. A continuous therapy with PUVA should not be applied due to its proven photocarcinogenicity. Three substances from the group of biologicals (Efalizumab, Etanercept, and Infliximab are now available in Europe and a further substance (Alefacept is available in the USA for the treatment of moderate to severe psoriasis. All biologicals have been

Safety of Induced Sputum Collection in Children Hospitalized With Severe or Very Severe Pneumonia.

Science.gov (United States)

DeLuca, Andrea N; Hammitt, Laura L; Kim, Julia; Higdon, Melissa M; Baggett, Henry C; Brooks, W Abdullah; Howie, Stephen R C; Deloria Knoll, Maria; Kotloff, Karen L; Levine, Orin S; Madhi, Shabir A; Murdoch, David R; Scott, J Anthony G; Thea, Donald M; Amornintapichet, Tussanee; Awori, Juliet O; Chuananon, Somchai; Driscoll, Amanda J; Ebruke, Bernard E; Hossain, Lokman; Jahan, Yasmin; Kagucia, E Wangeci; Kazungu, Sidi; Moore, David P; Mudau, Azwifarwi; Mwananyanda, Lawrence; Park, Daniel E; Prosperi, Christine; Seidenberg, Phil; Sylla, Mamadou; Tapia, Milagritos D; Zaman, Syed M A; O'Brien, Katherine L

2017-06-15

Induced sputum (IS) may provide diagnostic information about the etiology of pneumonia. The safety of this procedure across a heterogeneous population with severe pneumonia in low- and middle-income countries has not been described. IS specimens were obtained as part a 7-country study of the etiology of severe and very severe pneumonia in hospitalized children <5 years of age. Rigorous clinical monitoring was done before, during, and after the procedure to record oxygen requirement, oxygen saturation, respiratory rate, consciousness level, and other evidence of clinical deterioration. Criteria for IS contraindications were predefined and serious adverse events (SAEs) were reported to ethics committees and a central safety monitor. A total of 4653 IS procedures were done among 3802 children. Thirteen SAEs were reported in relation to collection of IS, or 0.34% of children with at least 1 IS specimen collected (95% confidence interval, 0.15%-0.53%). A drop in oxygen saturation that required supplemental oxygen was the most common SAE. One child died after feeding was reinitiated 2 hours after undergoing sputum induction; this death was categorized as "possibly related" to the procedure. The overall frequency of SAEs was very low, and the nature of most SAEs was manageable, demonstrating a low-risk safety profile for IS collection even among severely ill children in low-income-country settings. Healthcare providers should monitor oxygen saturation and requirements during and after IS collection, and assess patients prior to reinitiating feeding after the IS procedure, to ensure patient safety. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Containment severe accident thermohydraulic phenomena

International Nuclear Information System (INIS)

Frid, W.

1991-08-01

This report describes and discusses the containment accident progression and the important severe accident containment thermohydraulic phenomena. The overall objective of the report is to provide a rather detailed presentation of the present status of phenomenological knowledge, including an account of relevant experimental investigations and to discuss, to some extent, the modelling approach used in the MAAP 3.0 computer code. The MAAP code has been used in Sweden as the main tool in the analysis of severe accidents. The dependence of the containment accident progression and containment phenomena on the initial conditions, which in turn are heavily dependent on the in-vessel accident progression and phenomena as well as associated uncertainties, is emphasized. The report is in three parts dealing with: * Swedish reactor containments, the severe accident mitigation programme in Sweden and containment accident progression in Swedish PWRs and BWRs as predicted by the MAAP 3.0 code. * Key non-energetic ex-vessel phenomena (melt fragmentation in water, melt quenching and coolability, core-concrete interaction and high temperature in containment). * Early containment threats due to energetic events (hydrogen combustion, high pressure melt ejection and direct containment heating, and ex-vessel steam explosions). The report concludes that our understanding of the containment severe accident progression and phenomena has improved very significantly over the parts ten years and, thereby, our ability to assess containment threats, to quantify uncertainties, and to interpret the results of experiments and computer code calculations have also increased. (au)

Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma.

Science.gov (United States)

Verkleij, Marieke; van de Griendt, Erik-Jonas; Colland, Vivian; van Loey, Nancy; Beelen, Anita; Geenen, Rinie

2015-09-01

Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in previous research, scores on the Parenting Stress Index in mothers and fathers of the children with problematic severe asthma were low. Higher parenting stress was associated with higher levels of internalizing and externalizing behavioral problems in children (Child Behavior Checklist). Higher parenting stress in mothers was also associated with higher airway inflammation (FeNO). Thus, although parenting stress was suggested to be low in this group, higher parenting stress, especially in the mother, is associated with more airway inflammation and greater child behavioral problems. This indicates the importance of focusing care in this group on all possible sources of problems, i.e., disease exacerbations and behavioral problems in the child as well as parenting stress.

Invariant resolutions for several Fueter operators

Science.gov (United States)

Colombo, Fabrizio; Souček, Vladimir; Struppa, Daniele C.

2006-07-01

A proper generalization of complex function theory to higher dimension is Clifford analysis and an analogue of holomorphic functions of several complex variables were recently described as the space of solutions of several Dirac equations. The four-dimensional case has special features and is closely connected to functions of quaternionic variables. In this paper we present an approach to the Dolbeault sequence for several quaternionic variables based on symmetries and representation theory. In particular we prove that the resolution of the Cauchy-Fueter system obtained algebraically, via Gröbner bases techniques, is equivalent to the one obtained by R.J. Baston (J. Geom. Phys. 1992).

Computed tomography in severe protein energy malnutrition.

OpenAIRE

Househam, K C; de Villiers, J F

1987-01-01

Computed tomography of the brain was performed on eight children aged 1 to 4 years with severe protein energy malnutrition. Clinical features typical of kwashiorkor were present in all the children studied. Severe cerebral atrophy or brain shrinkage according to standard radiological criteria was present in every case. The findings of this study suggest considerable cerebral insult associated with severe protein energy malnutrition.

Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction

Science.gov (United States)

Pereira, Jeremy J.; Lauer, Michael S.; Bashir, Mohammad; Afridi, Imran; Blackstone, Eugene H.; Stewart, William J.; McCarthy, Patrick M.; Thomas, James D.; Asher, Craig R.

2002-01-01

OBJECTIVE: We sought to assess whether aortic valve replacement (AVR) among patients with severe aortic stenosis (AS), severe left ventricular (LV) dysfunction and a low transvalvular gradient (TVG) is associated with improved survival. BACKGROUND: The optimal management of patients with severe AS with severe LV dysfunction and a low TVG remains controversial. METHODS: Between 1990 and 1998, we evaluated 68 patients who underwent AVR at our institution (AVR group) and 89 patients who did not undergo AVR (control group), with an aortic valve area < or = 0.75 cm(2), LV ejection fraction < or = 35% and mean gradient < or = 30 mm Hg. Using propensity analysis, survival was compared between a cohort of 39 patients in the AVR group and 56 patients in the control group. RESULTS: Despite well-matched baseline characteristics among propensity-matched patients, the one- and four-year survival rates were markedly improved in patients in the AVR group (82% and 78%), as compared with patients in the control group (41% and 15%; p < 0.0001). By multivariable analysis, the main predictor of improved survival was AVR (adjusted risk ratio 0.19, 95% confidence interval 0.09 to 0.39; p < 0.0001). The only other predictors of mortality were age and the serum creatinine level. CONCLUSIONS: Among select patients with severe AS, severe LV dysfunction and a low TVG, AVR was associated with significantly improved survival.

Model for predicting the injury severity score.

Science.gov (United States)

Hagiwara, Shuichi; Oshima, Kiyohiro; Murata, Masato; Kaneko, Minoru; Aoki, Makoto; Kanbe, Masahiko; Nakamura, Takuro; Ohyama, Yoshio; Tamura, Jun'ichi

2015-07-01

To determine the formula that predicts the injury severity score from parameters that are obtained in the emergency department at arrival. We reviewed the medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The injury severity score, age, mean blood pressure, heart rate, Glasgow coma scale, hemoglobin, hematocrit, red blood cell count, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, and fibrin degradation products, were examined in those patients on arrival. To determine the formula that predicts the injury severity score, multiple linear regression analysis was carried out. The injury severity score was set as the dependent variable, and the other parameters were set as candidate objective variables. IBM spss Statistics 20 was used for the statistical analysis. Statistical significance was set at P  Watson ratio was 2.200. A formula for predicting the injury severity score in trauma patients was developed with ordinary parameters such as fibrin degradation products and mean blood pressure. This formula is useful because we can predict the injury severity score easily in the emergency department.

Improvement of severe accident analysis method for KSNP

Energy Technology Data Exchange (ETDEWEB)

Park, Jae Hong [Korea Institute of Nuclear Safety, Taejon (Korea, Republic of); Cho, Song Won; Cho, Youn Soo [Korea Radiation Technology Institute Co., Taejon (Korea, Republic of)

2002-03-15

The objective of this study is preparation of MELCOR 1.8.5 input deck for KSNP and simulation of some major severe accidents. The contents of this project are preparation of MELCOR 1.8.5 base input deck for KSNP to understand severe accident phenomena and to assess severe accident strategy, preparation of 20 cell containment input deck to simulate the distribution of hydrogen and fission products in containment, simulation of some major severe accident scenarios such as TLOFW, SBO, SBLOCA, MBLOCA, and LBLOCA. The method for MELCOR 1.8.5 input deck preparation can be used to prepare the input deck for domestic PWRs and to simulate severe accident experiments such as ISP-46. Information gained from analyses of severe accidents may be helpful to set up the severe accident management strategy and to develop regulatory guidance.

Effect of Posttraumatic Serum Thyroid Hormone Levels on Severity and Mortality of Patients with Severe Traumatic Brain Injury

Directory of Open Access Journals (Sweden)

Forough Saki

2012-02-01

Full Text Available Traumatic brain injury (TBI is an important cause of death and disability in young adults ,and may lead to physical disabilities and long-term cognitive, behavioral psychological and social defects. There is a lack of definite result about the effect of thyroid hormones after traumatic brain injury in the severity and no data about their effect on mortality of the injury. The aim of this study is to evaluate the effect of thyroid hormones after traumatic brain injury in the severity and mortality and gain a clue in brain injury prognosis. In a longitudinal prospective study from February 2010 until February 2011, we checked serum levels of T3, T4, TSH and TBG of severely brain injured patients and compared the relationship of them with primary Glasgow Coma Scale (GCS score and mortality of patients. Statistical analysis used SPSS 11.5 software with using chi-square and Fisher exact test. Serum levels of T3 and T4 were decreased after brain trauma but not TSH and TBG. Mortality rates were higher in patients with lower T4 serum levels. The head injury was more severe in whom with low T3 and T4. Follow a severe brain injury a secondary hypothyroidism is happened due to pituitary dysfunction. Also, serum level of T3 and T4 on the first day admission affect on primary GCS score of patients which is an indicator of severity of brain injury. In addition, mortality rates of severely brain injured patients have a high correlation with the serum level of T4 in the first day admission.

Gender differences in addiction severity.

Science.gov (United States)

Díaz-Mesa, Eva M; García-Portilla, Paz; Fernández-Artamendi, Sergio; Sáiz, Pilar A; Bobes Bascarán, Teresa; Casares, María José; Fonseca, Eduardo; Al-Halabí, Susana; Bobes, Julio

2016-06-14

Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSs) of men and women are similar, with the exception of Psychiatric and Partner- Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD.

12-Item Pruritus Severity Scale: Development and Validation of New Itch Severity Questionnaire

Directory of Open Access Journals (Sweden)

Adam Reich

2017-01-01

Full Text Available Introduction. A validated assessment of pruritus intensity is an important but still difficult clinical problem due to a subjective nature of this sensation. Objective. The aim of this study was the creation and validation of new itch severity questionnaire assessing pruritus intensity. Material and Methods. A total of 148 patients with pruritic dermatoses were asked to assess pruritus intensity using 12-Item Pruritus Severity Score (12-PSS and Visual Analogue Scale (VAS. Patients were also asked to complete the Dermatology Life Quality Index (DLQI and Hospitality Anxiety and Depression Scale (HADS. Test-retest comparison of 12-PSS was conducted in 102 subjects who completed the itch questionnaire twice with the 3- to 5-day interval. Results. We have created the 12-PSS assessing pruritus intensity (two questions, pruritus extent (one question and duration (one question, influence of pruritus on concentration and patient psyche (four questions, and scratching as a response to pruritus stimuli (four questions. A maximum scoring was 22 points. The results showed strong consistency (Cronbach α coefficient 0.81. A significant correlation was observed with VAS (r=0.58, p<0.001 and quality of life level according to DLQI (r=0.53, p<0.001. Test-retest comparison in 102 subjects revealed a satisfactory reproducibility of achieved results (ICC = 0,72. Conclusions. The newly developed pruritus severity questionnaire may be used in daily clinical practice in the future.

SEVERE ACCIDENT MANAGEMENT STATUS AT Loviisa

International Nuclear Information System (INIS)

Kymalainen, O.; Tuomisto, H.

1997-01-01

Some of the specific design features of IVO's Loviisa Plant, most notably the ice-condenser containment, strongly affect the plant response in a hypothetical core melt accident. They have together with the relatively stringent Finnish regulatory requirements forced IVO to develop a tailor made severe accident management strategy for Loviisa. The low design pressure of the ice-condenser containment complicates the design of the hydrogen management system. On the other hand, the ice-condensers and the water available from them are facilitating factors regarding in-vessel retention of corium by external cooling of reactor pressure vessel. This paper summarizes the Finnish severe accident requirements, IVO's approach to severe accidents, and its application to the Loviisa Plant

A "high severity" spruce beetle outbreak in Wyoming causes moderate-severity carbon cycle perturbations

Science.gov (United States)

Berryman, E.; Frank, J. M.; Speckman, H. N.; Bradford, J. B.; Ryan, M. G.; Massman, W. J.; Hawbaker, T. J.

2017-12-01

Bark beetle outbreaks in Western North American forests are often considered a high-severity disturbance from a carbon (C) cycling perspective, but field measurements that quantify impacts on C dynamics are very limited. Often, factors out of the researcher's control complicate the separation of beetle impacts from other drivers of C cycling variability and restrict statistical inference. Fortuitously, we had four years of pre-spruce beetle outbreak C cycle measurements in a subalpine forest in southeastern Wyoming (Glacier Lakes Ecosystem Experiments Site, or GLEES) and sustained intermittent monitoring for nearly a decade after the outbreak. Here, we synthesize published and unpublished pre- and post-outbreak measurements of key C cycle stocks and fluxes at GLEES. Multiple lines of evidence, including chamber measurements, eddy covariance measurements, and tracking of soil and forest floor C pools over time, point to the GLEES outbreak as a moderate-severity disturbance for C loss to the atmosphere, despite 70% to 80% of overstory tree death. Reductions in NEE were short-lived and the forest quickly returned to a carbon-neutral state, likely driven by an uptick in understory growth. Effect of mortality on the C cycle was asymmetrical, with a 50% reduction in net carbon uptake (NEE) two years into the outbreak, yet no measureable change in either ecosystem or growing season soil respiration. A small pulse in soil respiration occurred but was only detectable during the winter and amounted to < 10% of NEE. Possible reasons for the lack of measureable respiration response are discussed with emphasis on lessons learned for monitoring and modeling future outbreaks. We suggest a comprehensive assessment and definition of "moderate-severity" disturbances for Western forests and suggest that all tree mortality events may not be high-severity when it comes to C fluxes.

Impact of pavement conditions on crash severity.

Science.gov (United States)

Li, Yingfeng; Liu, Chunxiao; Ding, Liang

2013-10-01

Pavement condition has been known as a key factor related to ride quality, but it is less clear how exactly pavement conditions are related to traffic crashes. The researchers used Geographic Information System (GIS) to link Texas Department of Transportation (TxDOT) Crash Record Information System (CRIS) data and Pavement Management Information System (PMIS) data, which provided an opportunity to examine the impact of pavement conditions on traffic crashes in depth. The study analyzed the correlation between several key pavement condition ratings or scores and crash severity based on a large number of crashes in Texas between 2008 and 2009. The results in general suggested that poor pavement condition scores and ratings were associated with proportionally more severe crashes, but very poor pavement conditions were actually associated with less severe crashes. Very good pavement conditions might induce speeding behaviors and therefore could have caused more severe crashes, especially on non-freeway arterials and during favorable driving conditions. In addition, the results showed that the effects of pavement conditions on crash severity were more evident for passenger vehicles than for commercial vehicles. These results provide insights on how pavement conditions may have contributed to crashes, which may be valuable for safety improvement during pavement design and maintenance. Readers should notice that, although the study found statistically significant effects of pavement variables on crash severity, the effects were rather minor in reality as suggested by frequency analyses. Copyright © 2013 Elsevier Ltd. All rights reserved.

Photographic Documentation and Hand Eczema Severity Index for Severity Assessment of Hand Eczema

DEFF Research Database (Denmark)

Zabludovska, Kristine; Ibler, Kristina S; Jemec, Gregor B E

2017-01-01

.003), respectively, and major worsening, r = 0.41 (P = 0.021). With respect to minor changes, no statistically significant correlations were found (P > 0.05). CONCLUSIONS: In patients with mild HE, photographic assessment was found useful for major and moderate changes only. Further studies would need......BACKGROUND: Hand eczema (HE) is a fluctuating disease, and an objective assessment of HE severity is coveted. OBJECTIVES: This study was undertaken to test the association between Hand Eczema Severity Index (HECSI) score and panel scores of photographs taken by dermatologists. METHODS: A total...... were engaged in blinded evaluation of photographs. RESULTS: The highest correlation coefficients between delta HECSI scores and delta panel scores of photographs in the first and second evaluation rounds were found for moderate improvement and moderate worsening, rs = -0.46 (P = 0.009) and 0.52 (P = 0...

Fire severity classification: Uses and abuses

Science.gov (United States)

Theresa B. Jain; Russell T. Graham

2003-01-01

Burn severity (also referred to as fire severity) is not a single definition, but rather a concept and its classification is a function of the measured units unique to the system of interest. The systems include: flora and fauna, soil microbiology and hydrologic processes, atmospheric inputs, fire management, and society. Depending on the particular system of interest...

Association between pain severity, depression severity, and use of health care services in Japan: results of a nationwide survey

Directory of Open Access Journals (Sweden)

Vietri J

2015-03-01

Full Text Available Jeffrey Vietri,1 Tempei Otsubo,2 William Montgomery,3 Toshinaga Tsuji,4 Eiji Harada5 1Health Outcomes Practice, Kantar Health, Milan, Italy; 2Tokyo Shinjuku Medical Center, Tokyo, Japan; 3Eli Lilly Australia Pty Ltd., West Ryde, Australia; 4Medical Affairs, Shionogi & Co., Ltd., Osaka, Japan; 5Eli Lilly Japan KK, Kobe, Japan Background: Depression is often associated with painful physical symptoms. Previous research has seldom assessed the relationship between the severity of physical symptoms and the severity of mental and emotional symptoms of depression or other health outcomes, and no such studies have been conducted previously among individuals with depression in Japan. The aim of this study was to assess the relationship between the severity of physical pain and depression and other outcomes among individuals in Japan diagnosed with depression.Methods: Data for individuals aged 18 and older in Japan who reported being diagnosed with depression and also reported physical pain were obtained from the Japan National Health and Wellness Survey. These respondents were characterized on sociodemographics and health characteristics, and the relationship between ratings of severity on pain in the last week and health outcomes were assessed using bivariate correlations and generalized linear models. Measures included the Patient Health Questionnaire for depression severity, Medical Outcomes Study 12-Item Short Form Survey Instrument for health-related quality of life, the Work Productivity and Activity Impairment for work and activity impairment, and 6-month report of health care use.Results: More severe physical pain in the past week was correlated with more severe depression, worse health-related quality of life, lower health utility, greater impairment at work, and more health care provider visits. These relationships remained significant after incorporating sociodemographics and health characteristics in the statistical models

Detection of Severe Respiratory Disease Epidemic Outbreaks by CUSUM-Based Overcrowd-Severe-Respiratory-Disease-Index Model

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Carlos Polanco

2013-01-01

Full Text Available A severe respiratory disease epidemic outbreak correlates with a high demand of specific supplies and specialized personnel to hold it back in a wide region or set of regions; these supplies would be beds, storage areas, hemodynamic monitors, and mechanical ventilators, as well as physicians, respiratory technicians, and specialized nurses. We describe an online cumulative sum based model named Overcrowd-Severe-Respiratory-Disease-Index based on the Modified Overcrowd Index that simultaneously monitors and informs the demand of those supplies and personnel in a healthcare network generating early warnings of severe respiratory disease epidemic outbreaks through the interpretation of such variables. A post hoc historical archive is generated, helping physicians in charge to improve the transit and future allocation of supplies in the entire hospital network during the outbreak. The model was thoroughly verified in a virtual scenario, generating multiple epidemic outbreaks in a 6-year span for a 13-hospital network. When it was superimposed over the H1N1 influenza outbreak census (2008–2010 taken by the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, it showed that it is an effective algorithm to notify early warnings of severe respiratory disease epidemic outbreaks with a minimal rate of false alerts.

Detection of Severe Respiratory Disease Epidemic Outbreaks by CUSUM-Based Overcrowd-Severe-Respiratory-Disease-Index Model

Science.gov (United States)

Castañón-González, Jorge Alberto; Macías, Alejandro E.; Samaniego, José Lino; Buhse, Thomas; Villanueva-Martínez, Sebastián

2013-01-01

A severe respiratory disease epidemic outbreak correlates with a high demand of specific supplies and specialized personnel to hold it back in a wide region or set of regions; these supplies would be beds, storage areas, hemodynamic monitors, and mechanical ventilators, as well as physicians, respiratory technicians, and specialized nurses. We describe an online cumulative sum based model named Overcrowd-Severe-Respiratory-Disease-Index based on the Modified Overcrowd Index that simultaneously monitors and informs the demand of those supplies and personnel in a healthcare network generating early warnings of severe respiratory disease epidemic outbreaks through the interpretation of such variables. A post hoc historical archive is generated, helping physicians in charge to improve the transit and future allocation of supplies in the entire hospital network during the outbreak. The model was thoroughly verified in a virtual scenario, generating multiple epidemic outbreaks in a 6-year span for a 13-hospital network. When it was superimposed over the H1N1 influenza outbreak census (2008–2010) taken by the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, it showed that it is an effective algorithm to notify early warnings of severe respiratory disease epidemic outbreaks with a minimal rate of false alerts. PMID:24069063

The treatment of severe malaria.

Science.gov (United States)

Dondorp, Arjen M; Day, Nick P J

2007-07-01

In the SEAQUAMAT trial, parenteral artesunate was shown to be associated with a considerably lower mortality than quinine, and is now the recommended treatment for severe malaria in low-transmission areas and in the second and third trimesters of pregnancy. A trial is underway to establish its role in African children. The development of artesunate suppositories may provide the means to treat patients with severe disease in remote rural settings, potentially buying the time needed to reach a health care facility. The increasing availability of basic intensive care facilities in developing countries also has the potential to further reduce mortality.

National practices in relation to severe accidents

International Nuclear Information System (INIS)

Soda, Kunihisa

1989-01-01

After the accidents at Three Mile Island and Chernobyl, many studies have been carried out on severe accidents by various organizations including IAEA and OECD/CSNI. In the present article, measures taken in different countries against severe accidents are outlined based on the results of these studies. In Sweden, policies for the management of a severe accident and reduction in the release of radioactive materials were established based on reports issued by the Atomic Energy Committee, which was set up after the Three Mile Island accident. The current policies require that filter vents be provided where necessary. France, following Sweden, adopted the use of filter vents. Operation procedures to be followed in the event of a severe accident have been established in the nation. The measures against severe accidents adopted in West Germany mainly focus on the weakening of the effects of accidents, and are not covered by the design standards. The use of filter vents are also required in Finland and Switzerland. In the U.S., a program for individual plant examination will be implemented over the three-year period beginning in 1989. Studies on measures against severe accidents seem to be performed also in the Soviet Union. (N.K.)

Eating disorder severity and functional impairment

DEFF Research Database (Denmark)

Davidsen, Annika Helgadóttir; Hoyt, William T.; Poulsen, Stig Bernt

2017-01-01

Purpose: The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship. Methods: The study included 159 patients...... was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically. Results: Duration of illness significantly moderated the relationship between eating disorder severity and functional...... impairment; the relationship was strongest for patients with a shorter duration of illness. Psychological distress partly mediated the relationship between eating disorder severity and functional impairment. Duration of illness significantly moderated the relationship between psychological distress...

The role of stress in IBS symptom severity

Directory of Open Access Journals (Sweden)

Sanda Pletikosic

2016-04-01

Full Text Available Irritable bowel syndrome is regarded as a biopsychosocial disorder, the result of a complex combination of predisposing, precipitating and perpetuating factors. Personality traits, affective status and stress are some of the relevant factors contributing to lower quality of life and symptom exacerbation in IBS patients. In order to examine the role of stress in IBS symptom exacerbation, the aims of this study were to explore the relationship of daily stressful events and symptom severity in a prospective manner and to explore the roles of neuroticism, anxiety, depression and stress in the vicious circle of symptom perpetuation. A total of 49 patients with IBS reported their symptom severity and daily stressful events intensity each day for 14 consecutive days. They also completed the Big five personality inventory, the Beck Depression Inventory and the State-trait anxiety inventory. Cross-correlation analyses were performed on the time series data for daily stress and symptom severity for each participant separately. Four different patterns of relationships were found in different subgroups of participants: positive cross-correlations of symptom severity and stress intensity on the same day; higher symptom severity on days following stressful days; lower symptom severity on days following stressful days; and lower stress intensity on days following severe symptoms. Using average scores for daily stress and symptom severity, as well as scores for neuroticism, anxiety and depression, we performed a path analysis to test a model of symptom exacerbation. It showed that, on the group level, average stress intensity predicts average symptom severity. Neuroticism and anxiety were not significant predictors of symptom severity, while depression showed a marginally significant relationship with symptom severity, mediated by stress intensity. In conclusion, depression and daily stress seem to be important contributors to the vicious circle of IBS symptom

[Determinant-based classification of acute pancreatitis severity. International multidisciplinary classification of acute pancreatitis severity: the 2013 German edition

NARCIS (Netherlands)

Layer, P.; Dellinger, E.P.; Forsmark, C.E.; Levy, P.; Maravi-Poma, E.; Shimosegawa, T.; Siriwardena, A.K.; Uomo, G.; Whitcomb, D.C.; Windsor, J.A.; Petrov, M.S.; Geenen, E.J.M. van; et al.,

2013-01-01

OBJECTIVE: The aim of this study was to develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. BACKGROUND: The Atlanta definitions of acute pancreatitis severity

Allogeneic Transplant in ELANE and MEFV Mutation Positive Severe Cyclic Neutropenia: Review of Prognostic Factors for Secondary Severe Events

Directory of Open Access Journals (Sweden)

Onyemaechi N. Okolo

2017-01-01

Full Text Available Objective and Importance. Cyclic neutropenia (CyN is a rare autosomal dominant inherited disorder due to the mutation ELANE primarily affecting bone marrow stem cells and is characterized by recurrent neutropenia every 2 to 4 weeks. Symptoms vary from benign to severe, including death. Postulations on the cause of wide spectrum in symptom presentation include the possibility of other genetic mutations, such as MEFV. Recommended treatment for CyN is G-CSF to keep ANC higher to minimize risk of infection. Case. A 25-year-old male diagnosed with CyN, on G-CSF but worsening quality of life. Pretransplant investigations revealed ELANE mutation positive severe CyN along with familial Mediterranean fever (MEFV mutation. Intervention. Bone marrow transplantation as treatment for dual mutation (ELANE and MEFV mutation positive severe CyN. Conclusion. BMT may be considered as an alternative treatment for severe CyN in patients who are refractory to G-CSF. It is postulated that in our patient the combined mutations (CyN and MEFV may have contributed to the severity of this individual’s symptoms. We suggest CyN patients who present with severe symptoms have evaluation with ELANE mutation testing, Periodic Fever Syndromes Panel, and routine marrow assessment with FISH, conventional cytogenetics, and morphological evaluation for MDS/AML.

PEG-asparaginase induced severe hypertriglyceridemia.

Science.gov (United States)

Galindo, Rodolfo J; Yoon, Justin; Devoe, Craig; Myers, Alyson K

2016-04-01

Asparaginase (ASP) is an effective chemotherapy agent extensively used in children with acute lymphocytic leukemia (ALL). There has been a recent interest in using ASP in adults with ALL, particularly the less toxic pegylated (PEG) formulation. Hypertriglyceridemia (HTG) is a rare complication of PEG-ASP therapy. We report two cases of obese patients who developed severe HTG after receiving PEG for ALL. Both patients were incidentally found to have severe HTG (TG of 4,330 and 4,420 mg/dL). In both patients, there was no personal or family history of dyslipidemia or hypothyroidism. There was no evidence of pancreatitis or skin manifestations of HTG. Both patients were treated with PEG cessation, low-fat diet and pharmacotherapy. Both patients were re-challenged with PEG, with subsequent increase in TG but no associated complications. TG returned to baseline after discontinuing PEG and while on therapy for HTG. A literature review of PEG-induced HTG in adults demonstrated similar results: asymptomatic presentation despite very severe HTG. HTG is a rare but clinically important adverse effect of PEG. Underlying obesity and/or diabetes may represent risk factors. Clinicians should monitor TG levels during PEG therapy to avoid TG-induced pancreatitis.

Detecting signals of seasonal influenza severity through age dynamics

DEFF Research Database (Denmark)

Lee, Elizabeth C.; Viboud, Cécile; Simonsen, Lone

2015-01-01

stages of an outbreak. To address the limitations of traditional indicators, we propose a novel severity index based on influenza age dynamics estimated from routine physician diagnosis data that can be used retrospectively and for early warning. METHODS: We developed a quantitative 'ground truth......' severity benchmark that synthesizes multiple traditional severity indicators from publicly available influenza surveillance data in the United States. Observing that the age distribution of cases may signal severity early in an epidemic, we constructed novel retrospective and early warning severity indexes....... The retrospective index was well correlated with the severity benchmark and correctly identified the two most severe seasons. The early warning index performance varied, but it projected 2007-08 as relatively severe 10 weeks prior to the epidemic peak. Influenza severity varied significantly among states within...

Coolability of severely degraded CANDU cores

International Nuclear Information System (INIS)

Meneley, D.A.; Blahnik, C.; Rogers, J.T.; Snell, V.G.; Mijhawan, S.

1995-07-01

Analytical and experimental studies have shown that the separately cooled moderator in a CANDU reactor provides an effective heat sink in the event of a loss-of-coolant accident (LOCA) accompanied by total failure of the emergency core cooling system (ECCS). The moderator heat sink prevents fuel melting and maintains the integrity of the fuel channels, therefore terminating this severe accident short of severe core damage. Nevertheless, there is a probability, however low, that the moderator heat sink could fail in such an accident. The pioneering work of Rogers (1984) for such a severe accident using simplified models showed that the fuel channels would fail and a bed of dry, solid debris would be formed at the bottom of the calandria which would heat up and eventually melt. However, the molten pool of core material would be retained in the calandria vessel, cooled by the independently cooled shield-tank water, and would eventually re solidify. Thus, the calandria vessel would act inherently as a core-catcher as long as the shield tank integrity is maintained. The present paper reviews subsequent work on the damage to a CANDU core under severe accident conditions and describes an empirically based mechanistic model of this process. It is shown that, for such severe accident sequences in a CANDU reactor, the end state following core disassembly consists of a porous bed of dry solid, coarse debris, irrespective of the initiating event and the core disassembly process. (author). 48 refs., 3 tabs., 18 figs

Severe Weather Environments in Atmospheric Reanalyses

Science.gov (United States)

King, A. T.; Kennedy, A. D.

2017-12-01

Atmospheric reanalyses combine historical observation data using a fixed assimilation scheme to achieve a dynamically coherent representation of the atmosphere. How well these reanalyses represent severe weather environments via proxies is poorly defined. To quantify the performance of reanalyses, a database of proximity soundings near severe storms from the Rapid Update Cycle 2 (RUC-2) model will be compared to a suite of reanalyses including: North American Reanalysis (NARR), European Interim Reanalysis (ERA-Interim), 2nd Modern-Era Retrospective Reanalysis for Research and Applications (MERRA-2), Japanese 55-year Reanalysis (JRA-55), 20th Century Reanalysis (20CR), and Climate Forecast System Reanalysis (CFSR). A variety of severe weather parameters will be calculated from these soundings including: convective available potential energy (CAPE), storm relative helicity (SRH), supercell composite parameter (SCP), and significant tornado parameter (STP). These soundings will be generated using the SHARPpy python module, which is an open source tool used to calculate severe weather parameters. Preliminary results indicate that the NARR and JRA55 are significantly more skilled at producing accurate severe weather environments than the other reanalyses. The primary difference between these two reanalyses and the remaining reanalyses is a significant negative bias for thermodynamic parameters. To facilitate climatological studies, the scope of work will be expanded to compute these parameters for the entire domain and duration of select renalyses. Preliminary results from this effort will be presented and compared to observations at select locations. This dataset will be made pubically available to the larger scientific community, and details of this product will be provided.

The development of severe accident analysis technology

Energy Technology Data Exchange (ETDEWEB)

Kim, Heuy Dong; Cho, Sung Won; Kim, Sang Baek; Park, Jong Hwa; Lee, Kyu Jung; Park, Lae Joon; Hu, Hoh; Hong, Sung Wan [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

1993-07-01

The objective of the development of severe accident analysis technology is to understand the severe accident phenomena such as core melt progression and to provide a reliable analytical tool to assess severe accidents in a nuclear power plant. Furthermore, establishment of the accident management strategies for the prevention/mitigation of severe accidents is also the purpose of this research. The study may be categorized into three areas. For the first area, two specific issues were reviewed to identify the further research direction, that is the natural circulation in the reactor coolant system and the fuel-coolant interaction as an in-vessel and an ex-vessel phenomenological study. For the second area, the MELCOR and the CONTAIN codes have been upgraded, and a validation calculation of the MELCOR has been performed for the PHEBUS-B9+ experiment. Finally, the experimental program has been established for the in-vessel and the ex-vessel severe accident phenomena with the in-pile test loop in KMRR and the integral containment test facilities, respectively. (Author).

Surgical Management of Severe Epistaxis.

Science.gov (United States)

Lin, Giant; Bleier, Benjamin

2016-06-01

Many patients with severe epistaxis benefit from endoscopic intervention for control of bleeding. Critical maneuvers to improve endoscopic visualization during surgery include head-of-bed elevation, application of topical vasoconstrictors, and local injection of vasonstrictors. Controlled, hypotensive anesthesia may also decrease intraoperative blood loss and improve visualization during surgery. Intractable posterior epistaxis can be controlled with high rates of success with endoscopic sphenopalatine artery ligation. Although less common, intractable anterior epistaxis may be controlled by anterior ethmoid artery ligation once this artery is identified as the primary source. Less common sources of severe epistaxis are also discussed in this article. Copyright © 2016 Elsevier Inc. All rights reserved.

Addressing severe accidents in the CANDU 9 design

International Nuclear Information System (INIS)

Nijhawan, S.M.; Wight, A.L.; Snell, V.G.

1998-01-01

CANDU 9 is a single-unit evolutionary heavy-water reactor based on the Bruce/Darlington plants. Severe accident issues are being systematically addressed in CANDU 9, which includes a number of unique features for prevention and mitigation of severe accidents. A comprehensive severe accident program has been formulated with feedback from potential clients and the Canadian regulatory agency. Preliminary Probabilistic Safety Analyses have identified the sequences and frequency of system and human failures that may potentially lead to initial conditions indicating onset of severe core damage. Severe accident consequence analyses have used these sequences as a guide to assess passive heat sinks for the core, and containment performance. Estimates of the containment response to mass and energy injections typical of postulated severe accidents have been made and the results are presented. We find that inherent CANDU severe accident mitigation features, such as the presence of large water volumes near the fuel (moderator and shield tank), permit a relatively slow severe accident progression under most plant damage states, facilitate debris coolability and allow ample time for the operator to arrest the progression within, progressively, the fuel channels, calandria vessel or shield tank. The large-volume CANDU 9 containment design complements these features because of the long times to reach failure

Severe accident mitigation through containment design

International Nuclear Information System (INIS)

Bergeron, K.D.

1990-01-01

Recent U.S. Department of Energy plans to construct a Heavy Water Reactor for the production of defense nuclear materials have created a unique opportunity to explore ways to mitigate severe accident concerns in the design stage. Drawing on an extensive background in US-NRC-sponsored severe accident work, Sandia National Laboratories has been exploring a number of Heavy Water New Production Reactor (HW-NPR) containment design strategies that might mitigate the consequences of a core-melt accident without greatly impacting construction cost or reactor operations. Severe accident specialists have undertaken these assessments with the intent of providing the plant designers with some of the phenomenological advantages and disadvantages of various mitigation strategies. This paper will highlight some of the more interesting concepts and summarize the results obtained. (author). 9 refs., 2 tabs

Severe accident mitigation through containment design

International Nuclear Information System (INIS)

Bergeron, K.D.

1990-01-01

Recent US Department of Energy plans to construct a Heavy Water Reactor for the production of defense nuclear materials have created a unique opportunity to explore ways to mitigate severe accident concerns in the design stage. Drawing on an extensive background in USNRC-sponsored severe accident work, Sandia National Laboratories has been exploring a number of Heavy Water New Production Reactor (HW-NPR) containment design strategies that might mitigate the consequences of a core-melt accident without greatly impacting construction cost or reactor operations. Severe accident specialists have undertaken these assessments with the intent of providing the plant designers with some of the phenomenological advantages and disadvantages of various mitigation strategies. This paper will highlight some of the more interesting concepts and summarize the results obtained. 9 refs., 2 tabs

Severe chronic allergic (and related) diseases

DEFF Research Database (Denmark)

Bousquet, J; Anto, J M; Demoly, P

2012-01-01

-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic...... and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness...... and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies....

Correlates of illness severity in infectious mononucleosis

Science.gov (United States)

Odame, John; Robinson, Joan; Khodai-Booran, Nasser; Yeung, Simon; Mazzulli, Tony; Stephens, Derek; Allen, Upton D

2014-01-01

INTRODUCTION: Understanding the spectrum and frequencies of Epstein-Barr virus (EBV) complications and markers of illness severity in immunocompetent patients with primary EBV infection will inform management of patients with EBV-related illnesses. OBJECTIVES: To determine the clinical and laboratory correlates of illness severity among infants, children and youth with infectious mononucleosis (IM). METHODS: Study subjects with confirmed IM were prospectively enrolled. Illness severity was assessed at baseline and at six weeks using a scoring tool. Peripheral blood viral loads served as a measure of viral burden. RESULTS: Among 32 children and young adults with IM, the median age was 16 years (range two to 24 years). The predominant clinical findings were lymphadenopathy (23 of 32 [72%]), pharyngitis (16 of 32 [50%]), fever (nine of 32 [28%]) and splenomegaly (six of 32 [19%]). With respect to symptoms or signs that persisted to at least six weeks after illness onset, the predominant complaint was lymphadenopathy in 35% of subjects available for reassessment. Deranged liver function tests were present at presentation in up to 44% of subjects. Patients with the highest viral loads at presentation had significantly higher illness severity scores associated with fatigue (P=0.02). Other than the scores associated with fatigue, viral load values were not significantly correlated with the illness severity scores at baseline and at six weeks. CONCLUSION: In IM, viral loads are not necessarily correlated with illness severity, with the exception of fatigue. EBV-related hepatitis is common in IM, confirming the status of this virus as a relatively common cause of transient hepatitis in children and youth. This entity is not necessarily a marker of disease severity. PMID:25371691

Screening for severe combined immunodeficiency in neonates

OpenAIRE

Kelly, Brian T; Tam, Jonathan S; Verbsky, James W; Routes, John M

2013-01-01

Brian T Kelly,1 Jonathan S Tam,1 James W Verbsky,1,2 John M Routes1,2 1Department of Pediatrics, 2Department of Microbiology and Molecular Genetics, Medical College of Wisconsin, Milwaukee, WI, USA Abstract: Severe combined immunodeficiency (SCID) is a rare disease that severely affects the cellular and humoral immune systems. Patients with SCID present with recurrent or severe infections and often with chronic diarrhea and failure to thrive. The disease is uniformly fatal, making early diag...

Validity of the Severe Impairment Battery Short Version.

NARCIS (Netherlands)

Jonghe, J.F. de; Wetzels, R.B.; Mulders, A.; Zuidema, S.U.; Koopmans, R.T.C.M.

2009-01-01

BACKGROUND: Efficient neuropsychological tests are needed to measure cognitive impairment in moderate to severe dementia. OBJECTIVE: To examine construct validity of the Severe Impairment Battery Short Version (SIB-S) in nursing home patients with moderate to severe dementia, and to examine

Thermal-hydraulic uncertainties affecting severe accident progression

International Nuclear Information System (INIS)

Haskin, F.E.; Behr, V.L.

1984-01-01

To provide the proper technical bases for decisions regarding severe accidents, the US Nuclear Regulatory Commission (NRC) is sponsoring the following activities: (a) a variety of severe accident research programs, combined under the Severe Accident Research Plan; (b) nationwide task forces on containment loading, containment response, and fission product source terms; (c) a review by the American Physical Society of state-of-the-art methods for calculating radiological source terms; and (d) technical exchange meetings with the Industry Degraded Core (IDCOR) program. One of the means for integrating this developing array of technical information is the Severe Accident Risk Reduction Program (SARRP). One of the current SARRP objectives is to utilize insights gained from the activities listed above to characterize the relative likelihoods of competing containment failure modes for core-melt accidents

Seckel syndrome with severe sinus bradycardia.

Science.gov (United States)

Ramasamy, Chandramohan; Satheesh, Santhosh; Selvaraj, Raja

2015-03-01

Seckel syndrome is an uncommon form of microcephalic dwarfism. The authors report a young boy with Seckel syndrome who presented with severe sinus bradycardia with symptoms of syncope and presyncope. Implantation of a permanent pacemaker was necessary in view of the severe symptoms. Although uncommon, cardiac abnormalities have been rarely reported in Seckel syndrome. This is the one of the few reports of rhythm abnormalities in this condition.

Severe acute haemolytic anaemia associated with severe methaemoglobinaemia in a G6PD-deficient man.

Science.gov (United States)

Rehman, Abdul; Shehadeh, Mohanad; Khirfan, Diala; Jones, Akhnuwhkh

2018-03-28

Methaemoglobin is a form of haemoglobin in which the ferrous (Fe 2+ ) ion contained in the iron-porphyrin complex of haem is oxidised to its ferric (Fe 3+ ) state. Methaemoglobinaemia, the presence of methaemoglobin in the blood, is most commonly treated with methylene blue. However, methylene blue cannot be used in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency as it is ineffective in such patients and it can worsen G6PD deficiency haemolysis. We report the case of a 30-year-old man who presented with clinical features of G6PD deficiency-associated haemolysis and was found to have severe methaemoglobinaemia (35%). He was administered blood transfusions and intravenous ascorbic acid. His methaemoglobinaemia resolved within 24 hours. This case demonstrates the successful management of a patient with severe methaemoglobinaemia in the setting of G6PD deficiency haemolysis. Emergency physicians should be aware of the possible co-occurrence of severe methaemoglobinaemia in a patient with G6PD deficiency haemolysis. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Severe Accident Test Station Activity Report

Energy Technology Data Exchange (ETDEWEB)

Pint, Bruce A [ORNL; Terrani, Kurt A [ORNL

2015-06-01

Enhancing safety margins in light water reactor (LWR) severe accidents is currently the focus of a number of international R&D programs. The current UO2/Zr-based alloy fuel system is particularly susceptible since the Zr-based cladding experiences rapid oxidation kinetics in steam at elevated temperatures. Therefore, alternative cladding materials that offer slower oxidation kinetics and a smaller enthalpy of oxidation can significantly reduce the rate of heat and hydrogen generation in the core during a coolant-limited severe accident. In the U.S. program, the high temperature steam oxidation performance of accident tolerant fuel (ATF) cladding solutions has been evaluated in the Severe Accident Test Station (SATS) at Oak Ridge National Laboratory (ORNL) since 2012. This report summarizes the capabilities of the SATS and provides an overview of the oxidation kinetics of several candidate cladding materials. A suggested baseline for evaluating ATF candidates is a two order of magnitude reduction in the steam oxidation resistance above 1000ºC compared to Zr-based alloys. The ATF candidates are categorized based on the protective external oxide or scale that forms during exposure to steam at high temperature: chromia, alumina, and silica. Comparisons are made to literature and SATS data for Zr-based alloys and other less-protective materials.

Analyses of severe accident scenarios in RBMK-1500

International Nuclear Information System (INIS)

Kaliatka, A.; Rimkevicius, S.; Uspuras, E.; Urbonavicius, E.

2006-01-01

Even though research of severe accidents in light water reactors is performed around the world for several decades many questions remain. Research is mostly performed for vessel-type reactors. RBMK is a channel type light water reactor, which differs from the vessel-type reactors in several aspects. These differences impose some specifics in the accident phenomena and processes that occur during severe accidents. Severe accident research for RBMK reactors is taking first steps and very little information is available in the open literature. The existing severe accident analysis codes are developed for vessel-type reactors and their application to the analysis of accidents in RBMK is not straightforward. This paper presents the results of an analysis of large loss-of-coolant accident scenarios with loss of coolant injection to the core of RBMK-1500. The analysis performed considers processes in the reactor core, in the reactor cooling system and in the confinement until the fuel melting started. This paper does not aim to answer all the questions regarding severe accidents in RBMK but rather to start a discussion, identify the expected timing of the key phenomena. (orig.)

Severe accident management. Optimized guidelines and strategies

International Nuclear Information System (INIS)

Braun, Matthias; Löffler, Micha; Plank, Hermann; Asse, Dietmar; Dimmelmeier, Harald

2014-01-01

The highest priority for mitigating the consequences of a severe accident with core melt lies in securing containment integrity, as this represents the last barrier against fission product release to the environment. Containment integrity is endangered by several physical phenomena, especially highly transient phenomena following high-pressure reactor pressure vessel failure (like direct containment heating or steam explosions which can lead to early containment failure), hydrogen combustion, quasi-static over-pressure, temperature failure of penetrations, and basemat penetration by core melt. Each of these challenges can be counteracted by dedicated severe accident mitigation hardware, like dedicated primary circuit depressurization valves, hydrogen recombiners or igniters, filtered containment venting, containment cooling systems, and core melt stabilization systems (if available). However, besides their main safety function these systems often have also secondary effects that need to be considered. Filtered containment venting causes (though limited) fission product release into the environment, primary circuit depressurization leads to loss of coolant, and an ex-vessel core melt stabilization system as well as hydrogen igniters can generate high pressure and temperature loads on the containment. To ensure that during a severe accident any available systems are used to their full beneficial extent while minimizing their potential negative impact, AREVA has implemented a severe accident management for German nuclear power plants. This concept makes use of extensive numerical simulations of the entire plant, quantifying the impact of system activations (operational systems, safety systems, as well as dedicated severe accident systems) on the accident progression for various scenarios. Based on the knowledge gained, a handbook has been developed, allowing the plant operators to understand the current state of the plant (supported by computational aids), to predict

Severe accident testing of electrical penetration assemblies

International Nuclear Information System (INIS)

Clauss, D.B.

1989-11-01

This report describes the results of tests conducted on three different designs of full-size electrical penetration assemblies (EPAs) that are used in the containment buildings of nuclear power plants. The objective of the tests was to evaluate the behavior of the EPAs under simulated severe accident conditions using steam at elevated temperature and pressure. Leakage, temperature, and cable insulation resistance were monitored throughout the tests. Nuclear-qualified EPAs were produced from D. G. O'Brien, Westinghouse, and Conax. Severe-accident-sequence analysis was used to generate the severe accident conditions (SAC) for a large dry pressurized-water reactor (PWR), a boiling-water reactor (BWR) Mark I drywell, and a BWR Mark III wetwell. Based on a survey conducted by Sandia, each EPA was matched with the severe accident conditions for a specific reactor type. This included the type of containment that a particular EPA design was used in most frequently. Thus, the D. G. O'Brien EPA was chosen for the PWR SAC test, the Westinghouse was chosen for the Mark III test, and the Conax was chosen for the Mark I test. The EPAs were radiation and thermal aged to simulate the effects of a 40-year service life and loss-of-coolant accident (LOCA) before the SAC tests were conducted. The design, test preparations, conduct of the severe accident test, experimental results, posttest observations, and conclusions about the integrity and electrical performance of each EPA tested in this program are described in this report. In general, the leak integrity of the EPAs tested in this program was not compromised by severe accident loads. However, there was significant degradation in the insulation resistance of the cables, which could affect the electrical performance of equipment and devices inside containment at some point during the progression of a severe accident. 10 refs., 165 figs., 16 tabs

Multivariate Frequency-Severity Regression Models in Insurance

Directory of Open Access Journals (Sweden)

Edward W. Frees

2016-02-01

Full Text Available In insurance and related industries including healthcare, it is common to have several outcome measures that the analyst wishes to understand using explanatory variables. For example, in automobile insurance, an accident may result in payments for damage to one’s own vehicle, damage to another party’s vehicle, or personal injury. It is also common to be interested in the frequency of accidents in addition to the severity of the claim amounts. This paper synthesizes and extends the literature on multivariate frequency-severity regression modeling with a focus on insurance industry applications. Regression models for understanding the distribution of each outcome continue to be developed yet there now exists a solid body of literature for the marginal outcomes. This paper contributes to this body of literature by focusing on the use of a copula for modeling the dependence among these outcomes; a major advantage of this tool is that it preserves the body of work established for marginal models. We illustrate this approach using data from the Wisconsin Local Government Property Insurance Fund. This fund offers insurance protection for (i property; (ii motor vehicle; and (iii contractors’ equipment claims. In addition to several claim types and frequency-severity components, outcomes can be further categorized by time and space, requiring complex dependency modeling. We find significant dependencies for these data; specifically, we find that dependencies among lines are stronger than the dependencies between the frequency and average severity within each line.

Mild, Moderate, Severe Asthma: What Do Grades Mean?

Science.gov (United States)

... that arise by making this kind of distinction. What Really Matters Is Control, Not Severity It turns out that asthma severity ... Asthma” make a strong point that the overall control of your child’s asthma is really what is most important, not what the severity level ...

The burden of infection in severely injured trauma patients and the relationship with admission shock severity.

Science.gov (United States)

Cole, Elaine; Davenport, Ross; Willett, Keith; Brohi, Karim

2014-03-01

Infection following severe injury is common and has a major impact on patient outcomes. The relationship between patient, injury, and physiologic characteristics with subsequent infections is not clearly defined. The objective of this study was to characterize the drivers and burden of all-cause infection in critical care trauma patients. A prospective cohort study of severely injured adult patients admitted to critical care was conducted. Data were collected prospectively on patient and injury characteristics, baseline physiology, coagulation profiles, and blood product use. Patients were followed up daily for infectious episodes and other adverse outcomes while in the hospital. Three hundred patients (Injury Severity Score [ISS] >15) were recruited. In 48 hours or less, 29 patients (10%) died, leaving a cohort of 271. One hundred forty-one patients (52%) developed at least one infection. Three hundred four infections were diagnosed overall. Infection and noninfection groups were matched for age, sex, mechanism, and ISS. Infection rates were greater with any degree of admission shock and threefold higher in the most severely shocked cohort (p < 0.01). In multivariate analysis, base deficit (odds ratio [OR], 1.78, 95% confidence interval [CI], 1.48-1.94; p < 0.001) and lactate (OR, 1.36; 95% CI, 1.10-1.69; p = 0.05) were independently associated with the development of infection. Outcomes were significantly worse for the patients with infection. In multivariate logistic regression, infection was the only factor independently associated with multiple-organ failure (p < 0.001; OR, 15.4; 95% CI, 8.2-28.9; r = 0.402), ventilator-free days (p < 0.001; β, -4.48; 95% CI, -6.7 to -2.1; r = 0.245), critical care length of stay (p < 0.001; β, 13.2; 95% CI, 10.0-16.4; r = 0.466), and hospital length of stay (p < 0.001; β, 31.1; 95% CI, 24.0-38.2; r = 0.492). Infectious complications are a burden for severely injured patients and occur early in the critical care stay

Research Article ( New England Journal of Medicine ) Severe ...

African Journals Online (AJOL)

Methods: We conducted a case–control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors previously associated with severe anemia were studied. The data were ...

Commonly used severity scores are not good predictors of mortality in sepsis from severe leptospirosis: a series of ten patients.

Science.gov (United States)

Velissaris, Dimitrios; Karanikolas, Menelaos; Flaris, Nikolaos; Fligou, Fotini; Marangos, Markos; Filos, Kriton S

2012-01-01

Introduction. Severe leptospirosis, also known as Weil's disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. Methods. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Data were collected retrospectively, with approval from the Institution Ethics Committee. Results. Ten patients with severe leptospirosis were admitted in the Patras University Hospital ICU in a four-year period. Although, based on SOFA scores, predicted mortality was over 80%, seven of 10 patients survived and were discharged from the hospital in good condition. There was no association between SAPS II or SOFA scores and mortality, but survivors had significantly lower APACHE II scores compared to nonsurvivors. Conclusion. Commonly used severity scores do not seem to be useful in predicting mortality in severe leptospirosis. Early ICU admission and resuscitation based on a goal-directed therapy protocol are recommended and may reduce mortality. However, this study is limited by retrospective data collection and small sample size. Data from large prospective studies are needed to validate our findings.

Validation and simplification of Fournier's gangrene severity index.

Science.gov (United States)

Lin, Tsung-Yen; Ou, Chien-Hui; Tzai, Tzong-Shin; Tong, Yat-Ching; Chang, Chien-Chen; Cheng, Hong-Lin; Yang, Wen-Horng; Lin, Yung-Ming

2014-07-01

To validate the predictive value of Fournier's Gangrene Severity Index in patients with Fournier gangrene and to facilitate patient mortality risk-stratification by simplifying the Fournier's Gangrene Severity Index. From January 1989 to December 2011, 85 male patients with clinically-documented Fournier's gangrene undergoing intensive treatment and with complete medical records were recruited. The demographic information and nine parameters of Fournier's Gangrene Severity Index were compared between survivors and non-survivors. The parameters that showed a significant difference between the two groups were selected to generate a simplified scoring index. Of the 85 patients recruited, 16 patients died of the disease with mortality rate of 18.8%. The Fournier's Gangrene Severity Index score at initial diagnosis was significantly higher in non-survivors than in survivors. Of the nine parameters of Fournier's Gangrene Severity Index, the scores of serum creatinine level, hematocrit level and serum potassium level were significantly different between the two groups. However, the mean body temperatures, heart rate, respiration rate, white blood cell count, serum sodium and bicarbonate levels were non-significantly different. Of the 12 patients with chronic kidney disease or end-stage renal disease, 10 died of severe sepsis. A simplified scoring index including parameters of creatinine, hematocrit and potassium was generated, which provided sensitivity and specificity of 87% and 77% in predicting patient mortality, respectively. The predictive values of this simplified Fournier's Gangrene Severity Index were shown to be non-inferior to Fournier's Gangrene Severity Index in our patients. The simplified Fournier's Gangrene Severity Index is easy to use at initial diagnosis, and offers a way to compare outcomes in different clinical populations. © 2014 The Japanese Urological Association.

The New York Sepsis Severity Score: Development of a Risk-Adjusted Severity Model for Sepsis.

Science.gov (United States)

Phillips, Gary S; Osborn, Tiffany M; Terry, Kathleen M; Gesten, Foster; Levy, Mitchell M; Lemeshow, Stanley

2018-05-01

In accordance with Rory's Regulations, hospitals across New York State developed and implemented protocols for sepsis recognition and treatment to reduce variations in evidence informed care and preventable mortality. The New York Department of Health sought to develop a risk assessment model for accurate and standardized hospital mortality comparisons of adult septic patients across institutions using case-mix adjustment. Retrospective evaluation of prospectively collected data. Data from 43,204 severe sepsis and septic shock patients from 179 hospitals across New York State were evaluated. Prospective data were submitted to a database from January 1, 2015, to December 31, 2015. None. Maximum likelihood logistic regression was used to estimate model coefficients used in the New York State risk model. The mortality probability was estimated using a logistic regression model. Variables to be included in the model were determined as part of the model-building process. Interactions between variables were included if they made clinical sense and if their p values were less than 0.05. Model development used a random sample of 90% of available patients and was validated using the remaining 10%. Hosmer-Lemeshow goodness of fit p values were considerably greater than 0.05, suggesting good calibration. Areas under the receiver operator curve in the developmental and validation subsets were 0.770 (95% CI, 0.765-0.775) and 0.773 (95% CI, 0.758-0.787), respectively, indicating good discrimination. Development and validation datasets had similar distributions of estimated mortality probabilities. Mortality increased with rising age, comorbidities, and lactate. The New York Sepsis Severity Score accurately estimated the probability of hospital mortality in severe sepsis and septic shock patients. It performed well with respect to calibration and discrimination. This sepsis-specific model provides an accurate, comprehensive method for standardized mortality comparison of adult

Metformin Use and Severe Dengue in Diabetic Adults.

Science.gov (United States)

Htun, Htet Lin; Yeo, Tsin Wen; Tam, Clarence C; Pang, Junxiong; Leo, Yee Sin; Lye, David C

2018-02-20

Diabetes mellitus is a risk factor for severe dengue in adults, but few studies have examined the association between metformin use and disease severity in dengue. In addition to its effect on glucose control, metformin has been associated with pleiotropic properties in preclinical studies. Using a cohort of laboratory-confirmed adult (≥21 years) dengue patients with diabetes mellitus admitted to Tan Tock Seng Hospital, we conducted a retrospective cohort study involving 131 (58.7%) metformin users and 92 (41.3%) non-users. Dengue severity was categorized as dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) in World Health Organization (WHO) 1997 criteria and severe dengue (SD) in WHO 2009 criteria. Multivariable Poisson regression with robust error variance was used to estimate risk ratio (RR). Compared with non-use, metformin use was associated with a decreased risk of developing severe dengue (adjusted risk ratio [aRR] = 0.60, 95% confidence interval [CI]: 0.37-0.98, P = 0.04). Additionally, there was an inverse dose-response relationship (aRR = 0.69, 95% CI: 0.49-0.98, P = 0.04) with dengue severity as classified by WHO 2009 criteria. Use of metformin, however, was not associated with dengue severity based on WHO 1997 criteria; and no dose-response relationship was noted. Our results suggest metformin use could attenuate disease severity in dengue-infected diabetes mellitus individuals.

An epistaxis severity score for hereditary hemorrhagic telangiectasia.

Science.gov (United States)

Hoag, Jeffrey B; Terry, Peter; Mitchell, Sally; Reh, Douglas; Merlo, Christian A

2010-04-01

Hereditary hemorrhagic telangiectasia (HHT)-related epistaxis leads to alterations in social functioning and quality of life. Although more than 95% experience epistaxis, there is considerable variability of severity. Because no standardized method exists to measure epistaxis severity, the purpose of this study was to determine factors associated with patient-reported severity to develop a severity score. Prospective, survey-based study. HHT care providers and a focus group of patients were interviewed to determine epistaxis-associated factors. From this, an electronic survey was developed and administered to patients with HHT. Descriptive analyses were performed with calculations of means and medians for continuous and proportions for categorical variables. Multiple ordinal logistic and linear regression models were developed to determine risk factors for epistaxis severity. Nine hundred respondents from 21 countries were included. Eight hundred fifty-five (95%) subjects reported epistaxis. The mean (standard deviation) age was 52.1 (13.9) years, and 61.4% were female. Independently associated risk factors for self-reported epistaxis severity included epistaxis frequency (odds ratio [OR] 1.57), duration (OR 2.17), intensity (OR 2.45), need for transfusion (OR 2.74), anemia (OR 1.44), and aggressiveness of treatment required (OR 1.53, P epistaxis severity in patients with HHT include frequency, duration, and intensity of episodes; invasiveness of prior therapy required to stop epistaxis; anemia; and the need for blood transfusion. From these factors, an epistaxis severity score will be presented.

Management and outcomes in patients with moderate or severe functional mitral regurgitation and severe left ventricular dysfunction

DEFF Research Database (Denmark)

Samad, Zainab; Shaw, Linda K; Phelan, Matthew

2015-01-01

AIMS: The management and outcomes of patients with functional moderate/severe mitral regurgitation and severe left ventricular (LV) systolic dysfunction are not well defined. We sought to determine the characteristics, management strategies, and outcomes of patients with moderate or severe mitral...... fraction ≤ 30% or LV end-systolic diameter > 55 mm). We examined treatment effects in two ways. (i) A multivariable Cox proportional hazards model was used to assess the independent relationship of different treatment strategies and long-term event (death, LV assist device, or transplant)-free survival...... [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.42-0.76] and CABG with MV surgery (HR 0.58, 95% CI 0.44-0.78) were associated with long-term, event-free survival benefit. Percutaneous intervention treatment produced a borderline result (HR 0.78, 95% CI 0.61-1.00). However, the relationship...

NKT Cells in the Induced Sputum of Severe Asthmatics

Directory of Open Access Journals (Sweden)

2006-01-01

Full Text Available To determine whether there was a specific inflammatory process in severe asthmatics, the phenotypic characteristics of induced sputum immune cells were analysed among patients with severe asthma. Twenty-two induced sputa (10 severe asthmatics were studied. Flow cytometric analysis was performed using immune cells of the sputum and monoclonal antibodies to CD3, CD4, CD8, CD56, CD25, and TCRγδ . The number of NKT (CD3 + CD 56+ cells was significantly higher in the sputum of severe asthmatics compared with mild asthmatic and healthy control groups ( p<.05 . CD8+CD 56+ cells were the predominant subtype of the increased NKT cells in severe asthmatics. CD3 +CD56+Vα24 +, TCRγδ CD56+, and CD4+CD25+ T cells were significantly increased in severe asthmatic patients. These results suggest that the immunopathogenesis of severe asthmatics vary between severe and mild asthmatics, and that CD8+ CD 56+ NKT cells may play an important role in the immunopathogenesis of severe asthma.

Recurrent severe vomiting due to hyperthyroidism

OpenAIRE

Chen, Li-ying; Zhou, Bo; Chen, Zhou-wen; Fang, Li-zheng

2010-01-01

Thyrotoxicosis may present in many ways; severe vomiting as a prominent symptom of thyrotoxicosis is uncommon. In this paper, we report a 24-year-old Chinese male with hyperthyroidism who presented with recurrent severe vomiting. The patient had had intermittent vomiting for seven years and had lost approximately 15 kg of weight. Gastroscopic examinations revealed chronic gastritis and one occasion peptic ulcer. He was treated with antacid and proton pump inhibitors, but his symptoms had no r...

Ubiquitous-severance hospital project: implementation and results.

Science.gov (United States)

Chang, Bung-Chul; Kim, Nam-Hyun; Kim, Young-A; Kim, Jee Hea; Jung, Hae Kyung; Kang, Eun Hae; Kang, Hee Suk; Lee, Hyung Il; Kim, Yong Ook; Yoo, Sun Kook; Sunwoo, Ilnam; An, Seo Yong; Jeong, Hye Jeong

2010-03-01

The purpose of this study was to review an implementation of u-Severance information system with focus on electronic hospital records (EHR) and to suggest future improvements. Clinical Data Repository (CDR) of u-Severance involved implementing electronic medical records (EMR) as the basis of EHR and the management of individual health records. EHR were implemented with service enhancements extending to the clinical decision support system (CDSS) and expanding the knowledge base for research with a repository for clinical data and medical care information. The EMR system of Yonsei University Health Systems (YUHS) consists of HP integrity superdome servers using MS SQL as a database management system and MS Windows as its operating system. YUHS is a high-performing medical institution with regards to efficient management and customer satisfaction; however, after 5 years of implementation of u-Severance system, several limitations with regards to expandability and security have been identified.

Current management of severe dengue infection.

Science.gov (United States)

Lee, Tau Hong; Lee, Linda Kay; Lye, David Chien; Leo, Yee Sin

2017-01-01

Traditionally a disease mainly affecting the pediatric population, dengue burden has increased significantly in recent decades and adults with severe disease may become more common. There is currently no effective anti-viral agent available for the treatment of dengue and supportive care is the mainstay of management. Areas covered: We present a review of current literature on dengue severity classification systems and the management of severe dengue in adults. In particular, emphasis was placed on organ impairment in dengue and management of elderly individuals with multiple medical problems. Expert commentary: There is an urgent need to search for an effective anti-viral agent to treat infected individuals. The commercial availability of a dengue vaccine in older children has provided optimism in reducing the disease burden but long term efficacy and safety are unknown. The results from phase III trials of two new candidate vaccines are eagerly awaited.

Bone scanning in severe external otitis

International Nuclear Information System (INIS)

Levin, W.J.; Shary, J.H. III; Nichols, L.T.; Lucente, F.E.

1986-01-01

Technetium99 Methylene Diphosphate bone scanning has been considered an early valuable tool to diagnose necrotizing progressive malignant external otitis. However, to our knowledge, no formal studies have actually compared bone scans of otherwise young, healthy patients with severe external otitis to scans of patients with clinical presentation of malignant external otitis. Twelve patients with only severe external otitis were studied with Technetium99 Diphosphate and were compared to known cases of malignant otitis. All scans were evaluated by two neuroradiologists with no prior knowledge of the clinical status of the patients. Nine of the 12 patients had positive bone scans with many scans resembling those reported with malignant external otitis. Interestingly, there was no consistent correlation between the severity of clinical presentation and the amount of Technetium uptake. These findings suggest that a positive bone scan alone should not be interpreted as indicative of malignant external otitis

Staphylococcus aureus and hand eczema severity

DEFF Research Database (Denmark)

Haslund, P; Bangsgaard, N; Jarløv, J O

2009-01-01

BACKGROUND: The role of bacterial infections in hand eczema (HE) remains to be assessed. OBJECTIVES: To determine the prevalence of Staphylococcus aureus in patients with HE compared with controls, and to relate presence of S. aureus, subtypes and toxin production to severity of HE. METHODS......: Bacterial swabs were taken at three different visits from the hand and nose in 50 patients with HE and 50 controls. Staphylococcus aureus was subtyped by spa typing and assigned to clonal complexes (CCs), and isolates were tested for exotoxin-producing S. aureus strains. The Hand Eczema Severity Index...... and in the nose in all cases, and between visits in 90% of cases. Ten different CC types were identified, no association with severity was found, and toxin-producing strains were not found more frequently in patients with HE than in controls. CONCLUSIONS: Staphylococcus aureus was present on hands in almost half...

Study Of Severe Accident Phenomena In Nuclear Power Plant

International Nuclear Information System (INIS)

Sugiyanto; Antariksawan; Anhar, R.; Arifal

2001-01-01

Several phenomena that occurred in the light water reactor type of nuclear power plant during severe accident were studied. The study was carried out based on the results of severe accident researches in various countries. In general, severe accident phenomena can be classified into in-vessel phenomena, retention in the reactor coolant system, and ex-vessel phenomena. In-vessel retention has been recommended as a severe accident management strategy

Science 101: What Causes Severe Thunderstorms and Tornadoes?

Science.gov (United States)

Robertson, Bill

2016-01-01

What causes severe thunderstorms and tornadoes? Tornadoes, often accompanied by severe thunderstorms and hail, form in pretty much the same way as severe thunderstorms. In the continental United States, tornadoes usually form in spring and summer, when warm, humid air from the Gulf of Mexico moves across the continent from southeast to northwest…

Managing problematic severe asthma: beyond the guidelines.

Science.gov (United States)

Pike, Katharine C; Levy, Mark L; Moreiras, John; Fleming, Louise

2018-04-01

This review discusses issues related to managing problematic severe asthma in children and young people. A small minority of children have genuinely severe asthma symptoms which are difficult to control. Children with genuinely severe asthma need investigations and treatments beyond those described within conventional guidelines. However, the majority of children with poor symptom control despite high-intensity treatment achieve improvement in their asthma control once attention has been paid to the basics of asthma management. Basic asthma management requires optimisation of inhaler technique and treatment adherence, avoidance of environmental triggers and self-management education. It is also important that clinicians recognise risk factors that predispose patients to asthma exacerbations and potentially life-threatening attacks. These correctable issues need to be tackled in partnership with children and young people and their families. This requires a coordinated approach between professionals across healthcare settings. Establishing appropriate infrastructure for coordinated asthma care benefits not only those with problematic severe asthma, but also the wider asthma population as similar correctable issues exist for children with asthma of all severities. Investigation and management of genuine severe asthma requires specialist multidisciplinary expertise and a systematic approach to characterising patients' asthma phenotypes and delivering individualised care. While inhaled corticosteroids continue to play a leading role in asthma therapy, new treatments on the horizon might further support phenotype-specific therapy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Clinical profile and warning sign finding in children with severe dengue and non-severe dengue

Science.gov (United States)

Adam, A. S.; Pasaribu, S.; Wijaya, H.; Pasaribu, A. P.

2018-03-01

Dengue fever is one of the most important emerging vector-borne viral diseases. Approximately 500,000 out of 100 million cases develop to severe dengue infection. Patient with severe dengue (SD) can be predicted by clinical profile, laboratory and warning sign which could be saved by early interventions.This was a retrospective descriptive-analytic study to investigate clinical manifestations, laboratory and warning signs ofchildren with dengue infection in Haji Adam Malik hospital during January 2014–May 2016. Through medical records, we had selected 140 cases which fulfilled research criteria.Cases were classified as SD (n=28) and NSD (n=112). Most common clinical manifestations for NSD were abdominal pain (39.3%), myalgia (39.3%), headache (37.1%), mucosal bleeding (36.4%) while for SD were shock (15.7%), mucosal bleeding (15.7%), clinical fluid accumulation (15%), shortness of breath (14.3%). SGPT >1000IU/L (5 cases), SGOT >1000IU/L (9 cases), PT (10 cases) and aPTT (16 cases) were abnormal in SD. Severe dengue was frequently found in the range of white cell count 1000-4000/L and platelet count 20,000-50,000mm/uL. Clinical manifestations, warning sign, and laboratoryfinding, were different between SD and NSD.

Severe interpersonal violence against children in sport

NARCIS (Netherlands)

Vertommen, Tine; Kampen, Jarl; Schipper-van Veldhoven, Nicolette; Uzieblo, Kasia; Eede, Van Den Filip

2018-01-01

In a recent large-scale prevalence study of interpersonal violence (IV) against child athletes in the Netherlands and Belgium we found that 9% of adult respondents who participated in organized sports before the age of 18 had experienced severe psychological violence, 8% severe physical violence,

Defining childhood severe falciparum malaria for intervention studies.

Directory of Open Access Journals (Sweden)

Philip Bejon

2007-08-01

Full Text Available Clinical trials of interventions designed to prevent severe falciparum malaria in children require a clear endpoint. The internationally accepted definition of severe malaria is sensitive, and appropriate for clinical purposes. However, this definition includes individuals with severe nonmalarial disease and coincident parasitaemia, so may lack specificity in vaccine trials. Although there is no "gold standard" individual test for severe malaria, malaria-attributable fractions (MAFs can be estimated among groups of children using a logistic model, which we use to test the suitability of various case definitions as trial endpoints.A total of 4,583 blood samples were taken from well children in cross-sectional surveys and from 1,361 children admitted to a Kenyan District hospital with severe disease. Among children under 2 y old with severe disease and over 2,500 parasites per microliter of blood, the MAFs were above 85% in moderate- and low-transmission areas, but only 61% in a high-transmission area. HIV and malnutrition were not associated with reduced MAFs, but gastroenteritis with severe dehydration (defined by reduced skin turgor, lower respiratory tract infection (clinician's final diagnosis, meningitis (on cerebrospinal fluid [CSF] examination, and bacteraemia were associated with reduced MAFs. The overall MAF was 85% (95% confidence interval [CI] 83.8%-86.1% without excluding these conditions, 89% (95% CI 88.4%-90.2% after exclusions, and 95% (95% CI 94.0%-95.5% when a threshold of 2,500 parasites/mul was also applied. Applying a threshold and exclusion criteria reduced sensitivity to 80% (95% CI 77%-83%.The specificity of a case definition for severe malaria is improved by applying a parasite density threshold and by excluding children with meningitis, lower respiratory tract infection (clinician's diagnosis, bacteraemia, and gastroenteritis with severe dehydration, but not by excluding children with HIV or malnutrition.

Scapular fracture: lower severity and mortality

Directory of Open Access Journals (Sweden)

Javad Salimi

Full Text Available CONTEXT AND OBJECTIVE: The presence of scapular fracture is believed to be associated with high rates of other injuries and accompanying morbidities. The aim was to study injury patterns and their overall outcomes in patients with scapula fractures. DESIGN AND SETTING: Cross-sectional study of trauma patients treated at six general hospitals in Tehran. METHODS: One-year trauma records were obtained from six general hospitals Among these, forty-one had sustained a scapular fracture and were included in this study. RESULTS: Scapular fracture occurred predominantly among 20 to 50-year-old patients (78%. Road traffic accidents (RTAs were the main cause of injury (73.2%; 30/41. Pedestrians accounted for 46.7% (14/30 of the injuries due to RTAs. Falls were the next most common cause, accounting for seven cases (17.1%. Body fractures were the most common type of scapular fractures (80%. Eighteen patients (43.9% had isolated scapular fractures. Limb fracture was the most common associated injury, detected in 18 cases (43.9%. Three patients (7.3% had severe injuries (injury severity score, ISS > 16 which resulted in one death (2.4%. The majority of the patients were treated conservatively (87.8%. CONCLUSIONS: Patients with scapula fractures have more severe underlying chest injuries and clavicle fractures. However, this did not correlate with higher rates of injury severity score, intensive care unit admission or mortality.

Establishing the severity of personality disorder.

Science.gov (United States)

Tyrer, P; Johnson, T

1996-12-01

The authors developed a simplified method of rating the severity of personality disorder. The new rating method is based on four levels of severity: no personality disorder, personality difficulty, simple personality disorder, and diffuse personality disorder. The new method was applied to different diagnostic systems and was then compared with an old rating system based on six severity levels. Data were derived from a longitudinal study in which 163 patients with anxiety and depressive disorders had initial assessments of personality status and were followed up over 2 years. Ratings of psychiatric symptoms were made by using the Comprehensive Psychopathological Rating Scale over this period. The results were analyzed with special attention to linear and quadratic trends. The new system was clinically useful in separating patients' initial assessments and outcomes. Patients with no personality disorder had the lowest initial symptom scores and the best outcomes, and those with diffuse personality disorder had the highest initial levels of symptoms and improved least over the 2 years. When the patients were separated by the old classification system, 72% of the variation between groups was accounted for by linear and quadratic trends; the comparable percentage was 97% when the patients were categorized by the new system. The new system of rating severity of personality disturbance is an improvement on existing methods and allows ratings to be made easily from DSM-IV and ICD-10.

Application of FFTBM to severe accidents

International Nuclear Information System (INIS)

Prosek, A.; Leskovar, M.

2005-01-01

In Europe an initiative for the reduction of uncertainties in severe accident safety issues was initiated. Generally, the error made in predicting plant behaviour is called uncertainty, while the discrepancies between measured and calculated trends related to experimental facilities are called the accuracy of the prediction. The purpose of the work is to assess the accuracy of the calculations of the severe accident International Standard Problem ISP-46 (Phebus FPT1), performed with two versions of MELCOR 1.8.5 for validation purposes. For the quantitative assessment of calculations the improved fast Fourier transform based method (FFTBM) was used with the capability to calculate time dependent code accuracy. In addition, a new measure for the indication of the time shift between the experimental and the calculated signal was proposed. The quantitative results obtained with FFTBM confirm the qualitative conclusions made during the Jozef Stefan Institute participation in ISP-46. In general good agreement of thermal-hydraulic variables and satisfactory agreement of total releases for most radionuclide classes was obtained. The quantitative FFTBM results showed that for the Phebus FPT1 severe accident experiment the accuracy of thermal-hydraulic variables calculated with the MELCOR severe accident code is close to the accuracy of thermal-hydraulic variables for design basis accident experiments calculated with best-estimate system codes. (author)

Proceedings of the workshop on operator training for severe accident management and instrumentation capabilities during severe accidents

International Nuclear Information System (INIS)

2001-01-01

This Workshop was organised in collaboration with Electricite de France (Service Etudes et Projets Thermiques et Nucleaires). There were 34 participants, representing thirteen OECD Member countries, the Russian Federation and the OECD/NEA. Almost half the participants represented utilities. The second largest group was regulatory authorities and their technical support organisations. Basically, the Workshop was a follow-up to the 1997 Second Specialist Meeting on Operator Aids for Severe Accident Management (SAMOA-2) [Reports NEA/CSNI/R(97)10 and 27] and to the 1992 Specialist Meeting on Instrumentation to Manage Severe Accidents [Reports NEA/CSNI/R(92)11 and (93)3]. It was aimed at sharing and comparing progress made and experience gained from these two meetings, emphasizing practical lessons learnt during training or incidents as well as feedback from instrumentation capability assessment. The objectives of the Workshop were therefore: - to exchange information on recent and current activities in the area of operator training for SAM, and lessons learnt during the management of real incidents ('operator' is defined hear as all personnel involved in SAM); - to compare capabilities and use of instrumentation available during severe accidents; - to monitor progress made; - to identify and discuss differences between approaches relevant to reactor safety; - and to make recommendations to the Working Group on the Analysis and Management of Accidents and the CSNI (GAMA). The meeting confirmed that only limited information is needed for making required decisions for SAM. In most cases existing instrumentation should be able to provide usable information. Additional instrumentation requirements may arise from particular accident management measures implemented in some plants. In any case, depending on the time frame where the instrumentation should be relied upon, it should be assessed whether it is likely to survive the harsh environmental conditions it will be exposed

Severe accident issue resolution -- definition and perspective

International Nuclear Information System (INIS)

Harper, F.T.

1995-01-01

The purpose of this discussion is to introduce the session on the Progress on the Resolution of Severe Accident Issues. There has been much work in the area of resolution of severe accident issues over the past few years. This work has been focused on those issues most important to risk as assessed by comprehensive studies such as NUREG-1150. In particular, issues associated with early containment failure have been analyzed. These efforts to resolve issues have been hampered by the fact that open-quotes issue resolutionclose quotes has not always been well defined. The term open-quotes issue resolutionclose quotes conjures tip different images for the regulator, the accident analyst, the physicist, and the probabalist. In fact it is common to have as many different images of issue resolution as there are people in the room. This issue is complicated by the fact that the uncertainty in severe accident issues is enormous. (When convolved, the quantitative uncertainty in an integrated analysis due to severe accident issues can span several orders of magnitude.) In this summary, hierarchy is presented in an attempt to add some perspective to the resolution of issues in the face of large uncertainties. Recommendations are also made for analysts communicating in the area of issue resolution

Damage severity estimation from the global stiffness decrease

International Nuclear Information System (INIS)

Nitescu, C; Gillich, G R; Manescu, T; Korka, Z I; Abdel Wahab, M

2017-01-01

In actual damage detection methods, localization and severity estimation can be treated separately. The severity is commonly estimated using fracture mechanics approach, with the main disadvantage of involving empirically deduced relations. In this paper, a damage severity estimator based on the global stiffness reduction is proposed. This feature is computed from the deflections of the intact and damaged beam, respectively. The damage is always located where the bending moment achieves maxima. If the damage is positioned elsewhere on the beam, its effect becomes lower, because the stress is produced by a diminished bending moment. It is shown that the global stiffness reduction produced by a crack is the same for all beams with a similar cross-section, regardless of the boundary conditions. One mathematical relation indicating the severity and another indicating the effect of removing damage from the beam. Measurements on damaged beams with different boundary conditions and cross-sections are carried out, and the location and severity are found using the proposed relations. These comparisons prove that the proposed approach can be used to accurately compute the severity estimator. (paper)

Common paths to ASD severity and PTSD severity

DEFF Research Database (Denmark)

Hansen, Maj; Armour, Cherie; Wittmann, Lutz

Numerous studies have identified risk factors for acute and long term posttraumatic symptoms following traumatic exposure. However, little is known about possible common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests that a c......Numerous studies have identified risk factors for acute and long term posttraumatic symptoms following traumatic exposure. However, little is known about possible common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests...... that a common pathway to ASD and PTSD may lie in peritraumatic responses and cognitions. Using structural equation modeling we examined the role of three peritraumatic factors (tonic immobility, panic and dissociation) and three cognitive factors (anxiety sensitivity, negative cognitions about the world......, and negative cognitions about self ) on the development of ASD and PTSD severity in a national study of Danish bank robbery victims (N = 450). Peritraumatic panic, anxiety sensitivity, and negative cognitions about self were found to be significant common risk factors, whereas peritraumatic dissociation...

Prevalence of exchange blood transfusion in severe ...

African Journals Online (AJOL)

Background: Exchange blood transfusion (EBT) is carried out for the treatment of conditions presenting with severe hyperbilirubinaemia and anaemia, such as ABO incompatibility, sepsis, prematurity and birth trauma among others. While it is fast being abandoned as treatment modality for severe neonatal jaundice in the ...

Severe acute respiratory syndrome (SARS)

Science.gov (United States)

SARS; Respiratory failure - SARS ... Complications may include: Respiratory failure Liver failure Heart failure ... 366. McIntosh K, Perlman S. Coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). ...

Plasmapheresis in the management of severe hypertriglyceridemia.

Science.gov (United States)

Seda, Gilbert; Meyer, Jill M; Amundson, Dennis E; Daheshia, Massoud

2013-08-01

Plasmapheresis can benefit a variety of critically ill patients. A woman with diabetic ketoacidosis and severe hypertriglyceridemia was treated with plasmapheresis when conventional treatments did not markedly reduce her triglyceridemia. The patient was admitted to a medical intensive care unit because of diabetic ketoacidosis with severe lipemia. The lipemia-associated interference in laboratory studies made treatment of electrolyte abnormalities extremely difficult. The hypertriglyceridemia was initially treated with insulin, antilipidemic medications, and heparin, but the levels of triglycerides remained elevated, delaying results of needed laboratory studies for hours. After plasmapheresis, the serum level of triglycerides decreased by 77% in less than 24 hours. Severe lipemia interferes with photometric laboratory studies, yielding an underestimation of serum levels of electrolytes. Plasmapheresis is safe, rapid, and effective for emergent management of severe hypertriglyceridemia in critically ill patients. The impact of the procedure on critical care nursing is growing as nurses become involved in the treatment and follow-up care of patients who have plasmapheresis.

Lightning and severe thunderstorms in event management.

Science.gov (United States)

Walsh, Katie M

2012-01-01

There are a few national position stands/guidelines that address environmental conditions in athletics, yet they do not govern all outdoor sports. Extreme heat and cold, lightning, and severe wind can all be fatal, yet the majority of outdoor sports have no published guidelines addressing these conditions in relation to activity. Available research on extreme heat and cold conditions in athletics provides prevention strategies, to include acclimatization. Lightning and severe wind are two environmental conditions to which humans cannot accommodate, and they both can be deadly. There are strong positions on extreme heat/cold and lightning safety in athletics, but none affiliated with severe winds. Medical personnel involved in planning large outdoor sporting events must know of the presence of nationally published weather-related documents and apply them to their event. In addition, research needs to be expanded in the realm of establishing guidelines for safety to participants and spectators in severe wind conditions.

Associations between lifestyle factors and hand eczema severity

DEFF Research Database (Denmark)

Sørensen, Jennifer A; Fisker, Maja H; Agner, Tove

2017-01-01

no significant association was found for body weight and stress. Other factors linked to severe eczema were male sex and older age (p = 0.04 and p = 0.01, respectively), and wet work (p = 0.08). CONCLUSION: The data from the present study strongly support an association between smoking and hand eczema severity......BACKGROUND: It has been suggested that lifestyle factors such as smoking, being overweight and stress may influence the prevalence and severity of hand eczema. OBJECTIVES: To investigate the association between lifestyle factors and hand eczema severity in a cohort of patients with work...

Severe recurrent achalasia cardia responding to treatment of severe autoimmune acquired haemophilia

OpenAIRE

Al-Jafar, H; Laffan, M; Al-Sabah, S; Elmorsi, M; Habeeb, M; Alnajar, F

2012-01-01

Acquired haemophilia A and severe acquired achalasia are both very rare conditions with unknown aetiology. Haemophilia A is a haemorrhagic disease induced by deficiency or malfunction of coagulation factor VIII. Congenital haemophilia is an inherited disease transmitted by the mother through X-linked inheritance and primarily affects males. However, acquired haemophilia A is a serious, sudden-onset, autoimmune disease that affects either sex. In addition, achalasia is a disease of the oesopha...

Development of a totally integrated severe accident training system

International Nuclear Information System (INIS)

Kim, Ko Ryu; Park, Sun Hee; Choi, Young; Kim, Dong Ha

2006-01-01

Recently KAERI has developed the severe accident management guidance to establish the Korea standard severe accident management system. On the other hand the PC-based severe accident training simulator SATS has been developed, which uses the MELCOR code as the simulation engine. The simulator SATS graphically displays and simulates the severe accidents with interactive user commands. Especially the control capability of SATS could make a severe accident training course more interesting and effective. In this paper we will describe the development and functions of the electrical guidance module, HyperKAMG, and the SATS-HyperKAMG linkage system designed for a totally integrated and automated severe accident training. (author)

Sarnet lecture notes on nuclear reactor severe accident phenomenology

International Nuclear Information System (INIS)

Trambauer, K.; Adroguer, B.; Fichot, F.; Muller, C.; Meyer, L.; Breitung, W.; Magallon, D.; Journeau, C.; Alsmeyer, H.; Housiadas, C.; Clement, B.; Ang, M.L.; Chaumont, B.; Ivanov, I.; Marguet, S.; Van Dorsselaere, J.P.; Fleurot, J.; Giordano, P.; Cranga, M.

2008-01-01

The 'Severe Accident Phenomenology Short Course' is part of the Excellence Spreading activities of the European Severe Accident Research NETwork of Excellence SARNET (project of the EURATOM 6. Framework programme). It was held at Cadarache, 9-13 January 2006. The course was divided in 14 lectures covering all aspects of severe accident phenomena that occur during a scenario. It also included lectures on PSA-2, Safety Assessment and design measures in new LWR plants for severe accident mitigation (SAM). This book presents the lecture notes of the Severe Accident Phenomenology Short Course and condenses the essential knowledge on severe accident phenomenology in 2008. (authors)

Severe complication of posterior nasal packing: Case Report

Directory of Open Access Journals (Sweden)

Pinto, José Antônio

2012-01-01

Full Text Available Introduction: Severe Epistaxis is common in patients with head trauma, especially when associated with multiple fractures of the face and skull base. Several methods of controlling bleeding that can be imposed. The anterior nasal tapenade associated with posterior Foley catheter is one of the most widespread, and the universal availability of necessary materials or their apparent ease of execution. Methods: Case report on control of severe epistaxis after severe TBI, with posterior nasal packing by Foley catheter and control tomography showing multiple fractures of the skull base and penetration of the probe into the brain parenchyma. Conclusion: This is a rare but possible complication in the treatment of severe nose bleeds associated with fracture of the skull base. This brief report highlights risks related to the method and suggests some care to prevent complications related through a brief literature review.

Severe complication of posterior nasal packing: Case Report.

Science.gov (United States)

Pinto, José Antônio; Cintra, Pedro Paulo Vivacqua da Cunha; Sônego, Thiago Branco; Leal, Carolina de Farias Aires; Artico, Marina Spadari; Soares, Josemar Dos Santos

2012-10-01

 Severe Epistaxis is common in patients with head trauma, especially when associated with multiple fractures of the face and skull base. Several methods of controlling bleeding that can be imposed. The anterior nasal tapenade associated with posterior Foley catheter is one of the most widespread, and the universal availability of necessary materials or their apparent ease of execution.  Case report on control of severe epistaxis after severe TBI, with posterior nasal packing by Foley catheter and control tomography showing multiple fractures of the skull base and penetration of the probe into the brain parenchyma.  This is a rare but possible complication in the treatment of severe nose bleeds associated with fracture of the skull base. This brief report highlights risks related to the method and suggests some care to prevent complications related through a brief literature review.

Severity of depressive episodes according to ICD-10

DEFF Research Database (Denmark)

Kessing, Lars Vedel

2004-01-01

BACKGROUND: The ICD-10 categorisation of severity of depression into mild, moderate and severe depressive episodes has not been validated. AIMS: To validate the ICD-10 categorisation of severity of depression by estimating its predictive ability on the course of illness and suicidal outcome. METHOD......: All psychiatric in-patients in Denmark who had received a diagnosis of a single depressive episode at their first discharge between 1994 and 1999 were identified. The risk of relapse and the risk of suicide were compared for patients discharged with an ICD-10 diagnosis of a single mild, moderate...... or severe depressive episode. RESULTS: At their first discharge, 1103 patients had an ICD-10 diagnosis of mild depressive episode, 3182 had a diagnosis of moderate depressive episode and 2914 had a diagnosis of severe depressive episode. The risk of relapse and the risk of suicide were significantly...

A review of severe accident assessment

International Nuclear Information System (INIS)

Kawashima, Kei

2000-01-01

One of the most difficult problems on evaluation of external costs on nuclear power generation is value on a severe accident risk. Once forming a severe accident, its effect is very important and extends to a wide range, to give a lot of damages. It is a main area of study on externality of energy to compare various risks by means of price conversion at unit kWh. Here was outlined on research examples on main severe accident risks before then. A common fact on estimation cost such research examples is to limit it to direct cost (mainly to health damage) at accident phenomenon. As an actual problem, it is very difficult to substantially quantify such parameters because of basically belonging to social psychology. It is due to no finding out decisive evaluation method on this problem to be adopted conventional EED (Expert Expected Damages) approach in the ExternE Phase III, either. (G.K.)

[Severe vaginal discharge following rectal surgery].

Science.gov (United States)

Burg, L C; Bremers, A J A; Heesakkers, J P F A; Kluivers, K B

2018-01-01

Almost 50% of women who have had rectal surgery subsequently develop vaginal discharge. Due to the recurrent and unexpected nature of this heavy discharge, they often experience it as very distressing. Many of these women undergo extensive diagnostic tests that are mainly focused on identifying fistula formation. If no fistula is found, in most cases no other cause for severe vaginal discharge can be demonstrated. In our practice, we saw three patients (49-, 54- and 74-years-old, respectively) with similar severe vaginal discharge after rectal surgery and in whom no explanation for the vaginal discharge could be found. For this reason we conducted a literature search into this condition. Anatomical changes appear to be responsible for heavy vaginal discharge following rectal surgery. Changes in pelvic floor muscles and compression of the distal part of the vagina may lead to pooling of fluid in the proximal part of the vagina, resulting in severe discharge. Symptomatic treatment may reduce the symptoms.

Effect of pancreatic kallikrein combined with magnesium sulfate therapy on disease severity of patients with severe preeclampsia

Directory of Open Access Journals (Sweden)

Yi Yang

2016-10-01

Full Text Available Objective: To study the clinical effect of pancreatic kallikrein combined with magnesium sulfate therapy on severe preeclampsia. Methods: A total of 47 patients with severe preeclampsia treated in our hospital from May 2013 to October 2015 were retrospectively analyzed, patients who received pancreatic kallikrein combined with magnesium sulfate therapy were selected as observation group, patients who received magnesium sulfate therapy were selected as control group, and then blood pressure level, renal function, uterine artery and umbilical artery blood flow state, and hypoxia indexes in serum and placenta were compared between two groups. Results: After treatment, systolic pressure and diastolic pressure levels as well as serum CysC level and 24 h urine protein level of observation group were significantly lower than those of control group, the uterine artery and umbilical artery S/ D and PI were significantly lower than those of control group, PIGF and NO levels in serum as well as Xiap and Survivin levels in placenta were significantly higher than those of control group, and sVEGFR1 level in serum as well as Caspase-3 and Caspase-7 levels in placenta was significantly lower than those of control group. Conclusions: Pancreatic kallikrein combined with magnesium sulfate therapy can alleviate the disease severity, lower blood pressure and vascular resistance, and improve renal function and the apoptosis caused by placental hypoxia in patients with severe preeclampsia.

The burden of severe asthma in childhood and adolescence

DEFF Research Database (Denmark)

Fleming, Louise; Murray, Clare; Bansal, Aruna T

2015-01-01

U-BIOPRED aims to characterise paediatric and adult severe asthma using conventional and innovative systems biology approaches. A total of 99 school-age children with severe asthma and 81 preschoolers with severe wheeze were compared with 49 school-age children with mild/moderate asthma and 53...... in the severe wheeze cohort. Almost all participants in each cohort were atopic and had a normal body mass index. Asthma-related quality of life, as assessed by the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), was worse...... and mild/moderate cohorts were clinically very similar. Children with severe preschool wheeze or severe asthma are usually atopic and have impaired quality of life that is associated with poor control and airflow limitation: a very different phenotype from adult severe asthma. In-depth phenotyping...

Severe heparin osteoporosis in pregnancy.

OpenAIRE

Griffiths, H. T.; Liu, D. T.

1984-01-01

A case of severe osteoporosis following administration of low dose subcutaneous heparin in pregnancy is reported. Possible reasons for the condition are suggested which caution against the indiscriminate use of subcutaneous heparin in pregnancy.

Euthanasia of Severely Handicapped Infants: Ethical Issues.

Science.gov (United States)

Cohen, Libby

Ethical decisions are involved in life and death decisions for severely handicapped infants. Although it has become common practice for physicians not to treat severely handicapped infants, the ethical considerations involved in euthanasia are complex. A review of the literature reveals that concerns center around the quality of life of the…

Predictors of Severity in Pediatric Scrub Typhus.

Science.gov (United States)

Narayanasamy, Dinesh Kumar; Arun Babu, Thirunavukkarasu; Vijayadevagaran, Vijayasankar; Kittu, Devi; Ananthakrishnan, Shanthi

2018-01-24

To identify the factors that can predict the severity of scrub typhus in children. This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of 'severe scrub typhus' were identified based on criteria from published adult and pediatric studies. Out of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of 'severe scrub typhus' in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the 'severe scrub typhus' cases. Breathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.

Treatment of severe tracheobronchomalacia: Ten-year experience.

Science.gov (United States)

de Trey, Lorraine A; Dudley, Julia; Ismail-Koch, Hasnaa; Durward, Andrew; Bellsham-Revell, Hannah; Blaney, Sean; Hore, Ian; Austin, Conal B; Morrison, Gavin A

2016-04-01

Paediatric tracheobronchomalacia is a rare but potentially serious condition. Severe tracheobronchomalacia requires intervention or operation. This is an evaluation of a ten-year experience at an institution. In this retrospective study all patients were included that required an intervention for severe tracheobronchomalacia from 2003 to 2012. Symptoms, aetiology, comorbidities, localisation of the malacia, age at diagnosis, therapeutic measures and associated complications were evaluated. Forty-four patients with severe tracheobronchomalacia underwent intervention/operation. The predominant aetiology was vascular compression in 48%. The majority of patients had complex comorbidities, most importantly cardiac pathology in 66%. The median age at diagnosis was 3 months. A total of 17 aortopexies, 21 tracheostomies and 25 stent placements were performed. The mean follow-up was 2.6 years. Severe complications occurred in 12 patients. The most common complications were stent obstruction/fracture and tracheostomy tube obstruction. The management of severe tracheobronchomalacia is complex and the population of patients is very heterogeneous. Therefore the treatment has to be adapted for each patient individually. The decision strategies are discussed in this article. The surgical techniques for placement and safe removal of expandable bare metallic stents employed in our institution are presented. A multidisciplinary team of ENT surgeons, Intensivists, Cardiologists and Cardiac surgeons is of great importance. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Light water reactor severe accident seminar. Seminar presentation manual

International Nuclear Information System (INIS)

2004-01-01

The topics covered in this manual on LWR severe accidents were: Evolution of Source Term Definition and Analysis, Current Position on Severe Accident Phenomena, Current Position on Fission Product Behavior, Overview of Software Models Used in Severe Accident Analysis, Overview of Plant Specific Source Terms and Their Impact on Risk, Current Applications of Severe Accident Analysis, and Future plans

Light water reactor severe accident seminar. Seminar presentation manual

Energy Technology Data Exchange (ETDEWEB)

NONE

2004-07-01

The topics covered in this manual on LWR severe accidents were: Evolution of Source Term Definition and Analysis, Current Position on Severe Accident Phenomena, Current Position on Fission Product Behavior, Overview of Software Models Used in Severe Accident Analysis, Overview of Plant Specific Source Terms and Their Impact on Risk, Current Applications of Severe Accident Analysis, and Future plans.

Burn severity mapping using simulation modeling and satellite imagery

Science.gov (United States)

Eva C. Karau; Robert E. Keane

2010-01-01

Although burn severity maps derived from satellite imagery provide a landscape view of fire impacts, fire effects simulation models can provide spatial fire severity estimates and add a biotic context in which to interpret severity. In this project, we evaluated two methods of mapping burn severity in the context of rapid post-fire assessment for four wildfires in...

Characterizing individual painDETECT symptoms by average pain severity

Directory of Open Access Journals (Sweden)

Sadosky A

2016-07-01

Full Text Available Alesia Sadosky,1 Vijaya Koduru,2 E Jay Bienen,3 Joseph C Cappelleri4 1Pfizer Inc, New York, NY, 2Eliassen Group, New London, CT, 3Outcomes Research Consultant, New York, NY, 4Pfizer Inc, Groton, CT, USA Background: painDETECT is a screening measure for neuropathic pain. The nine-item version consists of seven sensory items (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure, a pain course pattern item, and a pain radiation item. The seven-item version consists only of the sensory items. Total scores of both versions discriminate average pain-severity levels (mild, moderate, and severe, but their ability to discriminate individual item severity has not been evaluated.Methods: Data were from a cross-sectional, observational study of six neuropathic pain conditions (N=624. Average pain severity was evaluated using the Brief Pain Inventory-Short Form, with severity levels defined using established cut points for distinguishing mild, moderate, and severe pain. The Wilcoxon rank sum test was followed by ridit analysis to represent the probability that a randomly selected subject from one average pain-severity level had a more favorable outcome on the specific painDETECT item relative to a randomly selected subject from a comparator severity level.Results: A probability >50% for a better outcome (less severe pain was significantly observed for each pain symptom item. The lowest probability was 56.3% (on numbness for mild vs moderate pain and highest probability was 76.4% (on cold/heat for mild vs severe pain. The pain radiation item was significant (P<0.05 and consistent with pain symptoms, as well as with total scores for both painDETECT versions; only the pain course item did not differ.Conclusion: painDETECT differentiates severity such that the ability to discriminate average pain also distinguishes individual pain item severity in an interpretable manner. Pain-severity

26 CFR 26.2642-6 - Qualified severance.

Science.gov (United States)

2010-04-01

... severance are recognized as separate trusts under applicable state law. The post-severance treatment of the... an inclusion ratio of one. In 2008, the trustee of Trust, pursuant to applicable state law, divides..., pursuant to applicable state law, divides Trust into two separate trusts, Trust 1 for the benefit of C (and...

Skateboarding injuries in Vienna: location, frequency, and severity.

Science.gov (United States)

Keilani, Mohammad; Krall, Christoph; Lipowec, Lucas; Posch, Martin; Komanadj, Tanya Sedghi; Crevenna, Richard

2010-07-01

To describe injury patterns of skateboard-associated injuries (SAIs) and to assess the frequency and severity of SAIs depending on an athlete's skateboarding experience. Cross-sectional observation. Skating areas. A total of 100 Viennese skateboarders. No intervention. The participants filled in a questionnaire that was used to assess selected sociodemographic data; duration and frequency of skateboarding; "stance"; and localization, rate, as well as the severity of SAIs during the past 24 months. Skating behavior and sociodemographic data were compared with frequency and severity of SAIs. Response rate of questionnaires was 75% (n=75) of the participants. Duration of skateboarding was 8+/-5 years, and training time was 18+/-11 hours/week. A total of 97% (73) of the respondents reported at least one injury: in 52% (39) of the respondents the most serious injury was mild to moderate (laceration, contusion, strain/sprain, and bruise), whereas in 45% (34) it was severe (ligament rupture, fracture). A total of 33% (13) of participants experiencing only mild-to-moderate injuries consulted a physician compared with 94% (32) with at least one serious injury. The most severely affected regions were lower leg/ankle/foot in 32% (24) of all respondents who experienced at least one severe injury and forearm/wrist/hand in 16% (12) who experienced at least one severe injury. Only 13% (10) used protective equipment. Multivariate logistic regression for the occurrence of at least one severe injury with all socioeconomic and sport-relevant data investigated revealed significant positive correlations with weekly training time (P=.037) and years of experience (P=.021). However, after correcting for multiple testing (Bonferroni adjustment for 8 tests), no significances remained. More experienced skateboarders seem to have a greater risk of incurring severe SAIs, but sociodemographic factors seem to have no influence on injury risk in this population. Only a minority of skateboarders

Regional gastrointestinal transit times in severe ulcerative colitis.

Science.gov (United States)

Haase, A M; Gregersen, T; Christensen, L A; Agnholt, J; Dahlerup, J F; Schlageter, V; Krogh, K

2016-02-01

Gastrointestinal (GI) dysmotility may present secondary to inflammatory bowel disease. The main aim of this study was to investigate GI motility in ulcerative colitis (UC) patients during severe disease activity. Twenty patients with severe UC were studied with a novel telemetric capsule system (3D-Transit) designed for minimally invasive, ambulatory assessment of total and regional GI transit times. Ten patients were available for follow-up during remission. Data were compared to those of 20 healthy subjects (HS). Total GI transit time was significantly longer in patients with severe UC (median 44.5 h [range 9.9-102.7 h]) than in HS (median 27.6 h [range 9.6-56.4 h]) (p = 0.032). Additionally, during severe UC, transit time was prolonged through the proximal colon (p = 0.003) and there were strong trends toward longer than normal small intestinal transit time (HS: median 4.9 h [range 3.4-8.3 h] vs severe UC patients: median 5.9 h [range 3.9-11.9 h]; p = 0.053) and colorectal transit times (HS: median 18.2 h [range 1.5-43.7] vs severe UC patients: median 34.9 h [range 0.4-90.9 h]; p = 0.056). Our data further indicate that total GI and colorectal transit times may be prolonged in UC during early remission. Total GI transit times are significantly prolonged during severe UC. © 2016 John Wiley & Sons Ltd.

NKT Cells in the Induced Sputum of Severe Asthmatics

Directory of Open Access Journals (Sweden)

Agnes Hamzaoui

2006-01-01

of the sputum and monoclonal antibodies to CD3, CD4, CD8, CD56, CD25, and TCRγδ. The number of NKT (CD3+CD56+ cells was significantly higher in the sputum of severe asthmatics compared with mild asthmatic and healthy control groups (P<.05. CD8+CD56+ cells were the predominant subtype of the increased NKT cells in severe asthmatics. CD3+CD56+Vα24+, TCRγδ+ CD56+, and CD4+CD25+ T cells were significantly increased in severe asthmatic patients. These results suggest that the immunopathogenesis of severe asthmatics vary between severe and mild asthmatics, and that CD8+CD56+ NKT cells may play an important role in the immunopathogenesis of severe asthma.

Nutrition of patients with severe neurologic impairment

Directory of Open Access Journals (Sweden)

Orel Anija

2017-12-01

Full Text Available Commercial enteral formulas are generally recommended for gastrostomy feeding in patients with severe neurologic impairment. However, pureed food diets are still widely used and even gaining popularity among certain groups. We tried to compare the effectiveness of gastrostomy feeding for treatment of severe malnutrition with either enteral formulas or pureed feeds.

Severe Recurrent Achalasia Cardia Responding to Treatment of Severe Autoimmune Acquired Haemophilia

Directory of Open Access Journals (Sweden)

H. Al-Jafar

2012-09-01

Full Text Available Acquired haemophilia A and severe acquired achalasia are both very rare conditions with unknown aetiology. Haemophilia A is a haemorrhagic disease induced by deficiency or malfunction of coagulation factor VIII. Congenital haemophilia is an inherited disease transmitted by the mother through X-linked inheritance and primarily affects males. However, acquired haemophilia A is a serious, sudden-onset, autoimmune disease that affects either sex. In addition, achalasia is a disease of the oesophagus caused by abnormal function of the nerves and muscles. It causes swallowing difficulties due to the inability of the lower oesophageal sphincter to relax during swallowing, leading to dysphagia, regurgitation and chest pain. In this report, we describe the case of a patient with severe, newly diagnosed, acquired haemophilia A with long-standing, recurrent achalasia; the achalasia had recurred 3 times despite complete and proper surgical fixation. Acquired haemophilia A is treated with immunosuppressive therapy. High-dose steroid therapy was administered for 7 months, during which the patient responded well; moreover, the achalasia did not recur for more than 2 years. The response of the achalasia to immunosuppressive therapy suggests that achalasia may be an autoimmune disorder and that there may be an association between both diseases. The findings of the present case suggest that achalasia may favourably respond to steroid therapy as a first-line treatment prior to surgery.

Music therapy for children with severe burn injury

OpenAIRE

Edwards, Jane

1998-01-01

peer-reviewed Music therapy for children with severe burns is a developing field of practice and research interest in pediatric music therapy. The following article presents an overview of the nature of severe burn injury and provides a rationale for the use of music therapy in the Burn Unit. The application of song writing techniques to address needs of children receiving care for severe burns in a hospital setting is presented.

Successful recovery from iatrogenic severe hypernatremia and severe metabolic acidosis resulting from accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment

Directory of Open Access Journals (Sweden)

Guruprasad P Bhosale

2015-01-01

Full Text Available Bicarbonate dialysis is the treatment modality of choice for correction of metabolic acidosis in chronic renal failure. However, improper selection of dialysate concentrate can result in life-threatening human errors. We report a case of iatrogenic severe hypernatremia (sodium 207 mEq/L and severe metabolic acidosis (pH 6.65 that resulted due to accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment. There was successful recovery in this patient with no neurological sequelae. To the best of our knowledge, this is the first case report in adults of severe hypernatremia along with severe metabolic acidosis due to error in the preparation of dialysis fluid.

CANDU safety under severe accidents

International Nuclear Information System (INIS)

Snell, V.G.; Howieson, J.Q.; Alikhan, S.; Frescura, G.M.; King, F.; Rogers, J.T.; Tamm, H.

1996-01-01

The characteristics of the CANDU reactor relevant to severe accidents are set first by the inherent properties of the design, and second by the Canadian safety/licensing approach. The pressure-tube concept allows the separate, low-pressure, heavy-water moderator to act as a backup heat sink even if there is no water in the fuel channels. Should this also fail, the calandria shell itself can contain the debris, with heat being transferred to the water-filled shield tank around the core. Should the severe core damage sequence progress further, the shield tank and the concrete reactor vault significantly delay the challenge to containment. Furthermore, should core melt lead to containment overpressure, the containment behaviour is such that leaks through the concrete containment wall reduce the possibility of catastrophic structural failure. The Canadian licensing philosophy requires that each accident, together with failure of each safety system in turn, be assessed (and specified dose limits met) as part of the design and licensing basis. In response, designers have provided CANDUs with two independent dedicated shutdown systems, and the likelihood of Anticipated Transients Without Scram is negligible. Probabilistic safety assessment studies have been performed on operating CANDU plants, and on the 4 x 880 MW(e) Darlington station now under construction; furthermore a scoping risk assessment has been done for a CANDU 600 plant. They indicate that the summed severe core damage frequency is of the order of 5 x 10 -6 /year. 95 refs, 3 tabs

A CANDU Severe Accident Analysis

International Nuclear Information System (INIS)

Negut, Gheorghe; Catana, Alexandru; Prisecaru, Ilie

2006-01-01

As interest in severe accident studies has increased in the last years, we have developed a set of simple models to analyze severe accidents for CANDU reactors that should be integrated in the EU codes. The CANDU600 reactor uses natural uranium fuel and heavy water (D2O) as both moderator and coolant, with the moderator and coolant in separate systems. We chose to analyze accident development for a LOCA with simultaneous loss of moderator cooling and the loss of emergency core cooling system (ECCS). This type of accident is likely to modify the reactor geometry and will lead to a severe accident development. When the coolant temperatures inside a pressure tube reaches 10000 deg C, a contact between pressure tube and calandria tube occurs and the residual heat is transferred to the moderator. Due to the lack of cooling, the moderator eventually begins to boil and is expelled, through the calandria vessel relief ducts, into the containment. Therefore the calandria tubes (fuel channels) will be uncovered, then will disintegrate and fall down to the calandria vessel bottom. After all the quantity of moderator is vaporized and expelled, the debris will heat up and eventually boil. The heat accumulated in the molten debris will be transferred through the calandria vessel wall to the shield tank water, which normally surrounds the calandria vessel. The phenomena described above are modelled, analyzed and compared with the existing data. The results are encouraging. (authors)

CANDU safety under severe accidents

Energy Technology Data Exchange (ETDEWEB)

Snell, V G; Howieson, J Q [Atomic Energy of Canada Ltd. (Canada); Alikhan, S [New Brunswick Electric Power Commission (Canada); Frescura, G M; King, F [Ontario Hydro (Canada); Rogers, J T [Carleton Univ., Ottawa, ON (Canada); Tamm, H [Atomic Energy of Canada Ltd. (Canada). Whiteshell Research Lab.

1996-12-01

The characteristics of the CANDU reactor relevant to severe accidents are set first by the inherent properties of the design, and second by the Canadian safety/licensing approach. The pressure-tube concept allows the separate, low-pressure, heavy-water moderator to act as a backup heat sink even if there is no water in the fuel channels. Should this also fail, the calandria shell itself can contain the debris, with heat being transferred to the water-filled shield tank around the core. Should the severe core damage sequence progress further, the shield tank and the concrete reactor vault significantly delay the challenge to containment. Furthermore, should core melt lead to containment overpressure, the containment behaviour is such that leaks through the concrete containment wall reduce the possibility of catastrophic structural failure. The Canadian licensing philosophy requires that each accident, together with failure of each safety system in turn, be assessed (and specified dose limits met) as part of the design and licensing basis. In response, designers have provided CANDUs with two independent dedicated shutdown systems, and the likelihood of Anticipated Transients Without Scram is negligible. Probabilistic safety assessment studies have been performed on operating CANDU plants, and on the 4 x 880 MW(e) Darlington station now under construction; furthermore a scoping risk assessment has been done for a CANDU 600 plant. They indicate that the summed severe core damage frequency is of the order of 5 x 10{sup -6}/year. 95 refs, 3 tabs.

Severe acute malnutrition and infection

Science.gov (United States)

Jones, Kelsey D J; Berkley, James A

2014-01-01

Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. The brief addresses antimicrobials; antipyretics; tuberculosis; HIV; malaria; pneumonia; diarrhoea; sepsis; measles; urinary tract infection; nosocomial Infections; soil transmitted helminths; skin infections and pharmacology in the context of SAM. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice. PMID:25475887

Large errors and severe conditions

CERN Document Server

Smith, D L; Van Wormer, L A

2002-01-01

Physical parameters that can assume real-number values over a continuous range are generally represented by inherently positive random variables. However, if the uncertainties in these parameters are significant (large errors), conventional means of representing and manipulating the associated variables can lead to erroneous results. Instead, all analyses involving them must be conducted in a probabilistic framework. Several issues must be considered: First, non-linear functional relations between primary and derived variables may lead to significant 'error amplification' (severe conditions). Second, the commonly used normal (Gaussian) probability distribution must be replaced by a more appropriate function that avoids the occurrence of negative sampling results. Third, both primary random variables and those derived through well-defined functions must be dealt with entirely in terms of their probability distributions. Parameter 'values' and 'errors' should be interpreted as specific moments of these probabil...

Association between severity of chronic obstructive pulmonary ...

African Journals Online (AJOL)

The statistical analysis was performed by SPSS software and the Kendall's tau-b correlation test. Results: The mean age (±standard deviation) was 64.3 ± 11.3 years. Twelve percent were female and 88 percent were male. The COPD severity, according to the ATS criteria, was mild in 16%, moderate in 48%, severe in 32% ...

Development of severe accident management advisory and training simulator (SAMAT)

International Nuclear Information System (INIS)

Jeong, K.-S.; Kim, K.-R.; Jung, W.-D.; Ha, J.-J.

2002-01-01

The most operator support systems including the training simulator have been developed to assist the operator and they cover from normal operation to emergency operation. For the severe accident, the overall architecture for severe accident management is being developed in some developed countries according to the development of severe accident management guidelines which are the skeleton of severe accident management architecture. In Korea, the severe accident management guideline for KSNP was recently developed and it is expected to be a central axis of logical flow for severe accident management. There are a lot of uncertainties in the severe accident phenomena and scenarios and one of the major issues for developing a operator support system for a severe accident is the reduction of these uncertainties. In this paper, the severe accident management advisory system with training simulator, SAMAT, is developed as all available information for a severe accident are re-organized and provided to the management staff in order to reduce the uncertainties. The developed system includes the graphical display for plant and equipment status, the previous research results by knowledge-base technique, and the expected plant behavior using the severe accident training simulator. The plant model used in this paper is oriented to severe accident phenomena and thus can simulate the plant behavior for a severe accident. Therefore, the developed system may make a central role of the information source for decision-making for a severe accident management, and will be used as the training simulator for severe accident management

Personality disorders in women with severe premenstrual syndrome.

Science.gov (United States)

Sassoon, Stephanie A; Colrain, Ian M; Baker, Fiona C

2011-06-01

Premenstrual syndrome (PMS) and its more severe form, premenstrual dysphoric disorder, affect up to 18% of women. Both are commonly associated with other mood-related disorders such as major depression, and cause significant life impairment, but their relationship with personality disorders is less clear. After completing the Structured Clinical Interview for DSM-IV-TR disorders, 33 women with severe PMS and 26 asymptomatic women, counterbalanced for menstrual cycle phase, were administered the Structured Interview for DSM-IV Personality Disorders, a diagnostic interview with low transparency, strong inter-rater reliability, and good diagnostic clarity. Women with severe PMS had a higher prevalence of personality disorders (p = 0.003) than asymptomatic women (27% versus 0%), and were more likely to have odd-eccentric, dramatic-erratic, and anxious-fearful personality disorder traits (p OCPD) was the most common character pathology in the PMS group (n = 6, 18%). OCPD, although not necessarily associated with greater severity of premenstrual symptoms, was related to poorer life functioning in women with PMS. The comorbidity of a personality disorder and severe PMS places an additive burden on general life functioning and may have implications for psychiatric treatment or medication given to those with severe premenstrual symptoms.

OSSA. A second generation of severe accident management

International Nuclear Information System (INIS)

Sauvage, E.C.; Musoyan, G.; Ducros, V.D.

2009-01-01

Nowadays the severe accident and their management are an integrated part of the new generation of power plants. The EPR, as the third generation of nuclear plants, includes both systems and instrumentation to mitigate a severe accident, but also a new generation of severe accident management guidelines: the OSSA. Severe accident management guidelines are highly dependent on human means available: emergency organization actors, training and knowledge shall be taken in consideration in an innovative way. Their impacts on ergonomy and content of the document lead to a new generation of guidelines with several innovative features. This second generation of severe accident management guidelines was developed in parallel with the PSA level 2, the human reliability analyses, the validation and verification process, the severe accident simulator progresses. By taking in consideration this variety of input the OSSA were developed in a user aspect orientation. For example in the OSSA a larger responsibility is given to the operational crew to better support the technical support group evaluation. Their existing knowledge of the plant and of the systems and instrumentation is used. This collaboration work implies a strong communication tool that has been developed to enhance the permanent communication within the emergency organization, but although to ensure the main up-to-date information for evaluation will be available where required. The entry condition is based on a strong and stand alone diagnostic for all plant states, that uses in particular a curve of core exit temperature as a function of primary pressure for a fixed core cladding temperature, or its equivalent in term of containment conditions. It ensures relatively consistent core conditions on entry. A first criterion for ultimate final primary depressurization is provided, ensuring all attempts to reflood the core with the available means have been ensured before the OSSA entry condition is reached. This

Coolability of severely degraded CANDU cores. Revised

International Nuclear Information System (INIS)

Meneley, D.A.; Blahnik, C.; Rogers, J.T.; Snell, V.G.; Nijhawan, S.

1996-01-01

Analytical and experimental studies have shown that the separately cooled moderator in a CANDU reactor provides an effective heat sink in the event of a loss-of-coolant accident (LOCA) accompanied by total failure of the emergency core cooling system (ECCS). The moderator heat sink prevents fuel melting and maintains the integrity of the fuel channels, therefore terminating this severe accident short of severe core damage. Nevertheless, there is a probability, however low, that the moderator heat sink could fail in such an accident. The pioneering work of Rogers (1984) for such a severe accident using simplified models showed that the fuel channels would fail and a bed of dry, solid debris would be formed at the bottom of the calandria which would heat up and eventually melt. However, the molten pool of core material would be retained in the calandria vessel, cooled by the independently cooled shield-tank water, and would eventually resolidify. Thus, the calandria vessel would act inherently as a 'core-catcher' as long as the shield tank integrity is maintained. The present paper reviews subsequent work on the damage to a CANDU core under severe accident conditions and describes an empirically based mechanistic model of this process. It is shown that, for such severe accident sequences in a CANDU reactor, the end state following core disassembly consists of a porous bed of dry solid, coarse debris, irrespective of the initiating event and the core disassembly process. (author)

Anaesthetic management of patients with severe sepsis.

Science.gov (United States)

Eissa, D; Carton, E G; Buggy, D J

2010-12-01

Severe sepsis, a syndrome characterized by systemic inflammation and acute organ dysfunction in response to infection, is a major healthcare problem affecting all age groups throughout the world. Anaesthetists play a central role in the multidisciplinary management of patients with severe sepsis from their initial deterioration at ward level, transfer to the diagnostic imaging suite, and intraoperative management for emergency surgery. The timely administration of appropriate i.v. antimicrobial therapy is a crucial step in the care of patients with severe sepsis who may require surgery to control the source of sepsis. Preoperative resuscitation, aimed at optimizing major organ perfusion, is based on judicious use of fluids, vasopressors, and inotropes. Intraoperative anaesthesia management requires careful induction and maintenance of anaesthesia, optimizing intravascular volume status, avoidance of lung injury during mechanical ventilation, and ongoing monitoring of arterial blood gases, lactate concentration, haematological and renal indices, and electrolyte levels. Postoperative care overlaps with ongoing management of the severe sepsis syndrome patient in the intensive care unit. These patients are by definition, high risk, already requiring multiple supports, and require experienced and skilful decision-making to optimize their chances of a favourable outcome. Similar to acute myocardial infarction, stroke, or acute trauma, the initial hours (golden hours) of clinical management of severe sepsis represent an important opportunity to reduce morbidity and mortality. Rapid clinical assessment, resuscitation and surgical management by a focused multidisciplinary team, and early effective antimicrobial therapy are the key components to improved patient outcome.

Use of simulators in severe accident management

International Nuclear Information System (INIS)

Evans, R.C.

1994-01-01

The U.S. nuclear utility industry is moving in a deliberate fashion through a coordinated industry severe accident working group to study and augment, where appropriate, the existing utility organizational and emergency planning structure to address accident and severe accident management. Full-scope simulators are used extensively to train licensed operators for their initial license examinations and continually thereafter in licensed operator requalification training and yearly examinations. The goal of the training (both initial and requalification) is to ensure that operators possess adequate knowledge, skills and abilities to prevent an event from progressing to core damage. The use of full-scope simulators in severe accident management training is in large part viewed by the industry as being premature. The working group study has not progressed to the point where the decision to employ full-scope simulators can be logically considered. It is not however premature to consider part-task or work station simulators as invaluable research tools to support the industry's study. These simulators could be employed, subject to limitations in the current state of knowledge regarding severe accident progression and phenomenological responses, in the validation and verification (V and V) of severe accident models or codes as they are developed. The U.S. nuclear utility industry has made substantial strides in the past 12 years in the accident prevention, mitigation and management arena. These strides are a product of the industry's preference for a logical and systematic approach to change. (orig.)

Metabolic profile of clinically severe obese patients.

Science.gov (United States)

Faria, Silvia Leite; Faria, Orlando Pereira; Menezes, Caroline Soares; de Gouvêa, Heloisa Rodrigues; de Almeida Cardeal, Mariane

2012-08-01

Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition. We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables. Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC. The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.

Concrete under severe conditions. Environment and loading

International Nuclear Information System (INIS)

2007-01-01

The objective of the CONSEC Conferences is to focus on concrete infrastructures, either subjected to severe environment or severe loading, or any combination of severe conditions. Experience from the performance of existing concrete structures, and especially under severe environmental conditions, severe accidental loading or extended lifespan, has demonstrated the need for better integration of structural and durability design, new design concepts including reliability-based durability design, performance-based material requirements, structural robustness, and an improved basis for documentation of obtained construction quality and durability properties during concrete construction. An improved basis for operation and preventive maintenance of concrete structures including repairs and retrofitting is also very important. Premature corrosion of reinforcing steel, inadequate structural design for seismic or blast loading, are examples of reduced service life of concrete structures that not only represent technical and economical problems, but also a huge waste of natural resources and hence also, an environmental and ecological problem. Experience of structures effectively submitted to severe conditions represents a unique benchmark for quantifying the actual safety and durability margin of concrete structures. In fact for several reasons, most concrete design codes, job specifications and other requirements for concrete structures have frequently shown to yield insufficient and unsatisfactory results and ability to solve the above problems, as well as issues raised by specific very long-term or very severe requirements for nuclear and industrial waste management, or civil works of strategic relevance. Recently available high to ultra-high performance concrete may find rational and valuable application in such cases. It is very important, therefore, to bring people with different professional backgrounds together to exchange experience and develop multi

Determinants of magnesium sulphate use in women hospitalized at <29 weeks with severe or non-severe pre-eclampsia.

Directory of Open Access Journals (Sweden)

Dane A De Silva

Full Text Available Magnesium sulphate is recommended by international guidelines to prevent eclampsia among women with pre-eclampsia, especially when it is severe, but fewer than 70% of such women receive magnesium sulphate. We aimed to identify variables that prompt Canadian physicians to administer magnesium sulphate to women with pre-eclampsia.Data were used from the Canadian Perinatal Network (2005-11 of women hospitalized at <29 weeks' who were thought to be at high risk of delivery due to pre-eclampsia (using broad Canadian definition. Unadjusted analyses of relative risks were estimated directly and population attributable risk percent (PAR% calculated to identify variables associated with magnesium sulphate use. A multivariable model was created and a generalized estimating equation was used to estimate the adjusted RR that explained magnesium sulphate use in pre-eclampsia. The adjusted PAR% was estimated by bootstrapping.Of 631 women with pre-eclampsia, 174 (30.1% had severe pre-eclampsia, of whom 131 (75.3% received magnesium sulphate. 457 (69.9% women had non-severe pre-eclamspia, of whom 291 (63.7% received magnesium sulphate. Use of magnesium sulphate among women with pre-eclampsia could be attributed to the following clinical factors (PAR%: delivery for 'adverse conditions' (48.7%, severe hypertension (21.9%, receipt of antenatal corticosteroids (20.0%, maternal transport prior to delivery (9.9%, heavy proteinuria (7.8%, and interventionist care (3.4%.Clinicians are more likely to administer magnesium sulphate for eclampsia prophylaxis in the presence of more severe maternal clinical features, in addition to concomitant antenatal corticosteroid administration, and shorter admission to delivery periods related to transport from another institution or plans for interventionist care.

Oral cyclosporine therapy for refractory severe vernal keratoconjunctivitis

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Nikhil S Gokhale

2012-01-01

Full Text Available We report the success of oral cyclosporine therapy in a patient with severe vision-threatening vernal keratoconjunctivitis. A child presented with severe allergy which was not controlled with topical steroids, cyclosporine and mast cell stabilizers. Oral steroids were required repeatedly to suppress inflammation. Child showed a dramatic improvement and stabilization with oral cyclosporine therapy. Oral cyclosporine therapy can be tried in severe vision-threatening allergy refractory to conventional therapy.

Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD

Directory of Open Access Journals (Sweden)

Laura Miranda de Oliveira Caram

Full Text Available ABSTRACT Objective: To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD in COPD patients according to disease severity. Methods: The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted. Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS score was determined. Results: Of the 50 patients evaluated, 38 (76% had been diagnosed with at least one comorbidity, 21 (42% having been diagnosed with at least one CVD. Twenty-four patients (48% had more than one CVD. Eighteen (36% of the patients were current smokers, 10 (20% had depression, 7 (14% had dyslipidemia, and 7 (14% had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p < 0.001, p = 0.008, and p = 0.02, respectively. The prevalence of high blood pressure, diabetes mellitus, alcoholism, ischemic heart disease, and chronic heart failure was comparable between the two groups. The Charlson comorbidity index and HADS scores did not differ between the groups. Conclusions: Comorbidities are highly prevalent in COPD, regardless of its severity. Certain risk factors for CVD, themselves classified as diseases (including smoking, dyslipidemia, and depression, appear to be more prevalent in patients with mild-to-moderate COPD.

Severe forms of food allergy

Directory of Open Access Journals (Sweden)

Emanuel Sarinho

2017-11-01

Conclusion: Severe food allergy may occur in the form of anaphylaxis and food‐protein‐induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment.

CT findings in severe thoracic sarcoidosis

International Nuclear Information System (INIS)

Hennebicque, Anne-Sophie; Brillet, Pierre-Yves; Moulahi, Hassen; Brauner, Michel W.; Nunes, Hilario; Valeyre, Dominique

2005-01-01

Severe thoracic sarcoidosis includes manifestations with significant clinical and functional impairment and a risk of mortality. Severe thoracic sarcoidosis can take on various clinical presentations and is associated with increased morbidity. The purpose of this article was to describe the CT findings in severe thoracic sarcoidosis and to explain some of their mechanisms. Subacute respiratory insufficiency is a rare and early complication due to a high profusion of pulmonary lesions. Chronic respiratory insufficiency due to pulmonary fibrosis is a frequent and late complication. Three main CT patterns are identified: bronchial distortion, honeycombing and linear opacities. CT can be helpful in diagnosing some mechanisms of central airway obstruction such as bronchial distortion due to pulmonary fibrosis or an extrinsic bronchial compression by enlarged lymph nodes. An intrinsic narrowing of the bronchial wall by endobronchial granulomatous lesions may be suggested by CT when it shows evidence of bronchial mural thickening. Pulmonary hypertension usually occurs in patients with end-stage pulmonary disease and is related to fibrotic destruction of the distal capillary bed and to the resultant chronic hypoxemia. Several other mechanisms may contribute to the development of pulmonary hypertension including extrinsic compression of major pulmonary arteries by enlarged lymph nodes and secondary pulmonary veno-occlusive disease. Aspergilloma colonization of a cavity is the main cause of hemoptysis in sarcoidosis. Other rare causes are bronchiesctasis, necrotizing bronchial aspergillosis, semi-invasive pulmonary aspergillosis, erosion of a pulmonary artery due to a necrotic sarcoidosis lesion, necrosis of parenchymal sarcoidosis lesions and specific endobronchial macroscopic lesions. (orig.)

Design features of ACR in severe accident mitigation

International Nuclear Information System (INIS)

Shapiro, H.; Krishnan, V.S.; Santamaura, P.; Lekakh, B.; Blahnik, C.

2007-01-01

New reactor designs require the evaluation of design alternatives to reduce the radiological risk by preventing severe accidents or by limiting releases from the plant in the event of such accidents. The Advanced CANDU Reactor TM (ACR TM ) design has provisions to prevent and mitigate severe accidents. This paper describes key ACR design features for severe accident mitigation. It provides a high-level overview of the findings to date. Several design provisions have not yet been finalized or decided, but the designers are keenly aware of the SAM concepts and their requirements. The active heat sinks for 'vessels' (i.e., the fuel channels, the calandria vessel, the calandria end-shields and the calandria vault) are all amply capable of dissipating the severe accident heat loads. These heat sinks are designed to be operable under severe accident environmental conditions; however, their operability is yet to be confirmed by assessments. The active heat sinks for the various process vessels are 'backed up' by passive heat sinks (i.e., steaming plus water make-up from the RWS). The supply side of passive heat sinks is simple, rugged, and not vulnerable to failures of plant systems. The importance of the steam relief side is recognized, and the adequate relief capacity will be provided. The passive heat sinks will give the SAM more than 1 day (likely several days) to diagnose the accident and to establish the ultimate heat sinks. The spray system for containment pressure suppression is designed for high reliability and has ample capacity to ensure low containment leakage without external intervention, after which time alternative supply to the sprays can be brought on line manually. The sprays are backed up by the LACs which are assessed for operability following a severe accident. The strong ACR containment will provide a long time of completely passive protection for any severe accident at decay power. Its characteristics are not prone to catastrophic failures. The

Analytic functions of several complex variables

CERN Document Server

Gunning, Robert C

2009-01-01

The theory of analytic functions of several complex variables enjoyed a period of remarkable development in the middle part of the twentieth century. After initial successes by Poincaré and others in the late 19th and early 20th centuries, the theory encountered obstacles that prevented it from growing quickly into an analogue of the theory for functions of one complex variable. Beginning in the 1930s, initially through the work of Oka, then H. Cartan, and continuing with the work of Grauert, Remmert, and others, new tools were introduced into the theory of several complex variables that resol

Neuropsychiatric aspects of severe brain injuries

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O. S. Zaitsev

2012-01-01

Full Text Available The state-of-the-art of Russian neuropsychiatry and priority developments in different psychopathological syndromes in severe brain injuries are assessed. Many cognitive and emotional impairments are explained in terms of the idea on the organization of psychic activity over time. It is emphasized that to achieve the premorbid levels of an interhemispheric interaction and functional asymmetry of the cerebral hemispheres affords psychic activity recovery. The experience in investigating, classifying, and treating various mental disorders occurring after severe brain injuries is generalized. The basic principles of psychopharmacotherapy and rehabilitation of victims are stated.

Is proportion burned severely related to daily area burned?

International Nuclear Information System (INIS)

Birch, Donovan S; Morgan, Penelope; Smith, Alistair M S; Kolden, Crystal A; Hudak, Andrew T

2014-01-01

The ecological effects of forest fires burning with high severity are long-lived and have the greatest impact on vegetation successional trajectories, as compared to low-to-moderate severity fires. The primary drivers of high severity fire are unclear, but it has been hypothesized that wind-driven, large fire-growth days play a significant role, particularly on large fires in forested ecosystems. Here, we examined the relative proportion of classified burn severity for individual daily areas burned that occurred during 42 large forest fires in central Idaho and western Montana from 2005 to 2007 and 2011. Using infrared perimeter data for wildfires with five or more consecutive days of mapped perimeters, we delineated 2697 individual daily areas burned from which we calculated the proportions of each of three burn severity classes (high, moderate, and low) using the differenced normalized burn ratio as mapped for large fires by the Monitoring Trends in Burn Severity project. We found that the proportion of high burn severity was weakly correlated (Kendall τ = 0.299) with size of daily area burned (DAB). Burn severity was highly variable, even for the largest (95th percentile) in DAB, suggesting that other variables than fire extent influence the ecological effects of fires. We suggest that these results do not support the prioritization of large runs during fire rehabilitation efforts, since the underlying assumption in this prioritization is a positive relationship between severity and area burned in a day. (letters)

Plantar pressures in children with and without sever's disease.

Science.gov (United States)

Becerro de Bengoa Vallejo, Ricardo; Losa Iglesias, Marta Elena; Rodríguez Sanz, David; Prados Frutos, Juan Carlos; Salvadores Fuentes, Paloma; Chicharro, José López

2011-01-01

a case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Sever's disease). the participants were 54 boys enrolled in a soccer academy, of which eight were lost to follow-up. Twenty-two boys with unilateral Sever's disease comprised the Sever's disease group and 24 healthy boys constituted a control group. Plantar pressure data were collected using pedobarography, and gastrocnemius soleus equinus was assessed. peak pressure and percentage of body weight supported were significantly higher in the symptomatic feet of the Sever's disease group than in the asymptomatic feet of the Sever's disease group and the control group. Every child in the Sever's disease group had bilateral gastrocnemius equinus, while nearly all children in the control group had no equinus. high plantar foot pressures are associated with Sever's disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever's disease. Further research is needed to identify other factors involved in the disease and to better understand the factors that contribute to abnormal distribution of body weight in the lower limbs.

One reason, several logics

Directory of Open Access Journals (Sweden)

Evandro Agazzi

2011-06-01

Full Text Available Humans have used arguments for defending or refuting statements long before the creation of logic as a specialized discipline. This can be interpreted as the fact that an intuitive notion of "logical consequence" or a psychic disposition to articulate reasoning according to this pattern is present in common sense, and logic simply aims at describing and codifying the features of this spontaneous capacity of human reason. It is well known, however, that several arguments easily accepted by common sense are actually "logical fallacies", and this indicates that logic is not just a descriptive, but also a prescriptive or normative enterprise, in which the notion of logical consequence is defined in a precise way and then certain rules are established in order to maintain the discourse in keeping with this notion. Yet in the justification of the correctness and adequacy of these rules commonsense reasoning must necessarily be used, and in such a way its foundational role is recognized. Moreover, it remains also true that several branches and forms of logic have been elaborated precisely in order to reflect the structural features of correct argument used in different fields of human reasoning and yet insufficiently mirrored by the most familiar logical formalisms.

Analysis and research status of severe core damage accidents

International Nuclear Information System (INIS)

1984-03-01

The Severe Core Damage Research and Analysis Task Force was established in Nuclear Safety Research Center, Tokai Research Establishment, JAERI, in May, 1982 to make a quantitative analysis on the issues related with the severe core damage accident and also to survey the present status of the research and provide the required research subjects on the severe core damage accident. This report summarizes the results of the works performed by the Task Force during last one and half years. The main subjects investigated are as follows; (1) Discussion on the purposes and necessities of severe core damage accident research, (2) proposal of phenomenological research subjects required in Japan, (3) analysis of severe core damage accidents and identification of risk dominant accident sequences, (4) investigation of significant physical phenomena in severe core damage accidents, and (5) survey of the research status. (author)

Design and Development of a Severe Accident Training System

International Nuclear Information System (INIS)

Kim, Ko Ryu; Park, Sun Hee; Kim, Dong Ha

2005-01-01

The nuclear plants' severe accidents have two big characteristics. One is that they are very rare accidents, and the other is that they bring extreme conditions such as the high pressure and temperature in their process. It is, therefore, very hard to get the severe accident data, without inquiring that the data should be real or experimental. In fact, most of severe accident analyses rely on the simulation codes where almost all severe accident knowledge is contained. These codes are, however, programmed by the Fortran language, so that their output are typical text files which are very complicated. To avoid this kind of difficulty in understanding the code output data, several kinds of graphic user interface (GUI) programs could be developed. In this paper, we will introduce a GUI system for severe accident management and training, partly developed and partly in design stage

Towards a Flood Severity Index

Science.gov (United States)

Kettner, A.; Chong, A.; Prades, L.; Brakenridge, G. R.; Muir, S.; Amparore, A.; Slayback, D. A.; Poungprom, R.

2017-12-01

Flooding is the most common natural hazard worldwide, affecting 21 million people every year. In the immediate moments following a flood event, humanitarian actors like the World Food Program need to make rapid decisions ( 72 hrs) on how to prioritize affected areas impacted by such an event. For other natural disasters like hurricanes/cyclones and earthquakes, there are industry-recognized standards on how the impacted areas are to be classified. Shake maps, quantifying peak ground motion, from for example the US Geological Survey are widely used for assessing earthquakes. Similarly, cyclones are tracked by Joint Typhoon Warning Center (JTWC) and Global Disaster Alert and Coordination System (GDACS) who release storm nodes and tracks (forecasted and actual), with wind buffers and classify the event according to the Saffir-Simpson Hurricane Wind Scale. For floods, the community is usually able to acquire unclassified data of the flood extent as identified from satellite imagery. Most often no water discharge hydrograph is available to classify the event into recurrence intervals simply because there is no gauging station, or the gauging station was unable to record the maximum discharge due to overtopping or flood damage. So, the question remains: How do we methodically turn a flooded area into classified areas of different gradations of impact? Here, we present a first approach towards developing a global applicable flood severity index. The flood severity index is set up such that it considers relatively easily obtainable physical parameters in a short period of time like: flood frequency (relating the current flood to historical events) and magnitude, as well as land cover, slope, and where available pre-event simulated flood depth. The scale includes categories ranging from very minor flooding to catastrophic flooding. We test and evaluate the postulated classification scheme against a set of past flood events. Once a severity category is determined, socio

Ohia forest decline: its spread and severity in Hawaii

Science.gov (United States)

Edwin Q. P. Petteys; Robert E. Burgan; Robert E. Nelson

1975-01-01

Ohia forest decline–its severity and rate of spread–was studied by aerial photographic techniques on a 197,000-acre (80,000-ha) portion of the island of Hawaii. In 1954, only 300 acres (121 ha) showed signs of severe decline; by 1972, the acreage of severely affected forest had increased to 85,200 acres (34,480 ha). Rate of decline and current severity were related to...

Bioimpedance in Severely Malnourished Children

DEFF Research Database (Denmark)

Girma Nigatu, Tsinuel

Worldwide severe acute malnutrition (SAM) affects millions of children and considerably contributes to under-five mortality, mainly in low-income settings. Among children with SAM, deaths occur largely in those with oedema and during early phase of treatment often aggravated by infection. Treatment...

Risk factors for cardiovascular disease in patients with COPD: mild-to-moderate COPD versus severe-to-very severe COPD.

Science.gov (United States)

Caram, Laura Miranda de Oliveira; Ferrari, Renata; Naves, Cristiane Roberta; Coelho, Liana Sousa; Vale, Simone Alves do; Tanni, Suzana Erico; Godoy, Irma

2016-01-01

To assess and compare the prevalence of comorbidities and risk factors for cardiovascular disease (CVD) in COPD patients according to disease severity. The study included 25 patients with mild-to-moderate COPD (68% male; mean age, 65 ± 8 years; mean FEV1, 73 ± 15% of predicted) and 25 with severe-to-very severe COPD (males, 56%; mean age, 69 ± 9 years; mean FEV1, 40 ± 18% of predicted). Comorbidities were recorded on the basis of data obtained from medical charts and clinical evaluations. Comorbidities were registered on the basis of data obtained from medical charts and clinical evaluations. The Charlson comorbidity index was calculated, and the Hospital Anxiety and Depression Scale (HADS) score was determined. Of the 50 patients evaluated, 38 (76%) had been diagnosed with at least one comorbidity, 21 (42%) having been diagnosed with at least one CVD. Twenty-four patients (48%) had more than one CVD. Eighteen (36%) of the patients were current smokers, 10 (20%) had depression, 7 (14%) had dyslipidemia, and 7 (14%) had diabetes mellitus. Current smoking, depression, and dyslipidemia were more prevalent among the patients with mild-to-moderate COPD than among those with severe-to-very severe COPD (p dislipidemia, e 7 (14%) tinham diabetes mellitus. Tabagismo atual, depressão e dislipidemia foram mais prevalentes nos pacientes com DPOC leve/moderada que naqueles com DPOC grave/muito grave (p dislipidemia e depressão), parecem ser mais prevalentes nos pacientes com DPOC leve/moderada.

Coagulopathy and its management in patients with severe burns

NARCIS (Netherlands)

Glas, G. J.; Levi, M. [=Marcel M.; Schultz, M. J.

2016-01-01

Severe burn injury is associated with systemic coagulopathy. The changes in coagulation described in patients with severe burns resemble those found patients with sepsis or major trauma. Coagulopathy in patients with severe burns is characterized by procoagulant changes, and impaired fibrinolytic

Ammonia levels and the severity of hepatic encephalopathy

International Nuclear Information System (INIS)

Qureshi, M.O.; Khokhar, N.; Shafqat, F.

2014-01-01

Objective: To evaluate the correlation between ammonia levels with the severity of HE in patients coming to the tertiary care hospital with liver cirrhosis and hepatic encephalopathy (HE). Study Design: Descriptive, analytical study. Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2011 to February 2012. Methodology: A total of 135 patients with liver cirrhosis and HE had serum ammonia levels measured on admission. The diagnosis of HE was based on clinical criteria, and its severity was graded according to the West Haven Criteria for grading of mental status. Ammonia levels were correlated with the severity of HE using Spearman rank correlation. Results: Out of 20 patients with normal ammonia levels, 13 (65%) were in HE I-II, 6 (30%) were in grade-III, while 1 (5%) patient was in grade-IV HE. Out of 45 patients with mild hyperammonemia, 27 (60%) were in grade I-II, 12 (26%) were in grade-III and 6 (13%) were in grade-IV HE. Out of 34 patients with moderate hyperammonemia, 9 (26%) were in grade I-II, 18 (53%) were in grade-III, and 7 (20%) were in grade-IV HE. Out of 36 patients with severe hyperammonemia, 31 (86%) patients were in grade-IV HE (p < 0.001). Conclusion: Ammonia levels correlated with the severity of hepatic encephalopathy. Greater the ammonia level, severe is the grade of hepatic encephalopathy. (author)

Pazopanib-Induced Severe Acute Pancreatitis

Directory of Open Access Journals (Sweden)

Kazumichi Kawakubo

2015-08-01

Full Text Available Pazopanib is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptors, platelet-derived growth factor receptors, and c-Kit approved for the treatment of renal cell carcinoma and soft tissue sarcoma. Nonselective kinase inhibitors, such as sunitinib and sorafenib, are known to be associated with acute pancreatitis. There are few case reports of severe acute pancreatitis induced by pazopanib treatment. We present a case of severe acute pancreatitis caused by pazopanib treatment for cutaneous angiosarcoma. The patient was an 82-year-old female diagnosed with cutaneous angiosarcoma. She had been refractory to docetaxel treatment and began pazopanib therapy. Three months after pazopanib treatment, CT imaging of the abdomen showed the swelling of the pancreas and surrounding soft tissue inflammation without abdominal pain. After she continued pazopanib treatment for 2 months, she presented with nausea and appetite loss. Abdominal CT showed the worsening of the surrounding soft tissue inflammation of the pancreas. Serum amylase and lipase levels were 296 and 177 IU/l, respectively. She was diagnosed with acute pancreatitis induced by pazopanib treatment and was managed conservatively with discontinuation of pazopanib, but the symptoms did not improve. Subsequently, an abdominal CT scan demonstrated the appearance of a pancreatic pseudocyst. She underwent endoscopic ultrasound-guided pseudocyst drainage using a flared-end fully covered self-expandable metallic stent. Then, the symptoms resolved without recurrence. Due to the remarkable progress of molecular targeted therapy, the oncologist should know that acute pancreatitis was recognized as a potential adverse event of pazopanib treatment and could proceed to severe acute pancreatitis.

Liver dysfunction in patients with severe anorexia nervosa.

Science.gov (United States)

Rosen, Elissa; Sabel, Allison L; Brinton, John T; Catanach, Brittany; Gaudiani, Jennifer L; Mehler, Philip S

2016-02-01

Evaluation of liver dysfunction in patients with severe anorexia nervosa (AN) has typically been limited to small case series. We report an investigation into the admission characteristics and clinical outcomes associated with liver dysfunction in a large cohort of adults hospitalized for medical stabilization of severe AN. We retrospectively evaluated electronic medical records to quantify the cumulative incidence of elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT). We compared mean (±SD), frequencies (%), and median (IQR) values of clinical covariates of interest by incidence of liver enzyme elevation. The study included 181 adults, admitted for medical stabilization of AN, from October 1, 2008 to December 31, 2013. AST and ALT were mildly elevated in 27.6% of patients and severely elevated (more than three times the upper limit of normal) in 35.4% of patients. On admission, patients with severely elevated liver enzymes had a lower body mass index (BMI) (11.9 ± 1.8 kg/m(2) vs.13.3 ± 1.7 kg/m(2)), lower percentage ideal body weight (56.5% ± 7.7% vs. 63.5% ± 8.3%), and lower prealbumin (64% vs. 37%) compared with the rest of the cohort (p < 0.001). While hospitalized, patients with severely elevated liver enzymes more often developed hypoglycemia, hypophosphatemia, and experienced longer lengths of stay (p < 0.001). Elevated liver enzymes are common in our patient population with severe AN. Liver enzymes reached near normal values by the time of discharge. Severely elevated liver enzymes were associated with a lower BMI and the development of hypoglycemia. © 2015 Wiley Periodicals, Inc.

Effect of weight loss on the severity of psoriasis

DEFF Research Database (Denmark)

Jensen, P; Zachariae, Claus; Christensen, R

2013-01-01

Psoriasis is associated with adiposity and weight gain increases the severity of psoriasis and the risk of incident psoriasis. Therefore, we aimed to measure the effect of weight reduction on the severity of psoriasis in obese patients with psoriasis.......Psoriasis is associated with adiposity and weight gain increases the severity of psoriasis and the risk of incident psoriasis. Therefore, we aimed to measure the effect of weight reduction on the severity of psoriasis in obese patients with psoriasis....

Designing a Pediatric Severe Sepsis Screening Tool

Directory of Open Access Journals (Sweden)

Robert eSepanski

2014-06-01

Full Text Available We sought to create a screening tool with improved predictive value for pediatric severe sepsis and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric Emergency Department (ED. Gold standard severe sepsis cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over two months. The tool’s identification of severe sepsis was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool’s predictive value based on receiver operating curve (ROC characteristics. Age-specific normal and abnormal values for heart rate (HR and respiratory rate (RR were empirically derived from 143,603 children seen in a second pediatric ED over three years. Univariate analyses were performed for each measure in the tool to assess its association with severe sepsis and to characterize it as an early or late indicator of severe sepsis. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool’s positive predictive value was 48.7%, a significant, nearly three-fold improvement over the original ICCPS tool. False positive Systemic Inflammatory Response Syndrome (SIRS identifications were nearly six-fold lower.

Interaction of radionuclides in severe accident conditions

International Nuclear Information System (INIS)

Nagrale, Dhanesh B.; Bera, Subrata; Deo, Anuj Kumar; Paul, U.K.; Prasad, M.; Gaikwad, A.J.

2015-01-01

Nuclear power plants are designed with inherent engineering safety systems and associated operational procedures that provide an in-depth defence against accidents. Radionuclides such as Iodine, Cesium, Tellurium, Barium, Strontium, Rubidium, Molybdenum and many others may get released during a severe accident. Among these, Iodine, one of the fission products, behaviour is significant for the analysis of severe accident consequences because iodine is a chemically more active to the potential components released to the environment. During severe accident, Iodine is released and transported in aqueous, organic and inorganic forms. Iodine release from fuel, iodine transport in primary coolant system, containment, and reaction with control rods are some of the important phases in a severe accident scenario. The behaviour of iodine is governed by aerosol physics, depletion mechanisms gravitational settling, diffusiophoresis and thermophoresis. The presence of gaseous organic compounds and oxidizing compounds on iodine, reactions of aerosol iodine with boron and formation of cesium iodide which results in more volatile iodine release in containment play significant roles. Water radiolysis products due to presence of dissolved impurities, chloride ions, organic impurities should be considered while calculating iodine release. Containment filtered venting system (CFVS) consists of venturi scrubber and a scrubber tank which is dosed with NaOH and NaS_2O_3 in water where iodine will react with the chemicals and convert into NaI and Na_2SO_4. This paper elaborates the issues with respect to interaction of radionuclides and its consideration in modeling of severe accident. (author)

Social networking for adolescents with severe haemophilia.

Science.gov (United States)

Khair, K; Holland, M; Carrington, S

2012-05-01

Access to modern treatments allows adolescents with haemophilia to manage their haemophilia at home, with improved treatment outcomes and quality of life, but has reduced peer support and the potential for experiential learning from older peers. Social networking, aided by modern communication technologies, may offer health benefits through peer support. We sought to assess whether or not disease-specific social networking could benefit adolescents with severe haemophilia. A total of 150 adolescents (aged 10-18) with severe haemophilia A or B from 11 UK treatment centres or those who had attended focus groups to explore the potential for a social network designed specifically for their use were surveyed. Teenage boys with severe haemophilia in the UK who responded to an online and paper questionnaire (n = 47; 31% response rate) rarely knew of or socialized with others with haemophilia outside their families. Two-thirds of respondents said they would like to meet others. For 70% of boys, parents were the major source of information about haemophilia, yet more than half said they often had trouble finding answers to their questions. These boys frequently used online social networks to chat with friends. Adolescents with severe haemophilia frequently have limited contact with others and many wish to have greater contact. They may benefit from peer support and experiential learning gained through online social networking. The SixVibe restricted access social network is to be launched in 2011. It includes features designed to promote and facilitate the development of peer-to peer disease management skills for adolescents with severe haemophilia. © 2011 Blackwell Publishing Ltd.

Strategies for the prevention and mitigation of severe accidents

International Nuclear Information System (INIS)

Ader, C.; Heusener, G.; Snell, V.G.

1999-01-01

The currently operating nuclear power plants have, in general, achieved a high level of safety, as a result of design philosophies that have emphasized concepts such as defense-in-depth. This type of an approach has resulted in plants that have robust designs and strong containments. These designs were later found to have capabilities to protect the public from severe accidents (accidents more severe than traditional design basis in which substantial damage is done to the reactor core). In spite of this high level of safety, it has also been recognized that future plants need to be designed to achieve an enhanced level of safety, in particular with respect to severe accidents. This has led both regulatory authorities and utilities to develop guidance and/or requirements to guide plant designers in achieving improved severe accident performance through prevention and mitigation. The considerable research programs initiated after the TMI-2 accident have provided a large body of technical data, analytical methods, and the expertise necessary to provide for an understanding of a range of severe accident phenomena. This understanding of the ways severe accidents can progress and challenge containments, combined with the wide use of probabilistic safety assessments, have provided designers of evolutionary water cooled reactors opportunities to develop designs that minimize the challenges to the plant and to the public from severe accidents, including the development of accident management strategies intended to further reduce the risk of severe accidents. This paper describes some of the recent progress made in the understanding of severe accidents and related safety assessment methodology and how this knowledge has supported the incorporation of features into representative evolutionary designs that will prevent or mitigate many of the severe accident challenges present in current plants. (author)

Stuttering Severity and Educational Attainment

Science.gov (United States)

O'Brian, Sue; Jones, Mark; Packman, Ann; Menzies, Ross; Onslow, Mark

2011-01-01

Purpose: This study investigated the relationship between self-reported stuttering severity ratings and educational attainment. Method: Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering…

Working while unwell: Workplace impairment in people with severe asthma.

Science.gov (United States)

Hiles, Sarah A; Harvey, Erin S; McDonald, Vanessa M; Peters, Matthew; Bardin, Philip; Reynolds, Paul N; Upham, John W; Baraket, Melissa; Bhikoo, Zaheerodin; Bowden, Jeffrey; Brockway, Ben; Chung, Li Ping; Cochrane, Belinda; Foxley, Gloria; Garrett, Jeffrey; Hew, Mark; Jayaram, Lata; Jenkins, Christine; Katelaris, Constance; Katsoulotos, Gregory; Koh, Mariko S; Kritikos, Vicky; Lambert, Marina; Langton, David; Rivero, Alexis Lara; Marks, Guy B; Middleton, Peter G; Nanguzgambo, Aldoph; Radhakrishna, Naghmeh; Reddel, Helen; Rimmer, Janet; Southcott, Anne Marie; Sutherland, Michael; Thien, Francis; Wark, Peter Ab; Yang, Ian A; Yap, Elaine; Gibson, Peter G

2018-04-20

Severe asthma affects quality of life; however, its impact on workplace productivity is poorly understood. To compare workplace productivity - absenteeism and presenteeism - and impairment in daily activities in severe and non-severe asthma over time and identify characteristics associated with presenteeism in severe asthma. The Severe Asthma Web-based Database (SAWD) is an ongoing observational registry from Australia, New Zealand and Singapore. At April 2017, 434 patients with severe asthma and 102 with non-severe asthma were enrolled (18 to 88 years; 59% female). Participants provided comprehensive clinical and questionnaire data at baseline and were followed-up every 6 months for 24 months. Absenteeism (percentage of time not at work), presenteeism (self-reported impairment at work) and impairment in daily activities outside work due to health problems in the last week were calculated. At baseline, 61.4% of participants with severe asthma and 66.2% with non-severe asthma under 65 years were employed. At younger ages (30-50 years), fewer severe asthma participants were employed (69% vs 100%). Presenteeism and impairment in daily activity were more frequently reported in severe asthma and in participants with poorer asthma control, poorer lung function and more past-year exacerbations (pworkplace. Improving asthma control and mental health may be important targets for optimising workplace productivity in severe asthma. Presenteeism and absenteeism may represent key metrics for assessing intervention efficacy in people with severe asthma of working age. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

COPD exacerbations by disease severity in England

Directory of Open Access Journals (Sweden)

Merinopoulou E

2016-04-01

Full Text Available Evie Merinopoulou,1 Mireia Raluy-Callado,1 Sreeram Ramagopalan,1 Sharon MacLachlan,1 Javaria Mona Khalid2 1Real-World Evidence, Evidera, 2Takeda Development Centre Europe Ltd, London, UK Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD are associated with accelerated disease progression and are important drivers of health care resource utilization. The study aimed to quantify the rates of COPD exacerbations in England and assess health care resource utilization by severity categories according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2013.Methods: Data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics were used to identify patients with a COPD diagnosis aged ≥40 years. Those with complete spirometric, modified Medical Research Council Dyspnea Scale information, and exacerbation history 12 months prior to January 1, 2011 (index date were classified into GOLD severity groups. Study outcomes over follow-up (up to December 31, 2013 were exacerbation rates and resource utilization (general practitioner visits, hospital admissions.Results: From the 44,201 patients in the study cohort, 83.5% were classified into severity levels GOLD A: 33.8%, GOLD B: 21.0%, GOLD C: 18.1%, and GOLD D: 27.0%. Mean age at diagnosis was 66 years and 52.0% were male. Annual exacerbation rates per person-year increased with severity, from 0.83 (95% confidence interval [CI]: 0.81–0.85 for GOLD A to 2.51 (95% CI: 2.47–2.55 for GOLD D. General practitioner visit rates per person-year also increased with severity, from 4.82 (95% CI: 4.74–4.93 for GOLD A to 7.44 (95% CI: 7.31–7.61 for GOLD D. COPD-related hospitalization rates per person-year increased from less symptoms (GOLD A: 0.28, GOLD C: 0.39 to more symptoms (GOLD B: 0.52, GOLD D: 0.84.Conclusion: Patients in the most severe category (GOLD D experienced nearly three times the number of exacerbations and COPD

In-Patient Treatment of Severe Acute Malnutrition

DEFF Research Database (Denmark)

Rytter, Maren Johanne Heilskov

Severe acute malnutrition is a serious health problem among children in low-income countries. Particularly malnourished children requiring in-hospital treatment are at high risk of dying. This dissertation investigates possible reasons for this high mortality, by following a group of 120 children...... during their in-hospital treatment of severe acute malnutrition at Mwanamugimu Nutrition Unit in Kampala, Uganda. We assessed how malnutrition affected the children’s immune system, by measuring the size of their thymus gland with ultrasound. We examined characteristics of children with the serious form...... of malnutrition, Kwashiorkor, where the children develop oedema. Finally, we explored symptoms, findings or treatments given that were associated with a higher risk of death in the children. Hopefully, these findings may contribute to improving the treatment offered to children with severe acute malnutrition....

Self-esteem in severely burned adults.

Science.gov (United States)

Imran Haider Zaidi, Syed Muhammad; Yaqoob, Nazia; Noreen, Sidra

2017-12-01

A cross-sectional study was conducted to investigate the level of and gender difference in self-esteem among adult victims of severe burn injuries. Severely burned adults aged 20 to 40 years participated in this investigation from March 2015 to April 2016 in five hospitals of Faisalabad and Lahore. Purposive sampling technique was used and a self-esteem scale was used to assess different dimensions of self-esteem. Out of 40 patients, there were 25 men (62.5%) and 15 women (37.5%) with mean age of 28.28±4.60 years (range: 20-40 years). A significant positive relationship between subscales of self-esteem scale were found: self-acceptance and self-competence r=0.55, pself-acceptance and academic self-competence r=0.47, pself-acceptance and social and physical acceptance r=0.57, pself-competence and academic self-competence r=0.48, pself-competence and social and physical acceptance r=0.50, pself-competence and social and physical acceptance r=0.45, pself-competence among severely burned men and women (t=2.18; pself-competency component of self-esteem among women victims.

Recommendations for severe hypertriglyceridemia treatment, are there new strategies?

Science.gov (United States)

Filippatos, Theodosios D; Elisaf, Moses S

2014-01-01

This review considers drug combinations and newer treatment strategies for patients with severe hypertriglyceridemia. Hypertriglyceridemia is associated with an atherogenic metabolic profile and in most studies with increased cardiovascular disease risk. Patients with severe hypertriglyceridemia also have increased incidence of pancreatitis. All types of severe hypertriglyceridemia are associated with a reduction in lipoprotein lipase activity. Patients with severe hypertriglyceridemia and abdominal pain or pancreatitis should be hospitalized and treated with hypolipidemic drugs and, if needed, with insulin/dextrose infusion or therapeutic apheresis. Fibrates are the first-line treatment in patients with severe hypertriglyceridemia. Omega-3 fatty acids and niacin are very useful drugs for patients with hypertriglyceridemia. Statins in high doses exhibit a significant hypotriglyceridemic activity. Drugs that interfere with chylomicron production such as orlistat are also useful for hypertriglyceridemic patients. In most patients with severe hypertriglyceridemia drug combinations are needed to maintain an acceptable triglyceride concentration. Gene therapy is under development for patients with known genetic abnormalities of triglyceride metabolism. Clinicians should be vigilant for the recognition and prompt treatment of patients with severe hypertriglyceridemia aimed to avoid the serious complication of pancreatitis and to reduce their cardiovascular risk.

Severe Malnutrition: A Global Approach.

Science.gov (United States)

Pelletier, Jean-Gerard

1993-01-01

This report examines the immediate and underlying causes of malnutrition in the developing world. The first section discusses the effects of malnutrition on childhood development and examines the efficacy of nutritional rehabilitation. The second section addresses the medical effects of severe malnutrition, including the onset of ponderostatural…

Prevalence of exchange blood transfusion in severe hyper ...

African Journals Online (AJOL)

2015-11-09

Nov 9, 2015 ... cause a large number of our pa- tients had severe NNJ at presenta- ... bilirubinaemiadue such as prematurity, rhesus isoimmu- nization, ABO ... presents very late to health facilities, often with severe neonatal jaundice, some ...

Severity indices in rheumatoid arthritis: A systematic review.

Science.gov (United States)

Toledano, Esther; García de Yébenes, M Jesús; González-Álvaro, Isidoro; Carmona, Loreto

2017-08-11

To identify tools designed to evaluate the severity of patients with rheumatoid arthritis (RA) in order to use them in the investigation of prognostic markers in early arthritis. We conducted a systematic review of studies that developed/validated an index for RA disease severity. They were analyzed using the COSMIN checklist to assess their methodological quality. In addition, all the variables included were evaluated for their clarity of definition, feasibility and probability of being present in each outcome during the first 2 years of the disease course. To estimate redundancy, variables were grouped by domains. After reviewing 3,519 articles, 3 studies were included. The first study, the PAS, assessed whether current and lifetime treatment with disease-modifying antirheumatic drugs and/or biologics accurately predicted RA severity, as measured by the patient-reported PAS. Treatment variables did not fully distinguish patients in the highest and lowest quartiles of PAS scores. Another severity index, the Claims-Based Index for RA Severity (CIRAS), included the variables age, sex, Felty's syndrome, number of rehabilitation and rheumatology visits, test for inflammatory markers, number of chemistry panels/platelet counts ordered and rheumatoid factor test. The correlation was low (r=0.56) with an index previously validated by the same research group, the RA medical records-based index of severity (RARBIS), with Disease Activity Score-C-reactive protein (DAS28-PCR) (r=0.07) and Multidimensional Health Assessment Questionnaire (MD-HAQ) (r=0.008). Finally, the RARBIS, used to validate the CIRAS, was devised as an RA severity index based on medical records. It includes as domains surgery, radiology, extra-articular manifestations, clinical and laboratory variables, previously chosen by an expert panel. RARBIS had a weak correlation with treatment intensity (r=0.35) and with DAS28 (r=0.41). There is no index to assess the severity of RA based on the course of the

Dangerous and severe personality disorder: an ethical concept?

Science.gov (United States)

Glen, Sally

2005-04-01

Most clinicians and mental health practitioners are reluctant to work with people with dangerous and severe personality disorders because they believe there is nothing that mental health services can offer. Dangerous and severe personality disorder also signals a diagnosis which is problematic morally. Moral philosophy has not found an adequate way of dealing with personality disorders. This paper explores the question: What makes a person morally responsible for his actions and what is a legitimate mitigating factor? How do psychiatric nurses working with this client group understand the awful things some clients do? What concepts do they need, if they are to know how to explain and how to react? It is suggested that dangerous and severe personality disorder is best regarded as a moral category, framed in terms of goodness, badness, obligation and other ethical concepts. It seems plausible that in important ways the dangerous and severe personality disordered client does not understand morality or understands it differently. The peculiar position of the dangerous and severe personality disordered individual in our system of moral responsibility stems from his apparent inability to see the importance of the interests of others. It might be more helpful to regard personality disordered clients as we do children: partially but not fully reasonable for their actions. We might regard the dangerous and severe personality disordered client responsible for those actions which he most clearly understands, such as causing others physical pain, but not for those with which he is only superficially engaged, such as causing emotional pain. The paper concludes by suggesting that the dangerous and severe personality disordered individual does not fit easily into any conventional moral category, be it criminal, patient, animal or child, and thus an assessment of his moral accountability must take into consideration his special circumstances.

Drug use and the severity of a traffic accident

NARCIS (Netherlands)

Smink, BE; Ruiter, B; Lusthof, KJ; de Gier, JJ; Uges, DRA; Egberts, ACG

Several studies have showed that driving under the influence of alcohol and/or certain illicit or medicinal drugs increases the risk of a (severe) crash. Data with respect to the question whether this also leads to a more severe accident are sparse. This study examines the relationship between the

Adult phenylketonuria presenting with subacute severe neurologic symptoms.

Science.gov (United States)

Seki, M; Takizawa, T; Suzuki, S; Shimizu, T; Shibata, H; Ishii, T; Hasegawa, T; Suzuki, N

2015-08-01

We report a 48-year-old Japanese woman with phenylketonuria (PKU) who presented with severe neurological symptoms more than 30 years after discontinuation of dietary treatment. She was diagnosed with PKU at 6-years-old and was treated with a phenylalanine restricted diet until she was 15 years old. When she was 48-years-old she started having difficulty walking. After several months, she presented with severe disturbance of consciousness and was admitted. She was diagnosed as having neurological complications associated with PKU. We observed temporal changes in her laboratory data, brain MRI and single-photon emission computed tomography (SPECT) scan findings. Brain MRI on T2-weighted, fluid-attenuated inversion recovery and diffusion-weighted images revealed high intensity lesions in her bilateral frontal lobes and 123I-IMP SPECT showed marked and diffuse hypoperfusion in the bilateral cerebrum and cerebellum. After the resumption of dietary treatment, serum phenylalanine concentrations immediately decreased to the normal range. However, her neurological symptoms took longer to improve. We also found no clear temporal association between MRI findings and clinical severity. SPECT abnormalities showed marked improvement after treatment. It is well known that PKU patients who discontinue the dietary restriction from their childhood develop minor neurological impairments. However, PKU patients with late-onset severe neurological symptoms are very rare. To our knowledge, this is the first report regarding SPECT findings of PKU patients with late-onset severe neurological deterioration. Copyright © 2015 Elsevier Ltd. All rights reserved.

Calculation of spent fuel pool severe accident with MELCOR

International Nuclear Information System (INIS)

Deng Jian; Xiang Qing'an; Zhou Kefeng

2014-01-01

A calculation model was established for spent fuel pool (SFP) using MELCOR code to study the severe accident phenomena caused by the long term station black-out (SBO), including spent fuel heatup, zirconium cladding oxidation, and the injection into SFP to mitigate the severe accident. The results show that the severe accident progression is slow and relates directly with the initial water level in SFP. It is illustrated that the injection into SFP is one of the best mitigated measures for the SFP severe accident. (authors)

Incidence of severe critical events in paediatric anaesthesia (APRICOT)

DEFF Research Database (Denmark)

Habre, Walid; Disma, Nicola; Virag, Katalin

2017-01-01

a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist......BACKGROUND: Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. METHODS...... 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring...

Psychological and audiological correlates of perceived tinnitus severity.

Science.gov (United States)

Erlandsson, S I; Hallberg, L R; Axelsson, A

1992-01-01

Beliefs and attitudes towards tinnitus have been found to play an important role in the process of rehabilitation. The relationship between audiological, psychological and psychosomatic factors (self-assessment of vertigo and headache and the perceived severity of tinnitus) was investigated in a clinical population of 163 subjects. Audiological descriptives comprised pure-tone average (dB HL), etiology of hearing loss, duration of tinnitus and tinnitus localisation. Perceived severity of tinnitus was assessed with a questionnaire focusing on tinnitus impact on aspects of quality of life, concentration and sleep. A 28-item handicap and support questionnaire was used and factor analysed, resulting in three factors: perceived attitudes, social support and disability/handicap. Tinnitus severity was significantly related to perceived attitudes. The influence of social support on tinnitus severity did not seem to be crucial. The results showed that significantly more women than men complained about vertigo. Unilateral tinnitus localisation was also more prevalent in females. The subjects with multiple tinnitus localisations were older and had significantly more sleep disturbance than subjects with tinnitus localized to the ears only. In accordance with previously reported observations, the frequency of headaches was strongly correlated with the severity of tinnitus.

Strategy-oriented display concept to assist severe accident management

International Nuclear Information System (INIS)

Jeong, Kwangsub; Ha, Jaejoo

2000-01-01

The Critical Function Monitoring System (CFMS) is a typical Safety Parameter Display System (SPDS) to assist the operation of Korean Standard Nuclear Power Plants during normal and emergency operation, and SPDS for severe accident is being developed in Korea. When the existing CFMS is used under a severe accident situation, some problems are expected from: (1) different design basis, i.e. prevention of core melt vs. protection of radiation release to environment, (2) different parameters for decision-making, and (3) different domain and depth of information to restore the plant. To resolve the above problems, a concept, 'Strategy-Oriented Information Display' concept, for displaying information for severe accident management is developed in this paper. Whereas the existing SPDS structure is based on the critical safety function, the developed concept is based on the severe accident management strategy. The display for each strategy includes the plant parameters to check the status of plant and component with the logical or graphical views necessary for executing the strategy. As the application of the proposed concept, KAERI is developing a display system, the prototype severe accident SPDS, Severe Accident Management Display System (SAMDIS), to assist plant personnel for executing Korean Severe Accident Management Guidelines. CFMS is developed for a general display suitable to all situations with various displays. On the contrary, SAMDIS provides all the relevant information on one screen based on the proposed concept. The SAMDIS screen shows more extensive area than CFMS and thus plant personnel can recognize the overall plant status at a glance. This concept is quite effective when used with severe accident management guidelines because of the relatively macroscopic characteristics of a severe accident management strategy. (author)

Analysis of severe accidents in pressurized heavy water reactors

International Nuclear Information System (INIS)

2008-06-01

Certain very low probability plant states that are beyond design basis accident conditions and which may arise owing to multiple failures of safety systems leading to significant core degradation may jeopardize the integrity of many or all the barriers to the release of radioactive material. Such event sequences are called severe accidents. It is required in the IAEA Safety Requirements publication on Safety of the Nuclear Power Plants: Design, that consideration be given to severe accident sequences, using a combination of engineering judgement and probabilistic methods, to determine those sequences for which reasonably practicable preventive or mitigatory measures can be identified. Acceptable measures need not involve the application of conservative engineering practices used in setting and evaluating design basis accidents, but rather should be based on realistic or best estimate assumptions, methods and analytical criteria. Recently, the IAEA developed a Safety Report on Approaches and Tools for Severe Accident Analysis. This publication provides a description of factors important to severe accident analysis, an overview of severe accident phenomena and the current status in their modelling, categorization of available computer codes, and differences in approaches for various applications of severe accident analysis. The report covers both the in- and ex-vessel phases of severe accidents. The publication is consistent with the IAEA Safety Report on Accident Analysis for Nuclear Power Plants and can be considered as a complementary report specifically devoted to the analysis of severe accidents. Although the report does not explicitly differentiate among various reactor types, it has been written essentially on the basis of available knowledge and databases developed for light water reactors. Therefore its application is mostly oriented towards PWRs and BWRs and, to a more limited extent, they can be only used as preliminary guidance for other types of reactors

A study of asthma severity in adult twins

DEFF Research Database (Denmark)

Thomsen, Simon Francis; van der Sluis, Sophie; Kyvik, Kirsten Ohm

2012-01-01

Introduction: The tendency to develop asthma runs in families, but whether the severity of asthma symptoms is inherited is not known. Objectives: The aim of this study was to examine whether genetic factors influence the variation in the severity of asthma. Methods: Of a sample of 21 133 adult......, and markers of airway impairment and allergy were measured. Results: After adjusting for confounders, genetic factors explained 24% (10%-37%), P = 0.0004, of the variation in overall asthma symptom severity, whereas non-shared environment accounted for the remaining 76% of the variation. A significant genetic...

Severe service sealing solutions

International Nuclear Information System (INIS)

Metcalfe, R.; Wensel, R.

1994-09-01

Successful sealing usually requires much more than initial leak-tightness. Friction and wear must also be acceptable, requiring a good understanding of tribology at the sealing interface. This paper describes various sealing solutions for severe service conditions. The CAN2A and CAN8 rotary face seals use tungsten carbide against carbon-graphite to achieve low leakage and long lifetime in nuclear main coolant pumps. The smaller CAN6 seal successfully uses tungsten carbide against silicon carbide in reactor water cleanup pump service. Where friction in CANDU fuelling machine rams must be essentially zero, a hydrostatic seal using two silicon carbide faces is the solution. In the NRU reactor moderator pumps, where pressure is much lower, eccentric seals that prevent boiling at the seal faces are giving excellent service. All these rotary face seals rely on supplementary elastomer seals between their parts. An integrated engineering approach to high performance sealing with O-rings is described. This is epitomized in critical Space Shuttle applications, but is increasingly being applied in CANDU plants. It includes gland design, selection and qualification of material, quality assurance, detection of defects and the effects of lubrication, surface finish, squeeze, stretch and volume constraints. In conclusion, for the severe service applications described, customized solutions have more than paid for themselves by higher reliability, lower maintenance requirements and reduced outage time. (author)

Gene-Environment Interactions in Severe Mental Illness

Directory of Open Access Journals (Sweden)

Rudolf eUher

2014-05-01

Full Text Available Severe mental illness is a broad category that includes schizophrenia, bipolar disorder and severe depression. Both genetic disposition and environmental exposures play important roles in the development of severe mental illness. Multiple lines of evidence suggest that the roles of genetic and environmental depend on each other. Gene-environment interactions may underlie the paradox of strong environmental factors for highly heritable disorders, the low estimates of shared environmental influences in twin studies of severe mental illness and the heritability gap between twin and molecular heritability estimates. Sons and daughters of parents with severe mental illness are more vulnerable to the effects of prenatal and postnatal environmental exposures, suggesting that the expression of genetic liability depends on environment. In the last decade, gene-environment interactions involving specific molecular variants in candidate genes have been identified. Replicated findings include an interaction between a polymorphism in the AKT1 gene and cannabis use in the development of psychosis and an interaction between the length polymorphism of the serotonin transporter gene and childhood maltreatment in the development of persistent depressive disorder. Bipolar disorder has been underinvestigated, with only a single study showing an interaction between a functional polymorphism in BDNF and stressful life events triggering bipolar depressive episodes. The first systematic search for gene-environment interactions has found that a polymorphism in CTNNA3 may sensitise the developing brain to the pathogenic effect of cytomegalovirus in utero, leading to schizophrenia in adulthood. Strategies for genome-wide investigations will likely include coordination between epidemiological and genetic research efforts, systematic assessment of multiple environmental factors in large samples, and prioritization of genetic variants.

Spotter's Guide for Identifying and Reporting Severe Local Storms.

Science.gov (United States)

National Oceanic and Atmospheric Administration (DOC), Rockville, MD.

This guide is designed to assist personnel working in the National Weather Service's Severe Local Storm Spotter Networks in identifying and reporting severe local storms. Provided are pictures of cloud types for severe storms including tornadoes, hail, thunder, lightning, heavy rains, and waterspouts. Instructions for key indications to watch for…

Mechanisms Mediating Pediatric Severe Asthma and Potential Novel Therapies

Directory of Open Access Journals (Sweden)

Aldara Martin Alonso

2017-07-01

Full Text Available Although a rare disease, severe therapy-resistant asthma in children is a cause of significant morbidity and results in utilization of approximately 50% of health-care resources for asthma. Improving control for children with severe asthma is, therefore, an urgent unmet clinical need. As a group, children with severe asthma have severe and multiple allergies, steroid resistant airway eosinophilia, and significant structural changes of the airway wall (airway remodeling. Omalizumab is currently the only add-on therapy that is licensed for use in children with severe asthma. However, limitations of its use include ineligibility for approximately one-third of patients because of serum IgE levels outside the recommended range and lack of clinical efficacy in a further one-third. Pediatric severe asthma is thus markedly heterogeneous, but our current understanding of the different mechanisms underpinning various phenotypes is very limited. We know that there are distinctions between the factors that drive pediatric and adult disease since pediatric disease develops in the context of a maturing immune system and during lung growth and development. This review summarizes the current data that give insight into the pathophysiology of pediatric severe asthma and will highlight potential targets for novel therapies. It is apparent that in order to identify novel treatments for pediatric severe asthma, the challenge of undertaking mechanistic studies using age appropriate experimental models and airway samples from children needs to be accepted to allow a targeted approach of personalized medicine to be achieved.

THE PANC 3 SCORE PREDICTING SEVERITY OF ACUTE PANCREATITIS.

Science.gov (United States)

Beduschi, Murilo Gamba; Mello, André Luiz Parizi; VON-Mühlen, Bruno; Franzon, Orli

2016-03-01

About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis.

Surface severe plastic deformation of AISI 304 via conventional shot peening, severe shot peening and repeening

Energy Technology Data Exchange (ETDEWEB)

Unal, Okan, E-mail: unalokan78@gmail.com [Mechanical Engineering Department, Bartın University, Bartın 74100 (Turkey); Varol, Remzi [Mechanical Engineering Department, Suleyman Demirel University, Isparta 32200 (Turkey)

2015-10-01

Highlights: • CSP and SSP treatments transform austenite to metastable martensite structure. • Nanograin layer thickness after CSP and SSP is 8 μm and 22 μm, respectively. • Shot peening leads to carbon segregation from coarse to nano grain layer. • Repeening is an effective way to reduce surface roughness. - Abstract: Air blast conventional shot peening (CSP), severe shot peening (SSP) and repeening (RP) as a severe plastic deformation applications on AISI 304 austenitic stainless steel is addressed. Shot peened specimens are investigated based on optical, FESEM and digital microscope. The investigations present the austenite transformation to metastable martensite via mechanical twinning due to plastic deformation with high strain rates. It is found that SSP induces thicker nanograin layer with compared to CSP. In XRD studies, the austenite peaks broaden by means of severe shot peening and FWHM increase reveals the grain size reduction below 25 nm regimes on the surface. In EDAX line analysis of CSP specimen, carbon content increase has been detected from deformed layer through the nanocrystalline layer then the content reduces. The carbon segregation takes place due to the energy level distinction between dislocations and Fe−C bonds. 3d contour digital microscope studies and roughness investigations reveal that SSP has deleterious side effect on the surface roughness and surface flatness. However, RP is an effective way to reduce the surface roughness to reasonable values.

Development of a severity score for CRPS.

Science.gov (United States)

Harden, R Norman; Bruehl, Stephen; Perez, Roberto S G M; Birklein, Frank; Marinus, Johan; Maihofner, Christian; Lubenow, Timothy; Buvanendran, Asokumar; Mackey, Sean; Graciosa, Joseph; Mogilevski, Mila; Ramsden, Christopher; Schlereth, Tanja; Chont, Melissa; Vatine, Jean-Jacques

2010-12-01

The clinical diagnosis of Complex Regional Pain Syndrome (CRPS) is a dichotomous (yes/no) categorization necessary for clinical decision-making. However, such dichotomous diagnostic categories do not convey an individual's subtle and temporal gradations in severity of the condition, and have poor statistical power when used as an outcome measure in research. This study evaluated the validity and potential utility of a continuous type score to index severity of CRPS. Psychometric and medical evaluations were conducted in 114 CRPS patients and 41 non-CRPS neuropathic pain patients. Based on the presence/absence of 17 clinically-assessed signs and symptoms of CRPS, an overall CRPS Severity Score (CSS) was derived. The CSS discriminated well between CRPS and non-CRPS patients (pCRPS diagnoses using both IASP diagnostic criteria (Eta=0.69) and proposed revised criteria (Eta=0.77-0.88). Higher CSS was associated with significantly higher clinical pain intensity, distress, and functional impairments, as well as greater bilateral temperature asymmetry and thermal perception abnormalities (p'sCRPS, and support its validity as an index of CRPS severity. Its utility as an outcome measure in research studies is also suggested, with potential statistical advantages over dichotomous diagnostic criteria. Copyright © 2010. Published by Elsevier B.V.

Underestimation of Severity of Previous Whiplash Injuries

Science.gov (United States)

Naqui, SZH; Lovell, SJ; Lovell, ME

2008-01-01

INTRODUCTION We noted a report that more significant symptoms may be expressed after second whiplash injuries by a suggested cumulative effect, including degeneration. We wondered if patients were underestimating the severity of their earlier injury. PATIENTS AND METHODS We studied recent medicolegal reports, to assess subjects with a second whiplash injury. They had been asked whether their earlier injury was worse, the same or lesser in severity. RESULTS From the study cohort, 101 patients (87%) felt that they had fully recovered from their first injury and 15 (13%) had not. Seventy-six subjects considered their first injury of lesser severity, 24 worse and 16 the same. Of the 24 that felt the violence of their first accident was worse, only 8 had worse symptoms, and 16 felt their symptoms were mainly the same or less than their symptoms from their second injury. Statistical analysis of the data revealed that the proportion of those claiming a difference who said the previous injury was lesser was 76% (95% CI 66–84%). The observed proportion with a lesser injury was considerably higher than the 50% anticipated. CONCLUSIONS We feel that subjects may underestimate the severity of an earlier injury and associated symptoms. Reasons for this may include secondary gain rather than any proposed cumulative effect. PMID:18201501

Relationship between cataract severity and socioeconomic status.

Science.gov (United States)

Wesolosky, Jason D; Rudnisky, Christopher J

2013-12-01

To determine the relationship between cataract severity and socioeconomic status (SES). Retrospective, observational case series. A total of 1350 eyes underwent phacoemulsification cataract extraction by a single surgeon using an Alcon Infiniti system. Cataract severity was measured using phaco time in seconds. SES was measured using area-level aggregate census data: median income, education, proportion of common-law couples, and employment rate. Preoperative best corrected visual acuity was obtained and converted to logarithm of the minimum angle of resolution values. For patients undergoing bilateral surgery, the generalized estimating equation was used to account for the correlation between eyes. Univariate analyses were performed using simple regression, and multivariate analyses were performed to account for variables with significant relationships (p < 0.05) on univariate testing. Sensitivity analyses were performed to assess the effect of including patient age in the controlled analyses. Multivariate analyses demonstrated that cataracts were more severe when the median income was lower (p = 0.001) and the proportion of common-law couples living in a patient's community (p = 0.012) and the unemployment rate (p = 0.002) were higher. These associations persisted even when controlling for patient age. Patients of lower SES have more severe cataracts. Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Exceptionally elevated triglyceride in severe lipemia retinalis

Directory of Open Access Journals (Sweden)

Yin HY

2016-10-01

Full Text Available Han Y Yin,1–3 Roberto Warman,2,4 Edward H Suh,2 Anny MS Cheng2,3 1Wayne State University, School of Medicine, Detroit, MI, 2Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, 3Ocular Surface Center, Miami, 4Division of Pediatric Ophthalmology, Nicklaus Children’s Hospital, Miami, FL, USA Purpose: To report a case of successful treatment for severe lipemia retinalis with extreme severe hypertriglyceridemia (sHTG.Design: Observational case report.Observations: A 6-week-old infant with severe lipemia retinalis manifested diffuse creamy retinal vessels complicated with vulvar xanthomas. Extreme sHTG with 185-folds of the normal level was reported. Chromosome microarray and lipid gene sequencing confirmed a homozygous lipoprotein lipase gene coding mutation.Results: Under strict adherence to a high medium-chain triglycerides formula and discontinuation of breast milk, the lipemia retinalis and vulval lesions resolved along with a stable plasma lipid level throughout the follow-up period of 6 months.Conclusion: Strict adherence to a low-fat diet without breast milk appears to be effective in treating infants with severe lipemia retinalis associated with exceptionally high triglycerides. Keywords: hypertriglyceride, infant, lipemia retinalis, lipoprotein lipase gene

Development of severe accident guidance module for the SATS simulator

International Nuclear Information System (INIS)

Kim, K.R.; Park, S.H.; Kim, D.H.; Song, Y.M.

2004-01-01

Recently KAERI has developed the severe accident management guidance to establish Korea standard severe accident management system. On the other hand the PC-based severe accident training simulator SATS has been developed, which uses MELCOR code as the simulation engine. SATS graphically displays and simulates the severe accidents with interactive user commands. The control capability of SATS could make severe accident training course more interesting and effective. In this paper we will describe the development and functions of the electrical hypertext guidance module HyperKAMG and the SATS-HyperKAMG linkage system for the severe accident management. (author)

Relations between soil hydraulic properties and burn severity

NARCIS (Netherlands)

Moody, J.A.; Ebel, B.A.; Stoof, C.R.; Nyman, P.; Martin, D.A.; McKinley, R.

2016-01-01

Wildfire can affect soil hydraulic properties, often resulting in reduced infiltration. The magnitude of change in infiltration varies depending on the burn severity. Quantitative approaches to link burn severity with changes in infiltration are lacking. This study uses controlled laboratory

Severe accident management program at Cofrentes Nuclear Power Plant

International Nuclear Information System (INIS)

Borondo, L.; Serrano, C.; Fiol, M.J.; Sanchez, A.

2000-01-01

Cofrentes Nuclear Power Plant (GE BWR/6) has implemented its specific Severe Accident Management Program within this year 2000. New organization and guides have been developed to successfully undertake the management of a severe accident. In particular, the Technical Support Center will count on a new ''Severe Accident Management Team'' (SAMT) which will be in charge of the Severe Accident Guides (SAG) when Control Room Crew reaches the Emergency Operation Procedures (EOP) step that requires containment flooding. Specific tools and training have also been developed to help the SAMT to mitigate the accident. (author)

Analyzing injury severity of bus passengers with different movements.

Science.gov (United States)

Li, Duo; Zhao, Yifei; Bai, Qiang; Zhou, Bei; Ling, Hongbiao

2017-07-04

Though public transport vehicles are rarely involved in mass casualty accidents, when they are, the number of injuries and fatalities is usually high due to the high passenger capacity. Of the few studies that have been conducted on bus safety, the majority focused on vehicle safety features, road environmental factors, as well as driver characteristics. Nevertheless, few studies have attempted to investigate the underlying risk factors related to bus occupants. This article presents an investigation aimed at identifying the risk factors affecting injury severity of bus passengers with different movements. Three different passenger movement types including standing, seated, and boarding/alighting were analyzed individually using classification and regression tree (CART) method based on publicly available accident database of Great Britain. According to the results of exploratory analyses, passenger age and vehicle maneuver are associated with passenger injury severity in all 3 types of accidents. Moreover, the variable "skidding and overturning" is associated with injury severity of seated passengers and driver age is correlated with injury severity of standing and boarding/alighting passengers. The CART method shows its ability to identify and easily explain the complicated patterns affecting passenger injury severity. Several countermeasures to reduce bus passenger injury severity are recommended.

Validation of dengue infection severity score

Directory of Open Access Journals (Sweden)

Pongpan S

2014-03-01

Full Text Available Surangrat Pongpan,1,2 Jayanton Patumanond,3 Apichart Wisitwong,4 Chamaiporn Tawichasri,5 Sirianong Namwongprom1,6 1Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Occupational Medicine, Phrae Hospital, Phrae, Thailand; 3Clinical Epidemiology Program, Faculty of Medicine, Thammasat University, Bangkok, Thailand; 4Department of Social Medicine, Sawanpracharak Hospital, Nakorn Sawan, Thailand; 5Clinical Epidemiology Society at Chiang Mai, Chiang Mai, Thailand; 6Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: To validate a simple scoring system to classify dengue viral infection severity to patients in different settings. Methods: The developed scoring system derived from 777 patients from three tertiary-care hospitals was applied to 400 patients in the validation data obtained from another three tertiary-care hospitals. Percentage of correct classification, underestimation, and overestimation was compared. The score discriminative performance in the two datasets was compared by analysis of areas under the receiver operating characteristic curves. Results: Patients in the validation data were different from those in the development data in some aspects. In the validation data, classifying patients into three severity levels (dengue fever, dengue hemorrhagic fever, and dengue shock syndrome yielded 50.8% correct prediction (versus 60.7% in the development data, with clinically acceptable underestimation (18.6% versus 25.7% and overestimation (30.8% versus 13.5%. Despite the difference in predictive performances between the validation and the development data, the overall prediction of the scoring system is considered high. Conclusion: The developed severity score may be applied to classify patients with dengue viral infection into three severity levels with clinically acceptable under- or overestimation. Its impact when used in routine

Determining triglyceride reductions needed for clinical impact in severe hypertriglyceridemia.

Science.gov (United States)

Christian, Jennifer B; Arondekar, Bhakti; Buysman, Erin K; Jacobson, Terry A; Snipes, Rose G; Horwitz, Ralph I

2014-01-01

Patients with severe hypertriglyceridemia have an increased risk of cardiovascular disease and pancreatitis. Target triglyceride levels associated with clinical benefit for patients with severe hypertriglyceridemia are not currently known. This study evaluates the association between lower follow-up triglyceride levels and incidence of clinical events for patients with severe hypertriglyceridemia. By using claims data from 2 large US healthcare databases, we conducted a retrospective cohort study and identified 41,210 adults with severe hypertriglyceridemia (triglycerides ≥ 500 mg/dL) between June 2001 and September 2010. The date of the first severe hypertriglyceridemia laboratory result was the index date. Patients were categorized into 1 of 5 triglyceride ranges (severe hypertriglyceridemia with follow-up triglyceride levels severe hypertriglyceridemia with follow-up triglyceride levels 200 to 299 mg/dL and 300 to 399 mg/dL (P severe hypertriglyceridemia with the lowest follow-up triglyceride levels. Copyright © 2014 Elsevier Inc. All rights reserved.

Severe exacerbations and decline in lung function in asthma

DEFF Research Database (Denmark)

O'Byrne, Paul M; Pedersen, Søren; Lamm, Carl Johan

2009-01-01

RATIONALE: To evaluate the association between asthma exacerbations and the decline in lung function, as well as the potential effects of an inhaled corticosteroid, budesonide, on exacerbation-related decline in patients with asthma. OBJECTIVES: To determine whether severe asthma exacerbations...... with low-dose inhaled budesonide prevents severe asthma-related events (exacerbations requiring hospitalization or emergency treatment) and decline in lung function. MEASUREMENTS AND MAIN RESULTS: There were 315 patients who experienced at least one severe asthma exacerbation, of which 305 were analyzable...... of reduction afforded by budesonide, in patients who experienced at least one severe asthma-related event compared with those who did not, was statistically significant (P = 0.042). CONCLUSIONS: Severe asthma exacerbations are associated with a more rapid decline in lung function. Treatment with low doses...

A project for monitoring trends in burn severity

Science.gov (United States)

Eidenshink, Jeffery C.; Schwind, Brian; Brewer, Ken; Zhu, Zhu-Liang; Quayle, Brad; Howard, Stephen M.

2007-01-01

Jeff Eidenshink, Brian Schwind, Ken Brewer, Zhi-Liang Zhu, Brad Quayle, and Elected officials and leaders of environmental agencies need information about the effects of large wildfires in order to set policy and make management decisions. Recently, the Wildland Fire Leadership Council (WFLC), which implements and coordinates the National Fire Plan (NFP) and Federal Wildland Fire Management Policies (National Fire Plan 2004), adopted a strategy to monitor the effectiveness of the National Fire Plan and the Healthy Forests Restoration Act (HFRA). One component of this strategy is to assess the environmental impacts of large wildland fires and identify the trends of burn severity on all lands across the United States. To that end, WFLC has sponsored a six-year project, Monitoring Trends in Burn Severity (MTBS), which requires the U.S. Department of Agriculture Forest Service (USDA-FS) and the U.S. Geological Survey (USGS) to map and assess the burn severity for all large current and historical fires. Using Landsat data and the differenced Normalized Burn Ratio (dNBR) algorithm, the USGS Center for Earth Resources Observation and Science (EROS) and USDA-FS Remote Sensing Applications Center will map burn severity of all fires since 1984 greater than 202 ha (500ac) in the east, and 404 ha (1,000 ac) in the west. The number of historical fires from this period combined with current fires occurring during the course of the project will exceed 9,000. The MTBS project will generate burn severity data, maps, and reports, which will be available for use at local, state, and national levels to evaluate trends in burn severity and help develop and assess the effectiveness of land management decisions. Additionally, the information developed will provide a baseline from which to monitor the recovery and health of fire-affected landscapes over time. Spatial and tabular data quantifying burn severity will augment existing information used to estimate risk associated with a range

Dyslexia and Severe Reading Disability.

Science.gov (United States)

Ngandu, Kathleen M.

This handbook contains advice for the teacher in diagnosing dyslexia and developing an individualized program for overcoming severe reading problems. Observable characteristics of dyslexia are listed as an aid to the teacher's diagnosis, but it is emphasized that cooperation between the teacher and a reading specialist is of great importance in…

The level of diagnostic assessment in severe asthma

DEFF Research Database (Denmark)

von Bulow, Anna; Backer, Vibeke; Bodtger, Uffe

2017-01-01

INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated. AIMS & OBJECTIVES: To describe the diagnostic work-...

Chinese herbal medicine for severe acute respiratory syndrome

DEFF Research Database (Denmark)

Liu, Jianping; Manheimer, Eric; Shi, Yi

2004-01-01

To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically.......To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically....

Correlation of severity of aphasia with cerebral blood flow

International Nuclear Information System (INIS)

Tagawa, Koichi; Sugimoto, Keiko; Sone, Noriaki; Yamaguchi, Takenori; Naritomi, Hiroaki; Sawada, Tohru

1982-01-01

In 46 patients with aphasia due to cerebral infarction, regional cerebral blood flow (rCBF) was measured by 133 Xe inhalation method, and relationship between severity of aphasia and degree of rCBF reduction was investigated. Measurements of rCBF were performed after 2 months of ictus in all patients. At the time of rCBF measurements, the severity of aphasia was mild in 13, moderate in 16 and severe in the other 17 patients. Control rCBF values were obtained from 16 subjects who had neither neurological deficits nor abnormal findings on CT scan. In control group, mean hemispheric rCBF values (mCBF), which were calculated from initial slope index, were 49.1 +- 3.8 and 49.4 +- 3.9 respectively in the right and left hemisphere. In all aphasic patients but two who had mild aphasia, mCBF in the left hemisphere showed lower values as compared to that in the right hemisphere. The mCBF in the left hemisphere was 46.5 +- 5.3 in the mild group, 41.3 +- 5.8 in the moderate group and 34.3 +- 5.0 in the severe group. The values in the moderate and severe groups were significantly reduced as compared to the control or those in the mild group. The mCBF in the severe group was also significantly lower than those in the moderate group. The mCBF in the right hemisphere was 48.4 +- 6.3 in the mild group, 45.6 +- 6.1 in the moderate group and 38.6 +- 4.9 in the severe group. The values in the severe group were significantly reduced as compared to those in the other groups as well as the control. The present study suggests that measurements of rCBF by 133 Xe inhalation method are valid for the evaluation of severity of aphasia in stroke patients. (author)

Analyzing the severity of accidents on the German Autobahn.

Science.gov (United States)

Manner, Hans; Wünsch-Ziegler, Laura

2013-08-01

We study the severity of accidents on the German Autobahn in the state of North Rhine-Westphalia using data for the years 2009 until 2011. We use a multinomial logit model to identify statistically relevant factors explaining the severity of the most severe injury, which is classified into the four classes fatal, severe injury, light injury and property damage. Furthermore, to account for unobserved heterogeneity we use a random parameter model. We study the effect of a number of factors including traffic information, road conditions, type of accidents, speed limits, presence of intelligent traffic control systems, age and gender of the driver and location of the accident. Our findings are in line with studies in different settings and indicate that accidents during daylight and at interchanges or construction sites are less severe in general. Accidents caused by the collision with roadside objects, involving pedestrians and motorcycles, or caused by bad sight conditions tend to be more severe. We discuss the measures of the 2011 German traffic safety programm in the light of our results. Copyright © 2013 Elsevier Ltd. All rights reserved.

Sputum Neutrophilia in Severe Persistent Asthmatics

International Nuclear Information System (INIS)

Naseem, A.; Zaidi, S. B. H.; Liaqat, J.; Iftikhar, R.

2014-01-01

Objective: To determine the frequency of sputum neutrophilia in patients with severe persistent bronchial asthma. Study Design: A cross-sectional study. Place and Duration of Study: Department of Medicine, Military Hospital, Rawalpindi, from November 2009 to November 2010. Methodology: Cases of severe persistent bronchial asthma, aged between 12 and 40 years, were included. Sputum samples were collected by induction with hypertonic saline (4.5%). All samples were centrifuged and differential neutrophil count was calculated. Data was analyzed using SPSS 11. Results: Out of 195 patients, there were 129 (66.2%) males and 66 (33.8%) females. The mean age was 27.01 A +- 6.92 years. Mean sputum neutrophilic count was 126.47 A +- 16.52 x 106/ml and the mean neutrophilic percentage was 63.187 A +- 8.3363. Sputum neutrophilia was present in 84 patients (43.1%), out of whom, 56 were males and 28 females. In patients with sputum neutrophilia, mean neutrophilic count was 142.40 A +- 8.49 x 106/ml and the mean neutrophilic percentage was 71.2024 A +- 4.2441%. Conclusion: Sputum neutrophilia is a frequent finding in cases with severe persistent bronchial asthma. Presence of sputum neutrophilia in such cases can lessen the inappropriate use of corticosteroids with their associated long-term side effects. (author)

Evaluation of Vehicle-Based Crash Severity Metrics.

Science.gov (United States)

Tsoi, Ada H; Gabler, Hampton C

2015-01-01

Vehicle change in velocity (delta-v) is a widely used crash severity metric used to estimate occupant injury risk. Despite its widespread use, delta-v has several limitations. Of most concern, delta-v is a vehicle-based metric which does not consider the crash pulse or the performance of occupant restraints, e.g. seatbelts and airbags. Such criticisms have prompted the search for alternative impact severity metrics based upon vehicle kinematics. The purpose of this study was to assess the ability of the occupant impact velocity (OIV), acceleration severity index (ASI), vehicle pulse index (VPI), and maximum delta-v (delta-v) to predict serious injury in real world crashes. The study was based on the analysis of event data recorders (EDRs) downloaded from the National Automotive Sampling System / Crashworthiness Data System (NASS-CDS) 2000-2013 cases. All vehicles in the sample were GM passenger cars and light trucks involved in a frontal collision. Rollover crashes were excluded. Vehicles were restricted to single-event crashes that caused an airbag deployment. All EDR data were checked for a successful, completed recording of the event and that the crash pulse was complete. The maximum abbreviated injury scale (MAIS) was used to describe occupant injury outcome. Drivers were categorized into either non-seriously injured group (MAIS2-) or seriously injured group (MAIS3+), based on the severity of any injuries to the thorax, abdomen, and spine. ASI and OIV were calculated according to the Manual for Assessing Safety Hardware. VPI was calculated according to ISO/TR 12353-3, with vehicle-specific parameters determined from U.S. New Car Assessment Program crash tests. Using binary logistic regression, the cumulative probability of injury risk was determined for each metric and assessed for statistical significance, goodness-of-fit, and prediction accuracy. The dataset included 102,744 vehicles. A Wald chi-square test showed each vehicle-based crash severity metric

Severe Weather Field Experience: An Undergraduate Field Course on Career Enhancement and Severe Convective Storms

Science.gov (United States)

Godfrey, Christopher M.; Barrett, Bradford S.; Godfrey, Elaine S.

2011-01-01

Undergraduate students acquire a deeper understanding of scientific principles through first-hand experience. To enhance the learning environment for atmospheric science majors, the University of North Carolina at Asheville has developed the severe weather field experience. Participants travel to Tornado Alley in the Great Plains to forecast and…

Piagetian Object Permanence in Severely Mentally Retarded Adults.

Science.gov (United States)

Brekke, Beverly; And Others

The measurability of sensorimotor development in 60 severely retarded, institutionalized adults was studied, using the Piagetian concept of object permanence in a delayed recall paradigm that involved special apparatus. Results suggested, among other things, that severely retarded, institutionalized adults learn most efficiently when trained with…

Evaluating the clinical management of severely malnourished children

African Journals Online (AJOL)

To assess the management of severely malnourished children in two rural district hospitals and to recommend improvements for their care. Methods. Based on draft World Health Organisation (WHO) guidelines for inpatient care of children with severe malnutrition, data collection instruments were developed in conjunction ...

Children with problematic severe asthma: A biopsychosocial perspective

NARCIS (Netherlands)

Verkleij, M.

2016-01-01

This thesis focuses on problematic severe asthma in children and its treatment from a biopsychosocial perspective. Asthma is a chronic inflammatory disease of the airways. In children with problematic severe asthma, asthma is not under control despite optimal medical treatment. Asthma control is the

Gambling disorder, DSM-5 criteria and symptom severity

DEFF Research Database (Denmark)

Grant, Jon E.; Odlaug, Brian L.; Chamberlain, Samuel R.

2017-01-01

Introduction: Gambling disorder (GD) is a prevalent psychiatric condition whose severity is typically defined by the number of DSM-5 criteria met out of a maximum of nine. The relationships between the levels of gambling severity, thus defined, and other measures of psychopathology and everyday...

Dengue infection severity score – improvised disease management

Directory of Open Access Journals (Sweden)

Mahmood SU

2016-08-01

Full Text Available Syed Uzair Mahmood,1 Maryam Jamil Syed,1 Aisha Jamal,1 Maria Shoaib2 1Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan; 2Dow Medical College, Dow University of Health Sciences, Karachi, PakistanWe would like to add our views regarding the paper “Validation of Dengue infection severity score” by Pongpan et al.1 As the paper outlines, the purpose of the Dengue Severity Score is to classify individuals with dengue infection into three levels of severity with clinically acceptable underestimation or overestimation. View the original paper by Pongpan and colleagues. 

Newborn with severe epidermolysis bullosa

DEFF Research Database (Denmark)

Boesen, Martin Lehmann; Bygum, Anette; Hertz, Jens Michael

2016-01-01

of EB depends on the subtype, and therefore maximum treatment is necessary until the final diagnosis is known. In this case, it took 2 weeks before a final diagnosis was reached. In the meantime, we had several ethical discussions on the treatment level. The most important issues were management of pain...

Severe Neurotoxicity Following Ingestion of Tetraethyl Lead

OpenAIRE

Wills, Brandon K.; Christensen, Jason; Mazzoncini, Joe; Miller, Michael

2010-01-01

Organic lead compounds are potent neurotoxins which can result in death even from small exposures. Traditionally, these compounds are found in fuel stabilizers, anti-knock agents, and leaded gasoline. Cases of acute organic lead intoxication have not been reported for several decades. We report a case of a 13-year-old Iraqi male who unintentionally ingested a fuel stabilizer containing 80–90% tetraethyl lead, managed at our combat support hospital. The patient developed severe neurologic symp...

Severe accident testing of a personnel airlock

International Nuclear Information System (INIS)

Clauss, D.B.; Parks, M.B.; Julien, J.T.; Peters, S.W.

1988-01-01

Sandia National Laboratories (Sandia) is investigating the leakage potential of mechanical penetrations as part of a research program on containment integrity under severe accident loads for the U.S. Nuclear Regulatory Commission (NRC). Barnes et al. (1984) and Shackelford et al. (1985) identified leakage from personnel airlocks as an important failure mode of containments subject to severe accident loads. However, these studies were based on relatively simple analysis methods. The complex structural interaction between the door, gasket, and bulkhead in personnel airlocks makes analytical evaluation of leakage difficult. In order to provide data to validate methods for evaluating the leakage potential, a full-size personnel airlock was subject to simulated severe accident loads consisting of pressure and temperature up to 300 psig and 800 degrees F. The test was conducted at Chicago Bridge and Iron under contract to Sandia. The authors provide a detailed report on the test program

Core loss during a severe accident (COLOSS)

International Nuclear Information System (INIS)

Adroguer, B.; Bertrand, F.; Chatelard, P.; Cocuaud, N.; Van Dorsselaere, J.P.; Bellenfant, L.; Knocke, D.; Bottomley, D.; Vrtilkova, V.; Belovsky, L.; Mueller, K.; Hering, W.; Homann, C.; Krauss, W.; Miassoedov, A.; Schanz, G.; Steinbrueck, M.; Stuckert, J.; Hozer, Z.; Bandini, G.; Birchley, J.; Berlepsch, T. von; Kleinhietpass, I.; Buck, M.; Benitez, J.A.F.; Virtanen, E.; Marguet, S.; Azarian, G.; Caillaux, A.; Plank, H.; Boldyrev, A.; Veshchunov, M.; Kobzar, V.; Zvonarev, Y.; Goryachev, A.

2005-01-01

The COLOSS project was a 3-year shared-cost action, which started in February 2000. The work-programme performed by 19 partners was shaped around complementary activities aimed at improving severe accident codes. Unresolved risk-relevant issues regarding H 2 production, melt generation and the source term were studied through a large number of experiments such as (a) dissolution of fresh and high burn-up UO 2 and MOX by molten Zircaloy (b) simultaneous dissolution of UO 2 and ZrO 2 (c) oxidation of U-O-Zr mixtures (d) degradation-oxidation of B 4 C control rods. Corresponding models were developed and implemented in severe accident computer codes. Upgraded codes were then used to apply results in plant calculations and evaluate their consequences on key severe accident sequences in different plants involving B 4 C control rods and in the TMI-2 accident. Significant results have been produced from separate-effects, semi-global and large-scale tests on COLOSS topics enabling the development and validation of models and the improvement of some severe accident codes. Breakthroughs were achieved on some issues for which more data are needed for consolidation of the modelling in particular on burn-up effects on UO 2 and MOX dissolution and oxidation of U-O-Zr and B 4 C-metal mixtures. There was experimental evidence that the oxidation of these mixtures can contribute significantly to the large H 2 production observed during the reflooding of degraded cores under severe accident conditions. The plant calculation activity enabled (a) the assessment of codes to calculate core degradation with the identification of main uncertainties and needs for short-term developments and (b) the identification of safety implications of new results. Main results and recommendations for future R and D activities are summarized in this paper

Warm-season severe wind events in Germany

Science.gov (United States)

Gatzen, Christoph

2013-04-01

A 15-year data set of wind measurements was analyzed with regard to warm season severe wind gusts in Germany. For April to September of the years 1997 to 2011, 1035 wind measurements of 26 m/s or greater were found. These wind reports were associated with 268 wind events. In total, 252 convective wind events contributed to 837 (81%) of the wind reports, 16 non-convective synoptic-scale wind events contributed to 198 reports (19%). Severe wind events were found with synoptic situations characterized by rather strong mid-level flow and advancing mid-level troughs. Severe convective wind events were analyzed using radar images and classified with respect to the observed radar structure. The most important convective mode was squall lines that were associated with one third of all severe wind gusts, followed by groups, bow echo complexes, and bow echoes. Supercells and cells were not associated with many wind reports. The low contribution of isolated cells indicates that rather large-scale forcing by synoptic-scale features like fronts is important for German severe wind events. Bow echoes were found to be present for 58% of all wind reports. The movement speed of bow echoes indicated a large variation with a maximum speed of 33 m/s. Extreme wind events as well as events with more than 15 wind reports were found to be related to higher movement speeds. Concentrating on the most intense events, derechos seem to be very important to the warm season wind threat in Germany. Convective events with a path length of more than 400 km contributed to 36% of all warm-season wind gusts in this data set. Furthermore, eight of nine extreme gusts exceeding 40 m/s were recorded with derecho events.

A climatology of potential severe convective environments across South Africa

Science.gov (United States)

Blamey, R. C.; Middleton, C.; Lennard, C.; Reason, C. J. C.

2017-09-01

Severe thunderstorms pose a considerable risk to society and the economy of South Africa during the austral summer months (October-March). Yet, the frequency and distribution of such severe storms is poorly understood, which partly stems out of an inadequate observation network. Given the lack of observations, alternative methods have focused on the relationship between severe storms and their associated environments. One such approach is to use a combination of covariant discriminants, derived from gridded datasets, as a probabilistic proxy for the development of severe storms. These covariates describe some key ingredient for severe convective storm development, such as the presence of instability. Using a combination of convective available potential energy and deep-layer vertical shear from Climate Forecast System Reanalysis, this study establishes a climatology of potential severe convective environments across South Africa for the period 1979-2010. Results indicate that early austral summer months are most likely associated with conditions that are conducive to the development of severe storms over the interior of South Africa. The east coast of the country is a hotspot for potential severe convective environments throughout the summer months. This is likely due to the close proximity of the Agulhas Current, which produces high latent heat fluxes and acts as a key moisture source. No obvious relationship is established between the frequency of potential severe convective environments and the main large-scale modes of variability in the Southern Hemisphere, such as ENSO. This implies that several factors, possibly more localised, may modulate the spatial and temporal frequency of severe thunderstorms across the region.

Severe fuel damage projects

International Nuclear Information System (INIS)

Sdouz, G.

1987-10-01

After the descriptions of the generation of a Severe Fuel Damage Accident in a LWR the hypothetical course of such an accident is explained. Then the most significant projects are described. At each project the experimental facility, the most important results and the concluding models and codes are discussed. The selection of the projects is concentrated on the German Projekt Nukleare Sicherheit (PNS), tests performed at the Idaho National Engineering Laboratory (INEL) and smaller projects in France and Great Britain. 25 refs., 26 figs. (Author)

Distribution, incidence and severity of yam (Dioscorea spp

African Journals Online (AJOL)

toualy

2014-01-15

Jan 15, 2014 ... incidence, severity of viral diseases, and viruses associated with the infected plants. Incidence and severity of the viral diseases were estimated based on symptoms. Enzyme-linked immunosorbent assay. (ELISA) and polymerase chain reaction (PCR)-based techniques were used for the detection of Yam.

Development of a severe accident training simulator using a MELCOR code

International Nuclear Information System (INIS)

Kim, Ko Ryu; Jeong, Kwang Sub; Ha, Jae Joo; Jung, Won Dae

2002-03-01

Nuclear power plants' severe accidents are, despite of their rareness, very important in safety aspects, because of their huge damages when occurred. For the appropriate execution of severe accident strategy, more information for decision-making are required because of the uncertainties included in severe accidents. Earlier NRC raised concerns over severe accident training in the report NUREC/CR-477, and accordingly, developing effective training tools for severe accident were emphasized. In fact the training tools were requested from industrial area, nevertheless, few training tools were developed due to the uncertainties in severe accidents, lacks of analysis computer codes and technical limitations. SATS, the severe accident training simulator, is developed as a multi-purpose tools for severe accident training. SATS uses the calculation results of MELCOR, an integral severe accident analysis code, and with the help of SL-GMS graphic tools, provides dynamic displays of severe accident phenomena on the terminal of IBM PC. It aimed to have two main features: one is to provide graphic displays to represent severe accident phenomena and the other is to process and simulate severe accident strategy given by plant operators and TSC staffs. Severe accident strategies are basically composed of series of operations of available pumps, valves and other equipments. Whenever executing strategies with SATS, the trainee should follow the HyperKAMG, the on line version of the recently developed severe accident guidance (KAMG). Severe accident strategies are closely related to accidents scenarios. TLOFW and LOCA , two representative severe accident scenarios of Uljin 3,4, are developed as a built-in scenarios of SATS. Although SATS has some minor problems at this time, we expect SATS will be a good severe accident training tool after the appropriate addition of accident scenarios. Moreover, we also expect SATS will be a good advisory tool for the severe accident research

Theory of mind predicts severity level in autism.

Science.gov (United States)

Hoogenhout, Michelle; Malcolm-Smith, Susan

2017-02-01

We investigated whether theory of mind skills can indicate autism spectrum disorder severity. In all, 62 children with autism spectrum disorder completed a developmentally sensitive theory of mind battery. We used intelligence quotient, Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis and level of support needed as indicators of severity level. Using hierarchical cluster analysis, we found three distinct clusters of theory of mind ability: early-developing theory of mind (Cluster 1), false-belief reasoning (Cluster 2) and sophisticated theory of mind understanding (Cluster 3). The clusters corresponded to severe, moderate and mild autism spectrum disorder. As an indicator of level of support needed, cluster grouping predicted the type of school children attended. All Cluster 1 children attended autism-specific schools; Cluster 2 was divided between autism-specific and special needs schools and nearly all Cluster 3 children attended general special needs and mainstream schools. Assessing theory of mind skills can reliably discriminate severity levels within autism spectrum disorder.

[Obstetric management in patients with severe pulmonary hypertension].

Science.gov (United States)

Castillo-Luna, Rogelio; Miranda-Araujo, Osvaldo

2015-12-01

Pulmonary hypertension is a disease of poor prognosis when is associated with pregnancy. A maternal mortality of 30-56% and a neonatal survival of approximately 85% is reported. Surveillance of patients with severe pulmonary hypertension during pregnancy must be multidisciplinary, to provide information and optimal treatment during and after gestation. Targeted therapy for pulmonary arterial hypertension during pregnancy significantly reduces mortality. The critical period with respect to mortality, is the first month after birth. Propose an algorithm for management during pregnancy for patients with severe pulmonary hypertension who want to continue with it. The recommendations established with clinical evidence for patients with severe pulmonary hypertension and pregnancy are presented: diagnosis, treatment, obstetrics and cardiology management, preoperative recommendations for termination of pregnancy, post-partum care and contraception. The maternal mortality remains significantly higher in patients with severe pulmonary hypertension and pregnancy, in these cases should be performed multidisciplinary management in hospitals that have experience in the management of this disease and its complications.

Severe Slugging in Air-Water Hybrid Riser System

Directory of Open Access Journals (Sweden)

Jing Gong

2014-11-01

Full Text Available In the subsea pipeline gathering system, severe slugging flow is prone to occur. Severe slugging flow brings major threat to production and flow assurance in oil and gas industry due to periodical pressure oscillation and large liquid volume. Currently many researchers pay much more attention on L-shaped riser, catenaries, and S-shaped riser; little research has been made on hybrid riser, which is applied in the Africa West and Gulf of Mexico oil fields. Flow characteristics simulation for hybrid riser is made in this paper, using the one-dimensional and quasi-equilibrium model to simulate not only the riser-base pressure, severe slugging period, and the liquid slug length of the whole system but also base-pressure in the flexible pipe section. The calculated results match well with the experiment data. Besides, the influence of flexible pipe to the severe slugging characteristics of hybrid riser system is analyzed, which are significant for the determination of riser structure.

Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs

Directory of Open Access Journals (Sweden)

Kumar M

2007-01-01

Full Text Available Background: The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS in severely injured lower limbs. Materials and Methods: Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed. Results: In the retrospective study 4.65 (4.65 ± 1.32 was the mean score for the salvaged limbs and 8.80 (8.8 ± 1.4 for the amputated limbs. In the prospective study 4.53 (4.53 ± 2.44 was the mean score for the salvaged limbs and 8.83 (8.83 ± 2.34 for the amputated limbs. There was a significant difference in the mean scores for salvaged and amputated limbs. Retrospective 21 (84% and prospective 29 (80.5% limbs remained in the salvage pathway six months after the injury. Conclusion: MESS could predict amputation of severely injured lower limbs, having score of equal or more than 7 with 91% sensitivity and 98% specificity. There was a significant difference in the mean MESS scores in the prospective study (n=36, 4.53 (4.53 ± 2.44 in thirty salvaged limbs (83.33% and 8.83 (8.83 ± 2.34 in six amputated limbs (16.66% with a P -value 0.002 ( P -value < 0.01. Similarly there was a significant difference in the mean MESS score in the retrospective study (n=25, 4.65 (4.65 ± 1.32 in twenty salvaged limbs (80% and 8.80 (8.8 ± 1.4 in five amputated limbs (20% with a P -value 0.00005 ( P -value < 0.01. MESS is a simple and relatively easy and readily available scoring system which can help the surgeon to decide the fate of the lower extremity with a high-energy injury.

Association Between Functional Dyspepsia And Severity Of Depression

International Nuclear Information System (INIS)

Jamil, O.; Sarwar, S.; Hussain, Z.; Fiaz, R. O.; Chaudary, R. D.

2016-01-01

Objective: To determine the association between functional dyspepsia and the severity of depression. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine, King Edward Medical University/Mayo Hospital, Lahore, from September 2012 till January 2013. Methodology: After taking informed written consent, patients with symptoms of dyspepsia fulfilling the Rome III criteria were included in the study. All patients were evaluated for depression, using Hamilton depression rating scale (HDRS). Upper gastrointestinal endoscopy was done. Fischers' exact test and independent t-test were used for determining significance of association. Result: One hundred and one patients with mean age of 35.81 14.81) years and male to female ratio of 1.41:1 (54/47) were included. Predominant symptoms were early satiety (72.3 percentage), epigastric pain (65.3 percentage), bloating (49.5 percentage), postprandial fullness (40.6 percentage), and regurgitation (40.6 percentage). Alarm symptoms were positive in 44 (43.6 percentage) patients. Dyspepsia were classified as epigastric pain syndrome (EPS, 69.3 percentage), and postprandial distress syndrome (PDS, 30.7 percentage). Significantly more females had PDS (p=0.04), with positive endoscopic findings in EPS (p=0.03). Positive endoscopic findings noted were esophagitis in 21.8 percentage, and gastritis in 48.5 percentage patients. All patients except one had depression, mild in 22.8 percentage, moderate in 33.7 percentage, severe in 31.7 percentage, and very severe in 10.9 percentage patients. Severe depression was seen in 32 (45.7 percentage) patients with EPS and PDS; whereas very severe depression was in 11 (15.7 percentage) patients of EPS, while 11 (35.4 percentage) patients of PDS had severe depression but the difference was not significant. Conclusion: Functional dyspepsia is associated with depression, while positive endoscopic findings are more likely in patients with EPS. Very severe depression

Treatment of severe acute pancreatitis

Directory of Open Access Journals (Sweden)

Praznik Ivan

2014-01-01

Full Text Available Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or other organ systems. The severe form of the disease occurs in 10-20% of cases, and usually requires prolonged hospitalization due to a frequent local and systemic complications. Additionally, considerable mortality despite diagnostic and therapeutic advances, makes this disease a serious health problem nowadays. The aim of this study was to conduct a review of randomized controlled trials to determine differences in the efficiency between standard methods of treatment for severe acute pancreatitis and new treatment ways in terms of decreased mortality. Search of the 'Medline' database of original scientific papers and systematic review articles was made, using a combination of the following keywords: acute pancreatitis, treatment, mortality. In total 914 papers were found, published in the last 13 years; 14 of 64 randomized controlled clinical trials met the selection criteria and were eligible for inclusion. From a total of 16 papers, the conservative treatment was related to 11, which includes some of the new treatment methods, while the effects of new methods of treatment have been the subject of research in the four studies. Combined endoscopic and surgical treatment was applied in only one study. The largest sample of 290 patients was included in the study with platelet activation factor antagonist, while the smallest sample of 22 patients was used in the study that compared total parenteral with enteral nutrition. Continuous regional arterial infusion of protease inhibitors in combination with antibiotics, intravenous supplementation of alanyl-glutamine dipeptide and the early, high-volume continuous veno-venous hemofiltration showed the best results in the treatment of patients with severe acute pancreatitis. Also, the use of low molecular weight heparin and enteral nutrition significantly reduced mortality.

Polyradiculopathy secondary to severe hypertriglyceridemia.

Science.gov (United States)

Nesbitt, Cassie; Wong, Daniel; Batchelor, Peter

2015-05-08

A 74-year-old man presented with a subacute severe thoracic polyradiculopathy affecting the T4-T8 dermatomes bilaterally. Extensive investigation demonstrated markedly raised triglyceride levels of 44 mmol/L (<1.7). The patient's unique presentation is discussed alongside a review of triglyceride-induced neurotoxicity and therapeutic management. 2015 BMJ Publishing Group Ltd.

Restoration of severely weathered wood

Science.gov (United States)

R. Sam. Williams; Mark. Knaebe

2000-01-01

Severely weathered window units were used to test various restoration methods and pretreatments. Sanded and unsanded units were pretreated with a consolidant or water repellent preservative, finished with an oil- or latex-based paint system, and exposed outdoors near Madison, WI, for five years. Pretreatments were applied to both window sashes (stiles and rails) and...

Mechanical ventilation for severe asthma.

Science.gov (United States)

Leatherman, James

2015-06-01

Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting.

Evaluation of the DSM-5 severity indicator for bulimia nervosa.

Science.gov (United States)

Grilo, Carlos M; Ivezaj, Valentina; White, Marney A

2015-04-01

This study examined the DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors. 199 community volunteers classified with BN were categorized using DSM-5 severity levels and compared on demographic and clinical variables. 77 (39%) participants were categorized as mild, 68 (34%) as moderate, 32 (16%) as severe, and 22 (11%) as extreme. The severity groups did not differ significantly in demographic variables or body mass index. Shape and Weight concerns did not differ significantly across severity groups. Binge eating differed with the extreme group having significantly higher frequency than the severe, moderate, and mild groups, which did not differ from each other. Restraint differed with the extreme group having significantly higher levels than the mild group. Eating concerns differed with the extreme group having significantly higher levels than moderate and mild groups. Depression differed with the extreme group having significantly higher levels than severe, moderate, and mild groups, which did not differ from each other. Findings from this non-clinical group provide new, albeit modest, support for DSM-5 severity rating for BN based on frequency of inappropriate weight compensatory behaviors. Statistical findings indicate that differences in collateral clinical variables associated with the DSM-5 severity ratings reflect small effect sizes. Further research is needed with treatment-seeking patient groups with BN to establish the validity of the DSM-5 severity specifier and should include broader clinical and functional validators. Copyright © 2015 Elsevier Ltd. All rights reserved.

Ancestry and Severity of Disability: A National Study.

Science.gov (United States)

Wheaton, Joe E.; Hertzfeld, Jennifer

2002-01-01

Examines effects of ancestry and severity of disability of vocational rehabilitation consumers. European Americans, individuals with higher costs, and persons who received assistive technology were more likely to be closed rehabilitated. Individuals from other ancestry groups, who were coded severely disabled, or who had been in the system for…

Severe hyponatraemia in an amiloride/hydrochlorothiazide-treated patient

NARCIS (Netherlands)

Van Assen, S.; Mudde, A.H.

1999-01-01

A 85-year-old woman treated with, among other drugs, a thiazide diuretic presented with a severe hyponatraemia. She met several of the criteria for SIADH and, besides drugs, no cause for SIADH was found. After stopping the thiazide diuretic and restricting fluid intake the patient recovered fully.

Comparing alertness and injury severity following motor vehicular ...

African Journals Online (AJOL)

Background: From casual observation of injury patterns in Motor Vehicular Accidents (MVAs), it was sometimes observed that if the victim had been more alert and reacts protectively, injury severity might be reduced. Protective response is often expected to minimize the severity of injuries. Objective: To determine the ...

Assessment and Management of Severe Malnutrition in Children ...

African Journals Online (AJOL)

BACKGROUND: Severe malnutrition is a common cause of morbidity and mortality among children less than five years of age. The World Health Organisation (WHO) has developed two manuals for the in-patient treatment of severe malnutrition. However, these manuals are not widely distributed with the result that most ...

Acute severe asthma presenting in late pregnancy.

Science.gov (United States)

Holland, S M; Thomson, K D

2006-01-01

Asthma is the commonest pre-existing medical condition to complicate pregnancy. Acute severe asthma in pregnancy is rare, but poses difficult problems. In particular, the decision about when and where to deliver the fetus is complex, since maternal response to asthma treatment is unpredictable. We report the successful management of a parturient presenting with acute severe asthma at 37 weeks' gestation. The controversies involved and the importance of adopting a multi-disciplinary team approach to optimise maternal and neonatal outcomes are discussed.

Pulse Clarithromycin Therapy In Severe ACNE Vulgaris

Directory of Open Access Journals (Sweden)

Rathi Sanjay K

2002-01-01

Full Text Available Three patients with severe acne vulgaris, not responding with long courses of doxycycline, minocycline and erythromycin were given oral clarithromycin in pulsed regimen. The patients were given 7 days course of clarithromycin 250mg twice daily, which was repeated after a gap of 10 days. Such 3 courses were given. The lesions responded significantly. No significant side effect was noted. Pulse clarithromycin therapy seems to be a good alternative and effective tool in the management of severe acne vulgaris.

Examining the unmet need in adults with severe asthma

Directory of Open Access Journals (Sweden)

M. R. Partridge

2007-09-01

Full Text Available Asthma currently affects an estimated 300 million people worldwide and the number is expected to rise to 400 million by 2025. Asthma morbidity remains high and the economic burden is significant. Approximately 20% of patients have severe persistent asthma. As patients with severe asthma often have a variety of conditions that may coexist with or be mistaken for asthma, careful diagnosis and management are essential, and adhering to a protocol for investigations is helpful. For patients with severe persistent asthma, the Global Initiative for Asthma 2005 guidelines recommend the use of high-dose inhaled corticosteroids in combination with a long-acting beta2-agonist, with one or more additional controller medications if required (step 4 therapy. However, recent studies have shown that asthma remains inadequately controlled in many patients with severe asthma, despite treatment in accordance with guidelines. Patients with severe asthma have the highest healthcare utilisation and mortality, and there is clearly an unmet need for the effective and safe treatment of patients with severe persistent allergic asthma who remain symptomatic despite optimised standard treatment. The latest guidelines suggest that omalizumab may address this unmet need.

Management of severe hypertriglyceridemia in the hospital: a review.

Science.gov (United States)

Schaefer, Eric W; Leung, Alicia; Kravarusic, Jelena; Stone, Neil J

2012-01-01

For hospitalists, hypertriglyceridemia (HTG) is more than cardiovascular risk. Severe HTG occurs when serum triglycerides rise above 1000 mg/dL, and it carries a risk of abdominal pain and pancreatitis. The etiology of severe HTG is usually a combination of genetic and secondary factors. A detailed history with attention to family history, medications, and alcohol consumption can often lead to the cause. Physical examination findings may stretch across multiple organ systems. Patients with severe HTG should be admitted to the hospital for aggressive medical therapy if they develop symptoms such as abdominal pain or pancreatitis. Asymptomatic patients with severe HTG who have significant short-term risk for developing symptoms require urgent consultation that may lead to a brief hospitalization to address exacerbating factors. Treatment of severe HTG includes a combination of pharmacologic agents and a restriction on dietary triglyceride intake. If oral medications fail to adequately lower triglyceride levels, intravenous insulin and in rare cases therapeutic plasma exchange may be required. To prevent recurrent severe HTG, the patient should be counseled about adherence to long-term medications and lifestyle changes. Copyright © 2011 Society of Hospital Medicine.

Non-performance of the Severance Pay Program in Slovenia

Directory of Open Access Journals (Sweden)

Milan Vodopivec

2009-03-01

Full Text Available Combining information from the Firm Survey of Labor Costs with the information about claims filed with the Guarantee Fund by workers whose employers defaulted on their severance pay obligations, the paper analyzes the so-called non-performance problem of severance pay – the fact that coverage, and thus legal entitlement, does not guarantee the actual receipt of the benefit – as experienced in Slovenia in 2000. The findings are threefold: (i one-third of total obligations incurred by firms failed to be honored and only a small portion of defaulted severance pay claims was reimbursed by the Guarantee Fund; (ii while both men and women seem to be equally affected, workers older than 40 were disproportionally represented among those whose severance pay claims failed to be honored; and, (iii among firms that incurred severance pay liabilities, larger and more productive firms were more likely to observe their fiduciary obligations and pay them out. These findings corroborate the weaknesses of severance pay as an income protection program, pointing to the large scale of the non-performance problem and the inequities created by it.

Severe dry-eye syndrome following external beam irradiation

International Nuclear Information System (INIS)

Parsons, J.T.; Bova, F.J.; Million, R.R.

1994-01-01

There are limited data in the literature on the probability of dry-eye complications according to radiotherapy dose. This study investigates the risk of radiation-induced severe dry-eye syndrome in patients in whom an entire orbit was exposed to fractionated external beam irradiation. Between October 1964 and May 1989, 33 patients with extracranial head and neck tumors received irradiation of an entire orbit. Most patients were treated with 60 Co. The dose to the lacrimal apparatus was calculated at a depth of 1 cm from the anterior skin surface, the approximate depth of the major lacrimal gland. The end point of the study was severe dry-eye syndrome sufficient to produce visual loss secondary to corneal opacification, ulceration, or vascularization. Twenty patients developed severe dry-eye syndrome. All 17 patients who received dose ≥57Gy developed severe dry-eye syndrome. Three (19%) of 16 patients who received doses ≥45 Gy developed severe dry-eye syndrome; injuries in the latter group were much more slower to develop (4 to 11 years) than in the higher dose group, in whom corneal vascularization and opacification were usually pronounced within 9-10 months. There were no data for the range of doses between 45.01 and 56.99 Gy. The data did not suggest an increased risk of severe dry-eye syndrome with increasing age. Data from the current series and the literature are combined to construct a sigmoid dose response curve. The incidence of injury increases from 0% reported after doses ≥30 Gy to 100% after doses ≥57 Gy. 13 refs., 3 figs., 5 tabs

Pathophysiological mechanisms of severe anaemia in Malawian children.

Directory of Open Access Journals (Sweden)

Michaël Boele van Hensbroek

2010-09-01

Full Text Available Severe anaemia is a major cause of morbidity and mortality in African children. The aetiology is multi-factorial, but interventions have often targeted only one or a few causal factors, with limited success.We assessed the contribution of different pathophysiological mechanisms (red cell production failure [RCPF], haemolysis and blood loss to severe anaemia in Malawian children in whom etiological factors have been described previously. More complex associations between etiological factors and the mechanisms were explored using structural equation modelling. In 235 children with severe anaemia (haemoglobin<3.2 mMol/L [5.0 g/dl] studied, RCPF, haemolysis and blood loss were found in 48.1%, 21.7% and 6.9%, respectively. The RCPF figure increased to 86% when a less stringent definition of RCPF was applied. RCPF was the most common mechanism in each of the major etiological subgroups (39.7-59.7%. Multiple aetiologies were common in children with severe anaemia. In the final model, nutritional and infectious factors, including malaria, were directly or indirectly associated with RCPF, but not with haemolysis.RCPF was the most common pathway leading to severe anaemia, from a variety of etiological factors, often found in combination. Unlike haemolysis or blood loss, RCPF is a defect that is likely to persist to a significant degree unless all of its contributing aetiologies are corrected. This provides a further explanation for the limited success of the single factor interventions that have commonly been applied to the prevention or treatment of severe anaemia. Our findings underline the need for a package of measures directed against all of the local aetiologies of this often fatal paediatric syndrome.

Sociodemographic and behavioural correlates of severe dental fluorosis.

Science.gov (United States)

Wondwossen, F; Astrøm, A N; Bjorvatn, K; Bårdsen, A

2006-03-01

The aim of this study was to identify sociodemographic and behavioural factors associated with the prevalence of severe dental fluorosis in moderate- and high-fluoride areas of the Ethiopian Rift Valley. Three hundred and six adolescents (12-15 years) and 233 mothers participated in the study. The children were examined for dental fluorosis according to the Thylstrup-Fejerskov Index (TFI). The children and their mothers were subsequently interviewed. Sixty mothers had more than one participating child. In order to perform a paired parent/child analysis, a total of 73 younger siblings had to be excluded. Among the remaining 233 children, the prevalence of severe dental fluorosis (TFI >or= 5) was 24.1% and 75.9% in the moderate- and high-fluoride areas, respectively. According to bivariate as well as multivariate analyses, a number of sociodemographic and behavioural factors were related to severe fluorosis. The odds for having severe fluorosis varied according to the fluoride concentration of the drinking water, age, consumption of tea, length of breastfeeding and method of storing water. The adjusted odds ratios ranged from 2.6 to 26.1. Breastfeeding for > 18 months and the use of clay pots for storing drinking water helped protect against severe dental fluorosis. Bivariate analyses indicated that being male and consuming fish might be associated with higher TFI scores. In order to avoid dental fluorosis, low-fluoride drinking water should be provided in the relevant villages. A prolonged period of breastfeeding, the use of clay pots for storing water, and possibly a reduced intake of tea and whole fish in infants might also help to avoid severe fluorosis in children growing up in traditionally fluoride-endemic areas.

Severe brachial plexus injuries in rugby.

Science.gov (United States)

Altaf, F; Mannan, K; Bharania, P; Sewell, M D; Di Mascio, L; Sinisi, M

2012-03-01

We describe the mechanisms, pattern of injuries, management and outcomes of severe injuries to the brachial plexus sustained during the play of rugby. Thirteen cases of severe injury to the brachial plexus caused by tackles in rugby had detailed clinical assessment, and operative exploration of the brachial plexus. Seventeen spinal nerves were avulsed, two were ruptured and there were traction lesions in continuity of 24 spinal nerves. The pattern of nerve lesion was related to the posture of the neck and the forequarter at the moment of impact. Early repair by nerve transfer enabled some functional recovery, and decompression of lesions in continuity was followed by recovery of nerve function and relief of pain. Copyright © 2011 Elsevier Ltd. All rights reserved.

Novel immunotherapy and treatment modality for severe food allergies.

Science.gov (United States)

Nagakura, Ken-Ichi; Sato, Sakura; Yanagida, Noriyuki; Ebisawa, Motohiro

2017-06-01

In recent years, many studies on oral immunotherapy (OIT) have been conducted; however, few have focused on severe food allergies. The purpose of this review was to assess the efficacy and safety of oral immunotherapies for patients with severe food allergy. We reviewed multiple immunotherapy reports published within a few years or reports focusing on severe food allergies. We also investigated recent studies on OIT and novel food allergy management. Immunotherapies targeting low-dose antigen exposure and oral food challenges using low-dose target volumes may be safer than conventional OIT. It is necessary to consider which immunotherapy regimen is appropriate based on allergy severity of the patient.

[Severe hypertriglyceridemia : Diagnostics and new treatment principles].

Science.gov (United States)

Kassner, U; Dippel, M; Steinhagen-Thiessen, E

2017-08-01

Severe hypertriglyceridemia is defined at a plasma triglyceride (TG) concentration of >885 mg/dl and may result - in particular when clinical symptoms appear before the age of 40 - from "large variant" mutations in genes which influence the function of the lipoprotein lipase (LPL). For diagnosis, secondary factors have to be excluded and treated before further genetic tests are considered. Typical symptoms in almost all patients are recurrent, sometimes severe abdominal pain attacks, which can result in acute pancreatitis, the most important, sometimes life-threatening complication. To minimize the risk of severe pancreatitis, the aim is to maintain the plasma TG concentration hypertriglyceridemia have an increased cardiovascular risk. To lower this is the primary treatment goal here. Treatment mainly consists of a life-long, strict fat- and carbohydrate-restricted diet and the abstention from alcohol. Omega‑3-Fatty acids and fibrates can be used to lower plasma TG levels. Recently, new gene therapy approaches for LPL-deficient patients have become available in Germany.

Emotional intelligence, trauma severity, and emotional expression.

Science.gov (United States)

Kao, Min C; Chen, Yung Y

2016-07-01

This study investigated Emotional Intelligence (EI) as a moderator for the association between emotional expression and adaptive trauma processing, as measured by depressive symptoms. Using Pennebaker's written emotional expression paradigm, 105 participants were assigned to either a conventional trauma-writing or religious trauma-writing condition. Depressive symptoms were assessed at baseline and again at one-month post writing. No significant association between EI and religiousness was found at baseline. Results indicated a three-way interaction among EI, trauma severity, and writing condition on depressive symptoms at follow-up. For the religious trauma-writing condition only, there was a significant difference between high- versus low-EI participants who experienced more severe trauma in depressive symptoms at follow-up, such that low-EI participants registered less depressive symptoms than high-EI participants; while there was no significant difference between low versus high EI for participants with less severe trauma. These findings encourage further investigation of the conditions under which religion may be a beneficial factor in trauma adaptation.

MRI manifestations of severe SSPE in infants

International Nuclear Information System (INIS)

Liu Hui; Xiao Enhua; Tan Lihua; Wu Xiaochuan; Fan Songqing

2006-01-01

Objective: To improve the understanding of MRI findings in severe SSPE. Methods: The MRI features in 2 cases of severe SSPE confirmed by pathology were reported, and related literature was reviewed. Results: In one case, various degrees of asymmetrical cerebral swelling were seen in bilateral gray matter and white matter under the cortex, and without clear dividing line between gray and white matter, especially in temporal lobe. Abnormal signals were revealed on T 1 and T 2 WI. In another case, lesions in the brain stem, temporal lobe, globus pallidus, putamen, thalamus, and radiate coronet showed hypointense signal on T 1 WI and hyperintense signal on T 2 WI with cerebral swelling, and no obviouse cerebral atrophy was found. The local abnormal lesions had occupying effects and enhancement in both cases. Conclusion: Lasting of various degrees of cerebral swelling may be the characteristic sign on MRI in severe SSPE, differing from cerebral atrophy that might be seen in common SSPE. (authors)

Harmonic and complex analysis in several variables

CERN Document Server

Krantz, Steven G

2017-01-01

Authored by a ranking authority in harmonic analysis of several complex variables, this book embodies a state-of-the-art entrée at the intersection of two important fields of research: complex analysis and harmonic analysis. Written with the graduate student in mind, it is assumed that the reader has familiarity with the basics of complex analysis of one and several complex variables as well as with real and functional analysis. The monograph is largely self-contained and develops the harmonic analysis of several complex variables from the first principles. The text includes copious examples, explanations, an exhaustive bibliography for further reading, and figures that illustrate the geometric nature of the subject. Each chapter ends with an exercise set. Additionally, each chapter begins with a prologue, introducing the reader to the subject matter that follows; capsules presented in each section give perspective and a spirited launch to the segment; preludes help put ideas into context. Mathematicians and...

NPP Krsko Severe Accident Management Guidelines Upgrade

International Nuclear Information System (INIS)

Mihalina, Mario; Spalj, Srdjan; Glaser, Bruno; Jalovec, Robi; Jankovic, Gordan

2014-01-01

Nuclear Power Plant Krsko (NEK) has decided to take steps for upgrade of safety measures to prevent severe accidents, and to improve the means to successfully mitigate their consequences. The content of the program for the NEK Safety Upgrade is consistent with the nuclear industry response to Fukushima accident, which revealed many new insights into severe accidents. Therefore, new strategies and usage of new systems and components should be integrated into current NEK Severe Accident Management Guidelines (SAMG's). SAMG's are developed to arrest the progression of a core damage accident and to limit the extent of resulting releases of fission products. NEK new SAMG's revision major changes are made due to: replacement of Electrical Recombiners by Passive Autocatalytic Recombiners (PARs) and the installation of Passive Containment Filtered Vent System (PCFV); to handle a fuel damage situation in Spent Fuel Pool (SFP) and to assess risk of core damage situation during shutdown operation. (authors)

Smartphone-based assessment of blood alteration severity

Science.gov (United States)

Li, Xianglin; Xue, Jiaxin; Li, Wei; Li, Ting

2018-02-01

Blood quality and safety management is a critical issue for cold chain transportation of blood or blood-based biological reagent. The conventional methods of blood alteration severity assessment mainly rely on kit test or blood-gas analysis required opening the blood package to get samples, which cause possible blood pollution and are complicate, timeconsuming, and expensive. Here we proposed to develop a portable, real-time, safety, easy-operated and low cost method aimed at assessing blood alteration severity. Color images of the blood in transparent blood bags were collected with a smartphone and the alteration severity of the blood was assessed by the smartphone app offered analysis of RGB color values of the blood. The algorithm is based on a large number sample of RGB values of blood at different alteration degree. The blood quality results evaluated by the smartphone are in accordance with the actual data. This study indicates the potential of smart phone in real time, convenient, and reliable blood quality assessment.

Management of severe hypertension in the newborn.

Science.gov (United States)

Dionne, Janis M; Flynn, Joseph T

2017-12-01

Blood pressure is considered a vital sign, as values too low or too high can be related with serious morbidity and mortality. In neonates, normal blood pressure values undergo rapid changes, especially in premature infants, making the recognition of abnormal blood pressures more challenging. Severe hypertension can occur in neonates and infants and is a medical emergency, often manifesting with congestive heart failure or other life-threatening complications. The cause or risk factors for the hypertension can usually be identified and may guide management. Most classes of antihypertensive medications have been used in the neonatal population. For severe hypertension, intravenous short-acting medications are preferred for a controlled reduction of blood pressure. In this article, we focus on identification, aetiology and management of severe hypertension in the newborn. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Asymptomatic myotonia congenita unmasked by severe hypothyroidism.

Science.gov (United States)

Passeri, Elena; Sansone, Valeria A; Verdelli, Chiara; Mendola, Marco; Corbetta, Sabrina

2014-04-01

Myotonia congenita is an inherited muscle disorder sustained by mutations in the skeletal muscle chloride channel gene CLCN1. Symptoms vary from mild to severe and generalized myotonia and worsen with cold, stressful events and hormonal fluctuations. Here we report the case of a young woman who sought medical attention because of subacute onset of diffuse and severe limb myotonia. CLCN1 gene sequencing showed a heterozygous transversion (T550M), two polymorphisms and one silent mutation. Thyroid function screening revealed severe hypothyroidism. She was placed on l-thyroxine replacement therapy which dramatically improved myotonia. We conclude that hypothyroidism unmasked a genetically determined, clinically asymptomatic chloride channelopathy. Diagnostic work-up in patients with clinically isolated myotonia should not be limited to genetic screening of non-dystrophic or dystrophic myotonias. Considering the high prevalence of hypothyroidism in females, systematic thyroid function screening by looking for additional hypothyroid symptoms and serum TSH levels measurement is mandatory in these patients. Copyright © 2014 Elsevier B.V. All rights reserved.

Intravenous artesunate for severe malaria in travelers, Europe

DEFF Research Database (Denmark)

Zoller, Thomas; Junghanss, Thomas; Kapaun, Annette

2011-01-01

Multicenter trials in Southeast Asia have shown better survival rates among patients with severe malaria, particularly those with high parasitemia levels, treated with intravenous (IV) artesunate than among those treated with quinine. In Europe, quinine is still the primary treatment for severe...... malaria. We conducted a retrospective analysis for 25 travelers with severe malaria who returned from malaria-endemic regions and were treated at 7 centers in Europe. All patients survived. Treatment with IV artesunate rapidly reduced parasitemia levels. In 6 patients at 5 treatment centers, a self...... of malaria patients in Europe. Patients should be monitored for signs of hemolysis, especially after parasitologic cure....

Sandia's severe human body Electrostatic Discharge Tester (SSET)

International Nuclear Information System (INIS)

Barnum, J.R.

1991-01-01

This paper reports that the Electromagnetic Testing Division at Sandia National Laboratories (SNL) has developed a simulator to replicate a severe human body electrostatic discharge event. This simulator is referred to as Sandia's Severe Human Body Electrostatic Discharge Tester (SSET). The SSET is configured as a coaxial transmission line, which allows control of parasitic inductance and capacitance to achieve the desired waveform signature, and operates reliably at voltages up to 35 kV. It is constructed from off-the-shelf or easily fabricated components and costs approximately $750 for materials, not including the power supply. The output is very repeatable and provides good simulation fidelity of a severe human body discharge

Clinical indicators for severe prognosis of scrub typhus

Directory of Open Access Journals (Sweden)

Sriwongpan P

2013-10-01

Full Text Available Pamornsri Sriwongpan,1,2 Pornsuda Krittigamas,3 Pacharee Kantipong,4 Naowarat Kunyanone,5 Jayanton Patumanond,1 Sirianong Namwongprom1,61Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Social Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand; 3Department of General Pediatrics, Nakornping Hospital, Chiang Mai, Thailand; 4Department of Internal Medicine, 5Department of Medical Technology, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand; 6Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandBackground: The study explored clinical risk characteristics that may be used to forecast scrub typhus severity under routine clinical practices.Methods: Retrospective data were collected from patients registered at two university-affiliated tertiary care hospitals in the north of Thailand, from 2004 to 2010. Key information was retrieved from in-patient records, out patient cards, laboratory reports and registers. Patients were classified into three severity groups: nonsevere, severe (those with at least one organ involvement, and deceased. Prognostic characteristics for scrub typhus severity were analyzed by a multivariable ordinal continuation ratio regression.Results: A total of 526 patients were classified into nonsevere (n = 357, severe (n = 100, and deceased (n = 69. The significant multivariable prognostic characteristics for scrub typhus severity were increased body temperature (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.45–0.74, P < 0.001, increased pulse rate (OR = 1.03, 95% CI = 1.01–1.05, P < 0.001, presence of crepitation (OR = 3.25, 95% CI = 1.52–6.96, P = 0.001, increased percentage of lymphocytes (OR = 0.97, 95% CI = 0.95–0.98, P = 0.001, increased aspartate aminotransferase (every 10 IU/L (OR = 1.04, 95% CI = 1.02–1.06, P < 0.001, increased serum albumin (OR = 0.47, 95% CI = 0.27–0.80, P = 0

Severe accident analysis methodology in support of accident management

International Nuclear Information System (INIS)

Boesmans, B.; Auglaire, M.; Snoeck, J.

1997-01-01

The author addresses the implementation at BELGATOM of a generic severe accident analysis methodology, which is intended to support strategic decisions and to provide quantitative information in support of severe accident management. The analysis methodology is based on a combination of severe accident code calculations, generic phenomenological information (experimental evidence from various test facilities regarding issues beyond present code capabilities) and detailed plant-specific technical information

The WHO maternal near-miss approach and the maternal severity index model (MSI: tools for assessing the management of severe maternal morbidity.

Directory of Open Access Journals (Sweden)

Joao Paulo Souza

Full Text Available OBJECTIVES: To validate the WHO maternal near-miss criteria and develop a benchmark tool for severe maternal morbidity assessments. METHODS: In a multicenter cross-sectional study implemented in 27 referral maternity hospitals in Brazil, a one-year prospective surveillance on severe maternal morbidity and data collection was carried out. Diagnostic accuracy tests were used to assess the validity of the WHO maternal near-miss criteria. Binary logistic regression was used to model the death probability among women with severe maternal complications and benchmark the management of severe maternal morbidity. RESULTS: Of the 82,388 women having deliveries in the participating health facilities, 9,555 women presented pregnancy-related complications, including 140 maternal deaths and 770 maternal near misses. The WHO maternal near-miss criteria were found to be accurate and highly associated with maternal deaths (Positive likelihood ratio 106.8 (95% CI 99.56-114.6. The maternal severity index (MSI model was developed and found to able to describe the relationship between life-threatening conditions and mortality (Area under the ROC curve: 0.951 (95% CI 0.909-0.993. CONCLUSION: The identification of maternal near-miss cases using the WHO list of pregnancy-related life-threatening conditions was validated. The MSI model can be used as a tool for benchmarking the performance of health services managing women with severe maternal complications and provide case-mix adjustment.

Outcome of severe infections in afebrile neutropenic cancer patients

Science.gov (United States)

Mahkovic-Hergouth, Ksenija; Novakovic, Barbara Jezersek; Seruga, Bostjan

2016-01-01

Abstract Background In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. Patients and methods We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher’s exact test. Results We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). Conclusions Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy. PMID:27904453

Transcatheter embolization of pseudoaneurysms complicating acute severe pancreatitis

International Nuclear Information System (INIS)

Wu Hanping; Liang Huimin; Zheng Chuansheng; Feng Gansheng

2005-01-01

Objective: To evaluate the therapeutic roles of transcatheter embolization in patients with pseudoaneurysms complicating acute severe pancreatitis. Methods: Seven patients who suffered from pseudoaneurysms complicating acute severe pancreatitis received abdominal angiography and were treated with transcatheter embolization. The angiographic findings, complications related to the procedure and post- embolization, and rebleeding were observed. Results: The pseudoaneurysms developed at the splenic artery (n=5), right gastroepiploic artery (n=1), and left gastric artery (n=1), respectively. Findings of active bleeding were observed in 3 patients. Six of them were embolized with coils, and the bleedings were stopped immediately. Rebleeding occurred 14-60 days after the embolization in 3 patients, and in one of them, another pseudo aneurysm was observed in repeated angiography and was successfully treated by repeated embolization. No causes of bleeding were found in repeated angiography in the other 2 patients, who died from severe hemorrhage. One pseudo aneurysm was embolized with gelfoam granule. The gastrointestinal bleeding was not controlled and the patient died 3 days later. Procedure related complications occurred in 2 patients. One was celiac trunk rupture during angiography, the other was intima dissecting in splenic artery. Severe post procedure complications occurred in none of the patients. Conclusion: Transcatheter embolization is safe and relatively effective in the management of pseudoaneurysms complicating acute severe pancreatitis. (authors)

Selected Geomagnetic Measurements From Several Satellites

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — More than 17 million selected magnetic observations from several orbiting low-altitude satellites are contained in this digital collection. Except for MAGSAT, all...

Severe hypoglycaemia associated with ingesting counterfeit medication.

Science.gov (United States)

Chaubey, Santosh K; Sangla, Kunwarjit S; Suthaharan, Emershia N; Tan, Yong M

2010-06-21

Cross-border importation of traditional and prescription medications is common, and many of these drugs are not approved by the Australian Therapeutic Goods Administration. Furthermore, counterfeit versions of prescription medications are also available (eg, weight-loss medications, anabolic steroids, and medications to enhance sexual performance). We describe a 54-year-old man with the first Australian case of severe hypoglycaemia induced by imported, laboratory-confirmed counterfeit Cialis. This serves to remind medical practitioners that counterfeit medication may be the cause of severe hypoglycaemia (or other unexplained illness).

CANDU severe accident management guidance update

International Nuclear Information System (INIS)

Jones, L.; Popov, N.; Gilbert, L.; Weed, J.

2014-01-01

The CANDU Owners Group (COG) developed a set of generic and initial station-specific Severe Accident Management Guidance (SAMG) documents to mitigate the consequences to the public in the event of a severe accident. The generic portion of the COG SAMG was completed in 2006; the overall project including the station-specific phase was completed in April 2007. Over the years, the CANDU industry and utilities have continuously increased the knowledge base for SAMG and have incorporated various engineered features based on the knowledge obtained. As a result of the event that occurred at the Fukushima Daiiachi nuclear power plant (NPP) in Japan, the Canadian Nuclear Safety Commission (CNSC) established the CNSC Fukushima Task Force. The results of the task force were documented in INFO-0828, CNSC Staff Action Plan on the CNSC Fukushima Task Force Recommendations. Among the recommendation documented in INFO-828 were Fukushima Action Items (FAIs) directed towards the CANDU utilities in Canada; a portion of which are related to SAMG documentation updates and directed at enhancing SAM response. A COG joint project was established to support the closure of the CNSC FAIs and to revise the current CANDU documentation accordingly. This paper provides a high level summary of the COG project scope and results. It also demonstrates that the CANDU SAMG programs in Canada provide robust protection and mitigation of severe accidents. (author)

CANDU severe accident management guidance update

Energy Technology Data Exchange (ETDEWEB)

Jones, L., E-mail: lisa.m.jones@opg.com [Ontario Power Generation, Pickering, ON (Canada); Popov, N., E-mail: nik.popov@rogers.com [Candu Owners Group, Toronto, ON (Canada); Gilbert, L., E-mail: lovell.gilbert@brucepower.com [Bruce Power, Tiverton, ON (Canada); Weed, J., E-mail: jeff.weed@candu.gov [Candu Owners Group, Toronto, ON (Canada)

2014-07-01

The CANDU Owners Group (COG) developed a set of generic and initial station-specific Severe Accident Management Guidance (SAMG) documents to mitigate the consequences to the public in the event of a severe accident. The generic portion of the COG SAMG was completed in 2006; the overall project including the station-specific phase was completed in April 2007. Over the years, the CANDU industry and utilities have continuously increased the knowledge base for SAMG and have incorporated various engineered features based on the knowledge obtained. As a result of the event that occurred at the Fukushima Daiiachi nuclear power plant (NPP) in Japan, the Canadian Nuclear Safety Commission (CNSC) established the CNSC Fukushima Task Force. The results of the task force were documented in INFO-0828, CNSC Staff Action Plan on the CNSC Fukushima Task Force Recommendations. Among the recommendation documented in INFO-828 were Fukushima Action Items (FAIs) directed towards the CANDU utilities in Canada; a portion of which are related to SAMG documentation updates and directed at enhancing SAM response. A COG joint project was established to support the closure of the CNSC FAIs and to revise the current CANDU documentation accordingly. This paper provides a high level summary of the COG project scope and results. It also demonstrates that the CANDU SAMG programs in Canada provide robust protection and mitigation of severe accidents. (author)

Consideration of severe accidents in design of advanced WWER reactors

International Nuclear Information System (INIS)

Fedorov, V.G.; Rogov, M.F.; Podshibyakin, A.K.; Fil, N.S.; Volkov, B.E.; Semishkin, V.P.

1998-01-01

Severe accident related requirements formulated in General Regulations for Nuclear Power Plant Safety (OPB-88), in Nuclear Safety Regulations for Nuclear Power Stations' Reactor Plants (PBYa RU AS-89) and in other NPP nuclear and radiation guides of the Russian Gosatomnadzor are analyzed. In accordance with these guides analyses of beyond design basis accidents should be performed in the reactor plant design. Categorization of beyond design basis accidents leading to severe accidents should be made on occurrence probability and severity of consequences. Engineered features and measures intended for severe accident management should be provided in reactor plant design. Requirements for severe accident analyses and for development of measures for severe accident management are determined. Design philosophy and proposed engineered measures for mitigation of severe accidents and decrease of radiation releases are demonstrated using examples of large, WWER-1000 (V-392), and medium size WWER-640 (V-407) reactor plant designs. Mitigation of severe accidents and decrease of radiation releases are supposed to be conducted on basis of consistent realization of the defense in depth concept relating to application of a system of barriers on the path of spreading of ionizing radiation and radioactive materials to the environment and a set of engineered measures protecting these barriers and retaining their effectiveness. Status of fulfilled by OKB Gidropress and other Russian organizations experimental and analytical investigations of severe accident phenomena supporting design decisions and severe accident management procedures is described. Status of the works on retention of core melt inside the WWER-640 reactor vessel is also characterized

Autism Severity and Qualities of Parent-Child Relations

Science.gov (United States)

Beurkens, Nicole M.; Hobson, Jessica A.; Hobson, R. Peter

2013-01-01

The aim of this study was to examine how severity of autism affects children's interactions (relatedness) and relationships with their parents. Participants were 25 parent-child dyads that included offspring who were children with autism aged from 4 to 14 years. The severity of the children's autism was assessed using the calibrated severity…

Prevalence and Severity of Malaria Parasitemia among Children ...

African Journals Online (AJOL)

induced anemia is much more common in younger children and may require blood transfusion with high mortality rates.[2,3]. In Sub-Saharan Africa (SSA), children admitted with severe anemia are more likely to die than those without anemia.[4,5]. Blood transfusion in severe malarial anemia can be important in preventing ...

CYCLOSPORINE IN TREATMENT OF SEVERE ATOPIC DERMATITIS IN CHILDREN

Directory of Open Access Journals (Sweden)

A.A. Alekseeva

2010-01-01

Full Text Available Atopic dermatitis (AtD is one of the most widespread types of allergic lesions of skin in children. Increase of severe types of AtD with lesion of big parts of skin, high frequency of exacerbations, presence of concomitant atopic diseases, and inefficiency of standard therapeutic approaches, torpid clinical course and early development of disability, causes an anxiety. Present standard approaches can be ineffective in children with severe clinical course of AtD and they are not able to prevent progression of disease, development of severe exacerbations and child’s disability. One of therapeutic alternatives for these patients is treatment with immunosuppressive agents. The article describes questions of treatment with cyclosporine in systemic therapy of severe resistant forms of AtD in children. Author discusses effectiveness and safety of a drug, formulated rules of treatment of severe AtD with cyclosporine. Key words: children, atopic dermatitis, cyclosporine, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(5:117-120

Geographic analysis of road accident severity index in Nigeria.

Science.gov (United States)

Iyanda, Ayodeji E

2018-05-28

Before 2030, deaths from road traffic accidents (RTAs) will surpass cerebrovascular disease, tuberculosis, and HIV/AIDS. Yet, there is little knowledge on the geographic distribution of RTA severity in Nigeria. Accident Severity Index is the proportion of deaths that result from a road accident. This study analysed the geographic pattern of RTA severity based on the data retrieved from Federal Road Safety Corps (FRSC). The study predicted a two-year data from a historic road accident data using exponential smoothing technique. To determine spatial autocorrelation, global and local indicators of spatial association were implemented in a geographic information system. Results show significant clusters of high RTA severity among states in the northeast and the northwest of Nigeria. Hence, the findings are discussed from two perspectives: Road traffic law compliance and poor emergency response. Conclusion, the severity of RTA is high in the northern states of Nigeria, hence, RTA remains a public health concern.

Inhibitor development and mortality in non-severe hemophilia A.

Science.gov (United States)

Eckhardt, C L; Loomans, J I; van Velzen, A S; Peters, M; Mauser-Bunschoten, E P; Schwaab, R; Mazzucconi, M G; Tagliaferri, A; Siegmund, B; Reitter-Pfoertner, S E; van der Bom, J G; Fijnvandraat, K

2015-07-01

The life expectancy of non-severe hemophilia A (HA) patients equals the life expectancy of the non-hemophilic population. However, data on the effect of inhibitor development on mortality and on hemophilia-related causes of death are scarce. The development of neutralizing factor VIII antibodies in non-severe HA patients may dramatically change their clinical outcome due to severe bleeding complications. We assessed the association between the occurrence of inhibitors and mortality in patients with non-severe HA. In this retrospective cohort study, clinical data and vital status were collected for 2709 non-severe HA patients (107 with inhibitors) who were treated between 1980 and 2011 in 34 European and Australian centers. Mortality rates for patients with and without inhibitors were compared. During 64,200 patient-years of follow-up, 148 patients died (mortality rate, 2.30 per 1000 person-years; 95% confidence interval (CI), 1.96-2.70) at a median age of 64 years (interquartile range [IQR], 49-76). In 62 patients (42%) the cause of death was hemophilia related. Sixteen inhibitor patients died at a median age of 71 years (IQR, 60-81). In ten patients the inhibitor was present at time of death; seven of them died of severe bleeding complications. The all-cause mortality rate in inhibitor patients was > 5 times increased compared with that for those without inhibitors (age-adjusted mortality rate ratio, 5.6). Inhibitor development in non-severe hemophilia is associated with increased mortality. High rates of hemophilia-related mortality in this study indicate that non-severe hemophilia is not mild at all and stress the importance of close follow-up for these patients. © 2015 International Society on Thrombosis and Haemostasis.

[Objective assessment of trauma severity in patients with spleen injuries].

Science.gov (United States)

Alekseev, V S; Ivanov, V A; Alekseev, S V; Vaniukov, V P

2013-01-01

The work presents an analysis of condition severity of 139 casualties with isolated and combined spleen injuries on admission to a surgical hospital. The assessment of condition severity was made using the traditional gradation and score scale VPH-SP. The degree of the severity of combined trauma of the spleen was determined by the scales ISS. The investigation showed that the scale ISS and VPH-SP allowed objective measurement of the condition severity of patients with spleen trauma. The score assessment facilitated early detection of the severe category of the patients, determined the diagnostic algorithm and the well-timed medical aid.

Prevention and mitigation of severe accidents

International Nuclear Information System (INIS)

Weisshaeupl, H.

1996-01-01

For the European Pressurized water Reactor (EPR), jointly developed by French and German industry, great emphasis is laid to gain further improvement in prevention of severe accidents based on the accumulative experience and proven technology of the French and German PWR reactors. In this evolutionary development, a balanced and comprehensive approach in respect to implement new passive features has been chosen. Improvements in each step of the defense in depth concept lead to a further decrease in the probability of occurrence of a severe accident with partial or even gross melting of the core. The different phenomenons that occur during such an hypothetical accident must be taken into account during the conception of specific measurements necessary to mitigate accident consequences. To cope with the consequences of a severe accident with core melt down means to deal with different phenomena which may threaten the integrity of the containment or may lead to an enhanced fission product release into the environment: high pressure reactor pressure vessel failure; energetic molten fuel coolant interaction; direct containment heating, molten core concrete interaction; hydrogen combustion; long term pressure and temperature increase in the containment. The EPR approach follows the recommendations from the DFD (Deutsch-Franzosischer Direktionsausschuss), jointly prepared by the French and German safety authorities. The EPR concept consist to prevent or eliminate as far as possible scenarios which are connected with high loads (high pressure failure of the reactor pressure vessel, or global hydrogen detonation etc..) by dedicated design provisions, and to deal with the consequences of severe accident scenarios which are not ruled out by specific safety measures. The measures comprise: the primary system depressurization; the control of hydrogen; the stabilisation and cooling of the melted core; the containment heat removal. They are completed by specific characteristics

Artemisinin derivatives for treating severe malaria.

Science.gov (United States)

McIntosh, H M; Olliaro, P

2000-01-01

Artemisinin derivatives may have advantages over quinoline drugs for treating severe malaria since they are fast acting and effective against quinine resistant malaria parasites. The objective of this review was to assess the effects of artemisinin drugs for severe and complicated falciparum malaria in adults and children. We searched the Cochrane Infectious Diseases Group trials register, Cochrane Controlled Trials Register, Medline, Embase, Science Citation Index, Lilacs, African Index Medicus, conference abstracts and reference lists of articles. We contacted organisations, researchers in the field and drug companies. Randomised and pseudo-randomised trials comparing artemisinin drugs (rectal, intramuscular or intravenous) with standard treatment, or comparisons between artemisinin derivatives in adults or children with severe or complicated falciparum malaria. Eligibility, trial quality assessment and data extraction were done independently by two reviewers. Study authors were contacted for additional information. Twenty three trials are included, allocation concealment was adequate in nine. Sixteen trials compared artemisinin drugs with quinine in 2653 patients. Artemisinin drugs were associated with better survival (mortality odds ratio 0.61, 95% confidence interval 0.46 to 0.82, random effects model). In trials where concealment of allocation was adequate (2261 patients), this was barely statistically significant (odds ratio 0.72, 95% CI 0.54 to 0.96, random effects model). In 1939 patients with cerebral malaria, mortality was also lower with artemisinin drugs overall (odds ratio 0.63, 95% CI 0.44 to 0.88, random effects model). The difference was not significant however when only trials reporting adequate concealment of allocation were analysed (odds ratio 0.78, 95% CI 0.55 to 1.10, random effects model) based on 1607 patients. No difference in neurological sequelae was shown. Compared with quinine, artemisinin drugs showed faster parasite clearance from

Predicting fire severity using surface fuels and moisture

Science.gov (United States)

Pamela G. Sikkink; Robert E. Keane

2012-01-01

Fire severity classifications have been used extensively in fire management over the last 30 years to describe specific environmental or ecological impacts of fire on fuels, vegetation, wildlife, and soils in recently burned areas. New fire severity classifications need to be more objective, predictive, and ultimately more useful to fire management and planning. Our...

Learning about Severe Combined Immunodeficiency (SCID)

Science.gov (United States)

... immunodeficiency From The Journal of Allergy and Clinical Immunology Learning About Severe Combined Immunodeficiency (SCID) What is ... immunodeficiency From The Journal of Allergy and Clinical Immunology Get Email Updates Privacy Copyright Contact Accessibility Plug- ...

Occupational Radiation Protection in Severe Accident Management

International Nuclear Information System (INIS)

2015-01-01

As an early response to the Fukushima Daiichi NPP accident, the Information System on Occupational Exposure (ISOE) Bureau decided to focus on the following issues as an initial response of the joint program after having direct communications with the Japanese official participants in April 2011: - Management of high radiation area worker doses: It has been decided to make available the experience and information from the Chernobyl accident in terms of how emergency worker / responder doses were legally and practically managed, - Personal protective equipment for highly-contaminated areas: It was agreed to collect information about the types of personnel protective equipment and other equipment (e.g. air bottles, respirators, air-hoods or plastic suits, etc.), as well as high-radiation area worker dosimetry use (e.g. type, number and placement of dosimetry) for different types of emergency and high-radiation work situations. Detailed information was collected on dose criteria which are used for emergency workers /responders and their basis, dose management criteria for high dose/dose rate areas, protective equipment which is recommended for emergency workers / responders, recommended individual monitoring procedures, and any special requirement for assessment from the ISOE participating nuclear utilities and regulatory authorities and made available for Japanese utilities. With this positive response of the ISOE official participants and interest in the situation in Fukushima, the Expert Group on Occupational Radiation Protection in Severe Accident Management (EG-SAM) was established by the ISOE Management Board in May 2011. The overall objective of the EG-SAM is to contribute to occupational exposure management (providing a view on management of high radiation area worker doses) within the Fukushima plant boundary with the ISOE participants and to develop a state-of-the-art ISOE report on best radiation protection management practices for proper radiation

Estrogen-associated severe hypertriglyceridemia with pancreatitis.

Science.gov (United States)

Aljenedil, Sumayah; Hegele, Robert A; Genest, Jacques; Awan, Zuhier

Estrogen, whether therapeutic or physiologic, can cause hypertriglyceridemia. Hypertriglyceridemia-induced pancreatitis is a rare complication. We report 2 women who developed estrogen-associated severe hypertriglyceridemia with pancreatitis. The first patient developed pancreatitis secondary to hypertriglyceridemia associated with in vitro fertilization cycles. Marked reduction in her triglyceride was achieved with dietary restrictions and fibrate. The second patient developed pancreatitis secondary to hypertriglyceridemia during her pregnancies. She was noncompliant with the treatment; therefore, her triglyceride remained high after delivery. In both patients, no hypertriglyceridemia-associated genes mutations were identified, although the second patient had strong polygenic susceptibility to hypertriglyceridemia. Estrogen-induced severe hypertriglyceridemia with pancreatitis can be a life-threatening condition. Screening in high-risk patients is crucial to prevent subsequent complications. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Severe periodontitis and higher cirrhosis mortality

DEFF Research Database (Denmark)

Ladegaard Grønkjær, Lea; Holmstrup, Palle; Schou, Søren

2018-01-01

Background Periodontitis and edentulism are prevalent in patients with cirrhosis, but their clinical significance is largely unknown. Objective The objective of this article is to determine the association of severe periodontitis and edentulism with mortality in patients with cirrhosis. Methods...... A total of 184 cirrhosis patients underwent an oral examination. All-cause and cirrhosis-related mortality was recorded. The associations of periodontitis and edentulism with mortality were explored by Kaplan–Meier survival plots and Cox proportional hazards regression adjusted for age, gender, cirrhosis...... etiology, Child–Pugh score, Model for End-Stage Liver Disease score, smoker status, present alcohol use, comorbidity, and nutritional risk score. Results The total follow-up time was 74,197 days (203.14 years). At entry, 44% of the patients had severe periodontitis and 18% were edentulous. Forty...

Predicting severity of paranoid schizophrenia

OpenAIRE

Kolesnichenko Elena Vladimirovna

2015-01-01

Clinical symptoms, course and outcomes of paranoid schizophrenia are polymorphic. 206 cases of paranoid schizophrenia were investigated. Clinical predictors were collected from hospital records and interviews. Quantitative assessment of the severity of schizophrenia as special indexes was used. Schizoid, epileptoid, psychasthenic and conformal accentuation of personality in the premorbid, early onset of psychosis, paranoid and hallucinatory-paranoid variants of onset predicted more expressed ...

Hotspots in clinical management of severe liver diseases

Directory of Open Access Journals (Sweden)

LYU Jiayu

2017-09-01

Full Text Available Severe liver diseases such as liver failure and acute decompensated cirrhosis have critical conditions and high mortality rates, and the prognosis of such patients is closely associated with early warning, timely dynamic assessment, and comprehensive and effective therapy. The patients require a series of effective clinical management measures for elimination of causative factors, organ support, and prevention and treatment of complications. Medical treatment-artificial liver-liver transplantation is an important modality for severe liver diseases. Granulocyte colony-stimulating factor, stem cell therapy, and bioartificial liver have a promising future, while there are still controversies over non-selective β-blocker. This article reviews the hotspots in the clinical management of severe liver diseases.

Power Burst Facility Severe Fuel Damage test series

International Nuclear Information System (INIS)

Buescher, B.J.; Osetek, D.J.; Ploger, S.A.

1982-01-01

The Severe Fuel Damage (SFD) tests planned for the Power Burst Facility (PBF) are described. Bundles containing 32 zircaloy-clad, PWR-type fuel rods will be subjected to severe overheating transients in a high-pressure, superheated-steam environment. Cladding temperatures are expected to reach 2400 0 K, resulting in cladding ballooning and rupture, severe cladding oxidation, cladding melting, fuel dissolution, fuel rod fragmentation, and possibly, rubble bed formation. An experiment effluent collection system is being installed and the PBF fission product monitoring system is being upgraded to meet the special requirements of the SFD tests. Scoping calculations were performed to evaluate performance of the SFD test design and to establish operational requirements for the PBF loop

Power Burst Facility severe-fuel-damage test program

International Nuclear Information System (INIS)

McCardell, R.K.; MacDonald, P.E.

1982-01-01

As a result of the Three Mile Island Unit 2 (TMI-2) accident, the United States Nuclear Regulatory Commission (USNRC) has initiated a severe fuel damage research program to investigate fuel rod and core response, and fission product and hydrogen release and transport during degraded core cooling accidents. This paper presents a discussion of the expected benefits of the PBF severe fuel damage tests to the nuclear industry, a description of the first five planned experiments, the results of pretest analysis performed to predict the fuel bundle heatup for the first two experiments, and a discussion of Phase II severe fuel damage experiments. Modifications to the fission product detection system envisioned for the later experiments are also described

Airborne concentrations of radioactive materials in severe accidents

International Nuclear Information System (INIS)

Ross, D.F. Jr.; Denning, R.S.

1989-01-01

Radioactive materials would be released to the containment building of a commercial nuclear reactor during each of the stages of a severe accident. Results of analyses of two accident sequences are used to illustrate the magnitudes of these sources of radioactive materials, the resulting airborne mass concentrations, the characteristics of the airborne aerosols, the potential for vapor forms of radioactive materials, the effectiveness of engineered safety features in reducing airborne concentrations, and the release of radioactive materials to the environment. Ability to predict transport and deposition of radioactive materials is important to assessing the performance of containment safety features in severe accidents and in the development of accident management procedures to reduce the consequences of severe accidents

Cylindrical pressure vessel constructed of several layers

International Nuclear Information System (INIS)

Yamauchi, Takeshi.

1976-01-01

For a cylindrical pressure vessel constructed of several layers whose jacket has at least one circumferential weld joining the individual layers, it is proposed to provide this at least at the first bending line turning point (counting from the weld between the jacket and vessel floor), which the sinusoidally shaped jacket has. The section of the jacket extending in between should be made as a full wall section. The proposal is based on calculations of the bending stiffness of cylindrical jackets, which could not yet be confirmed for jackets having several layers. (UWI) [de

Lectures on counterexamples in several complex variables

CERN Document Server

Fornæss, John Erik

2007-01-01

Counterexamples are remarkably effective for understanding the meaning, and the limitations, of mathematical results. Fornæss and Stensønes look at some of the major ideas of several complex variables by considering counterexamples to what might seem like reasonable variations or generalizations. The first part of the book reviews some of the basics of the theory, in a self-contained introduction to several complex variables. The counterexamples cover a variety of important topics: the Levi problem, plurisubharmonic functions, Monge-Ampère equations, CR geometry, function theory, and the \\bar\\

Heat transfer phenomena revelant to severe accidents

International Nuclear Information System (INIS)

Dallman, R.J.; Duffey, R.B.

1990-01-01

A number of aspects of severe accidents have been reviewed, particularly in relation to the heat transfer characteristics and the important phenomena. It is shown that natural circulation, forced convection, and entrainment phenomena are important for both the reactor system and ex-vessel events. It is also shown that the phenomena related to two component enhanced heat transfer is important in the pool of molten core debris, in relation to the potential for attack of the liner structure and the concrete. These mechanisms are discussed within the general context of severe accident progression

Heat transfer phenomena relevant to severe accidents

International Nuclear Information System (INIS)

Dallman, R.J.; Duffey, R.B.

1990-01-01

A number of aspects of severe accidents have been reviewed, particularly in relation to the heat transfer characteristics and the important phenomena. It is shown that natural circulation, forced convection, and entrainment phenomena are important for both the reactor system and ex-vessel events. It is also shown that the phenomena related to two component enhanced heat transfer is important in the pool of molten core debris, in relation to the potential for attack of the liner structure and the concrete. These mechanisms are discussed within the general context of severe accident progression. 26 refs

Pulmonary Contusion in Mechanically Ventilated Subjects After Severe Trauma.

Science.gov (United States)

Dhar, Sakshi Mathur; Breite, Matthew D; Barnes, Stephen L; Quick, Jacob A

2018-03-13

Pulmonary contusions are thought to worsen outcomes. We aimed to evaluate the effects of pulmonary contusion on mechanically ventilated trauma subjects with severe thoracic injuries and hypothesized that contusion would not increase morbidity. We conducted a single-center, retrospective review of 163 severely injured trauma subjects (injury severity score ≥ 15) with severe thoracic injury (chest abbreviated injury score ≥ 3), who required mechanical ventilation for >24 h at a verified Level 1 trauma center. Subject data were analyzed for those with radiographic documentation of pulmonary contusion and those without. Statistical analysis was performed to determine the effects of coexisting pulmonary contusion in severe thoracic trauma. Pulmonary contusion was present in 91 subjects (55.8%), whereas 72 (44.2%) did not have pulmonary contusions. Mean chest abbreviated injury score (3.54 vs 3.47, P = .53) and mean injury severity score (32.6 vs 30.2, P = .12) were similar. There was no difference in mortality (11 [12.1%] vs 9 [12.5%], P > .99) or length of stay (16.29 d vs 17.29 d, P = .60). Frequency of ventilator-associated pneumonia was comparable (43 [47.3%] vs 32 [44.4%], P = .75). Subjects with contusions were more likely to grow methicillin-sensitive Staphylococcus aureus in culture (33 vs 10, P = .004) as opposed to Pseudomonas aeruginosa in culture (6 vs 13, P = .003). Overall, no significant differences were noted in mortality, length of stay, or pneumonia rates between severely injured trauma subjects with and without pulmonary contusions. Copyright © 2018 by Daedalus Enterprises.

Features of Atopic Reactivity in Schoolchildren with Severe Bronchial Asthma

Directory of Open Access Journals (Sweden)

U.I. Marusyk

2014-11-01

Full Text Available The study involved 30 students with severe bronchial asthma and 30 children with moderate to severe course. Patients with severe bronchial asthma revealed a clear tendency to increase the relative content of interleukin 4 in peripheral blood, which indirectly indicates the severity of inflammation in the bronchi. Almost every second child suffering from severe bronchial asthma reported an increase in the concentration of immunoglobulin E (more than 545.3 IU/ml, and the odds ratio was 1.9 (95% CI 1.1–3.4. In the group of patients with severe bronchial asthma, cases of increased skin sensitivity to household allergens were significantly more frequent compared to the second group. Thus, the size of hyperemia over 15.0 mm was recorded in 81.5 % of children of the first group and only in 51.9 % of persons (Pϕ < 0.05 in the second one. Clinical and epidemiological risk and diagnostic value of individual indicators of atopic reactivity were determined to verify the phenotype of severe bronchial asthma.

CANDU severe accident analysis

International Nuclear Information System (INIS)

Negut, Gheorghe; Catana, Alexandru; Prisecaru, Ilie; Dupleac, Daniel

2007-01-01

Romania is a EU member since January first 2007. This country faces now new challenges which imply also the nuclear power reactors now in operation. Romania operates since 1996 a CANDU nuclear power reactor and soon will start up a second unit. In EU PWR reactors are mostly operated, so that the Romania's reactors have to meet EU standards. Safety analysis guidelines require to model severe accidents for reactors of this type. Starting from previous studies a thermal-hydraulic model for a degraded CANDU core was developed. The initiating event is assumed to be a LOCA with simultaneous loss of moderator and coolant and the failure of emergency core cooling system (ECCS). This type of accident is likely to modify the reactor geometry and will lead to a severe accident development. When the coolant temperatures inside a pressure tube reaches 1000 deg. C, a contact between pressure tube and calandria tube occurs and the decay heat is transferred to the moderator. Due to the lack of cooling, the moderator eventually begins to boil and is expelled, through the calandria vessel relief ducts, into the containment. Therefore the calandria tubes (fuel channels) uncover, then disintegrate and fall down to the calandria vessel bottom. All the quantity of calandria moderator is vaporized and expelled, the debris will heat up and eventually boil. The heat accumulated in the molten debris will be transferred through the calandria vessel wall to the shield water tank surrounding the calandria vessel. The thermal hydraulics phenomena described above are modeled, analyzed and compared with the existing data. (authors)

Relationship of attention-deficit/hyperactivity disorder symptom severity with severity of alcohol-related problems in a sample of inpatients with alcohol use disorder

Directory of Open Access Journals (Sweden)

Bozkurt M

2016-07-01

Full Text Available Muge Bozkurt,1 Cuneyt Evren,1 Gokhan Umut,1 Bilge Evren2 1Research, Treatment and Training Center for Alcohol and Substance Dependence, Bakirkoy Prof Dr Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, 2Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey Purpose: Attention-deficit/hyperactivity disorder (ADHD has been shown to be related to a higher risk of developing psychiatric problems such as depressive disorders, substance use disorder, and impulsivity. Adults who have comorbid ADHD and alcohol use disorder (AUD are at greater risk of negative outcomes. Thus, it is important to evaluate the relationship of ADHD symptoms and the severity of alcohol-related problems among patients with AUD. The aim of the present study was to evaluate the effect of ADHD symptoms on severity of alcohol-related problems, while controlling the effects of depression and impulsivity in a sample of inpatients with AUD. Patients and methods: Participants (n=190 were evaluated with the Beck Depression Inventory, the Short Form Barratt Impulsiveness Scale, the Michigan Alcohol Screening Test, and the Adult ADHD Self-Report Scale. Results: Severity of the scale scores was positively correlated with each other. Although severity of depression and impulsivity (particularly non-planning impulsivity predicted the severity of alcohol-related problems in a linear regression model, when severity of ADHD symptoms was included in the analysis, the inattentive subscale score, in particular, predicted the severity of alcohol-related problems together with non-planning impulsivity, whereas depression was no longer a predictor. Conclusion: These findings suggest that, together with non-planning impulsivity, symptoms of ADHD (particularly inattentive factor are an important factor that predict alcohol-related problems, while controlling the severity of depressive symptoms among inpatients

Predicting severe injury using vehicle telemetry data.

Science.gov (United States)

Ayoung-Chee, Patricia; Mack, Christopher D; Kaufman, Robert; Bulger, Eileen

2013-01-01

In 2010, the National Highway Traffic Safety Administration standardized collision data collected by event data recorders, which may help determine appropriate emergency medical service (EMS) response. Previous models (e.g., General Motors ) predict severe injury (Injury Severity Score [ISS] > 15) using occupant demographics and collision data. Occupant information is not automatically available, and 12% of calls from advanced automatic collision notification providers are unanswered. To better inform EMS triage, our goal was to create a predictive model only using vehicle collision data. Using the National Automotive Sampling System Crashworthiness Data System data set, we included front-seat occupants in late-model vehicles (2000 and later) in nonrollover and rollover crashes in years 2000 to 2010. Telematic (change in velocity, direction of force, seat belt use, vehicle type and curb weight, as well as multiple impact) and nontelematic variables (maximum intrusion, narrow impact, and passenger ejection) were included. Missing data were multiply imputed. The University of Washington model was tested to predict severe injury before application of guidelines (Step 0) and for occupants who did not meet Steps 1 and 2 criteria (Step 3) of the Centers for Disease Control and Prevention Field Triage Guidelines. A probability threshold of 20% was chosen in accordance with Centers for Disease Control and Prevention recommendations. There were 28,633 crashes, involving 33,956 vehicles and 52,033 occupants, of whom 9.9% had severe injury. At Step 0, the University of Washington model sensitivity was 40.0% and positive predictive value (PPV) was 20.7%. At Step 3, the sensitivity was 32.3 % and PPV was 10.1%. Model analysis excluding nontelematic variables decreased sensitivity and PPV. The sensitivity of the re-created General Motors model was 38.5% at Step 0 and 28.1% at Step 3. We designed a model using only vehicle collision data that was predictive of severe injury at

Severe hypoglycaemia in 1076 adult patients with type 1 diabetes

DEFF Research Database (Denmark)

Pedersen-Bjergaard, Ulrik; Pramming, Stig; Heller, Simon R

2004-01-01

BACKGROUND: Differences between studies in rates of severe hypoglycaemia in type 1 diabetic cohorts are common and poorly understood. The purpose of this study was to assess the frequency of severe hypoglycaemia in unselected patients treated in different secondary care centres and to evaluate...... the influence of risk markers, clinical setting and selection. METHODS: Cross-sectional Danish-British multicentre survey of 1076 consecutive adult patients with clinical type 1 diabetes who completed a detailed questionnaire on hypoglycaemia and related issues. Key variable was the self-reported rate of severe......, the rate of severe hypoglycaemia was 0.35 episodes/patient-year and only retinopathy was a significant risk marker together with state of awareness. CONCLUSION: Severe hypoglycaemia remains a significant clinical problem in type 1 diabetes. The rate of severe hypoglycaemia and the influence of risk markers...

Optimal severance payment: theory and practice

Czech Academy of Sciences Publication Activity Database

Jeong, Byeongju

-, č. 255 (2005), s. 1-22 ISSN 1211-3298 Institutional research plan: CEZ:AV0Z70850503 Keywords : severance payment * optimal separation Subject RIV: AH - Economics http://www.cerge-ei.cz/pdf/wp/Wp255.pdf

Formulating the Canadian regulatory position on severe accidents

International Nuclear Information System (INIS)

Viktorov, Alex

2006-01-01

In response to the increasing potential of new nuclear build in Canada, and as part of documentation harmonization effort, CNSC staff has initiated development of requirements for design of nuclear power plants. These requirements build both on the IAEA standards, most notably, NS-R-1, and the Canadian practices and experience. The three safety objectives, formulated by the IAEA, are adopted, and Safety Goals are proposed consistent with the international trend. This Canadian standard will require, for the first time, explicit consideration of severe accidents in design and safety assessments. Specific requirements are formulated for several plant systems that assure an effective fourth level of defence in depth. Available results from probabilistic safety assessments indicate that the risks posed by severe accidents are acceptably low. Nevertheless, such risks are not negligible. CNSC staff considers that severe accident management (SAM) represents the most practical way to achieve risk reduction with a moderate effort. Ultimately, SAM actions are aimed at bringing the reactor, and the plant in general, into a controlled and stable state. For the operating reactors, SAM provides an additional defense barrier against the consequences of those accidents that fall beyond the scope of events considered in the reactor design basis. The establishment of a SAM program ensures availability of the information, procedures, and resources necessary to take full advantage of existing plant capabilities to arrest core degradation, and prevent or mitigate large releases of radioactive material. To the extent practicable, a SAM program builds on the existing emergency operating procedures and makes use of the plant design capabilities. On this basis, the CNSC requested nuclear power reactor licensees to develop and implement SAM at all operating reactors. To be able to demonstrate compliance with requirements for plant design and severe accident management, it is necessary to

Development of a prototype graphic simulation program for severe accident training

International Nuclear Information System (INIS)

Kim, Ko Ryu; Jeong, Kwang Sub; Ha, Jae Joo

2000-05-01

This is a report of the development process and related technologies of severe accident graphic simulators, required in industrial severe accident management and training. Here, we say 'a severe accident graphic simulator' as a graphics add-in system to existing calculation codes, which can show the severe accident phenomena dynamically on computer screens and therefore which can supplement one of main defects of existing calculation codes. With graphic simulators it is fairly easy to see the total behavior of nuclear power plants, where it was very difficult to see only from partial variable numerical information. Moreover, the fast processing and control feature of a graphic simulator can give some opportunities of predicting the severe accident advancement among several possibilities, to one who is not an expert. Utilizing graphic simulators' we expect operators' and TSC members' physical phenomena understanding enhancement from the realistic dynamic behavior of plants. We also expect that severe accident training course can gain better training effects using graphic simulator's control functions and predicting capabilities, and therefore we expect that graphic simulators will be effective decision-aids tools both in sever accident training course and in real severe accident situations. With these in mind, we have developed a prototype graphic simulator having surveyed related technologies, and from this development experiences we have inspected the possibility to build a severe accident graphic simulator. The prototype graphic simulator is developed under IBM PC WinNT environments and is suited to Uljin 3and4 nuclear power plant. When supplied with adequate severe accident scenario as an input, the prototype can provide graphical simulations of plant safety systems' dynamic behaviors. The prototype is composed of several different modules, which are phenomena display module, MELCOR data interface module and graphic database interface module. Main functions of

The management of severe accidents

International Nuclear Information System (INIS)

Pelce, J.; Brignon, P.

1987-01-01

In considering severe accidents in water power reactors, a major problem that arises is how to manage them in such a way that the situation can be controlled as well as possible, from the aspects both of preventing serious damage to the core of limiting the discharge of radioactivity. A number of countries have announced provisions in the field of accident management, some already set up, others planned, but these mainly apply to preventing damage to the core. Part of this report deals with this aspect, to show that there is a fairly wide consensus on how problems should be approached. Attitudes vary, on the other hand, in the approach to mitigate radioactive release. In fact, few countries have proposed concrete steps to manage severe accidents in the final stages when the core is seriously damaged. Since it is difficult to compare different approaches, only the French approach is described. This description is however very brief, because in the five or six years since it was defined, the approach has been presented many times. The stress is placed more on the comments which this type of approach suggests, to make the subsequent general discussion easier

Assessment of problematic severe asthma in children

DEFF Research Database (Denmark)

Carlsen, K. C. L.; Hedlin, G.; Bush, A.

2011-01-01

Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessm......Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi......-disciplinary assessment is performed to identify issues that may need attention, including comorbidities. Thirdly, the pattern of inflammation is assessed, and finally steroid responsiveness is documented. Based upon these four steps an optimal individualised treatment plan is developed. In this article the many gaps...... in our current knowledge in all these steps are highlighted, and recommendations for current clinical practice and future research are made. The lack of good data and the heterogeneity of problematic severe asthma still limit our ability to optimise the management on an individual basis in this small...

Behavior of fission products released from severely damaged fuel during the PBF severe fuel damage tests

International Nuclear Information System (INIS)

Osetek, D.J.; Cronenberg, A.W.; Hagrman, D.L.; Broughton, J.M.; Rest, J.

1984-01-01

The results of fission product release behavior during the first two Power Burst Facility Severe Fuel Damage tests are presented. Measured fission product release is compared with calculated release using temperature dependent release rate correlations and FASTGRASS analysis. The test results indicate that release from fuel of the high volatility fission products (Xe, Kr, I, Cs, and Te) is strongly influenced by parameters other than fuel temperature; namely fuel/fission product morphology, fuel and cladding oxidation state, extent of fuel liquefaction, and quench induced fuel shattering. Fission product transport from the test fuel through the sample system was strongly influenced by chemical effects. Holdup of I and Cs was affected by fission product chemistry, and transport time while Te release was primarily influenced by the extent of zircaloy oxidation. Analysis demonstrates that such integral test data can be used to confirm physical, chemical, and mechanistic models of fission product behavior for severe accident conditions

Does the Severity of Hangovers Decline with Age?

DEFF Research Database (Denmark)

Tolstrup, Janne S; Stephens, Richard; Grønbaek, Morten

2014-01-01

Alcohol hangover is a growing research area, but differences across the life span have not been assessed. Here, we test the hypothesis that the severity of hangovers depends on age.......Alcohol hangover is a growing research area, but differences across the life span have not been assessed. Here, we test the hypothesis that the severity of hangovers depends on age....

Predictive risk factors for moderate to severe hyperbilirubinemia

OpenAIRE

Gláucia Macedo de Lima; Maria Amélia Sayeg Campos Porto; Arnaldo Prata Barbosa; Antonio José Ledo Alves da Cunha

2007-01-01

Objective: to describe predictive factors for severity of neonataljaundice in newborn infants treated at the University Neonatal Clinic,highlighting maternal, obstetric and neonatal factors. Methods: Acohort retrospective study by means of review of medical charts todefine risk factors associated with moderate and severe jaundice.The cohort consisted of newborns diagnosed with indirect neonatalhyperbilirubinemia and submitted to phototherapy. Risk was classifiedas maternal, prenatal, obstetri...

Improving free play skills of severely retarded children.

Science.gov (United States)

Wehman, P; Marchant, J A

1978-02-01

Severely and profoundly retarded children are usually deficient in play skills. Since play facilitates socialization, language, and motor development, it is a vitally improtant skill to acquire. This pilot study examined the effects of a behavioral training program on the autistic, independent, and social types of play of four severely and profoundly retarded children. The training program involved the use of instructions, modeling, physical guidance, and verbal reinforcement. Results indicated that a marked increase in independent and social play occurred with the introduction of the training program with all four children. Occupational therapists can play an increasingly important role in helping educators formulate relevant educational programs for severely retarded children, particularly in the areas of play and motor skill development.

Examining Pedestrian Injury Severity Using Alternative Disaggregate Models

DEFF Research Database (Denmark)

Abay, Kibrom Araya

2013-01-01

This paper investigates the injury severity of pedestrians considering detailed road user characteristics and alternative model specification using a high-quality Danish road accident data. Such detailed and alternative modeling approach helps to assess the sensitivity of empirical inferences...... to the choice of these models. The empirical analysis reveals that detailed road user characteristics such as crime history of drivers and momentary activities of road users at the time of the accident provides an interesting insight in the injury severity analysis. Likewise, the alternative analytical...... specification of the models reveals that some of the conventionally employed fixed parameters injury severity models could underestimate the effect of some important behavioral attributes of the accidents. For instance, the standard ordered logit model underestimated the marginal effects of some...

Contribution of the Exposure Pathways After a Severe Accident

Energy Technology Data Exchange (ETDEWEB)

Lee, Joeun; Hwang, Wontae; Han, Moonhee [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Jae, Moosung [Hanyang University, Seoul (Korea, Republic of)

2016-10-15

A radiological dose assessment calculates the amount of radiation energy absorbed by a potentially exposed individual as a result of a specific exposure. Public can be exposure from several exposure pathways. External doses occur when the body is exposed to radioactive material outside the body. When making the emergency preparedness for severe accident from NPPs, therefore, we need to have comprehension about those exposure pathways. Thus, in this study, an evaluation of external and internal dose from radioactive materials during severe accident was performed to find out exposure pathway from which the dose has the highest value for several radionuclides. The basic study to make out the relation between exposure pathways and dose from them was performed. In the emergency phase, the most affecting nuclide type on public was noble gas, especially {sup 133}Xe, and the dominant exposure pathway was could shine. Also, in the long term-phase, the most affecting nuclide type on public was fission product, especially {sup 90}Sr, and the dominant exposure pathway was water ingestion. The information of the dose composition from exposure pathway obtained in this study might be basic data for making emergency preparedness plan for severe accident. In the future, assessment of the source term is expected to enhance the reliability of dose assessment during severe accident.

Leiden Mutation and the Course of Severe Acute Pancreatitis

Directory of Open Access Journals (Sweden)

A. V. Ershov

2013-01-01

Full Text Available Objective: to evaluate the impact of Leiden mutation on the course of severe acute pancreatitis. Subjects and methods. One hundred and twelve people were examined. Group 1 comprised 50 patients diagnosed with severe acute pancreatitis without coagulation factor V (Leiden mutation. Group 2 included 42 patients with severe acute pancreatitis who were found to have Leiden mutation. Acute pancreatitis was first diagnosed in both groups. Group 3 consisted of 20 apparently healthy individuals (a control group. The severity of the underlying disease was determined in accordance with the clinical and laboratory parameters recommended by the I. I. Dzhanelidze Saint Petersburg Research Institute of Emergence Care. Results. This investigation revealed an association of Leiden mutation with trends in the development of acute pancreatitis. Group 2 exhibited a more severe disease: large focal pancreatic necrosis was twice more common and infectious complications developed more frequently; more aggressive and radical treatments were more often used. The patients with Leiden mutation had higher mortality rates (33% in the Leiden mutation group and 24% in the non-mutation group. Conclusion. The findings should be kept in mind in elaborating new diagnostic methods and principles in the treatment of the underlying disease and in the prevention of its complications in patients with severe acute pancreatitis. Key words: acute pancreatitis, Leiden mutation.

Severe Hailstorm in Nepal: A case study

Science.gov (United States)

Aryal, D.

2017-12-01

During the pre-monsoon months (March-May) in Nepal, severe thunder and hailstorms cause significant property and agricultural damage in addition to loss of life from lightening. Forecasting thunderstorm severity remains a challenge even in wealthy, developed countries that have modern meteorological data gathering infrastructure, such as Doppler Radar. This study attempts to isolate the specific and unique characteristics of a hailstorm that not only might explain its severity, but also suggest forecasting techniquees for future forecasting in Nepal. The primary data sources for this investigation included Infrared Satellite images, which illustrated the sequences of convective activity, and original archived ESRL India and China upper air data, which was used for synoptic and mesoscale analyses. On May 3, 2001 between the hours of 1100pm and midnight, a severe thunderstorm accompanied by hail stones estimated at 1kg, devastated the village of Thori (Southern border to India). 800 thatched houses were destroyed, over 500 farm animals were killed and more than 200 hectares of crops lost. Many inhabitants were injured, but luckily only one death. Thori hailstorm had its origins in a topographically induced lee-side convergence area in the deserts of Pakistan on May 2, 2001, from where it propagated eastwards into India and evolved into an eastward travelling Mesoscale Convective System reaching Thori near midnight on May 3. Atmospheric instability over the Gangetic Plains, fuelled by a very active surface heat low, cold temperatures and dynamic lifting mechanisms aloft, created a synoptic and mesoscale environment capable of generating a dangerous thunderstorm.

Multiple sclerosis with predominant, severe cognitive impairment

Science.gov (United States)

Staff, Nathan P.; Lucchinetti, Claudia F.; Keegan, B. Mark

2009-01-01

Objective To describe the characteristics of multiple sclerosis (MS) presenting with severe cognitive impairment as its primary disabling manifestation. Design Retrospective case series. Setting Tertiary referral center. Patients Patients were identified through the Mayo Clinic data retrieval system (1996–2008) with definite MS (McDonald criteria) and severe cognitive impairment as their primary neurological symptom without accompanying significant MS-related impairment or alternative diagnosis for cognitive dysfunction. Twenty-three patients meeting inclusion criteria were compared regarding demographics, clinical course and radiological features. Main Outcome Measures Demographic, clinical, and radiological characteristics of the disease. Results Twelve patients were men. The median age of the first clinical symptom suggestive of CNS demyelination was 33 years, and severe MS-related cognitive impairment developed at a median of 39 years. Cognitive impairment could be dichotomized as subacute fulminant (n=9) or chronic progressive (n=14) in presentation, which corresponded to subsequent relapsing or progressive MS courses. Study patients commonly exhibited psychiatric (65%), mild cerebellar (57%) and cortical symptoms and signs (e.g. seizure, aphasia, apraxia) (39%). Fourteen of 21 (67%), where documented, smoked cigarettes. Brain MRI demonstrated diffuse cerebral atrophy in 16 and gadolinium enhancing lesions in 11. Asymptomatic spinal cord MRI lesions were present in 12 of 16 patients (75%). Immunomodulatory therapies were generally ineffective in improving these patients. Conclusions We describe patients with MS whose clinical phenotype is characterized by severe cognitive dysfunction and prominent cortical and psychiatric signs presenting as a subacute fulminant or chronic progressive clinical course. Cigarette smokers may be over represented in this phenotype. PMID:19752304

Recurrent severe vomiting due to hyperthyroidism

Science.gov (United States)

Chen, Li-ying; Zhou, Bo; Chen, Zhou-wen; Fang, Li-zheng

2010-01-01

Thyrotoxicosis may present in many ways; severe vomiting as a prominent symptom of thyrotoxicosis is uncommon. In this paper, we report a 24-year-old Chinese male with hyperthyroidism who presented with recurrent severe vomiting. The patient had had intermittent vomiting for seven years and had lost approximately 15 kg of weight. Gastroscopic examinations revealed chronic gastritis and one occasion peptic ulcer. He was treated with antacid and proton pump inhibitors, but his symptoms had no relief. His presenting symptoms suggested hyperthyroidism and were confirmed by laboratory data. After a month of propylthiouracil therapy, his symptoms were relieved. It should be noted that hyperthyroidism patients can have unexplained vomiting, and that hyperthyroidism may coexist with peptic ulcer in rare cases. Awareness of such atypical presentations of hyperthyroidism may help to make a correct diagnosis. PMID:20205308

Severe fuel-damage scoping test performance

International Nuclear Information System (INIS)

Gruen, G.E.; Buescher, B.J.

1983-01-01

As a result of the Three Mile Island Unit-2 (TMI-2) accident, the Nuclear Regulatory Commission has initiated a severe fuel damage test program to evaluate fuel rod and core response during severe accidents similar to TMI-2. The first test of Phase I of this series has been successfully completed in the Power Burst Facility at the Idaho National Engineering Laboratory. Following the first test, calculations were performed using the TRAC-BD1 computer code with actual experimental boundary conditions. This paper discusses the test conduct and performance and presents the calculated and measured test bundle results. The test resulted in a slow heatup to 2000 K over about 4 h, with an accelerated reaction of the zirconium cladding at temperatures above 1600 K in the lower part or the bundle and 2000 K in the upper portion of the bundle

Fatigue and multidimensional disease severity in chronic obstructive pulmonary disease

Directory of Open Access Journals (Sweden)

Inal-Ince Deniz

2010-06-01

Full Text Available Abstract Background and aims Fatigue is associated with longitudinal ratings of health in patients with chronic obstructive pulmonary disease (COPD. Although the degree of airflow obstruction is often used to grade disease severity in patients with COPD, multidimensional grading systems have recently been developed. The aim of this study was to investigate the relationship between perceived and actual fatigue level and multidimensional disease severity in patients with COPD. Materials and methods Twenty-two patients with COPD (aged 52-74 years took part in the study. Multidimensional disease severity was measured using the SAFE and BODE indices. Perceived fatigue was assessed using the Fatigue Severity Scale (FSS and the Fatigue Impact Scale (FIS. Peripheral muscle endurance was evaluated using the number of sit-ups, squats, and modified push-ups that each patient could do. Results Thirteen patients (59% had severe fatigue, and their St George's Respiratory Questionnaire scores were significantly higher (p Conclusions Peripheral muscle endurance and fatigue perception in patients with COPD was related to multidimensional disease severity measured with both the SAFE and BODE indices. Improvements in perceived and actual fatigue levels may positively affect multidimensional disease severity and health status in COPD patients. Further research is needed to investigate the effects of fatigue perception and exercise training on patients with different stages of multidimensional COPD severity.

Severe blood-brain barrier disruption and surrounding tissue injury.

Science.gov (United States)

Chen, Bo; Friedman, Beth; Cheng, Qun; Tsai, Phil; Schim, Erica; Kleinfeld, David; Lyden, Patrick D

2009-12-01

Blood-brain barrier opening during ischemia follows a biphasic time course, may be partially reversible, and allows plasma constituents to enter brain and possibly damage cells. In contrast, severe vascular disruption after ischemia is unlikely to be reversible and allows even further extravasation of potentially harmful plasma constituents. We sought to use simple fluorescent tracers to allow wide-scale visualization of severely damaged vessels and determine whether such vascular disruption colocalized with regions of severe parenchymal injury. Severe vascular disruption and ischemic injury was produced in adult Sprague Dawley rats by transient occlusion of the middle cerebral artery for 1, 2, 4, or 8 hours, followed by 30 minutes of reperfusion. Fluorescein isothiocyanate-dextran (2 MDa) was injected intravenously before occlusion. After perfusion-fixation, brain sections were processed for ultrastructure or fluorescence imaging. We identified early evidence of tissue damage with Fluoro-Jade staining of dying cells. With increasing ischemia duration, greater quantities of high molecular weight dextran-fluorescein isothiocyanate invaded and marked ischemic regions in a characteristic pattern, appearing first in the medial striatum, spreading to the lateral striatum, and finally involving cortex; maximal injury was seen in the mid-parietal areas, consistent with the known ischemic zone in this model. The regional distribution of the severe vascular disruption correlated with the distribution of 24-hour 2,3,5-triphenyltetrazolium chloride pallor (r=0.75; P<0.05) and the cell death marker Fluoro-Jade (r=0.86; P<0.05). Ultrastructural examination showed significantly increased areas of swollen astrocytic foot process and swollen mitochondria in regions of high compared to low leakage, and compared to contralateral homologous regions (ANOVA P<0.01). Dextran extravasation into the basement membrane and surrounding tissue increased significantly from 2 to 8 hours of

A framework for assessing severe accident management strategies

International Nuclear Information System (INIS)

Kastenberg, W.E.; Apostolakis, G.; Dhir, V.K.; Okrent, D.; Jae, M.; Lim, H.; Milici, T.; Park, H.; Swider, J.; Xing, L.; Yu, D.

1991-01-01

Accident management can be defined as the innovative use of existing and or alternative resources, systems and actions to prevent or mitigate a severe accident. Together with risk management (changes in plant operation and/or addition of equipment) and emergency planning (off-site actions), accident management provides an extension of the defense-in-depth safety philosophy for severe accidents. A significant number of probabilistic safety assessments (PSA) have been completed which yield the principal plant vulnerabilities. For each sequence/threat and each combination of strategy there may be several options available to the operator. Each strategy/option involves phenomenological and operational considerations regarding uncertainty. These considerations include uncertainty in key phenomena, uncertainty in operator behavior, uncertainty in system availability and behavior, and uncertainty in available information (i.e., instrumentation). The objective of this project is to develop a methodology for assessing severe accident management strategies given the key uncertainties mentioned above. Based on Decision Trees and Influence Diagrams, the methodology is currently being applied to two case studies: cavity flooding in a PWR to prevent vessel penetration or failure, and drywell flooding in a BWR to prevent containment failure

Neglect severity after left and right brain damage.

Science.gov (United States)

Suchan, Julia; Rorden, Chris; Karnath, Hans-Otto

2012-05-01

While unilateral spatial neglect after left brain damage is undoubtedly less common than spatial neglect after a right hemisphere lesion, it is also assumed to be less severe. Here we directly test this latter hypothesis using a continuous measure of neglect severity: the so-called Center of Cancellation (CoC). Rorden and Karnath (2010) recently validated this index for right brain damaged neglect patients. A first aim of the present study was to evaluate this new measure for spatial neglect after left brain damage. In a group of 48 left-sided stroke patients with and without neglect, a score greater than -0.086 on the Bells Test and greater than -0.024 on the Letter Cancellation Task turned out to indicate neglect behavior for acute left brain damaged patients. A second aim was to directly compare the severity of spatial neglect after left versus right brain injury by using the new CoC measure. While neglect is less frequent following left than right hemisphere injury, we found that when this symptom occurs it is of similar severity in acute left brain injury as in patients after acute right brain injury. Copyright © 2012 Elsevier Ltd. All rights reserved.

Severe idiopathic pulmonary fibrosis: what can be done?

Directory of Open Access Journals (Sweden)

Antonella Caminati

2017-09-01

Full Text Available Idiopathic pulmonary fibrosis (IPF remains a challenging disease to manage. Two drugs are now available that can slow disease progression in patients with mild-to-moderate IPF. This means that early diagnosis is mandatory, because there are no proven effective therapies for severe IPF. This lack of proven therapies may be at least partially due to the fact that severe IPF patients are usually not enrolled in randomised, prospective, multicentre, international trials. Clinical observation experiences and preliminary results of long-term, open-label extensions of clinical trials suggest that both pirfenidone and nintedanib may also slow or decrease progression in patients with severe IPF. However, data are sparse and obtained from a relatively small number of patients. Lung transplantation should be taken into account early and discussed with patients, when indicated. Rehabilitative strategies are important and effective supportive therapies. The needs of patients with severe IPF are similar to those of patients with an advanced neoplastic disease. Palliative care and psychological support play an important role in the relief of symptoms of anxiety and depression. Accordingly, these therapeutic approaches should start early in IPF patients.

Association between Experience of Child Abuse and Severity of Drug Addiction Measured by the Addiction Severity Index among Japanese Drug-Dependent Patients

Science.gov (United States)

Ogai, Yasukazu; Senoo, Eiichi; Gardner, Fumiyuki Chin; Haraguchi, Ayako; Saito, Tamaki; Morita, Nobuaki; Ikeda, Kazutaka

2015-01-01

The aim of the present study was to clarify the association between child abuse experiences and drug addiction severity among Japanese drug-dependent patients using the Addiction Severity Index-Japanese version (ASI-J). One hundred and eleven inpatients and outpatients with drug dependence participated in the study. Some of the questions on the ASI-J asked about lifetime experiences of abuse. A higher percentage of female participants experienced child abuse compared with male participants. Male participants who experienced child abuse (MEA) had a significantly higher severity of drug use than men who did not experience it (MNEA). Female participants who experienced child abuse (FEA) had significantly more serious problems in family/social relationships than female participants who did not experience it (FNEA). Patients in the MEA group were arrested less frequently for drug charges, experienced more serious problems with their fathers, and experienced more severe anxiety in their lifetime compared with the MNEA group. The FEA group experienced more serious troubles with their sexual partners, close friends, and families and experienced more severe psychiatric problems in their lifetime compared with the FNEA group. These results suggest gender differences in the problems experienced by drug-dependent patients with child abuse experiences, and gender-specific interventions may be more effective in treating their drug dependence. PMID:25741639

Association between experience of child abuse and severity of drug addiction measured by the Addiction Severity Index among Japanese drug-dependent patients.

Science.gov (United States)

Ogai, Yasukazu; Senoo, Eiichi; Gardner, Fumiyuki Chin; Haraguchi, Ayako; Saito, Tamaki; Morita, Nobuaki; Ikeda, Kazutaka

2015-03-03

The aim of the present study was to clarify the association between child abuse experiences and drug addiction severity among Japanese drug-dependent patients using the Addiction Severity Index-Japanese version (ASI-J). One hundred and eleven inpatients and outpatients with drug dependence participated in the study. Some of the questions on the ASI-J asked about lifetime experiences of abuse. A higher percentage of female participants experienced child abuse compared with male participants. Male participants who experienced child abuse (MEA) had a significantly higher severity of drug use than men who did not experience it (MNEA). Female participants who experienced child abuse (FEA) had significantly more serious problems in family/social relationships than female participants who did not experience it (FNEA). Patients in the MEA group were arrested less frequently for drug charges, experienced more serious problems with their fathers, and experienced more severe anxiety in their lifetime compared with the MNEA group. The FEA group experienced more serious troubles with their sexual partners, close friends, and families and experienced more severe psychiatric problems in their lifetime compared with the FNEA group. These results suggest gender differences in the problems experienced by drug-dependent patients with child abuse experiences, and gender-specific interventions may be more effective in treating their drug dependence.

An algorithmic approach for the treatment of severe uncontrolled asthma

Science.gov (United States)

Zervas, Eleftherios; Samitas, Konstantinos; Papaioannou, Andriana I.; Bakakos, Petros; Loukides, Stelios; Gaga, Mina

2018-01-01

A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers. The diagnosis and management of severe asthma requires specialised experience, time and effort to comprehend the needs and expectations of each individual patient and incorporate those as well as his/her specific phenotype characteristics into the management planning. Although some new treatment options are currently available for these patients, there is still a need for further research into severe asthma and yet more treatment options. PMID:29531957

Development of a prototype graphic simulation program for severe accident training

Energy Technology Data Exchange (ETDEWEB)

Kim, Ko Ryu; Jeong, Kwang Sub; Ha, Jae Joo

2000-05-01

This is a report of the development process and related technologies of severe accident graphic simulators, required in industrial severe accident management and training. Here, we say 'a severe accident graphic simulator' as a graphics add-in system to existing calculation codes, which can show the severe accident phenomena dynamically on computer screens and therefore which can supplement one of main defects of existing calculation codes. With graphic simulators it is fairly easy to see the total behavior of nuclear power plants, where it was very difficult to see only from partial variable numerical information. Moreover, the fast processing and control feature of a graphic simulator can give some opportunities of predicting the severe accident advancement among several possibilities, to one who is not an expert. Utilizing graphic simulators' we expect operators' and TSC members' physical phenomena understanding enhancement from the realistic dynamic behavior of plants. We also expect that severe accident training course can gain better training effects using graphic simulator's control functions and predicting capabilities, and therefore we expect that graphic simulators will be effective decision-aids tools both in sever accident training course and in real severe accident situations. With these in mind, we have developed a prototype graphic simulator having surveyed related technologies, and from this development experiences we have inspected the possibility to build a severe accident graphic simulator. The prototype graphic simulator is developed under IBM PC WinNT environments and is suited to Uljin 3and4 nuclear power plant. When supplied with adequate severe accident scenario as an input, the prototype can provide graphical simulations of plant safety systems' dynamic behaviors. The prototype is composed of several different modules, which are phenomena display module, MELCOR data interface module and graphic database

Protein metabolism in severe childhood malnutrition

Science.gov (United States)

The major clinical syndromes of severe childhood malnutrition (SCM) are marasmus (non-oedematous SCM), kwashiorkor and marasmic-kwashiorkor (oedematous SCM). Whereas treatment of marasmus is straightforward and the associated mortality is low, kwashiorkor and marasmic-kwashiorkor are difficult to tr...

GERD: Can Certain Medications Increase Severity?

Science.gov (United States)

... increase severity? I've heard that some medications can aggravate the symptoms of GERD. Can you tell me more? Answers from Michael F. Picco, M.D. Certain medications and dietary supplements can irritate the lining of your esophagus, causing heartburn ...

Viral etiology, seasonality and severity of hospitalized patients with severe acute respiratory infections in the Eastern Mediterranean Region, 2007-2014.

Science.gov (United States)

Horton, Katherine C; Dueger, Erica L; Kandeel, Amr; Abdallat, Mohamed; El-Kholy, Amani; Al-Awaidy, Salah; Kohlani, Abdul Hakim; Amer, Hanaa; El-Khal, Abel Latif; Said, Mayar; House, Brent; Pimentel, Guillermo; Talaat, Maha

2017-01-01

Little is known about the role of viral respiratory pathogens in the etiology, seasonality or severity of severe acute respiratory infections (SARI) in the Eastern Mediterranean Region. Sentinel surveillance for SARI was conducted from December 2007 through February 2014 at 20 hospitals in Egypt, Jordan, Oman, Qatar and Yemen. Nasopharyngeal and oropharyngeal swabs were collected from hospitalized patients meeting SARI case definitions and were analyzed for infection with influenza, respiratory syncytial virus (RSV), adenovirus (AdV), human metapneumovirus (hMPV) and human parainfluenza virus types 1-3 (hPIV1-3). We analyzed surveillance data to calculate positivity rates for viral respiratory pathogens, describe the seasonality of those pathogens and determine which pathogens were responsible for more severe outcomes requiring ventilation and/or intensive care and/or resulting in death. At least one viral respiratory pathogen was detected in 8,753/28,508 (30.7%) samples tested for at least one pathogen and 3,497/9,315 (37.5%) of samples tested for all pathogens-influenza in 3,345/28,438 (11.8%), RSV in 3,942/24,503 (16.1%), AdV in 923/9,402 (9.8%), hMPV in 617/9,384 (6.6%), hPIV1 in 159/9,402 (1.7%), hPIV2 in 85/9,402 (0.9%) and hPIV3 in 365/9,402 (3.9%). Multiple pathogens were identified in 501/9,316 (5.4%) participants tested for all pathogens. Monthly variation, indicating seasonal differences in levels of infection, was observed for all pathogens. Participants with hMPV infections and participants less than five years of age were significantly less likely than participants not infected with hMPV and those older than five years of age, respectively, to experience a severe outcome, while participants with a pre-existing chronic disease were at increased risk of a severe outcome, compared to those with no reported pre-existing chronic disease. Viral respiratory pathogens are common among SARI patients in the Eastern Mediterranean Region. Ongoing surveillance is

Temporary jobs and the severity of workplace accidents.

Science.gov (United States)

Picchio, Matteo; van Ours, Jan C

2017-06-01

From the point of view of workplace safety, it is important to know whether having a temporary job has an effect on the severity of workplace accidents. We present an empirical analysis on the severity of workplace accidents by type of contract. We used microdata collected by the Italian national institute managing the mandatory insurance against work related accidents. We estimated linear models for a measure of the severity of the workplace accident. We controlled for time-invariant fixed effects at worker and firm levels to disentangle the impact of the type of contract from the spurious one induced by unobservables at worker and firm levels. Workers with a temporary contract, if subject to a workplace accident, were more likely to be confronted with severe injuries than permanent workers. When correcting the statistical analysis for injury under-reporting of temporary workers, we found that most of, but not all, the effect is driven by the under-reporting bias. The effect of temporary contracts on the injury severity survived the inclusion of worker and firm fixed effects and the correction for temporary workers' injury under-reporting. This, however, does not exclude the possibility that, within firms, the nature of the work may vary between different categories of workers. For example, temporary workers might be more likely to be assigned dangerous tasks because they might have less bargaining power. The findings will help in designing public policy effective in increasing temporary workers' safety at work and limiting their injury under-reporting. Copyright © 2017. Published by Elsevier Ltd.

Some outstanding issues in severe accidents containment performance

International Nuclear Information System (INIS)

Sehgal, B.R.

2004-01-01

This paper describes the current status of the outstanding issues in severe accident performance of Light Water Reactor containments that have been raised in the last several years. The results of the research that has been performed on the topics concerning these issues will be described. Some of these issues have been resolved, some are close to resolution, while others need further evaluation and research results. (author)

Simulator drills for the management of severe accidents

International Nuclear Information System (INIS)

Hoffmann, E.

1989-01-01

The present state of deliberations on the simulation of severe accidents is presented and applied to a training philosophy. The special characteristics of 'severe' accidents are addressed and, falling under this category, the 'psychological structure of the man-machine-situation' is examined. The valid rules for drilling 'post-RESA-conduct' (RESA = fast reactor shut down) and the monitoring of safety goals are introduced. 2 figs., 1 tab

Modeling alcohol use disorder severity: an integrative structural equation modeling approach

Directory of Open Access Journals (Sweden)

Nathasha R Moallem

2013-07-01

Full Text Available Background: Alcohol dependence is a complex psychological disorder whose phenomenology changes as the disorder progresses. Neuroscience has provided a variety of theories and evidence for the development, maintenance, and severity of addiction; however, clinically, it has been difficult to evaluate alcohol use disorder (AUD severity. Objective: This study seeks to evaluate and validate a data-driven approach to capturing alcohol severity in a community sample. Method: Participants were non-treatment seeking problem drinkers (n = 283. A structural equation modeling (SEM approach was used to (a verify the latent factor structure of the indices of AUD severity; and (b test the relationship between the AUD severity factor and measures of alcohol use, affective symptoms, and motivation to change drinking. Results: The model was found to fit well, with all chosen indices of AUD severity loading significantly and positively onto the severity factor. In addition, the paths from the alcohol use, motivation, and affective factors accounted for 68% of the variance in AUD severity. Greater AUD severity was associated with greater alcohol use, increased affective symptoms, and higher motivation to change.Conclusions: Unlike the categorical diagnostic criteria, the AUD severity factor is comprised of multiple quantitative dimensions of impairment observed across the progression of the disorder. The AUD severity factor was validated by testing it in relation to other outcomes such as alcohol use, affective symptoms, and motivation for change. Clinically, this approach to AUD severity can be used to inform treatment planning and ultimately to improve outcomes.

Pathway discovery using transcriptomic profiles in adult-onset severe asthma

DEFF Research Database (Denmark)

Hekking, Pieter-Paul; Loza, Matt J; Pavlidis, Stelios

2017-01-01

in nasal brushings (5 signatures), sputum (3 signatures), and endobronchial brushings (6 signatures). Signatures associated with eosinophilic airway inflammation, mast cells, and group 3 innate lymphoid cells were more enriched in adult-onset severe asthma, whereas signatures associated with induced lung...... injury were less enriched in adult-onset severe asthma. CONCLUSIONS: Adult-onset severe asthma is characterized by inflammatory pathways involving eosinophils, mast cells, and group 3 innate lymphoid cells. These pathways could represent useful targets for the treatment of adult-onset severe asthma....

The philosophy of severe accident management in the US

International Nuclear Information System (INIS)

Baratta, A.J.

1990-01-01

The US NRC has put forth the initial steps in what is viewed as the resolution of the severe accident issue. Underlying this process is a fundamental philosophy that if followed will likely lead to an order of magnitude reduction in the risk of severe accidents. Thus far, this philosophy has proven cost effective through improved performance. This paper briefly examines this philosophy and the next step in closure of the severe accident issue, the IPE. An example of the authors experience with determinist. (author)

Development of the severe accident risk information database management system SARD

International Nuclear Information System (INIS)

Ahn, Kwang Il; Kim, Dong Ha

2003-01-01

The main purpose of this report is to introduce essential features and functions of a severe accident risk information management system, SARD (Severe Accident Risk Database Management System) version 1.0, which has been developed in Korea Atomic Energy Research Institute, and database management and data retrieval procedures through the system. The present database management system has powerful capabilities that can store automatically and manage systematically the plant-specific severe accident analysis results for core damage sequences leading to severe accidents, and search intelligently the related severe accident risk information. For that purpose, the present database system mainly takes into account the plant-specific severe accident sequences obtained from the Level 2 Probabilistic Safety Assessments (PSAs), base case analysis results for various severe accident sequences (such as code responses and summary for key-event timings), and related sensitivity analysis results for key input parameters/models employed in the severe accident codes. Accordingly, the present database system can be effectively applied in supporting the Level 2 PSA of similar plants, for fast prediction and intelligent retrieval of the required severe accident risk information for the specific plant whose information was previously stored in the database system, and development of plant-specific severe accident management strategies

Development of the severe accident risk information database management system SARD

Energy Technology Data Exchange (ETDEWEB)

Ahn, Kwang Il; Kim, Dong Ha

2003-01-01

The main purpose of this report is to introduce essential features and functions of a severe accident risk information management system, SARD (Severe Accident Risk Database Management System) version 1.0, which has been developed in Korea Atomic Energy Research Institute, and database management and data retrieval procedures through the system. The present database management system has powerful capabilities that can store automatically and manage systematically the plant-specific severe accident analysis results for core damage sequences leading to severe accidents, and search intelligently the related severe accident risk information. For that purpose, the present database system mainly takes into account the plant-specific severe accident sequences obtained from the Level 2 Probabilistic Safety Assessments (PSAs), base case analysis results for various severe accident sequences (such as code responses and summary for key-event timings), and related sensitivity analysis results for key input parameters/models employed in the severe accident codes. Accordingly, the present database system can be effectively applied in supporting the Level 2 PSA of similar plants, for fast prediction and intelligent retrieval of the required severe accident risk information for the specific plant whose information was previously stored in the database system, and development of plant-specific severe accident management strategies.

Instrumentation for the follow-up of severe accidents

International Nuclear Information System (INIS)

Munoz Sanchez, A.; Nino Perote, R.

2000-01-01

During severe accidents, it is foreseeable that the instrumentation installed in a plant is subjected to conditions which are more hostile than those for which the instrumentation was designed and qualified. Moreover, new, specific instrumentation is required to monitor variables which have not been considered until now, and to control systems which lessen the consequences of severe accidents. Both existing instrumentation used to monitor critical functions in design basis accident conditions and additional instrumentation which provides the information necessary to control and mitigate the consequences of severe accidents, have to be designed to withstand such conditions, especially in terms of measurements range, functional characteristics and qualification to withstand pressure and temperature loads resulting from steam explosion, hydrogen combustion/explosion and high levels of radiation over long periods of time. (Author)

One thousand cases of severe occupational contact dermatitis

DEFF Research Database (Denmark)

Schwensen, Jakob Ferløv; Friis, Ulrik Fischer; Menné, Torkil

2013-01-01

Background. Occupational contact dermatitis is frequent, and further understanding of the epidemiology will improve the basis of its prevention. Objectives. To identify occupations at risk for severe occupational contact dermatitis. Methods. The last 1000 cases of severe occupational contact...... dermatitis seen at our department were identified. Results. The study population comprised 618 females and 382 males. The mean age at onset of irritant contact dermatitis was significantly lower than the mean age at onset of allergic contact dermatitis for both sexes, irrespective of the presence of atopic....... Occupational contact dermatitis remains frequent, even if only severe cases are considered. It is a concern that no effective, systematic interventions and prevention schemes have been launched in Europe, despite documentation of a significant problem overmany years, and knowledge of risk occupations and risk...

Mortality caused by intracranial bleeding in non-severe hemophilia A patients

NARCIS (Netherlands)

Loomans, Janneke I.; Eckhardt, Corien L.; Reitter-Pfoertner, Sylvia E.; Holmstrom, Mats; Van Gorkom, B. Laros; Leebeek, F. W. G.; Santoro, C.; Haya, Saturnino; Meijer, K.; Nijziel, M. R.; Van Der Bom, J. G.; Fijnvandraat, K.

Background: Non-severe hemophilia (factor VIII concentration [FVIII: C] of 2-40 IU dL(-1)) is characterized by a milder bleeding phenotype than severe hemophilia A. However, some patients with non-severe hemophilia A suffer from severe bleeding complications that may result in death. Data on

Z-plasty for severe gluteal muscle contracture in children.

Science.gov (United States)

Zha, Kun; Liu, GuoHui; Yang, Shuhua; Cao, Faqi

2016-12-01

To review the records of 363 patients with severe gluteal muscle contracture to determine its mechanism, underlying pathology, and treatment outcome. Records of 136 males and 227 females aged 5 to 18 (mean, 12.2) years who underwent Z-plasty for bilateral (n=347) or unilateral (n=16) severe gluteal muscle contracture were reviewed. Severe gluteal muscle contracture was classified as typical (n=52) or special (n=311). The typical type is associated with symptoms of positive out-toe gait, Ober sign, back-extending test, cross-leg test, squatting with knee side-by-side test, and hip dysfunction. It is further subdivided into mild (n=0), moderate (n=40), or severe (n=12). The special type is associated with additional symptoms of pelvic tilt and leg length discrepancy (4 cm in 48 hips). 311 hips had pelvic tilt and 47 hips had lumbar compensatory scoliosis. Treatment outcome was assessed at 6 months. Hip functional score was assessed at the final follow-up. The mean hospitalisation period was 11 days. After a mean follow-up of 1.5 years, the mean hip functional score improved from 8.03 to 11.69; improvement was higher in children (age 5-13 years) than in adolescents (age 14-18 years) [3.7 vs. 2.9, p4 cm, and intra-operatively the contracture band severely affected the joint capsule. The third patient did not comply with postoperative exercises. Surgical treatment for severe gluteal muscle contracture achieved good outcome.

Measuring Disease Severity in Duchenne and Becker Muscular Dystrophy

Directory of Open Access Journals (Sweden)

Melinda F. Davis

2010-10-01

Full Text Available Medical investigations use a wide variety of outcome indicators that are often not comparable. It can be challenging to integrate results across multiple studies that do not share a common metric. Some conditions such as Duchenne and Becker muscular dystrophy have a predictable course of disease progression. Severity can be inferred from a patient's medical history. This paper describes the development of a disease severity measure using common markers of disease progression. Rasch modeling was used to estimate severity using dichotomous events that indicate disease progression. Caregivers of 34 young men with Duchenne or Becker muscular dystrophy completed structured interviews about their care and medical history. Interview questions included surgeries (tendon release, scoliosis, tracheostomy, respiratory equipment (assisted ventilation, cough assist devices, and the use of other medical equipment (e.g., braces, walkers, wheelchairs, transfer boards, hospital beds. The resulting measure had a reliability of .83. The correlation between the severity measure and the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS was .68. Preliminary results and item calibrations are provided for the severity measure that can be estimated from caregiver reports or administrative data. DOI: 10.2458/azu_jmmss.v1i1.76

Revised Severe Accident Research Program plan, FY 1990--1992

International Nuclear Information System (INIS)

1989-08-01

For the past 10 years, since the Three Mile Island accident, the NRC has sponsored an active research program on light-water-reactor severe accidents as part of a multi-faceted approach to reactor safety. This report describes the revised Severe Accident Research Program (SARP) and how the revisions are designed to provide confirmatory information and technical support to the NRC staff in implementing the staff's Integration Plan for Closure of Severe Accident Issues as described in SECY-88-147. The revised SARP addresses both the near-term research directed at providing a technical basis upon which decisions on important containment performance issues can be made and the long-term research needed to confirm and refine our understanding of severe accidents. In developing this plan, the staff recognized that the overall goal is to reduce the uncertainties in the source term sufficiently to enable the staff to make regulatory decisions on severe accident issues. However, the staff also recognized that for some issues it may not be practical to attempt to further reduce uncertainties, and some regulatory decisions or conclusions will have to be made with full awareness of existing uncertainties. 2 figs., 1 tab

Severe hypertriglyceridemia presenting as eruptive xanthomatosis

Directory of Open Access Journals (Sweden)

Sameera S Vangara

2018-01-01

Full Text Available Eruptive xanthomatosis is described as the sudden eruption of erythematous yellow papules in the presence of hypertriglyceridemia, often associated with serum triglyceride levels above 2000 mg/dl. Severe hypertriglyceridemia can be caused by primary genetic mutations, secondary chronic diseases, or a combination of both. Uncontrolled diabetes mellitus is a known risk factor. It is imperative for physicians to be aware of eruptive xanthomatosis as a warning sign for severe hypertriglyceridemia due to the underlying risk for the potentially fatal complication of acute pancreatitis. Herein, we discuss a case of a 52-year-old man with uncontrolled diabetes mellitus who presented with eruptive xanthomata and a triglyceride level of 7157 mg/dl, the highest recorded value in the absence of acute pancreatitis, with a remarkable response to drug therapy. A review of the literature is included to discuss the clinical relevance and appropriate treatment of this disease entity.

[State of the art diagnostic criteria of severe periodontitis].

Science.gov (United States)

Ouyang, X Y

2017-02-09

Periodontitis could be categorized as mild, moderate, and severe according to the severity of the disease. This categorizing system could also be used together with other classification systems. The present article introduced the status about the case definition of severe periodontitis, including the standard of case definitions for surveillance of periodontitis reported by the Centers for Disease Control and Prevention (CDC) in partnership with the American Academy of Periodontology (AAP) and the consensus report on the definition of periodontitis case for use in risk factor research by Europe workshop. A consensus on the state of the art definition of severe periodontitis for use in clinical work was gained base on the expertise of Chinese Society of Periodontology, Chinese Association of Stomatology. The background of this consensus and the significance of the criteria for the case definition were discussed.

Full-length fuel rod behavior under severe accident conditions

International Nuclear Information System (INIS)

Lombardo, N.J.; Lanning, D.D.; Panisko, F.E.

1992-12-01

This document presents an assessment of the severe accident phenomena observed from four Full-Length High-Temperature (FLHT) tests that were performed by the Pacific Northwest Laboratory (PNL) in the National Research Universal (NRU) reactor at Chalk River, Ontario, Canada. These tests were conducted for the US Nuclear Regulatory Commission (NRC) as part of the Severe Accident Research Program. The objectives of the test were to simulate conditions and provide information on the behavior of full-length fuel rods during hypothetical, small-break, loss-of-coolant severe accidents, in commercial light water reactors

Severe skin reaction secondary to concomitant radiotherapy plus cetuximab

International Nuclear Information System (INIS)

Berger, Bernhard; Belka, Claus

2008-01-01

The therapeutic use of monoclonal antibodies against the epidermal growth factor receptor (EGFR) is specifically associated with dermatologic reactions of variable severity. Recent evidence suggests superiority of the EGFR inhibitor (EGFRI) cetuximab plus radiotherapy compared to radiotherapy alone in patients with squamous cell carcinoma of the head and neck. Although not documented in a study population, several reports indicate a possible overlap between radiation dermatitis and the EGFRI-induced skin rash. We here present a case of severe skin reaction secondary to the addition of cetuximab to radiotherapy

Fire severity and ecosytem responses following crown fires in California shrublands.

Science.gov (United States)

Keeley, Jon E; Brennan, Teresa; Pfaff, Anne H

2008-09-01

Chaparral shrublands burn in large high-intensity crown fires. Managers interested in how these wildfires affect ecosystem processes generally rely on surrogate measures of fire intensity known as fire severity metrics. In shrublands burned in the autumn of 2003, a study of 250 sites investigated factors determining fire severity and ecosystem responses. Using structural equation modeling we show that stand age, prefire shrub density, and the shortest interval of the prior fire history had significant direct effects on fire severity, explaining > 50% of the variation in severity. Fire severity per se is of interest to resource managers primarily because it is presumed to be an indicator of important ecosystem processes such as vegetative regeneration, community recovery, and erosion. Fire severity contributed relatively little to explaining patterns of regeneration after fire. Two generalizations can be drawn: fire severity effects are mostly shortlived, i.e., by the second year they are greatly diminished, and fire severity may have opposite effects on different functional types. Species richness exhibited a negative relationship to fire severity in the first year, but fire severity impacts were substantially less in the second postfire year and varied by functional type. Much of this relationship was due to alien plants that are sensitive to high fire severity; at all scales from 1 to 1000 m2, the percentage of alien species in the postfire flora declined with increased fire severity. Other aspects of disturbance history are also important determinants of alien cover and richness as both increased with the number of times the site had burned and decreased with time since last fire. A substantial number of studies have shown that remote-sensing indices are correlated with field measurements of fire severity. Across our sites, absolute differenced normalized burn ratio (dNBR) was strongly correlated with field measures of fire severity and with fire history at a

Overview of severe accident research at JAERI

International Nuclear Information System (INIS)

Sugimoto, Jun

1999-01-01

Severe accident research at JAERI aims at the confirmation of the safety margin, the quantification of the associated risk, and the evaluation of the effectiveness of the accident management measures of the nuclear power reactors, in accordance with the government five-year nuclear safety research program. JAERI has been conducting a wide range of severe accident research activities both in experiment and analysis, such as melt coolant interactions, fission product behaviors in coolant system, containment integrity and assessment of accident management measures. Molten core/coolant interaction and in-vessel molten coolability have been investigated in ALPHA Program. MUSE experiments in ALPHA Program has been conducted for the precise energy measurement due to steam explosion in melt jet and stratified geometries. In VEGA Program, which aims at FP release from irradiated fuels at high temperature and high pressure under various atmospheric conditions, the facility construction is almost completed. In WIND Program the revaporization of aerosols due to decay heating and also the integrity of the piping from this heat source are being investigated. Code development activities are in progress for an integrated source term analysis with THALES, fission product behaviors with ART, steam explosion with JASMINE, and in-vessel debris behaviors with CAMP. The experimental analyses and reactor application have made progress by participating international standard problem and code comparison exercises, along with the use of introduced codes, such as SCDAP/RELAP5 and MELCOR. The outcome of the severe accident research will be utilized for the evaluation of more reliable severe accident scenarios, detailed implementation of the accident management measures, and also for the future reactor development, basically through the sophisticated use of verified analytical tools. (author)

Transarterial embolization for management of severe postcoital bleeding

Directory of Open Access Journals (Sweden)

Armen Eskandari

2016-08-01

Full Text Available Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.

Communication impairment and activity limitation in stroke patients with severe aphasia.

Science.gov (United States)

Darrigrand, Benedicte; Dutheil, Sabine; Michelet, Valerie; Rereau, Stephanie; Rousseaux, Marc; Mazaux, Jean-Michel

2011-01-01

This study investigated how patients with severe aphasia communicated in daily living, which verbal and non-verbal communication skills were spared and which were impaired, and whether activity limitations in communication are related to verbal impairments. Twenty-seven patients with severe aphasia and 9 with moderate aphasia originating from a sample of 102 aphasic persons followed up in a French regional survey were assessed with a communication test and a communication activity limitation questionnaire 12-18 months after a first stroke. Patients with severe aphasia suffered severe activity limitations in communication, with performance 3-fold lower than that of patients with moderate aphasia, and 4-fold lower than scores attained by normals. Both aphasia severity and communication disability at follow-up were related to the initial severity of aphasia. Using a phone, credit card and a chequebook, reading and filling in administrative documents, and communication behaviours involved in social life were the most severely impaired. Non-verbal communication performance was not related to aphasia severity. We conclude that there is a great need for speech therapy research to develop new compensatory or alternative strategies for patients with severe aphasia.

Hierarchical feature selection for erythema severity estimation

Science.gov (United States)

Wang, Li; Shi, Chenbo; Shu, Chang

2014-10-01

At present PASI system of scoring is used for evaluating erythema severity, which can help doctors to diagnose psoriasis [1-3]. The system relies on the subjective judge of doctors, where the accuracy and stability cannot be guaranteed [4]. This paper proposes a stable and precise algorithm for erythema severity estimation. Our contributions are twofold. On one hand, in order to extract the multi-scale redness of erythema, we design the hierarchical feature. Different from traditional methods, we not only utilize the color statistical features, but also divide the detect window into small window and extract hierarchical features. Further, a feature re-ranking step is introduced, which can guarantee that extracted features are irrelevant to each other. On the other hand, an adaptive boosting classifier is applied for further feature selection. During the step of training, the classifier will seek out the most valuable feature for evaluating erythema severity, due to its strong learning ability. Experimental results demonstrate the high precision and robustness of our algorithm. The accuracy is 80.1% on the dataset which comprise 116 patients' images with various kinds of erythema. Now our system has been applied for erythema medical efficacy evaluation in Union Hosp, China.

Neighborhood Influences on Vehicle-Pedestrian Crash Severity.

Science.gov (United States)

Toran Pour, Alireza; Moridpour, Sara; Tay, Richard; Rajabifard, Abbas

2017-12-01

Socioeconomic factors are known to be contributing factors for vehicle-pedestrian crashes. Although several studies have examined the socioeconomic factors related to the location of the crashes, limited studies have considered the socioeconomic factors of the neighborhood where the road users live in vehicle-pedestrian crash modelling. This research aims to identify the socioeconomic factors related to both the neighborhoods where the road users live and where crashes occur that have an influence on vehicle-pedestrian crash severity. Data on vehicle-pedestrian crashes that occurred at mid-blocks in Melbourne, Australia, was analyzed. Neighborhood factors associated with road users' residents and location of crash were investigated using boosted regression tree (BRT). Furthermore, partial dependence plots were applied to illustrate the interactions between these factors. We found that socioeconomic factors accounted for 60% of the 20 top contributing factors to vehicle-pedestrian crashes. This research reveals that socioeconomic factors of the neighborhoods where the road users live and where the crashes occur are important in determining the severity of the crashes, with the former having a greater influence. Hence, road safety countermeasures, especially those focussing on the road users, should be targeted at these high-risk neighborhoods.

[The Nutrition Care of Severe Burn Patients].

Science.gov (United States)

Hsieh, Yu-Hsiu

2016-02-01

In addition to recent advances in burn patient care techniques such as maintaining warm circumambient temperature, the early excision of wounds, and the use of closed dressing, providing nutrition support through early feeding has proven instrumental in greatly increasing the survival rate of burn patients. Severe burns complicated by many factors initiate tremendous physiological stress that leads to postburn hypermetabolism that includes enhanced tissue catabolism, the loss of muscle mass, and decreases in the body's reservoirs of protein and energy. These problems have become the focus of burn therapy. Treating severe burns aims not only to enhance survival rates but also to restore normal bodily functions as completely as possible. Recent research evaluating the application of anabolic agents and immune-enhance formula for severe burns therapy has generated significant controversy. Inadequate caloric intake is one of the main differences among the related studies, with the effect of many special nutrients such as bran acid amides not taken into consideration. Therefore, considering the sufficiency of caloric and protein intake is critical in assessing effectiveness. Only after patients receive adequate calories and protein may the effect of special nutrients such as glutamine and supplements be evaluated effectively.

A framework for the assessment of severe accident management strategies

International Nuclear Information System (INIS)

Kastenberg, W.E.; Apostolakis, G.; Dhir, V.K.

1993-09-01

Severe accident management can be defined as the use of existing and/or altemative resources, systems and actors to prevent or mitigate a core-melt accident. For each accident sequence and each combination of severe accident management strategies, there may be several options available to the operator, and each involves phenomenological and operational considerations regarding uncertainty. Operational uncertainties include operator, system and instrumentation behavior during an accident. A framework based on decision trees and influence diagrams has been developed which incorporates such criteria as feasibility, effectiveness, and adverse effects, for evaluating potential severe accident management strategies. The framework is also capable of propagating both data and model uncertainty. It is applied to several potential strategies including PWR cavity flooding, BWR drywell flooding, PWR depressurization and PWR feed and bleed

Aberrant cortical associative plasticity associated with severe adult Tourette syndrome.

Science.gov (United States)

Martín-Rodríguez, Juan Francisco; Ruiz-Rodríguez, María Adilia; Palomar, Francisco J; Cáceres-Redondo, María Teresa; Vargas, Laura; Porcacchia, Paolo; Gómez-Crespo, Mercedes; Huertas-Fernández, Ismael; Carrillo, Fátima; Madruga-Garrido, Marcos; Mir, Pablo

2015-03-01

Recent studies have shown altered cortical plasticity in adult patients with Tourette syndrome. However, the clinical significance of this finding remains elusive. Motor cortical plasticity was evaluated in 15 adult patients with severe Tourette syndrome and 16 healthy controls using the paired associative stimulation protocol by transcranial magnetic stimulation. Associations between paired associative stimulation-induced plasticity and relevant clinical variables, including cortical excitability, psychiatric comorbidities, drug treatment and tic severity, were assessed. Motor cortical plasticity was abnormally increased in patients with Tourette syndrome compared with healthy subjects. This abnormal plasticity was independently associated with tic severity. Patients with severe Tourette syndrome display abnormally increased cortical associative plasticity. This aberrant cortical plasticity was associated with tic severity, suggesting an underlying mechanism for tic pathophysiology. © 2015 International Parkinson and Movement Disorder Society.

A framework for the assessment of severe accident management strategies

Energy Technology Data Exchange (ETDEWEB)

Kastenberg, W.E. [ed.; Apostolakis, G.; Dhir, V.K. [California Univ., Los Angeles, CA (United States). Dept. of Mechanical, Aerospace and Nuclear Engineering] [and others

1993-09-01

Severe accident management can be defined as the use of existing and/or altemative resources, systems and actors to prevent or mitigate a core-melt accident. For each accident sequence and each combination of severe accident management strategies, there may be several options available to the operator, and each involves phenomenological and operational considerations regarding uncertainty. Operational uncertainties include operator, system and instrumentation behavior during an accident. A framework based on decision trees and influence diagrams has been developed which incorporates such criteria as feasibility, effectiveness, and adverse effects, for evaluating potential severe accident management strategies. The framework is also capable of propagating both data and model uncertainty. It is applied to several potential strategies including PWR cavity flooding, BWR drywell flooding, PWR depressurization and PWR feed and bleed.

Management preferences of pediatricians in moderate and severe acute asthma.

Science.gov (United States)

Arga, Mustafa; Bakirtas, Arzu; Catal, Ferhat; Derinoz, Oksan; Topal, Erdem; Demirsoy, M Sadik; Turktas, Ipek

2013-05-01

To assess and compare management preferences of physicians for moderate and severe acute asthma based on case scenarios and to determine the factors influencing their decisions. A questionnaire based on the Global Initiative on Asthma (GINA) guideline and comprising eight questions on management of acute asthma was delivered to participants of two national pediatric congresses. Management of moderate and severe acute asthma cases was evaluated by two clinical case scenarios for estimation of acute attack severity, initial treatment, treatment after 1h, and discharge recommendations. A uniform answer box comprising the possible choices was provided just below the questions, and respondents were requested to tick the answers they thought was appropriate. Four-hundred and eighteen questionnaires were analyzed. All questions regarding moderate and severe acute asthma case scenarios were answered accurately by 15.8% and 17.0% of physicians, respectively. The initial treatment of moderate and severe cases was known by 100.0% and 78.2% of physicians, respectively. Knowledge of the appropriate plan for treatment after 1h was low both for moderate (45.0%) and severe attacks (35.4%). Discharge recommendations were adequate in 32.5% and 70.8% of physicians for moderate and severe attacks, respectively. Multiple logistic regression analysis revealed that working at a hospital with a continuing medical education program was the only significant predictor of a correct response to all questions regarding severe attacks (p = .04; 95%CI, 1.02-3.21). No predictors were found for information on moderate attacks. Pediatricians have difficulty in planning treatment after 1 hour both for moderate and severe asthma attacks. Postgraduate education programs that target physicians in hospitals without continuing medical education facilities may improve guideline adherence.

A multivariate tobit analysis of highway accident-injury-severity rates.

Science.gov (United States)

Anastasopoulos, Panagiotis Ch; Shankar, Venky N; Haddock, John E; Mannering, Fred L

2012-03-01

Relatively recent research has illustrated the potential that tobit regression has in studying factors that affect vehicle accident rates (accidents per distance traveled) on specific roadway segments. Tobit regression has been used because accident rates on specific roadway segments are continuous data that are left-censored at zero (they are censored because accidents may not be observed on all roadway segments during the period over which data are collected). This censoring may arise from a number of sources, one of which being the possibility that less severe crashes may be under-reported and thus may be less likely to appear in crash databases. Traditional tobit-regression analyses have dealt with the overall accident rate (all crashes regardless of injury severity), so the issue of censoring by the severity of crashes has not been addressed. However, a tobit-regression approach that considers accident rates by injury-severity level, such as the rate of no-injury, possible injury and injury accidents per distance traveled (as opposed to all accidents regardless of injury-severity), can potentially provide new insights, and address the possibility that censoring may vary by crash-injury severity. Using five-year data from highways in Washington State, this paper estimates a multivariate tobit model of accident-injury-severity rates that addresses the possibility of differential censoring across injury-severity levels, while also accounting for the possible contemporaneous error correlation resulting from commonly shared unobserved characteristics across roadway segments. The empirical results show that the multivariate tobit model outperforms its univariate counterpart, is practically equivalent to the multivariate negative binomial model, and has the potential to provide a fuller understanding of the factors determining accident-injury-severity rates on specific roadway segments. Published by Elsevier Ltd.

Hemodynamic and metabolic correlates of perinatal white matter injury severity.

Directory of Open Access Journals (Sweden)

Art Riddle

Full Text Available Although the spectrum of perinatal white matter injury (WMI in preterm infants is shifting from cystic encephalomalacia to milder forms of WMI, the factors that contribute to this changing spectrum are unclear. We hypothesized that the variability in WMI quantified by immunohistochemical markers of inflammation could be correlated with the severity of impaired blood oxygen, glucose and lactate.We employed a preterm fetal sheep model of in utero moderate hypoxemia and global severe but not complete cerebral ischemia that reproduces the spectrum of human WMI. Since there is small but measurable residual brain blood flow during occlusion, we sought to determine if the metabolic state of the residual arterial blood was associated with severity of WMI. Near the conclusion of hypoxia-ischemia, we recorded cephalic arterial blood pressure, blood oxygen, glucose and lactate levels. To define the spectrum of WMI, an ordinal WMI rating scale was compared against an unbiased quantitative image analysis protocol that provided continuous histo-pathological outcome measures for astrogliosis and microgliosis derived from the entire white matter.A spectrum of WMI was observed that ranged from diffuse non-necrotic lesions to more severe injury that comprised discrete foci of microscopic or macroscopic necrosis. Residual arterial pressure, oxygen content and blood glucose displayed a significant inverse association with WMI and lactate concentrations were directly related. Elevated glucose levels were the most significantly associated with less severe WMI.Our results suggest that under conditions of hypoxemia and severe cephalic hypotension, WMI severity measured using unbiased immunohistochemical measurements correlated with several physiologic parameters, including glucose, which may be a useful marker of fetal response to hypoxia or provide protection against energy failure and more severe WMI.

Estuary wader capacity following severe weather mortality

International Nuclear Information System (INIS)

Clark, J.A.; Baillie, S.R.; Clark, N.A.; Langston, R.H.W.

1993-01-01

The building of a tidal power barrage across an estuary may lead to substantial changes in its ecology. Many of Britain's estuaries hold internationally important numbers of waders. Careful consideration, therefore, needs to be given to the likely effects of tidal power barrages on wader populations. The opportunity for increased understanding of the mechanisms which govern wader populations was provided by a period of severe winter weather in 1991, which resulted in a substantial mortality of waders in eastern England. Such conditions are known to be stressful to birds and the study objectives were to investigate both the effects of and recovery from severe weather. (author)

Dronabinol in severe, enduring anorexia nervosa

DEFF Research Database (Denmark)

Andries, Alin; Frystyk, Jan; Flyvbjerg, Allan

2014-01-01

The evidence for pharmacological treatment of severe, longstanding anorexia nervosa (AN) is sparse and the few controlled pharmacologic studies have focused on a narrow range of drugs. The aim of the present study was to investigate the effects of treatment with a synthetic cannabinoid agonist...

Cyclosporine treatment of severe Hidradenitis suppurativa

DEFF Research Database (Denmark)

Anderson, Marianne D; Zauli, Stefania; Bettoli, Vincenzo

2016-01-01

Background: Hidradenitis suppurativa (HS) is an overlooked but common disease severely affecting both genders. HS is generally perceived as difficult to treat and although a number of treatments are available, the need for more effective treatment is apparent. Objectives: Cyclosporine A (CsA) has...

Severe aortic valve stenosis and nosebleed

NARCIS (Netherlands)

Schoedel, Johannes; Obergfell, Achim; Maass, Alexander H.; Schodel, Johannes

2007-01-01

Aortic valve stenosis is known to be associated with loss of high molecular von Willebrand multimers. This can lead to gastrointestinal bleeding in patients with gastrointestinal angiodysplasia, the Heyde syndrome. Here we present a case of anaemia and severe epistaxis associated with acquired von

Event-based prospective memory in mildly and severely autistic children.

Science.gov (United States)

Sheppard, Daniel P; Kvavilashvili, Lia; Ryder, Nuala

2016-01-01

There is a growing body of research into the development of prospective memory (PM) in typically developing children but research is limited in autistic children (Aut) and rarely includes children with more severe symptoms. This study is the first to specifically compare event-based PM in severely autistic children to mildly autistic and typically developing children. Fourteen mildly autistic children and 14 severely autistic children, aged 5-13 years, were matched for educational attainment with 26 typically developing children aged 5-6 years. Three PM tasks and a retrospective memory task were administered. Results showed that severely autistic children performed less well than typically developing children on two PM tasks but mildly autistic children did not differ from either group. No group differences were found on the most motivating (a toy reward) task. The findings suggest naturalistic tasks and motivation are important factors in PM success in severely autistic children and highlights the need to consider the heterogeneity of autism and symptom severity in relation to performance on event-based PM tasks. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prevalence of celiac disease in patients with severe food allergy.

Science.gov (United States)

Pillon, R; Ziberna, F; Badina, L; Ventura, A; Longo, G; Quaglia, S; De Leo, L; Vatta, S; Martelossi, S; Patano, G; Not, T; Berti, I

2015-10-01