Andeweg, Caroline S.; Mulder, Irene M.; Felt-Bersma, Richelle J. F.; Verbon, Annelies; van der Wilt, Gert Jan; van Goor, Harry; Lange, Johan F.; Stoker, Jaap; Boermeester, Marja A.; Bleichrodt, Robert P.
The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. A multidisciplinary working group, representing experts of relevant specialties, was
Choi, Christine S; Koltun, Walter A; Hollenbeak, Christopher S
Although right-sided diverticulitis is perceived to have a higher incidence among Asians and infrequently requires surgical management in comparison with sigmoid diverticulitis, it is unknown whether differences in outcomes are due to ethnic disparity or disease pathophysiology. The aim of this study was to determine the surgical outcomes for Asian and non-Asian patients with diverticulitis who underwent colectomy. Patients identifiable by ethnicity in the Nationwide Inpatient Sample with diverticulitis and colectomy between 2004 and 2010 were included. Univariate comparisons were made between Asian and non-Asian patients by using t tests for continuous variables and χ tests for categorical variables. Propensity score matching analysis was performed to compare Asian patients with otherwise similar non-Asian patients. Included were 58,142 non-Asian and 335 Asian patients with diverticulitis who underwent a colectomy. The primary outcomes were in-hospital mortality, hospital length of stay, and total costs. Asian patients were younger (56.1 vs. 59.2 years, p ethnicity variable was not uniformly collected by all states within the Nationwide Inpatient Sample database. Among patients undergoing a colectomy for diverticulitis, a higher mortality was observed in Asian patients and right-sided disease. Future longitudinal studies comparing the natural history and outcomes of management between right- and left-sided diverticulitis are necessary to investigate whether a true ethnic disparity exists.
Ayantunde Abraham A
Full Text Available Abstract Solitary caecal diverticulum is an uncommon entity and therefore difficult to diagnose except at surgery. Caecal diverticulitis is an infrequent cause of acute abdomen and usually presents in a manner similar to acute appendicitis. It is extremely difficult to differentiate it preoperative from acute appendicitis and such distinction is usually made in the operating room. The optimal management of this clinical condition is still controversial, ranging from conservative treatment with antibiotics to aggressive surgical resections. We report a case of a 61 year old Caucasian who presented with acute onset right iliac fossa pain indistinguishable from acute appendicitis. The true diagnosis of a perforated acute caecal diverticulitis with an abscess mass was only made at operation in the presence of a macroscopically normal appendix. We reviewed the literature to highlight the difficulty of a preoperative diagnosis and the need for a high index of suspicion especially in the older age group presenting in manner similar to acute appendicitis.
Dana A. Telem
Full Text Available We present the case of a 52-year-old female with recurrent symptomatic ascending colon diverticulitis who ultimately underwent elective laparoscopic right hemicolectomy. The following is a case report and literature review pertaining to right colonic diverticular disease.
Yoon, Hoi Soo; Kim, Young Hoon; Kim, Joung Sook; Cho, Woo Ho; Lim, Sung Jig; Lee, Jin Ho; Kim, Young Duk; Cha, Soon Joo
To evaluate ultrasonographic (US) findings of right-side colonic diverticulitis and to correlate them with pathologic findings. Twenty nine patients with surgically (n=7) and radiographically (n=8) proven diverticulitis in the cecum and ascending colon for the past five years were included in this study, and they all underwent US due to right lower quadrant abdominal pain. US findings were analyzed by two radiologists with a special emphasis on: (1) the presence, size, and internal echo of hypoechoic lesion bulging out from the colonic wall (thickened diverticulum), (2) changes in the adjacent cecum and ascending colon, (3) changes in the adjacent mesentery, (4) accompanying fluid collection, and (5) the presence of lymphadenopathy. US finding of 18 surgically proven patients were correlated with pathologic findings. On US, 25 of 29 patients (86.2%0 were found to have thicken diverticulum with the greater dimension of 8-20 mm (mean,, 12 mm). Wall thickening of the adjacent cecum and ascending colon was seen in 28 patients (96.5%), and 22 (75.9%) of them had eccentrically thickened wall. Comparing US findings with pathologic findings in 18 surgically proven patients, all revealed to have inflamed diverticulum on surgery, but only 15 showed thickened diverticulum on US. In 12 patients, fecalith, purulent exudates, and hemorrhage were found within diverticulum on surgery. In case of diverticulitis containing fecalith, all of their echogenecities were increased. All patients showed wall thickening of the adjacent colon and increased echogenecity of the adjacent mesentery on US. Pathologic findings of these thickened walls contained nonspecific inflammatory change and hemorrhage while the mesentery with an increased echogenecity contained purulent or hemorrhagic exudates. Ultrasonography can diagnose the right-side colonic diverticulitis when there is the presence of thickened diverticulum in the area with the thickened right side colonic wall in patients with right
Fidan, Nurdan; Mermi, Esra Ummuhan; Acay, Mehtap Beker; Murat, Muammer; Zobaci, Ethem
Jejunal diverticulosis is a rare, usually asymptomatic disease. Its incidence increases with age. If symptomatic, diverticulosis may cause life-threatening acute complications such as diverticulitis, perforation, intestinal hemorrhage and obstruction. In this report, we aimed to present a 67-year-old male patient with jejunal diverticulitis accompanying with abdominal pain and vomiting. A 67-year-old male patient complaining of epigastric pain for a week and nausea and fever for a day presented to our emergency department. Ultrasonographic examination in our clinic revealed diverticulum-like images with thickened walls adjacent to the small intestine loops, and increase in the echogenicity of the surrounding mesenteric fat tissue. Contrast-enhanced abdominal computed tomography showed multiple diverticula, thickened walls with showing contrast enhancement and adjacent jejunum in the left middle quadrant, increased density of the surrounding mesenteric fat tissue, and mesenteric lymph nodes. The patient was hospitalized by general surgery department with the diagnosis of jejunal diverticulitis. Conservative intravenous fluid administration and antibiotic therapy were initiated. Clinical symptoms regressed and the patient was discharged from hospital after 2 weeks. In cases of diverticulitis it should be kept in mind that in patients with advanced age and pain in the left quadrant of the abdomen, diverticular disease causing mortality and morbidity does not always originate from the colon but might also originate from the jejunum
Laqmani, Azien; Dulz, Simon; Behzadi, Cyrus; Schmidt-Holtz, Jakob; Wassenberg, Felicia; Adam, Gerhard; Regier, Marc [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Veldhoen, Simon [University Medical Center Wuerzburg, Department of Diagnostic and Interventional Radiology, Wuerzburg (Germany); Derlin, Thorsten [Hannover Medical School, Department of Nuclear Medicine, Hannover (Germany); Sehner, Susanne [University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg (Germany); Nagel, Hans-Dieter [Scientific and Application-oriented Studies and Consulting in Radiology (SASCRAD), Buchholz (Germany)
To assess the effect of hybrid iterative reconstruction (HIR) and filtered back projection (FBP) on abdominopelvic CT with reduced-dose (RD-APCT) in the evaluation of acute left-sided colonic diverticulitis (ALCD). Twenty-five consecutive patients with suspected ALCD who underwent RD-APCT (mean CTDIvol 11.2 ± 4.2 mGy) were enrolled in this study. Raw data were reconstructed using FBP and two increasing HIR levels, L4 and L6. Two radiologists assessed image quality, image noise and reviewer confidence in interpreting findings of ALCD, including wall thickening, pericolic fat inflammation, pericolic abscess, and contained or free extraluminal air. Objective image noise (OIN) was measured. OIN was reduced up to 54 % with HIR compared to FBP. Subjective image quality of HIR images was superior to FBP; subjective image noise was reduced. The detection rate of extraluminal air was higher with HIR L6. Reviewer confidence in interpreting CT findings of ALCD significantly improved with application of HIR. RD-APCT with HIR offers superior image quality and lower image noise compared to FBP, allowing a high level of reviewer confidence in interpreting CT findings in ALCD. HIR facilitates detection of ALCD findings that may be missed with the FBP algorithm. (orig.)
Tan, Ker-Kan; Wong, Jiayi; Sim, Richard
Data highlighting the long-term outcome following an initial episode of right-sided colonic diverticulitis is lacking. This study aims to evaluate and follow up on all patients with right-sided colonic diverticulitis. A retrospective review of all patients who were discharged with a diagnosis of right-sided colonic diverticulitis from January 2003 to April 2008 was performed. A total of 226 patients, with a median age of 49 (range, 16-93) years, were admitted for acute right-sided colonic diverticulitis. The majority of the patients (n = 198, 87.6 %) had mild diverticulitis (Hinchey Ia and Ib). Seventy-three (32.3 %) patients underwent emergency surgery. The indications of surgery were predominantly suspected appendicitis (n = 50, 22.1 %) and perforated diverticulitis (n = 16, 7.1 %). Right hemicolectomy was performed in 32 (43.8 %) patients, while appendectomy, with or without diverticulectomy, was performed in the rest (n = 41, 56.2 %). There were seven patients who underwent elective right hemicolectomy after their acute admissions.Over a median duration of 64 (12-95) months, there were only nine patients who were readmitted 12 times for recurrent diverticulitis at a median duration of 17 (1-48) months from the index admission. The freedom from failure (recurrent attacks or definitive surgery (right hemicolectomy)) at 60 months was 92.0 % (95 % Confidence interval 86.1 %-97.9 %). Right-sided diverticulitis is commonly encountered in the Asian population and often gets misdiagnosed as acute appendicitis. If successfully managed conservatively, the long-term outcome is excellent.
Kyle W. Meinke
Full Text Available Clinical infection with Prototheca species can present in many ways including cutaneous, bursal, or disseminated forms. Of these clinical forms, protothecal intestinal infections are a very rare occurrence, and there have only been a few documented cases within the medical literature. We present a case of a 67 year old African American male who presented to our veterans hospital with bowel obstruction. The patient has a pertinent medical history of prolonged immunosuppressive therapy for cadaveric renal transplant, Clostridium difficile infection, herpetic perirectal ulcer, and diverticulosis. The patient presented with symptoms of weight loss, left lower quadrant pain, and pencil thin stool. Colonoscopic and barium studies confirmed a complete obstruction at the level of the distal descending colon. Carcinoembryonic levels were within normal limits. The patient underwent a left hemicolectomy, and gross examination of the specimen revealed a markedly thickened bowel wall with multiple diverticula. Histologic examination revealed diverticular disease with associated transmural inflammation and numerous associated dark round structures. The basophilic round structures appeared to contain cell walls and stained positively for fungal stains. Overall, the diagnosis of Prototheca zopfii was made based on the characteristic histopathologic features and the results of the fungal staining pattern. To our knowledge, this is the first reported case of a colonic diverticulitis with involvement by Prototheca zopfii. We present an overview of the biology, epidemiology, histopathologic features, clinical manifestations, and treatment options of Prototheca as it relates to our patient.
Sanchez, E.; Martin, S.; Garcia, J.; Dominguez, A.
Duodenal diverticular occur very frequently among the general public. However, duodenal diverticulitis is a very uncommon clinical entity, the diagnosis of which requires radiological studies since the clinical signs cam mimic a great number of disease processes with different treatments. We present a case of duodenal diverticulitis in which the diagnosis according to ultrasound and computed tomography (CT) studies was confirmed intraoperatively. We also review the few cases of this entity reported in the literature. The CT findings are highly suggestive of duodenal diverticulitis given their similarity to those associated with diverticulitis at other sites. (Author) 5 refs,
Full Text Available We report a case of a 71-year-old female who presented with right lower quadrant (RLQ abdominal pain and was diagnosed on CT scan with right-sided diverticulitis with perforation. She was admitted under the surgical service after consultation and received intravenous fluids, intravenous antibiotics, and pain medications as needed. The patient was discharged 2 days after admission in stable condition with follow-up with gastroenterology. The differential diagnosis of right lower quadrant abdominal pain is vast. Right-sided diverticulitis often presents in a manner similar to appendicitis. In the absence of peritonitis, conservative treatment may be possible. It is predictable that as the population ages, the incidence of right-sided diverticular disease will increase and will result in more presentations of acute right-sided diverticulitis to the emergency department (ED. The aim of this case report is to increase awareness of the incidence, pathophysiology, presentation, work-up (laboratory studies and imaging, and management (medical and surgical of right-sided diverticulitis among emergency physicians.
Full Text Available Diverticular disease of the colon is a disease that mainly affects the elderly and presents in 50–70% of those aged 80 years or older. The most common complication is colonic diverticulitis. Eighty percent of patients who present with colonic diverticulitis are aged 50 years and older. Diagnosis and treatment of colonic diverticulitis in the elderly is more difficult and complicated owing to more comorbid conditions. Computed tomography is recommended for diagnosis when colonic diverticulitis is suspected. Most patients admitted with acute colonic diverticulitis respond to conservative treatment, but 15–30% of patients require surgery. Because surgery for acute colonic diverticulitis carries significant rates of morbidity and mortality, conservative treatment is recommended in the elderly. Conservative treatment of colonic diverticulitis with antibiotics, bowel rest, possibly including parenteral alimentation, is usually applied for 1–2 weeks. In the absence of a response to conservative treatment, frequent recurrence or complications (abscesses, fistulas, bowel obstructions, and free perforations, surgery is indicated.
Shabanzadeh, Daniel M; Wille-Jørgensen, Peer
Diverticulitis is an inflammatory complication to the very common condition diverticulosis. Uncomplicated diverticulitis has traditionally been treated with antibiotics with reference to the microbiology, extrapolation from trials on complicated intra-abdominal infections and clinical experience....
Full Text Available Non-Meckel small intestine diverticulitis can have many manifestations and its management is not well-defined. We report 4 unselect cases of small intestine diverticulitis; all patients were seen by the same physician at the Emergency Center at The University of Texas MD Anderson Cancer Center between 1999 and 2014. The median age at diagnosis of these patients was 82 years (range, 76–87 years. All 4 patients presented with acute onset of abdominal pain, and computed tomography scans showed characteristics of small intestine diverticulitis unrelated to cancer. Most of the diverticula were found in the region of the duodenum and jejuno-ileal segments of the small intestine. The patients, even those with peripancreatic inflammation and localized perforation, were treated conservatively. Non-Meckel diverticulitis can be overlooked in the initial diagnosis because of the location of the diverticulosis, the age of the patient, and the rarity of the disease. Because patients with non-Meckel small intestine diverticulitis can present with acute abdominal pain, non-Meckel small intestine diverticulitis should be considered in the differential diagnosis of patients with acute abdominal pain, and computed tomography scans can help identify the condition. Because of the rarity of non-Meckel small intestine diverticulitis, few studies have been published, and the data are inconclusive about how best to approach these patients. Our experience with these 4 elderly patients indicates that non-Meckel small intestine diverticulitis can be treated conservatively, which avoids the potential morbidity and mortality of a surgical approach.
Full Text Available Sean T Martin, Luca StocchiDepartment of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USAAbstract: Sigmoid diverticulitis is a common benign condition which carries significant morbidity and socioeconomic burden. This article describes the management of sigmoid diverticulitis with a focus on indications for surgical intervention. The mainstay of management of uncomplicated diverticulitis is broad-spectrum antibiotic therapy. The old surgical dictum that two episodes of sigmoid diverticulitis warranted surgical intervention has been challenged by recently published data. Surgery for diverticulitis thus needs to be tailored to suit individual presentation; patients presenting with recurrent diverticulitis, severe symptoms or debilitating disease impacting patient's quality of life mandate surgical intervention. Complicated diverticular disease typically prompts intervention to resect a diseased, strictured sigmoid colon, fistulizing disease, or a life-threatening colonic perforation. Laterally, minimally invasive surgery has been utilized in the management of this disease and recent data suggests that localized colonic perforation may be managed by laparoscopic peritoneal lavage, without resection. This review focuses discussion on available evidence for contemporary surgical and nonoperative management of diverticulitis.Keywords: sigmoid diverticulitis, colon, laparoscopic peritoneal lavage, surgical intervention
Ahmet Fikret Yücel,
Full Text Available Objective: We aimed to present our treatment approach and results of the treatment in patients with the diagnosis of sigmoid diverticulitis. Material and Methods: In this study, we evaluated patients who presented to the emergency unit between March 2009 and February 2010 and have been diagnosed with sigmoid diverticulitis. The data were prospectively collected and retrospectively analyzed. Our patients were classified and staged according to Hinchey’s classification system. The results of the treatment, complication rates, and duration of hospitalization were presented in the light of the literature. Results: Thirteen patients (9 males, 4 females with a mean age of 52 years and median age of 58 (35-58 years were diagnosed with sigmoid diverticulitis. Five patients underwent laparotomy (Hinchey III-IV, while Hartmann’s procedure was carried out in 4 patients and resection and primer anastomosis was performed in 1 patient. Eight patients who were classified as Hinchey I-II (diverticulitis-abscess were followed up with medical treatment. The mean duration of hospitalization was 8.6 (4-21 days and 17.4 (10-27 days days in Hinchey I-II and III-IV groups, respectively. All patients in the laparotomy group developed at least one complication. Conclusion: Hinchey stage III-IV sigmoid diverticulitis requires laparotomy. Complication rates are higher and duration of hospitalization is longer in patients with Hinchey stage III-IV when compared to those with Hinchey I-II. We conclude that Hinchey stage I-II diverticulitis can be successfully managed with medical treatment. (The Me di cal Bul le tin of Ha se ki 2012; 50: 21-4
Martin, Sean T; Stocchi, Luca
Sigmoid diverticulitis is a common benign condition which carries significant morbidity and socioeconomic burden. This article describes the management of sigmoid diverticulitis with a focus on indications for surgical intervention. The mainstay of management of uncomplicated diverticulitis is broad-spectrum antibiotic therapy. The old surgical dictum that two episodes of sigmoid diverticulitis warranted surgical intervention has been challenged by recently published data. Surgery for diverticulitis thus needs to be tailored to suit individual presentation; patients presenting with recurrent diverticulitis, severe symptoms or debilitating disease impacting patient’s quality of life mandate surgical intervention. Complicated diverticular disease typically prompts intervention to resect a diseased, strictured sigmoid colon, fistulizing disease, or a life-threatening colonic perforation. Laterally, minimally invasive surgery has been utilized in the management of this disease and recent data suggests that localized colonic perforation may be managed by laparoscopic peritoneal lavage, without resection. This review focuses discussion on available evidence for contemporary surgical and nonoperative management of diverticulitis. PMID:22016581
Rossini, S.A.; Gonzalez Villaveiran, R.F.; Merola, S.
Objective: The evaluation of the usefulness of helical computed tomography (HCT) in the diagnosis and therapeutic management of the acute diverticulitis. Materials and methods: Six months retrospective cohort study of 100 patient population clinically suspected of diverticulitis was carried out. The exams were made with oral and intravenous contrast unless the patient presented contraindications. A correlation of these studies with the therapeutic response and clinical follow up was done with surgery and histopathology. Results: From a total of 100 patients studied, 62 presented tomographic diagnosis of diverticulitis, 41 were classified as simple diverticulitis and 21 were complicated cases (abscess, phlegmon, plastron, free perforation, vesicocolonic fistula and intestinal obstruction). In 24 patients an alternative diagnosis was made (appendicitis, appendagitis, urethral litiasis, colitis, salpingitis, pancreatitis, uraco cyst complication, colonic mechanical obstruction, colonic perforation with foreign body): 14 patients did not present tomographic findings to support the clinical symptoms, two of them were false-negative by the clinic and by the response to treatment. These data represented a sensibility of 96,87%, specificity of 100%, PPV of 100% and NPV of 94,7% and a certainty of 98 for the tomography diagnosis of acute diverticulitis. Of the 41 patients with tomographic diagnostic of not complicated diverticulitis, 37 received medical outpatient treatment and only 4 medical treatment with placement; of the 21 patients diagnosed with complicated diverticulitis, 18 were hospitalised with medical treatment and the other 3 patients needed surgery; of the 14 patients without tomographic findings of diverticulitis, in 12 outpatients an expectant conduct was followed and the other 2 received medical outpatient treatment. Conclusion: HCT is very useful and effective in diagnosis, evaluation and management of patients with clinical suspicion of diverticulitis
Chan, Dedrick Kok Hong; Tan, Ker-Kan
Diverticulitis in Asians is a different disease entity from Western counterparts. Few Asian studies have evaluated the management of acute Hinchey Ia diverticulitis with consideration for outpatient management. The purpose of this study was to evaluate the outcomes of Asian patients with Hinchey Ia acute diverticulitis. A retrospective review of all patients who were treated for Hinchey Ia acute colonic diverticulitis between 2012 and 2014 was performed. All patients were diagnosed on computed tomography (CT). There were 129 patients with Hinchey Ia acute diverticulitis. Fifty-five (42.6%) patients were male, and the median age was 54 years (range, 30-86). Eighty-seven (67.4%) patients had right-sided diverticulitis. Most patients were treated empirically with intravenous ceftriaxone and metronidazole (89.1%). They were then discharged with oral antibiotics. Only 6.1% of patients had a positive blood culture. The median length of stay in the hospital was 4 (range, 3-4) days. Only three (2.3%) patients were readmitted for acute diverticulitis within 30 days. They were managed with antibiotics and discharged well. The repeated CT scans reconfirmed Hinchey Ia diverticulitis. No patients required emergency surgery, and there were no 30-day mortalities. Asian patients with Hinchey Ia diverticulitis recovered well with conservative management and could be amenable to outpatient therapy. Future prospective studies should be performed amongst Asians to evaluate managing this condition in an ambulatory setting.
Jorge Eduardo Frías Espinosa
Full Text Available La diverticulitis cecal es una rara entidad de difícil diagnóstico que con frecuencia se confunde con un proceso apendicular agudo. Los divertículos primarios o de origen congénito, generalmente son únicos, suelen presentarse en una edad más temprana que la enfermedad diverticular cólica (divertículos secundarios.La presencia de estos en el colon derecho se reporta con menor frecuencia, su diagnóstico es en muchas ocasiones indistinguible de la apendicitis aguda y se realiza en la mayoría de los casos durante la laparotomía, el tratamiento es variable, según la literatura abarca desde la resección del divertículo hasta la hemicolectomía derecha. El objetivo de esta presentación es referir la dificultad diagnostica y la alta frecuencia de error diagnóstico que presenta esta entidad.The cecal diverticulitis is a strange disease, difficult to be diagnosed, frequently confused with acute appendicular process. The primary diverticula or those of congenital origin are generally unique; they usually appear at younger age than the colic diverticular disease (secondary diverticula. Their presence in the right colon is less frequently reported, the diagnosis is often confused with that of acute appendicitis and most of cases undergo laparatomy. According to the scientific literature, the treatment is variable, ranging from diverticular resection to right hemi-cholectomy. The objective of this paper was to present the difficulties and the high frequency of errors in diagnosing this disease.
Macari, M.; Faust, M.; Liang, H.; Pachter, H.L.
Aim: To describe the imaging findings of jejunal diverticulitis as depicted at contrast-enhanced computed tomography (CT) and review the differential diagnosis and clinical management. Materials and Methods: CT and pathology databases were searched for the diagnosis of jejunal diverticulitis. Three cases were identified and the imaging and clinical findings correlated. Results: Jejunal diverticulitis presents as a focal inflammatory mass involving the proximal small bowel. A trial of medical management with antibiotics may be attempted. Surgical resection may be required if medical management is unsuccessful. Conclusion: The imaging findings at MDCT may allow a specific diagnosis of jejunal diverticulitis to be considered and may affect the clinical management of the patient
Sasaki, Shigeru; Ohba, Satoru; Mizutani, Masaru
Although colonic diverticulitis has no indication for operation, but in some mistaken cases were operated with a diagnosis of acute appendicitis. We evaluated the CT findings of colonic diverticulitis about 19 cases and of asymptomatic colonic diverticula about 15 cases retrospectively. Diagnosis was confirmed of barium enema and operation. CT are complementary methods of examination that can delineated the range of thickening of the colon and the extension of inflammatory changes around the colon. We also believe that CT findings of colonic diverticulitis are useful for differentiating from a diagnosis of appendicitis. (author)
Isacson, Daniel; Andreasson, Kalle; Nikberg, Maziar; Smedh, Kenneth; Chabok, Abbas
The first randomized multicenter study evaluating the need for antibiotic treatment in patients with acute uncomplicated diverticulitis (AUD) could not demonstrate any benefit gained from antibiotic use. The aim of this study was to review the application of the no antibiotic policy and its consequences in regard to complications and recurrence. This retrospective population-based cohort study included all patients diagnosed with all types of colonic diverticulitis during the year 2011 at Västmanland Hospital Västerås, Sweden. All medical records were carefully reviewed. Primary outcomes were the types of treatment adopted for diverticulitis, complications and recurrence. In total, 246 patients with computer tomography-verified diverticulitis were identified, 195 with primary AUD and 51 with acute complicated diverticulitis. Age, sex, and temperature at admission were similar between the groups but there was a significant difference in white blood cell count, C-reactive protein, and length of hospital stay. In the AUD group, 178 (91.3%) patients were not treated with antibiotics. In this group, there were six (3.4%) readmissions but only two developed an abscess. Of the remaining 17 patients (8.7%) who were treated with antibiotics in the AUD group, one developed an abscess. Twenty-five (12.8%) patients in the AUD group presented with a recurrence within 1 year. The no-antibiotic policy for AUD is safe and applicable in clinical practice. The previous results of a low complication and recurrence rate in AUD are confirmed. There is no need for antibiotic treatment for AUD. What does this paper add to the literature? Despite published papers with excellent results, there are still doubts about patient safety against the policy to not use antibiotics in acute uncomplicated diverticulitis. This is the first paper, in actual clinical practice, to confirm that the no antibiotic policy for acute uncomplicated diverticulitis is applicable and safe.
Kagolanu, Deepthi Chaitanya; Subhani, Miral; Novick, Daniel; Rizvon, Kaleem
A 91-year-old African American man was admitted with sudden onset diffuse abdominal pain which radiated to the right flank. CT of the abdomen with contrast showed diverticula in the jejunum with adjacent inflammation and microperforation that was contained. Conservative therapy similar to colonic diverticulitis was effective. Although rare, our case highlights the importance of having an early and high suspicion for jejunal diverticulitis when patients present with non-specific abdominal symptoms in order to avoid perforation. © 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.
Huang, Chenxi; Alamili, Mahdi; Rosenberg, Jacob
BACKGROUND: The aim of the present study was to report the trajectory of heart rate variability (HRV) indices during a low-grade acute inflammation and their associations to biomarkers for infection. METHODS: Twelve patients with uncomplicated acute diverticulitis completed this observational study...
Oh, Kwang Hoon; Han, Koon Hee; Kim, Eun Jung; Lee, Je Hoon; Choi, Kyu Un; Han, Myung Sik; Ahn, Jae Hong; Cheon, Gab Jin
Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an epis...
Naves, Aline de Araujo; D' Ippolito, Giuseppe; Souza, Luis Ronan Marquez Ferreira; Borges, Silvia Portela; Fernandes, Glenio Moraes, E-mail: firstname.lastname@example.org [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil); Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, MG, (Brazil)
Acute diverticulitis of the colon is a common indication for computed tomography, and its diagnosis and complications are essential to determining the proper treatment and establishing the prognosis. The adaptation of the surgical classification for computed tomography has allowed the extent of intestinal inflammation to be established, the computed tomography findings correlating with the indication for treatment. In addition, computed tomography has proven able to distinguish among the main differential diagnoses of diverticulitis. This pictorial essay aims to present the computed tomography technique, main radiological signs, major complications, and differential diagnoses, as well as to review the classification of acute diverticulitis. (author)
Gorter-Stam, Marguerite Annelie Willemijn
Each year approximately 22,000 patients in the Netherlands are seen in the emergency department with suspected diverticulitis. This leads to an estimated 18,000 admissions a year with total estimated costs of 40 to 80 million euro per year. Diverticulitis is thus one of the most common and costly
Abraha, Iosief; Binda, Gian A; Montedori, Alessandro; Arezzo, Alberto; Cirocchi, Roberto
Diverticular disease is a common condition in Western industrialised countries. Most individuals remain asymptomatic throughout life; however, 25% experience acute diverticulitis. The standard treatment for acute diverticulitis is open surgery. Laparoscopic surgery - a minimal-access procedure - offers an alternative approach to open surgery, as it is characterised by reduced operative stress that may translate into shorter hospitalisation and more rapid recovery, as well as improved quality of life. To evaluate the effectiveness of laparoscopic surgical resection compared with open surgical resection for individuals with acute sigmoid diverticulitis. We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 2) in the Cochrane Library; Ovid MEDLINE (1946 to 23 February 2017); Ovid Embase (1974 to 23 February 2017); clinicaltrials.gov (February 2017); and the World Health Organization (WHO) International Clinical Trials Registry (February 2017). We reviewed the bibliographies of identified trials to search for additional studies. We included randomised controlled trials comparing elective or emergency laparoscopic sigmoid resection versus open surgical resection for acute sigmoid diverticulitis. Two review authors independently selected studies, assessed the domains of risk of bias from each included trial, and extracted data. For dichotomous outcomes, we calculated risk ratios (RRs) with 95% confidence intervals (CIs). For continuous outcomes, we planned to calculate mean differences (MDs) with 95% CIs for outcomes such as hospital stay, and standardised mean differences (SMDs) with 95% CIs for quality of life and global rating scales, if researchers used different scales. Three trials with 392 participants met the inclusion criteria. Studies were conducted in three European countries (Switzerland, Netherlands, and Germany). The median age of participants ranged from 62 to 66 years; 53% to 64% were
Schwenter, Frank; Gervaz, Pascal; de Saussure, Philippe; McKee, Thomas; Morel, Philippe
In Crohn's disease, the extension of active terminal ileitis into a Meckel's diverticulum is possible, but usually has no impact on clinical decision-making. We describe an original surgical approach in a young woman presenting with a combination of perforated Meckel's diverticulitis and active Crohn's ileitis. We report the case of a 22-year-old woman with Crohn's disease, who was admitted for abdominal pain, fever and diarrhoea. CT scan demonstrated active inflammation of the terminal ileum, as well as a fluid collection in the right iliac fossa, suggesting intestinal perforation. Laparoscopy was performed and revealed, in addition to extensive ileitis, a 3 x 3 cm abscess in connection with perforated Meckel's diverticulitis. It was therefore possible to avoid ileocaecal resection by only performing Meckel's diverticulectomy; pathological examination of the surgical specimen revealed the presence of transmural inflammation with granulomas and perforation of the diverticulum at its extremity. Crohn's disease of the ileum may be responsible for Meckel's diverticulitis and cause perforation which, in this case, proved to be a blessing in disguise and spared the patient an extensive small bowel resection.
Full Text Available Appendiceal diverticulosis is a rare condition. Herein reported is a case of appendiceal diverticulosis and diverticulitis clinically masquerading as appendiceal carcinoma. A 62-year-old woman presented with abdominal pain. US and CT showed a tumor measuring 5 × 4 × 4 cm in vermiform appendix. Colon endoscopy showed mucosal elevation and irregularity in the orifice of vermiform appendix. A biopsy of the appendiceal mucosa showed no significant changes. Clinical diagnosis was appendiceal carcinoma and wide excision of terminal ileum, appendix, cecum, and ascending colon was performed. Grossly, the appendix showed a tumor measuring 5 × 3 × 4 cm. The appendiceal lumen was opened, and the appendiceal mucosa was elevated and irregular. The periappendiceal tissue showed thickening. Microscopically, the lesion was multiple appendiceal diverticula. The diverticula were penetrating the muscle layer. The mucosa showed erosions in places. Much fibrosis, abscess formations, and lymphocytic infiltration were seen in the subserosa. Abscesses were also seen in the diverticular lumens. Some diverticula penetrated into the subserosa. The pathologic diagnosis was appendiceal diverticulitis. When they encounter an appendiceal mass, clinicians should consider appendiceal diverticulitis as a differential diagnosis.
Ferstl, F.J.; Obert, R. [St. Theresienkrankenhaus Nuernberg (DE). Radiologisch-Nuklearmedizinisches Zentrum (RNZ)
Acute diverticulitis of the cecum and ascending colon, also called right-sided diverticulitis, represents a relatively rare disorder in the western hemisphere. Pseudodiverticula and, less frequently, solitary congenital diverticula are regarded as the underlying causes of acute diverticulitis. We report the helical CT findings in four patients with acute right-sided colonic diverticulitis. The CT was performed with a collimation of 8 mm, a pitch of 1.5 and an increment of 8 mm, and with variable administration of intravenous, oral and rectal contrast material. In two of the four patients, the acute diverticulitis was detected in the cecum and ascending colon, respectively. In two patients, the diagnosis could be confirmed during surgery and subsequent histologic examination of the resected specimen. On the initial CT studies, acute diverticulitis was correctly diagnosed in two patients and suspected in one patient without identifying and inflamed diverticulum. In one patient, the offending diverticulum in the ascending colon caused an inflammatory pseudotumor at the level of the ileocecal region. This process was initially mistaken as Crohn's disease. The CT diagnosis of a right-sided colonic diverticulitis is based on an inflamed diverticulum in the center of pericolic inflammatory changes and a preserved wall enhancement (target sign). Other CT findings, such as fatty pericolic infiltration and colon wall thickening, are rather non-specific and can also be found in a number of different ileocolic disorders, especially in colon cancer. In selected cases, the diagnosis can only be established by follow up CT after the pericolic infiltration has markedly subsided and an offending diverticulum has emerged. (orig.)
... the amount of high-fiber foods in the diet. Severe cases of diverticulitis, with acute pain and complications, will likely require a hospital stay. Most cases of severe diverticulitis are treated ...
Bhuket TP, Stollman NH. Diverticular disease of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 10th ed. Philadelphia, PA: Elsevier ...
Lee, Jong Hwa; Ham, Su Yeon; Whang, Kang Ik
The purpose of this study is to investigate the CT findings of acute right colonic diverticulitis, and to determine the difference between these and published reports describing left colonic, especially sigmoid, diverticulitis. Inflamed diverticula were visible in all cases, and were solitary. Nine cases occurred in the ascending colon and four in the cecum; in particular, eleven occurred around the ileocecal valve. In three cases, the inflamed diverticulum was less than 1 cm in diameter; in five cases, 1-2 cm; in three, 2-3 cm, and in two, 3-4 cm. These were able to be classified into two major forms. In three cases it was nodular with hyperattenuation and some inhomogeneity, and ten shows the target form with thick walls and a central cavity. In five of these target lesions, the wall pattern was partially or completely inhomogeneous, or multilayered. The material filling the central cavity were gas in five cases, fecalith in two, and fluid in three. Abnormal pericoloic fat infiltrations were seen in twelve cases (92%), segmental colonic wall thickening in eleven (85%), other not-inflamed diverticula in five (38%), mesenteric lymph node enlargement in three (23%), free pericecal fluid collection in three (23%), and perirenal fascial thickening in two (15%). The complications such as remote abscess cavity, colonic obstruction, fistula or perforation were not found. On barium colon study, diverticulitis was in all cases confirmed by the presence of barium in the deformed diversiculum. Among CT findings for acute right colonic diverticulitis, the most important and pathognomonic is inflamed diverticula; the forms of these vary, and include gangrenous diverticulitis. The CT findings of early right colonic diverticulitis in Koreans might not, however, reveal the complications which sigmoid diverticulitis frequently involves; in patients with right lower quadrant pain imaging studies are performed promptly, and for the mesentery, the anatomical base between right and
Pandeva, Ivilina; Kumar, Sumit; Alvi, Atif; Nosib, Hema
Introduction. Meckel's diverticulitis is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation tends to be rather unusual and therefore commonly delaying diagnosis. The surgical method of exploration can be either by laparoscopy or through an open incision. Case Report. We report a case of a 34-year-old, P1 with previous Caesarean section, who presented at 20 weeks with worsening right-sided abdominal pain, distention, and peritonism. Ultrasound scan showed an area of a possibly thickened loop of bowel inconsistent with an appendicitis. The findings at laparoscopy were purulent fluid in the pelvis, a congested appendix, and inflamed Meckel's diverticulum. An appendectomy and excision of the diverticulum was performed using stapler technique. Discussion. Meckel's diverticulitis in pregnancy can have nonspecific presentation and poses difficulties for preoperative diagnosis. Delay in diagnosis and management poses significant maternal and fetal risks. The use of laparoscopy if the gestational age and uterine size permit its use allows a thorough exploration of the abdominal cavity and management of rarer and unexpected pathology. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective.
Full Text Available Introduction. Meckel’s diverticulitis is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation tends to be rather unusual and therefore commonly delaying diagnosis. The surgical method of exploration can be either by laparoscopy or through an open incision. Case Report. We report a case of a 34-year-old, P1 with previous Caesarean section, who presented at 20 weeks with worsening right-sided abdominal pain, distention, and peritonism. Ultrasound scan showed an area of a possibly thickened loop of bowel inconsistent with an appendicitis. The findings at laparoscopy were purulent fluid in the pelvis, a congested appendix, and inflamed Meckel’s diverticulum. An appendectomy and excision of the diverticulum was performed using stapler technique. Discussion. Meckel’s diverticulitis in pregnancy can have nonspecific presentation and poses difficulties for preoperative diagnosis. Delay in diagnosis and management poses significant maternal and fetal risks. The use of laparoscopy if the gestational age and uterine size permit its use allows a thorough exploration of the abdominal cavity and management of rarer and unexpected pathology. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective.
Francisco Javier Medina-Fernández
Full Text Available Colonic diverticular disease is a chronic disorder presenting with a variety of abdominal symptoms and recurrent episodes of acute diverticulitis. It is close linked to age so its prevalence has risen notably during the last decades in western countries, increasing costs related to medical attention. Recently, several works have provided evidence to a series of measures that could improve the outcomes as well as reduce expenses associated to this process. The aim of the present review is to expose a view of the new trends in the management of diverticulitis and colonic diverticular disease, based on the highest clinical evidence available.
A 70-year-old woman presented with clinical features of right heart failure. Cardiopulmonary investigations included an echocardiogram, which showed a hepatic cyst compromising venous return and affecting right atrial filling and a CT abdomen showed a 15.5 x 11.5 cm-cystic mass involving the right hepatic lobe and compressing the right atrium. Percutaneous drainage of the cyst was performed. This led to complete resolution of symptoms but these recurred as the fluid re-accumulated. Subsequent definitive treatment with excision of the cyst was undertaken with symptomatic cure. This case is the first report of a hepatic cyst presenting as right heart due to compression of the right atrium.
Ünlü, Çagdas; Gunadi, Patrick M.; Gerhards, Michael F.; Boermeester, Marja A.; Vrouenraets, Bart C.
Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment
Agarwal, Amit K; Karanjawala, Burzeen E; Maykel, Justin A; Johnson, Eric K; Steele, Scott R
Diverticular disease incidence is increasing up to 65% by age 85 in industrialized nations, low fiber diets, and in younger and obese patients. Twenty-five percent of patients with diverticulosis will develop acute diverticulitis. This imposes a significant burden on healthcare systems, resulting in greater than 300000 admissions per year with an estimated annual cost of $3 billion USD. Abdominal computed tomography (CT) is the diagnostic study of choice, with a sensitivity and specificity greater than 95%. Unfortunately, similar CT findings can be present in colonic neoplasia, especially when perforated or inflamed. This prompted professional societies such as the American Society of Colon Rectal Surgeons to recommend patients undergo routine colonoscopy after an episode of acute diverticulitis to rule out malignancy. Yet, the data supporting routine colonoscopy after acute diverticulitis is sparse and based small cohort studies utilizing outdated technology. While any patient with an indication for a colonoscopy should undergo appropriate endoscopic evaluation, in the era of widespread use of high-resolution computed tomography, routine colonic endoscopic evaluation following resolution of acute uncomplicated diverticulitis poses additional costs, comes with inherent risks, and may require further study. In this manuscript, we review the current data related to this recommendation. PMID:25253951
Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob
with antibiotics and laparoscopic lavage. Conversion to laparotomy was made in six (3%) patients and the mean hospital stay was nine days. Ten percent of the patients had complications. During the mean follow-up of 38 months, 38% of the patients underwent elective sigmoid resection with primary anastomosis....... CONCLUSION: Primary laparoscopic lavage for complicated diverticulitis may be a promising alternative to more radical surgery in selected patients. Larger studies have to be made before clinical recommendations can be given....
postoperative day 6. DISCUSSION Diverticuli of the right colon exist in approximately 1% to 5% of patients with diverticular disease .1-3 They are...ORIGINAL REPORTS Perforated Solitary Diverticulitis of the Ascending Colon CPT David S. Kauvar, MC, USA, MAJ, Jayson Aydelotte, MC, USA, and MAJ...Michael Harnisch, MC, USA Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas KEY WORDS: solitary colon diverticulum
Oeistaemoe, Emma; Hjern, Fredrik; Abraham-Nordling, Mirna [Dept. of Clinical Sciences, Div. of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm (Sweden)], e-mail: email@example.com; Blomqvist, Lennart [Dept. of Diagnostic Radiology, Dept. of Molecular Medicine and Surgery Karolinska Univ. Hospital Solna and Karolinska Institutet, Stockholm (Sweden); Von Heijne, Anders [Dept. of Clinical Sciences, Div. of Radiology, Danderyd Hospital, Karolinska Institutet, Stockholm (Sweden)
Background: Both colon cancer and diverticular disease are common in the Western world. A challenge when patients present with clinical findings is that both diseases can present with symptoms that may mimic the other. Purpose: To determine whether magnetic resonance imaging (MRI) could be helpful to differentiate between diverticulitis and cancer of the sigmoid colon compared to the differentiation offered by evaluation of multidetector computed tomography (CT) in a clinical situation. Material and Methods: Thirty patients were consecutively included. Fifteen patients were under work-up for a recently diagnosed sigmoid cancer and 15 patients had recently been treated in hospital due to first-time acute sigmoid diverticulitis. All patients underwent CT, T2- weighted MRI and diffusion-weighted MRI. Anonymized examinations were retrospectively presented in random order to one experienced radiologist. Results: With contrast-enhanced CT, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 66.7% (10/15) and 93.3% (14/15), respectively. Using T2-weighted and diffusion-weighted MR images, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 100% (14/14) and 100% (14/14), respectively. Conclusion: MRI provides information that may contribute to improve the differentiation between sigmoid cancer and diverticulitis that is offered by CT. These encouraging results need to be confirmed in a larger study.
Oeistaemoe, Emma; Hjern, Fredrik; Abraham-Nordling, Mirna; Blomqvist, Lennart; Von Heijne, Anders
Background: Both colon cancer and diverticular disease are common in the Western world. A challenge when patients present with clinical findings is that both diseases can present with symptoms that may mimic the other. Purpose: To determine whether magnetic resonance imaging (MRI) could be helpful to differentiate between diverticulitis and cancer of the sigmoid colon compared to the differentiation offered by evaluation of multidetector computed tomography (CT) in a clinical situation. Material and Methods: Thirty patients were consecutively included. Fifteen patients were under work-up for a recently diagnosed sigmoid cancer and 15 patients had recently been treated in hospital due to first-time acute sigmoid diverticulitis. All patients underwent CT, T2- weighted MRI and diffusion-weighted MRI. Anonymized examinations were retrospectively presented in random order to one experienced radiologist. Results: With contrast-enhanced CT, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 66.7% (10/15) and 93.3% (14/15), respectively. Using T2-weighted and diffusion-weighted MR images, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 100% (14/14) and 100% (14/14), respectively. Conclusion: MRI provides information that may contribute to improve the differentiation between sigmoid cancer and diverticulitis that is offered by CT. These encouraging results need to be confirmed in a larger study
Muradbegovic, Mirza; St-Amour, Pénélope; Martin, David; Petermann, David; Benabidallah, Samir; Di Mare, Luca
Abstract Rationale: Acute colonic diverticulitis is a well-known surgical emergency, which occurs in about 10 percent of patients known for diverticulosis. Patient concerns: The case of a 77-year-old woman is reported, with past history of abdominoperineal resection with end-colostomy for low rectal adenocarcinoma, and who developed an acute colonic diverticulitis in a subcutaneous portion of colostomy with parastomal phlegmon. Diagnoses: Initial computed tomography imaging demonstrated a significant submucosal parietal edema with local fat tissues infiltration in regard of 3 diverticula. Interventions: A two-step treatment was decided: first a nonoperative treatment was initiated with 2 weeks antibiotics administration, followed by, 6 weeks after, a segmental resection of the terminal portion of the colon with redo of a new colostomy by direct open approach. Outcomes: Patient was discharged on the second postoperative day without complications. Follow-up at 2 weeks revealed centimetric dehiscence of the stoma, which was managed conservatively until sixth postoperative week by stomatherapists. Lessons subsections: Treatment of acute diverticulitis with parastomal phlegmon in a patient with end-colostomy could primary be nonoperative. Delayed surgical treatment with segmental colonic resection was proposed to avoid recurrence and potential associated complications. PMID:29069019
Lohrmann, Christian; Ghanem, Nadir; Pache, Gregor; Makowiec, Frank; Kotter, Elmar; Langer, Mathias
Background: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. Methods: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification. Results: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. Conclusions: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning
Ferstl, F.J.; Obert, R. [Radiologisch-Nuklearmedizinisches Zentrum (RNZ) am St. Theresienkrankenhaus Nuernberg (Germany)
Small bowel diverticulitis is a rare cause of an acute abdomen. Originating from acquired diverticula of the jejunum, less often of the ileum, or Meckel diverticulum, the symptoms are non-specific, simulating other acute inflammatory disorders, such as appendicitis, cholecystitis or colonic diverticulitis. The diagnosis of small bowel diverticulitis is solely based on radiologic findings, with computed tomography (CT) regarded as the method of choice. In recent years, a number of case reports have described the spectrum of the CT features in acute small bowel diverticulitis and its dependence on the severity of the inflammatory process. Typical findings are an inflamed diverticulum, inflammatory mesenteric infiltration, extraluminal gas collection and mural edema of adjacent small bowel loops with resultant separation of bowel loops. An enterolith is rarely found in an inflamed diverticulum. Complications include abscesses, fistulae, small bowel obstruction and free perforation with peritonitis. Small bowel diverticulitis can be a diagnostic problem if it involves the terminal ileum or Meckel's diverticulum. For preoperative confirmation of the presumed diagnosis of small bowel diverticulitis on CT, an enteroclysis for acquired diverticula or a technetium scan for Meckel's diverticulum should be performed. We present the CT findings in three patients of acute small bowel diverticulitis, two affecting the jejunum and one a Meckel's diverticulum. (orig.) [German] Die akute Duenndarmdivertikulitis ist eine seltene Ursache eines akuten Abdomens. Ausgehend von den erworbenen Divertikeln des Jejunums, seltener des Ileums, oder von einem Meckel-Divertikel, manifestiert sich die Divertikulitis klinisch durch eine unspezifische Symptomatik, die zuerst an die haeufigeren, akutentzuendlichen Erkrankungen des Abdomens wie z. B. Appendizitis, Cholezystitis oder Kolondivertikulitis denken laesst. Die Duenndarmdivertikulitis kann praeoperativ nur durch
Daniels, L.; Budding, A. E.; de Korte, N.; Eck, A.; Bogaards, J. A.; Stockmann, H. B.; Consten, E. C.; Savelkoul, P. H.; Boermeester, M. A.
Disease-specific variations in intestinal microbiome composition have been found for a number of intestinal disorders, but little is known about diverticulitis. The purpose of this study was to compare the fecal microbiota of diverticulitis patients with control subjects from a general
Full Text Available Introduction Small bowel diverticulitis is a rare clinical disease of the small bowel. The incidence of small bowel diverticulitis varies from 0.3 to 2.3 % in the general population. Complications of this rare clinical entity are often confused with other causes of acute abdomen such as acute appendicitis, perforated peptic ulcer, inflammatory bowel disease or ischemic bowel disease. Case Presentation We describe a 65-year-old male with a history of ileal diverticulosis who presented with acute abdomen and was subsequently found to have perforated ileal diverticulitis with abscess formation. Conclusions The case, differential diagnosis, imaging studies, complications and management of this rare clinical disease are discussed.
Full Text Available Even though the incidence of toxic epidermal necrolysis (TEN is low, it is also associated with a high mortality rate. The condition predominantly affects the skin, but may also affect the gastrointestinal tract, dramatically increasing mortality. We present a case of perforated sigmoid diverticulitis in the presence of TEN. The patient was taking medication, known to be a risk factor, and presented an affected total body surface area and temporal development similar to previously reported cases of TEN. Characteristic abdominal symptoms, however, were missing. Gastrointestinal involvement in TEN appears to be a poor prognostic factor; medical staff must therefore be alert to patients with TEN who complain of abdominal discomfort. The exact pathogenesis, however, remains unclear.
Kim, Ji Hyun; Kim, Min Jeong; Ha, Hong Il; Lee, Kwan Seop; Min, Soo Kee [Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)
Endometriosis is defined as the presence of ectopic endometrial tissue outside the uterus. It is a common disease in menstruating females and intestinal involvement is not uncommon. Intestinal endometriosis most commonly involves the sigmoid colon, rectum, ileum, appendix, and cecum. However, the descending colon is a rare site of intestinal endometriosis. Although computed tomography (CT) findings of bowel endometriosis have been presented in several articles, there has been no report describing the CT findings of descending colon endometriosis above the pelvic cavity. Here, we report a rare case of descending colon endometriosis located in the retroperitoneal space, in which the initial impression was acute colonic diverticulitis with a small abscess on preoperative multidetector CT.
Kim, Ji Hyun; Kim, Min Jeong; Ha, Hong Il; Lee, Kwan Seop; Min, Soo Kee
Endometriosis is defined as the presence of ectopic endometrial tissue outside the uterus. It is a common disease in menstruating females and intestinal involvement is not uncommon. Intestinal endometriosis most commonly involves the sigmoid colon, rectum, ileum, appendix, and cecum. However, the descending colon is a rare site of intestinal endometriosis. Although computed tomography (CT) findings of bowel endometriosis have been presented in several articles, there has been no report describing the CT findings of descending colon endometriosis above the pelvic cavity. Here, we report a rare case of descending colon endometriosis located in the retroperitoneal space, in which the initial impression was acute colonic diverticulitis with a small abscess on preoperative multidetector CT
Çağlar, Emrah; Arıbaş, Bilgin; Tiken, Ramazan; Keskin, Suat
In patients presenting with abdominal pain, appendicitis is the most common surgical disorder. Appendicitis causing pain in the left lower quadrant is extremely rare and can occur with congenital abnormalities that include true left-sided appendix or as an atypical presentation of right-sided long appendix, which projects into the left lower quadrant. We report a case of a 69-year-old man showing midgut malrotation with acute appendicitis presenting as left lower quadrant abdominal pain. PMID:24682135
Medina-Fernández, Francisco Javier; Díaz-Jiménez, Nélida; Gallardo-Herrera, Ana Belén; Gómez-Luque, Irene; Garcilazo-Arsimendi, Dimas Javier; Gómez-Barbadillo, José
Colonic diverticular disease is a chronic disorder presenting with a variety of abdominal symptoms and recurrent episodes of acute diverticulitis. It is close linked to age so its prevalence has risen notably during the last decades in western countries, increasing costs related to medical attention. Recently, several works have provided evidence to a series of measures that could improve the outcomes as well as reduce expenses associated to this process. The aim of the present review is to e...
Full Text Available The most common cause of massive hemorrhagic effusion is malignancy. Herein we present a case of dissecting aneurysm of descending thoracic aorta presenting initially with shortness of breath due to left sided massive pleural effusion. Effusion was hemorrhagic in nature with high hematocrit value. CT scan of thorax with CT angiogram was done and that revealed the diagnosis.
Full Text Available Purpose. In the study presented, preoperative examinations and surgical methods were discussed along with literature, regarding two cases who were operated with the prediagnosis of acute appendicitis and for whom caecum diverticulitis was determined. Case 1. 21 years old male patient who had applied to hospital with complaint of abdominal pain, underwent an operation with a prediagnosis of acute appendicitis. Right hemicolectomy was performed with mass perioperatively determined in caecum. Histopathological examination revealed necrosis and inflammation in diverticulum wall. Case 2. 36 years old female patient applied to emergency department with abdominal pain and underwent an operation with a prediagnosis of acute appendicitis. Appendectomy and diverticulectomy were performed for whom inflame diverticula in caecum was determined perioperatively. Histopathological examination was revealed acute inflammation in diverticulum wall. Conclusion. Although solitary caecum diverticulitis is a rarely encountered disease, it must be considered in the differential diagnosis of right lower abdomen pain.
Uno, Yoshiharu; van Velkinburgh, Jennifer C
Despite little evidence for the therapeutic benefits of a high-fiber diet for diverticulitis, it is commonly recommended as part of the clinical management. The ongoing uncertainty of the cause(s) of diverticulitis confounds attempts to determine the validity of this therapy. However, the features of a high-fiber diet represent a logical contradiction for colon diverticulitis. Considering that Bernoulli’s principle, by which enlarged diameter of the lumen leads to increased pressure and decreased fluid velocity, might contribute to development of the diverticulum. Thus, theoretically, prevention of high pressure in the colon would be important and adoption of a low FODMAP diet (consisting of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) may help prevent recurrence of diverticulitis. PMID:27867683
Peters, J.H.; Bleichrodt, R.P.; Goor, H. van
Perforation is a serious complication of diverticular disease. The sigmoid is the main affected anatomic site of perforated diverticulitis and sigmoid resection followed either by Hartmann procedure or primary anastomosis are the standard surgical approaches. Surgery, however, does not cure
Rogers, Ailín C
Laparoscopic lavage has shown promising results in nonfeculent perforated diverticulitis. It is an appealing strategy; it avoids the complications associated with resection. However, there has been some reluctance to widespread uptake because of the scarcity of large-scale studies.
Jeong, Jewon; Hong, Seong Sook; Hwang, Ji Young; Kim, Hyun Joo; Chang, Yun Woo [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)
We describe a rare case of terminal ileal diverticulitis in a 68-year-old female with a day of history Epub ahead of print of right lower quadrant pain and tenderness, mimicking acute appendicitis. Ultrasonography revealed small sac-like out-pouching lesions with increased echogenicity of surrounding fat in thickened terminal ileum, suggesting inflamed diverticula. We diagnosed terminal ileal diverticulitis primarily by ultrasonography. The diagnosis was confirmed by subsequent computed tomography.
Buckley, O.; Geoghegan, T.; O'Riordain, D.S.; Lyburn, I.D.; Torreggiani, W.C.
Colonic diverticulitis occurs when diverticula within the colon become infected or inflamed. It is becoming an increasingly common cause for hospital admission, particularly in western society, where it is linked to a low fibre diet. Symptoms of diverticulitis include abdominal pain, diarrhoea and pyrexia, however, symptoms are often non-specific and the clinical diagnosis may be difficult. In addition, elderly patients and those taking corticosteroids may have limited findings on physical examination, even in the presence of severe diverticulitis. A high index of suspicion is required in such patients in order to avoid a significant delay in arriving at the correct diagnosis. Imaging plays an important role in establishing an early and correct diagnosis. In the past, contrast enema studies were the principal imaging test used to make the diagnosis. However, such studies lack sensitivity and have limited success in identifying abscesses that may require drainage. Conversely computed tomography (CT) is both sensitive and specific in making a diagnosis of diverticulitis. In addition, it is the imaging technique of choice in depicting complications such as perforation, abscess formation and fistulae. CT-guided drainage of diverticular abscesses helps to reduce sepsis and to permit a one-stage, rather than two-stage, surgical operation. The purpose of this review article is to discuss the role of CT in the imaging of diverticulitis, describe the CT imaging features and complications of this disease, as well as review the impact and rationale of CT imaging and intervention in the overall management of patients with diverticulitis
Starnes, H F; Lazarus, J M; Vineyard, G
Twenty-five patients were operated on at the Brigham and Women's Hospital for colonic diverticulitis complicating treated renal failure during the period 1951 to 1983. Twelve patients had functioning renal allografts (eight cadaver, four living-related); 13 were on dialysis therapy. Six patients had polycystic kidney disease. The majority of patients had acute abdominal pain. Four had histories of chronic abdominal pain; nondiagnostic exploratory laparotomies were performed on two of these patients, who developed localized tenderness. The overall mortality in this series was 28 percent, with sepsis being the most common cause of death. Six of seven patients who died had free colonic perforations at surgery. Mortality correlated with age, with six of 14 patients (43 percent) over age 50 dying, as compared with one of 11 patients (9 percent) under age 50. There was no correlation between survival rate and type of surgery performed, dose of prednisone or azathioprine used, or type of treatment received for renal failure.
Ganeshpure, Swapnil Panjabrao; Vaidya, Gaurang Nandkishor; Gattani, Vipul
A young female presented with evidence of right-sided heart failure and was subsequently found to have significant pulmonary artery hypertension (PAH). Because of her normal left ventricular function and pulmonary capillary wedge pressure, the most probable site of etiology seemed to be the pulmonary vasculature. All the common possible secondary causes of PAH were ruled out, but during the investigations, she was found to have elevated thyroid function tests compatible with the diagnosis of...
Ripollés, Tomás; Martínez-Pérez, María Jesús; Gómez Valencia, Diana Patricia; Vizuete, José; Martín, Gregorio
To retrospectively evaluate the accuracy of ultrasound as a diagnostic method for differentiating acute diverticulitis from colon cancer in patients with sigmoid colon stenosis. Ultrasound examinations of 91 consecutive patients with sigmoid stenosis (50 diverticulitis and 41 colon cancers) were reviewed by two trained radiologists. Sixty-five (71%) patients presented with acute abdominal symptoms. Thirteen sonographic criteria retrieved from the literature were evaluated to differentiate benign from malignant strictures. A score including all parameters which showed significant differences between benign vs. malignant was built. Sensitivity, specificity, accuracy, and positive or negative predictive values of each sonographic sign, the overall diagnosis, and sonographic score were calculated. Loss of the bowel wall stratification was the most reliable criteria for the diagnosis of malignancy (92% and 94% of sensitivity and specificity, respectively), and the best inter-radiologist agreement (κ = 0.848). Adjacent lymph nodes were the most specific feature (98%) for colon cancer, but its sensitivity was low. Global assessment could differentiate both diseases with high sensitivity (92-94.9%) and specificity (98-100%). Sonographic score >3 enabled differentiation of carcinoma from diverticulitis with 95% sensitivity and 92-94% specificity, with an area under the ROC curve of 0.98-0.987. There were no significant differences in the results between patients with acute and nonacute abdominal symptoms. The combination of several morphological sonographic findings using a score can differentiate most cases of diverticulitis from colon carcinoma in sigmoid strictures.
Angenete, Eva; Thornell, Anders; Burcharth, Jakob
OBJECTIVE: To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial. BACKGROUND: Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection...
Amoza Pais, Sonia; Batlle Marin, Xavi; Oronoz Martinez, Begoña; Balen Ribera, Enrique; Yarnoz Irazabal, Concepción
Purpose The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery. Methods We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode. Results Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated
Thornell, Anders; Angenete, Eva; Bisgaard, Thue
Background: Perforated diverticulitis with purulent peritonitis has traditionally been treated with open colon resection and stoma formation with risk for reoperations, morbidity, and mortality. Laparoscopic lavage alone has been suggested as definitive treatment. Objective: To compare laparoscopic...... lavage with open colon resection and colostomy (Hartmann procedure) for perforated diverticulitis with purulent peritonitis. Design: Randomized, controlled, multicenter, open-label trial. (ISRCTN registry number: ISRCTN82208287) Setting: 9 hospitals in Sweden and Denmark. Patients: Patients who have...... confirmed Hinchey grade III perforated diverticulitis with purulent peritonitis at diagnostic laparoscopy. Intervention: Randomization between laparoscopic lavage and the Hartmann procedure. Measurements: Primary outcome was the percentage of patients having 1 or more reoperations within 12 months. Key...
Ganeshpure, Swapnil Panjabrao; Vaidya, Gaurang Nandkishor; Gattani, Vipul
A young female presented with evidence of right-sided heart failure and was subsequently found to have significant pulmonary artery hypertension (PAH). Because of her normal left ventricular function and pulmonary capillary wedge pressure, the most probable site of etiology seemed to be the pulmonary vasculature. All the common possible secondary causes of PAH were ruled out, but during the investigations, she was found to have elevated thyroid function tests compatible with the diagnosis of Grave's disease. The treatment of Grave's disease, initially by medications and subsequently by radioiodine therapy, was associated with a significant reduction in the pulmonary artery systolic pressure. The purpose of this case report is to highlight one of the unusual and underdiagnosed presentations of Grave's disease.
Cohen, Erica; Fuller, Garth; Bolus, Roger; Modi, Rusha; Vu, Michelle; Shahedi, Kamyar; Shah, Rena; Atia, Mary; Kurzbard, Nicole; Sheen, Victoria; Agarwal, Nikhil; Kaneshiro, Marc; Yen, Linnette; Hodgkins, Paul; Erder, M Haim; Spiegel, Brennan
Individuals with diverticulosis frequently also have irritable bowel syndrome (IBS), but there are no longitudinal data to associate acute diverticulitis with subsequent IBS, functional bowel disorders, or related emotional distress. In patients with postinfectious IBS, gastrointestinal disorders cause long-term symptoms, so we investigated whether diverticulitis might lead to IBS. We compared the incidence of IBS and functional bowel and related affective disorders among patients with diverticulitis. We performed a retrospective study of patients followed up for an average of 6.3 years at a Veteran's Administration medical center. Patients with diverticulitis were identified based on International Classification of Diseases, 9th revision codes, selected for the analysis based on chart review (cases, n = 1102), and matched with patients without diverticulosis (controls, n = 1102). We excluded patients with prior IBS, functional bowel, or mood disorders. We then identified patients who were diagnosed with IBS or functional bowel disorders after the diverticulitis attack, and controls who developed these disorders during the study period. We also collected information on mood disorders, analyzed survival times, and calculated adjusted hazard ratios. Cases were 4.7-fold more likely to be diagnosed later with IBS (95% confidence interval [CI], 1.6-14.0; P = .006), 2.4-fold more likely to be diagnosed later with a functional bowel disorder (95% CI, 1.6-3.6; P mood disorder (CI, 1.4-3.5; P IBS and functional bowel disorders. We propose calling this disorder postdiverticulitis IBS. Diverticulitis appears to predispose patients to long-term gastrointestinal and emotional symptoms after resolution of inflammation; in this way, postdiverticulitis IBS is similar to postinfectious IBS. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
Full text: A 68-year-old woman with widespread vascular disease presented to the Nuclear Medicine Department with severe hypertension, (a blood pressure of 200/160 supine), a known small right kidney, and a large abdominal aortic aneurysm. A baseline renal scan was performed with IV administration of 300 MBq of 99m Tc-labelled MAG3. A normal left kidney was demonstrated, with a Grade 0 renogram pattern. The right kidney was non visualised and non functioning. The patient was then administered orally with 25 mg of A.C.E. inhibitor captopril and her blood pressure fell by greater than 100 mm Hg. A second MAG3 Renal Scan was performed. The finding conflicted with results of a Renal Artery Angiogram and Renal Artery Doppler Ultrasound, both demonstrating a normal left renal artery. A repeat MAG3 Renal scan with captopril challenge was performed. Differential diagnosis included: 1.Left sided microvascular disease; 2. A functioning though very ischaemic right kidney that was producing renin, suggested by contrast opacification of the right renal cortex on CT; or 3. A false negative renal artery angiogram, with non-visualisation of an arterial stenosis caused by thrombus or compression of the left renal artery by the abdominal aortic aneurysm. Subsequent Renal Vein Renin Sampling measured left renal vein renin activity at 4.50,μg/L/h, (compared with 4.80μg/L/h in the IVC). Right renal vein renin activity was 13.20μg/L/h. This lateralization of renin secretion to the right side with suppression of left sided secretion suggested that the renovascular hypertension was caused by the right kidney. This was a very unusual result, as the MAG3 captopril renal scan had incorrectly and strongly suggested a left sided origin to the renovascular hypertension. In addition, the right kidney not seen to accumulate MAG3 was in fact functioning sufficiently to produce renin. It is hypothesized that the left kidney had adjusted to allow normal function only at very high circulating
Tabbara, Malek; Velmahos, George C; Butt, Muhammad U; Chang, Yuchiao; Spaniolas, Konstantinos; Demoya, Marc; King, David R; Alam, Hasan B
Complicated acute diverticulitis (CAD) requiring an urgent operation is usually managed by fecal diversion (FD) despite reports suggesting that primary repair (PR) is safe. We aim to identify patient characteristics predicting successful PR and explore if patients are managed by FD despite the presence of such characteristics. We reviewed the medical records of 194 patients with CAD, requiring colectomy within 48 hr of admission from January 1996 to January 2006. Exclusion criteria included: admission for elective repair, treatment with antibiotics and/or percutaneous abscess drainage prior to operation (semi-elective), concurrent inflammatory disease, cancer, and inadequate documentation. Univariate and multivariate analysis identified independent predictors of PR. Patients who despite having these independent predictors underwent FD, were compared with the PR group. Eighteen patients (9%) received PR. They were younger than FD patients, had a lower incidence of left-sided disease, were less frequently operated on within 4 hr of hospital arrival, and had less severe disease (Hinchey I or II). They also had shorter postoperative hospital stays (6.2 ± 2.3 vs 14.6 ±16.1; P = .002) and a trend towards a lower mortality (0% vs 6.8%; P = .38). The independent predictors of performing PR included: age less than 55 years, interval between admission and operation longer than 4 hr, and a Hinchey score I or II. There were 71 patients who had 2 (64) or all 3 (7) independent predictors of PR but still received FD. These patients were not different in any characteristic from the PR patients but had worse outcomes. FD remains the prevailing operative method of choice of CAD. Despite the presence of factors favoring PR, many patients still receive FD and have worse outcomes. PR can be used more liberally in CAD. Copyright © 2010 Mosby, Inc. All rights reserved.
O'Leary, D Peter; Lynch, Noel; Clancy, Cillian; Winter, Desmond C; Myers, Eddie
This Delphi study provides consensus related to many aspects of acute diverticulitis and identifies other areas in need of research. To generate an international, expert-based, consensus statement to address controversies in the management of acute diverticulitis. This study was conducted using the Delphi technique from April 3 through October 21, 2014. A survey website was used and a panel of acute diverticulitis experts was formed via the snowball method. The top 5 acute diverticulitis experts in 5 international geographic regions were identified based on their number of publications related to acute diverticulitis. The Delphi study used 3 rounds of questions, after which the consensus statement was collated. A consensus statement related to the management of acute diverticulitis. Twenty items were selected for inclusion in the consensus statement following 3 rounds of questioning. A clear definition of uncomplicated and complicated diverticulitis is provided. In uncomplicated diverticulitis, consensus was reached regarding appropriate laboratory and radiological evaluation of patients as well as nonsurgical, surgical, and follow-up strategies. A number of important topics, including antibiotic treatment, failed to reach consensus. In addition, consensus was reached regarding many nonsurgical and surgical treatment strategies in complicated diverticulitis. Controversy continues internationally regarding the management of acute diverticulitis. This study demonstrates that there is more nonconsensus among experts than consensus regarding most issues, even in the same region. It also provides insight into the status quo regarding the treatment of acute diverticulitis and provides important direction for future research.
Fleming, Fergal J
BACKGROUND: Patients who undergo a Hartmann\\'s procedure may not be offered a reversal due to concerns over the morbidity of the second procedure. The aims of this study were to examine the morbidity post reversal of Hartmann\\'s procedure. METHODS: Patients who underwent a Hartmann\\'s procedure for acute diverticulitis (Hinchey 3 or 4) between 1995 and 2006 were studied. Clinical factors including patient comorbidities were analysed to elucidate what preoperative factors were associated with complications following reversal of Hartmann\\'s procedure. RESULTS: One hundred and ten patients were included. Median age was 70 years and 56% of the cohort were male (n = 61). The mortality and morbidity rate for the acute presentation was 7.3% (n = 8) and 34% (n = 37) respectively. Seventy six patients (69%) underwent a reversal at a median of 7 months (range 3-22 months) post-Hartmann\\'s procedure. The complication rate in the reversal group was 25% (n = 18). A history of current smoking (p = 0.004), increasing time to reversal (p = 0.04) and low preoperative albumin (p = 0.003) were all associated with complications following reversal. CONCLUSIONS: Reversal of Hartmann\\'s procedure can be offered to appropriately selected patients though with a significant (25%) morbidity rate. The identification of potential modifiable factors such as current smoking, prolonged time to reversal and low preoperative albumin may allow optimisation of such patients preoperatively.
Holmer, Christoph; Kreis, Martin E
The clinical spectrum of sigmoid diverticulitis (SD) varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications. Sigmoid colectomy with restoration of continuity has been the prevailing modality for treating acute and recurrent SD, and is often performed as a laparoscopy-assisted procedure. For elective sigmoid colectomy, the postoperative morbidity rate is 15-20% whereas morbidity rates reach up to 30% in patients who undergo emergency surgery for perforated SD. Some of the more common and serious surgical complications after sigmoid colectomy are anastomotic leaks and peritonitis, wound infections, small bowel obstruction, postoperative bleeding, and injuries to the urinary tract structures. Regarding the management of complications, it makes no difference whether the complication is a result of an emergency or an elective procedure. The present work gives an overview of the management of complications in the surgical treatment of SD based on the current literature. To achieve successful management, early diagnosis is mandatory in cases of deviation from the normal postoperative course. If diagnostic procedures fail to deliver a correlate for the clinical situation of the patient, re-laparotomy or re-laparoscopy still remain among the most important diagnostic and/or therapeutic principles in visceral surgery when a patient's clinical status deteriorates. The ability to recognize and successfully manage complications is a crucial part of the surgical treatment of diverticular disease and should be mastered by any surgeon qualified in this field.
Buckley, Orla; Geoghegan, Tony; McAuley, Grainne; Persaud, Thara; Khosa, Faisal; Torreggiani, William C.
Magnetic resonance imaging (MRI) is rapidly emerging as a useful imaging modality for the evaluation of the gastrointestinal tract. Increasingly rapid sequences and improving hardware have significantly improved the visualisation of diseases of the colon. MRI has a major advantage over CT in that there is no ionising radiation. In our institution, MRI has increasingly been used as a complimentary imaging modality to CT in the diagnosis and evaluation of diverticulitis and its complications. In this review article, we illustrate the emerging role of MRI in the diagnosis and evaluation of colonic diverticulitis. (orig.)
Cao, Yin; Strate, Lisa L; Keeley, Brieze R; Tam, Idy; Wu, Kana; Giovannucci, Edward L; Chan, Andrew T
Diverticulitis is a common disease with a substantial clinical and economic burden. Besides dietary fibre, the role of other foods in the prevention of diverticulitis is underexplored. We prospectively examined the association between consumption of meat (total red meat, red unprocessed meat, red processed meat, poultry and fish) with risk of incident diverticulitis among 46 461 men enrolled in the Health Professionals Follow-Up Study (1986-2012). Cox proportional hazards models were used to compute relative risks (RRs) and 95% CIs. During 651 970 person-years of follow-up, we documented 764 cases of incident diverticulitis. Compared with men in the lowest quintile (Q1) of total red meat consumption, men in the highest quintile (Q5) had a multivariable RR of 1.58 (95% CI 1.19 to 2.11; p for trend=0.01). The increase in risk was non-linear, plateauing after six servings per week (p for non-linearity=0.002). The association was stronger for unprocessed red meat (RR for Q5 vs Q1: 1.51; 95% CI 1.12 to 2.03; p for trend=0.03) than for processed red meat (RR for Q5 vs Q1: 1.03; 95% CI 0.78 to 1.35; p for trend=0.26). Higher consumption of poultry or fish was not associated with risk of diverticulitis. However, the substitution of poultry or fish for one serving of unprocessed red meat per day was associated with a decrease in risk of diverticulitis (multivariable RR 0.80; 95% CI 0.63 to 0.99). Red meat intake, particularly unprocessed red meat, was associated with an increased risk of diverticulitis. The findings provide practical dietary guidance for patients at risk of diverticulitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Vishalkumar G. Shelat
Full Text Available Meckel’s diverticulum occurs in 2% of the general population and majority of patients remain asymptomatic. Gastrointestinal bleeding is the most common presentation in the paediatric population. While asymptomatic and incidentally found Meckel’s diverticulum may be left alone, surgery is essential for treating a symptomatic patient. Despite advances in imaging and technology, pre-operative diagnosis is often difficult. We present a first report of an unusual mechanism of small bowel obstruction due to Meckel’s diverticulitis in a paediatric patient. The diagnosis was only apparent at laparotomy.
Toorenvliet, Boudewijn R.; Swank, Hilko; Schoones, Jan W.; Hamming, Jaap F.; Bemelman, Willem A.
Aim This systematic review aimed to evaluate the efficacy, morbidity and mortality of laparoscopic peritoneal lavage for patients with perforated diverticulitis. Method We searched PubMed, EMBASE, Web of Science, the Cochrane Library and CINAHL databases, Google Scholar and five major publisher
Energy is central to development, and energy availability, accessibility and affordability are central challenges for most African countries. Due to rapidly growing energy demand, the need for socioeconomic development, persistent concerns over climate change and environmental impacts and dependence on imported supplies of fossil fuels, African Member States are looking into possible options to secure sustainable energy supplies, including nuclear energy. The IAEA assists those countries in assessing the nuclear power option and building the necessary infrastructure for a safe, secure and sustainable nuclear power programme. This year, the IAEA is conducting Integrated Nuclear Infrastructure Review (INIR) missions to three African countries (Nigeria, Kenya and Morocco) considering introducing nuclear power. The side event presents recent updates from Africa on the potential role of nuclear power, including the IAEA Third Regional Conference on Energy and Nuclear Power in Africa, held in Mombasa, Kenya, in April 2015, an initiative to launch a new African network for enhancing nuclear power programme development, and others. The event reports on recent developments in several African Member States considering, embarking on, or expanding national nuclear power programmes.
Garcia-Aguayo, F J; Gil, P M [Hospital de Sagunto. Valencia (Spain)
To assess the value of ultrasound as an initial diagnostic method in cases of acute diverticulitis. Ultrasound was carried out in 76 patients with a clinical diagnosis of acute sigmoid diverticulitis. The final diagnosis was based on the clinical course in every case, as well as on computed tomography (CT; n=46), histopathological examination (n=10), colonoscopy (n=4) and barium enema (n=2). The diagnostic criteria established for ultrasound was a thickening of the sigmoid colon wall of >4 mm and the presence of a least one of the following features: diverticular, phlegmon or abscess. The CT diagnosis was based on two indispensable findings: thickening of the sigmoid colon of>4 mm and inflammation of pericolonic fat. The final diagnosis was acute diverticulitis in 52 patients, some other disease in 18 and undetermined in 6. The sensitivities of ultrasound and CT were 81% and 94%, respectively, and their specificities were 79% and 83%, respectively. Of the 10 false negatives on ultrasound, seven corresponded to cases of simple diverticulitis and three to cases of complicated diverticulitis (two in patients with abscess and one in a patient with pneumoperitoneum). CT provided the correct diagnosis in eight of these cases, and resulted in false negatives in two cases of mild diverticulitis. Ultrasound is a valid test in the initial diagnosis of acute diverticulitis of the sigmoid colon. CT should be performed when ultrasound fails to provide a diagnosis or in cases of negative results when there is a strong clinical suspicion of diverticulitis, as well as when the possibility of complicated diverticulitis exists. (Author) 14 refs.
Muradbegovic, Mirza; St-Amour, Pénélope; Martin, David; Petermann, David; Benabidallah, Samir; Di Mare, Luca
Acute colonic diverticulitis is a well-known surgical emergency, which occurs in about 10 percent of patients known for diverticulosis. The case of a 77-year-old woman is reported, with past history of abdominoperineal resection with end-colostomy for low rectal adenocarcinoma, and who developed an acute colonic diverticulitis in a subcutaneous portion of colostomy with parastomal phlegmon. Initial computed tomography imaging demonstrated a significant submucosal parietal edema with local fat tissues infiltration in regard of 3 diverticula. A two-step treatment was decided: first a nonoperative treatment was initiated with 2 weeks antibiotics administration, followed by, 6 weeks after, a segmental resection of the terminal portion of the colon with redo of a new colostomy by direct open approach. Patient was discharged on the second postoperative day without complications. Follow-up at 2 weeks revealed centimetric dehiscence of the stoma, which was managed conservatively until sixth postoperative week by stomatherapists. Treatment of acute diverticulitis with parastomal phlegmon in a patient with end-colostomy could primary be nonoperative. Delayed surgical treatment with segmental colonic resection was proposed to avoid recurrence and potential associated complications.
Full Text Available Colocutaneous fistula caused by diverticulitis is relatively rare, and a delayed recrudescent case of colocutaneous fistula is very uncommon. We herein report a rare case of a Japanese 56-year-old male with delayed recrudescent sigmoidocutaneous fistula due to diverticulitis. A colocutaneous fistula was formed after a drainage operation against a perforation of the sigmoid colon diverticulum. After 5 years from treatment, he was admitted to our hospital because of lower abdominal pain. We diagnosed the recrudescent sigmoidocutaneous fistula by abdominal computed tomography and gastrografin enema, and managed the patient with total parenteral nutrition and antibiotics. As the fistula formation did not improve, a low anterior resection with fistulectomy was performed. The postoperative course was uneventful and the patient was discharged. It has been reported that, in fistulas of the skin caused by diverticular disease, complete closure of the fistula by conservative therapy may not be possible. This case also implies the possibility of a recurrence of the fistula even if the conservative treatment was effective. In cases of colocutaneous fistulas due to diverticulitis, radical surgery is considered necessary because of possibility of recurrence of the fistula.
Kohl, A; Rosenberg, J; Bock, D
BACKGROUND: Traditionally, perforated diverticulitis with purulent peritonitis was treated with resection and colostomy (Hartmann's procedure), with inherent complications and risk of a permanent stoma. The DILALA (DIverticulitis - LAparoscopic LAvage versus resection (Hartmann's procedure...... in the Hartmann's group had a colostomy at 24 months. CONCLUSION: Laparoscopic lavage is a better option for perforated diverticulitis with purulent peritonitis than open resection and colostomy....
Background: The documentation of acute and chronic treatment sequelae is a decisive precondition for the appropriate evaluation of the treatment quality of any cancer therapy. Methods and results: Interdisciplinary (inter)national efforts have resulted in a new consensus for recording of treatment sequelae in oncology. While the acute treatment side effects (day 1 to 90 after treatment) are recommended to be documented and evaluated using the Common Toxicity Criteria (CTC), for the chronic treatment side effects (day 91 and thereafter) the Late Effect Normal Tissue (LENT) criteria are to be implemented. The latter classification system allows to differentiate between the Subjective, Objective, Management and Analytic (SOMA) toxicity aspects. Both classification systems can be implemented not only for clinical applications using radiotherapy or chemotherapy alone but also for combinations with each other or with other treatment modalities. This allows for an effective interdisciplinary comparison between different treatment concepts not only within each institution but also in multicenter trials. Conclusions: Prospective documentation and evaluation of treatment toxicity in oncology should be intensified and systematically included in future mono- and multi-institutional clinical trials. (orig.) [de
AIM: To characterize the bifidobacterial microbiota of the colonic mucosa in patients with colon cancer,inflammatory bowel disease or diverticulitis.METHODS: A sample of the distal colonic mucosa was taken during surgery from a total of 34 patients,twenty-one with diagnosed colorectal cancer, nine with diverticulitis and four with inflammatory bowel disease, requiring surgery for their condition. Bacterial DNA was extracted from the resected mucosal samples and bifidobacterial mucosa-associated microbiota was qualitatively and quantitatively determined by means of qualitative and quantitative PCR.RESULTS: Bifidobacteria were found in 100% of the samples from patients with diverticulitis or IBD and a 76% of those suffering colon cancer. The species B. longum and B. bifidum were the most widely found, followed by B. animalis, B. catenulatum and B.adolescentis. B. breve, B. dentium and B. angulatum were not detected in any sample. A significantly higher occurrence of B. longum was observed in patients with diverticulitis than in those with colon cancer or IBD (100%, 62% and 75%, respectively, P ＜ 0.05).Similar results were obtained for B. animalis (56%, 0%and 25%, P ＜ 0.05), while B. adolescentis was only found in the mucosa from patients with colon cancer (5 out of 21, 24%). At the quantitative level, patients with colon cancer or IBD showed lower counts of total Bifidobacterium (4.94 and 5.91 vs 6.96 log Cells/sample,respectively, P ＜ 0.05) and of the species B.longum (4.05 and 4.79 vs 6.76, P ＜ 0.05) than those with diverticulitis.CONCLUSION: Aberrancies in mucosa associated microbiota are present in different intestinal diseases.This may indicate a role of the microbiota in the pathogenesis of these diseases.
Franca, Manuela; Certo, Manuela; Varzim, Pedro; Silva, Donzilia; Peixoto, Carlos
An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis. (orig.)
Full Text Available Background. Natural history and risk factors for diverticulitis in young patients are still debatable. This study aimed to assess whether difference exists in patients aged 50 and younger when compared to older patients and to identify risk factors for acute diverticulitis in the young. Patients and Methods. From January 2006 to December 2011, 80 patients were admitted to our department for acute diverticulitis. We carried out a cross-sectional study in 23 patients (28.7% aged 50 and younger and 57 older patients (71.3%. Results. Acute diverticulitis in the young was not more aggressive than in the older patient. Diverticulitis at patient’s admission was similar with respect to Hinchey’s stage and prior history of diverticulitis. No significant difference was found for both medical and surgical treatment. The rate of recurrent diverticulitis in nonoperated patients was similar. Male gender, body mass index ≥25, and assumption of alcohol were independent risk factors for the occurrence of an acute diverticulitis in the young. Conclusions. The same disease seems to be affecting young patients such as overweight or obese male individual. Current policies to prevent diverticular disease and its related complications must include obesity control together with high-fiber diet and regular exercise.
Boermeester, Marja A; Humes, David J; Velmahos, George C; Søreide, Kjetil
Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis. We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the https://clinicaltrials.gov/ ) were searched for ongoing, recruiting, or closed trials not yet published. Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients. A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection.
Hupfeld, Line; Burcharth, Jakob; Pommergaard, Hans-Christian
Severe stages of acute, colonic diverticulitis can progress into intestinal perforations with peritonitis. In such cases, urgent treatment is needed, and Hartmann's procedure is the standard treatment for cases with fecal peritonitis. Peritoneal lavage may be an alternative to resection for acute...... diverticulitis with purulent peritonitis, but ongoing randomized trials are awaited to clarify this....
McDermott, F D
The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.
Demand-side management or DSM refers to active efforts by electric and gas utilities to modify customers' energy use patterns. The experience in the US shows that utilities, when provided with appropriate incentives, can provide a powerful stimulus to energy efficiency in the private sector. This paper describes the range and history of DSM programs offered by US electric utilities, with a focus on the political, economic, and regulatory events that have shaped their evolution. It also describes the changes these programs are undergoing as a result of US electricity industry restructuring. DSM programs began modestly in the 1970s in response to growing concerns about dependence on foreign sources of oil and environmental consequences of electricity generation, especially nuclear power. The foundation for the unique US partnership between government and utility interests can be traced first to the private-ownership structure of the vertically integrated electricity industry and second to the monopoly franchise granted by state regulators. Electricity industry restructuring calls into question both of these basic conditions, and thus the future of utility DSM programs for the public interest. Future policies guiding ratepayer-funded energy-efficiency DSM programs will need to pay close attention to the specific market objectives of the programs and to the balance between public and private interests
Eto, J. [Lawrence Berkeley National Lab., CA (United States). Environmental Energy Technologies Div.
Demand-side management or DSM refers to active efforts by electric and gas utilities to modify customers` energy use patterns. The experience in the US shows that utilities, when provided with appropriate incentives, can provide a powerful stimulus to energy efficiency in the private sector. This paper describes the range and history of DSM programs offered by US electric utilities, with a focus on the political, economic, and regulatory events that have shaped their evolution. It also describes the changes these programs are undergoing as a result of US electricity industry restructuring. DSM programs began modestly in the 1970s in response to growing concerns about dependence on foreign sources of oil and environmental consequences of electricity generation, especially nuclear power. The foundation for the unique US partnership between government and utility interests can be traced first to the private-ownership structure of the vertically integrated electricity industry and second to the monopoly franchise granted by state regulators. Electricity industry restructuring calls into question both of these basic conditions, and thus the future of utility DSM programs for the public interest. Future policies guiding ratepayer-funded energy-efficiency DSM programs will need to pay close attention to the specific market objectives of the programs and to the balance between public and private interests.
Tong, Vivien; Raynor, David K; Blalock, Susan J; Aslani, Parisa
Consumer Medicine Information (CMI) is a brand-specific and standardized source of written medicine information available in Australia for all prescription medicines. Side-effect information is poorly presented in CMI and may not adequately address consumer information needs. To explore consumer opinions on (i) the presentation of side-effect information in existing Australian CMI leaflets and alternative study-designed CMIs and (ii) side-effect risk information and its impact on treatment decision making. Fuzzy trace, affect heuristic, frequency hypothesis and cognitive-experiential theories were applied when revising existing CMI side-effects sections. Together with good information design, functional linguistics and medicine information expertise, alternative ramipril and clopidogrel CMI versions were proposed. Focus groups were then conducted to address the study objectives. Three focus groups (n = 18) were conducted in Sydney, Australia. Mean consumer age was 58 years (range 50-65 years), with equal number of males and females. All consumers preferred the alternative CMIs developed as part of the study, with unequivocal preference for the side-effects presented in a simple tabular format, as it allowed quick and easy access to information. Consumer misunderstandings reflected literacy and numeracy issues inherent in consumer risk appraisal. Many preferred no numerical information and a large proportion preferred natural frequencies. One single method of risk presentation in CMI is unable to cater for all consumers. Consumer misunderstandings are indicative of possible health literacy and numeracy factors that influence consumer risk appraisal, which should be explored further. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.
This event presented the IAEA’s programmes for the education and training of a new generation of nuclear professionals. It also featured the annual European Master of Science in Nuclear Engineering (EMSNE) award ceremony
This event presented roadmaps for nuclear energy innovation linked to nationally determined contributions (NDCs) to the global response to climate change. It covered enabling conditions for research and development, the regulatory framework and infrastructure to support Member States’ NDC updates from 2020 to 2050
Barret, Maximilien; Abbes, Leila; Zinzindohoué, Franck
Currently published data do not demonstrate the benefit of any medical treatment in the prevention of the onset or the recurrence of colonic diverticular disease. No specific diet can be recommended to patients with colonic diverticula for the prevention of diverticular disease. Non steroidal anti-inflammatory drugs as well as corticosteroids should be used cautiously in patients with diverticular disease since they induce a higher rate of complications, especially diverticular haemorrhage and severe sigmoid diverticulitis. In patients over 50 years old, or if a sigmoidectomy is needed, physicians should perform a colonoscopy in order to rule out colonic polyps or neoplasm.
McCabe, Fergus J; McCabe, John P
Rarely, sciatica is of extraspinal aetiology. By compressing the sciatic nerve, swelling of the short external rotators of the hip can cause sciatica. Uncommon anatomical relationships between the sciatic nerve and local muscles may potentiate this compressive effect. In this report, we describe the presentation of right sciatica and foot drop resulting from both extreme local constriction and unusual anatomical variation of the right sciatic nerve.
Walker, C. E.; Pompea, S. M.
In a partnership last Spring with Arizona Public Service, the National Optical Astronomy Observatory (NOAO) created the 'Dark-Skies Energy Education Program: Energy Awareness for a Sustainable Future'. In this program, experienced science and technology education specialists from NOAO led 2 one-day professional development workshops for thirteen 6th grade teachers on dark skies and energy education. The workshops focused on three foundational, scaffolding activities and a final student research project. This in turn culminated in a Family Science Night where students presented their projects. In between these events, our NOAO team provided support for teachers through real-time video conferencing using FaceTime. In addition to the professional development, each teacher received a kit full of resource materials to perform the activities and research project. The kit was at no cost to the teacher, school, or district. Each kit contained the latest version of a tablet, which was used to facilitate communication and support for the teachers, as well as provide all the program's written teaching materials. The activities are in accordance with state, Common Core and Next Generation Science Standards. Our NOAO instructors gave firsthand experiences on how best to use these materials in a classroom or public setting. They also discussed opportunities on how they can incorporate, adapt and expand upon the activities and research projects in the classroom. Evaluation reports from the program's independent evaluator showed that the students enjoyed learning from the three foundational activities and research projects. The project presentations by the Yuma students were outstanding in their creativity, level of effort, and scientific accuracy. To summarize the evaluations, significant changes in knowledge and attitude were made with the teachers and students (from one-on-one interviews and surveys), but behavioral changes (albeit only over a semester) seemed minimal. The AGU
Garcia-Aguayo, F. J.; Gil, P. M.
To assess the value of ultrasound as an initial diagnostic method in cases of acute diverticulitis. Ultrasound was carried out in 76 patients with a clinical diagnosis of acute sigmoid diverticulitis. The final diagnosis was based on the clinical course in every case, as well as on computed tomography (CT; n=46), histopathological examination (n=10), colonoscopy (n=4) and barium enema (n=2). The diagnostic criteria established for ultrasound was a thickening of the sigmoid colon wall of >4 mm and the presence of a least one of the following features: diverticular, phlegmon or abscess. The CT diagnosis was based on two indispensable findings: thickening of the sigmoid colon of>4 mm and inflammation of pericolonic fat. The final diagnosis was acute diverticulitis in 52 patients, some other disease in 18 and undetermined in 6. The sensitivities of ultrasound and CT were 81% and 94%, respectively, and their specificities were 79% and 83%, respectively. Of the 10 false negatives on ultrasound, seven corresponded to cases of simple diverticulitis and three to cases of complicated diverticulitis (two in patients with abscess and one in a patient with pneumoperitoneum). CT provided the correct diagnosis in eight of these cases, and resulted in false negatives in two cases of mild diverticulitis. Ultrasound is a valid test in the initial diagnosis of acute diverticulitis of the sigmoid colon. CT should be performed when ultrasound fails to provide a diagnosis or in cases of negative results when there is a strong clinical suspicion of diverticulitis, as well as when the possibility of complicated diverticulitis exists. (Author) 14 refs
Full Text Available A large number of studies has been carried out to investigate the pathophysiology and the clinical implications of QT interval prolongation in the ECG over recent years (1, 2, 3, 4, 5, 6. It was only in the last decade, however, that the scientists have focused on the specular aspects of the long QT syndrome (LQTS, and it is now well established that the abnormal shortening of the QT interval is associated with meaningful clinical consequences and adverse outcomes. The aim of the present article is to summarize knowledge and existing evidence about the Short QT Syndrome (SQTS. SQTS is a rare, albeit largely underdiagnosed, genetically determined disease, which is characterized by a high tendency to develop life-threatening arrhythmias. The two clinical landmarks of SQTS are the presence of a short QT interval (i.e., less than 320 ms in a structurally normal heart. The disease is now classified as a “channellopathy”, and is principally caused by a defective functioning of both potassium and calcium ion channels. The underlying genetic anomalies cause an abnormal ripolarization and a reduced refractoriness of myocardiocites. Pharmacologic treatments are mainly tailored to slow the conduction and to prolong the refractory period of myocardiocites. The implantable cardioverter and defibrillator (ICD is currently considered the therapeutic gold standard (7.
Sohn, M; Agha, A; Heitland, W; Gundling, F; Steiner, P; Iesalnieks, I
The best surgical strategy for the management of perforated diverticulitis with generalized peritonitis of the sigmoid colon is not clearly defined. The aim of this retrospective cohort study was to evaluate the value of a damage control strategy. All patients who underwent emergency laparotomy for perforated diverticular disease of the sigmoid colon with generalized peritonitis between 2010 and 2015 were included. The damage control strategy (study group), included a two- stage procedure: limited resection of the diseased colonic segment, closure of proximal colon and distal stump, and application of an abdominal vacuum at the initial surgery followed by second-look laparotomy 24-48 h later At this point a choice was made between anastomosis and Hartmann's procedure. The control group consisted of patients receiving definitive reconstruction (anastomosis or Hartmann's procedure) at the initial operation. Thirty-seven patients were included in the study. Damage control strategy was applied in 19 patients and the control group consisted of 18 patients. Both groups were comparable in terms of demographics, severity of peritonitis, and comorbidities. The overall postoperative mortality was 11 % (n = 4). There were no statistically significant differences between both groups regarding postoperative morbidity and mortality; however, a significantly higher proportion of patients in the control group had a stoma after the initial hospital stay (83 vs. 47 %, p = 0.038). This difference was still significant after adjustment for sex, age, Mannheim Peritonitis Index, American Society of Anesthesiologists class and presence of septic shock at presentation. At the end of the follow-up period, 15 of 17 survivors in the study group and 13 of 16 survivors in the control group had their intestinal continuity restored (p = 0.66). Damage control strategy in patients with generalized peritonitis due to perforated diverticulitis leads to a significantly reduced stoma rate
Gehrman, J.; Angenete, E; Björholt, I.
Background: Open surgery with resection and colostomy (Hartmann's procedure) has been the standard treatment for perforated diverticulitis with purulent peritonitis. In recent years laparoscopic lavage has emerged as an alternative, with potential benefits for patients with purulent peritonitis...
Full Text Available Background/Aims: Traditionally, patients with acute diverticulitis undergo follow-up endoscopy to exclude colorectal cancer (CRC. However, its usefulness has been debated in this era of high-resolution computed tomography (CT diagnosis. We assessed the frequency and outcome of endoscopic follow-up for patients with CT-proven acute diverticulitis, according to the confidence in the CT diagnosis.Methods: Records of patients with CT-proven acute diverticulitis between October 2007 and March 2014 at Sandwell & West Birmingham Hospitals NHS Trust were retrieved. The National Cancer Registry confirmed the cases of CRC. Endoscopy quality indicators were compared between these patients and other patients undergoing the same endoscopic examination over the same period.Results: We identified 235 patients with CT-proven acute diverticulitis, of which, 187 were managed conservatively. The CT report was confident of the diagnosis of acute diverticulitis in 75% cases. Five of the 235 patients were subsequently diagnosed with CRC (2.1%. Three cases of CRC were detected in the 187 patients managed conservatively (1.6%. Forty-eight percent of the conservatively managed patients underwent follow-up endoscopy; one case of CRC was identified. Endoscopies were often incomplete and caused more discomfort for patients with diverticulitis compared with controls.Conclusions: CRC was diagnosed in patients with CT-proven diverticulitis at a higher rate than in screened asymptomatic populations, necessitating follow-up. CT reports contained statements regarding diagnostic uncertainty in 25% cases, associated with an increased risk of CRC. Follow-up endoscopy in patients with CT-proven diverticulitis is associated with increased discomfort and high rates of incompletion. The use of other follow-up modalities should be considered.
Stefansson, T.; Univ. Hospital, Uppsala; Nyman, R.; Nilsson, S.; Ekbom, A.; Univ. Hospital, Uppsala; Paahlman, L.
Purpose: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP)) in diagnosing diverticulitis of the sigmoid colon. Material and Methods: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. Results: Fity-two patients were found to have sigmoid diverticulitis: 20 patients by lanparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. Conclusion: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be rule out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis. (orig.)
Ajaj, Waleed; Lauenstein, Thomas; Goehde, Susanne; Kuehle, Christiane; Herborn, Christoph U.; Ruehm, Stefan G.; Langhorst, Jost; Zoepf, Thomas; Gerken, Guido; Goyen, Mathias
To assess dark-lumen magnetic resonance colonography (MRC) for the evaluation of patients with suspected sigmoid diverticulitis. Forty patients with suspected sigmoid diverticulitis underwent MRC within 72 h prior to conventional colonoscopy (CC). A three-dimensional T1-weighted volumetric interpolated breath-hold examination sequence was acquired after an aqueous enema and intravenous administration of gadolinium-based contrast agents. All MRC data were evaluated by two radiologists. Based on wall thickness and focal uptake of contrast material and pericolic reaction including mesenteric infiltration on T1-weighted sequence the sigmoid colon was assessed for the presence of diverticulitis. MRC classified 17 of the 40 patients as normal with regard to sigmoid diverticulitis. However, CC confirmed the presence of light inflammatory signs in four patients which were missed in MRC. MRC correctly identified wall thickness and contrast uptake of the sigmoid colon in the other 23 patients. In three of these patients false-positive findings were observed, and MRC classified the inflammation of the sigmoid colon as diverticulitis whereas CC and histopathology confirmed invasive carcinoma. MRC detected additionally relevant pathologies of the entire colon and could be performed in cases where CC was incomplete. MRC may be considered a promising alternative to CC for the detection of sigmoid diverticulitis. (orig.)
Itai, Ghersin; Slijper, Nadav; Sroka, Gideon; Matter, Ibrahim
Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis.
Strate, Lisa L; Keeley, Brieze R; Cao, Yin; Wu, Kana; Giovannucci, Edward L; Chan, Andrew T
Dietary fiber is implicated as a risk factor for diverticulitis. Analyses of dietary patterns may provide information on risk beyond those of individual foods or nutrients. We examined whether major dietary patterns are associated with risk of incident diverticulitis. We performed a prospective cohort study of 46,295 men who were free of diverticulitis and known diverticulosis in 1986 (baseline) using data from the Health Professionals Follow-Up Study. Each study participant completed a detailed medical and dietary questionnaire at baseline. We sent supplemental questionnaires to men reporting incident diverticulitis on biennial follow-up questionnaires. We assessed diet every 4 years using a validated food frequency questionnaire. Western (high in red meat, refined grains, and high-fat dairy) and prudent (high in fruits, vegetables, and whole grains) dietary patterns were identified using principal component analysis. Follow-up time accrued from the date of return of the baseline questionnaire in 1986 until a diagnosis of diverticulitis, diverticulosis or diverticular bleeding; death; or December 31, 2012. The primary end point was incident diverticulitis. During 894,468 person years of follow-up, we identified 1063 incident cases of diverticulitis. After adjustment for other risk factors, men in the highest quintile of Western dietary pattern score had a multivariate hazard ratio of 1.55 (95% CI, 1.20-1.99) for diverticulitis compared to men in the lowest quintile. High vs low prudent scores were associated with decreased risk of diverticulitis (multivariate hazard ratio, 0.74; 95% CI, 0.60-0.91). The association between dietary patterns and diverticulitis was predominantly attributable to intake of fiber and red meat. In a prospective cohort study of 46,295 men, a Western dietary pattern was associated with increased risk of diverticulitis, and a prudent pattern was associated with decreased risk. These data can guide dietary interventions for the prevention of
Margaret B. Greenwood-Ericksen
Full Text Available Introduction: Diverticulitis is a common diagnosis in the emergency department (ED. Outpatient management of diverticulitis is safe in selected patients, yet the rates of admission and surgical procedures following ED visits for diverticulitis are unknown, as are the predictive patient characteristics. Our goal is to describe trends in admission and surgical procedures following ED visits for diverticulitis, and to determine which patient characteristics predict admission. Methods: We performed a cross-sectional descriptive analysis using data on ED visits from 2006-2011 to determine change in admission and surgical patterns over time. The Nationwide Emergency Department Sample database, a nationally representative administrative claims dataset, was used to analyze ED visits for diverticulitis. We included patients with a principal diagnosis of diverticulitis (ICD-9 codes 562.11, 562.13. We analyzed the rate of admission and surgery in all admitted patients and in low-risk patients, defined as age <50 with no comorbidities (Elixhauser. We used hierarchical multivariate logistic regression to identify patient characteristics associated with admission for diverticulitis. Results: From 2006 to 2011 ED visits for diverticulitis increased by 21.3% from 238,248 to 302,612, while the admission rate decreased from 55.7% to 48.5% (-7.2%, 95% CI [–7.78 to -6.62]; p<0.001 for trend. The admission rate among low-risk patients decreased from 35.2% in 2006 to 26.8% in 2011 (-8.4%, 95% CI [–9.6 to –7.2]; p<0.001 for trend. Admission for diverticulitis was independently associated with male gender, comorbid illnesses, higher income and commercial health insurance. The surgical rate decreased from 6.5% in 2006 to 4.7% in 2011 (-1.8%, 95% CI [–2.1 to –1.5]; p<0.001 for trend, and among low-risk patients decreased from 4.0% to 2.2% (- 1.8%, 95% CI [–4.5 to –1.7]; p<0.001 for trend. Conclusion: From 2006 to 2011 ED visits for diverticulitis increased
Maconi, Giovanni; Barbara, Giovanni; Bosetti, Cristina; Cuomo, Rosario; Annibale, Bruno
Diverticular disease of the colon is a common disorder, characterized by recurrent symptoms and complications such as diverticulitis, requiring hospital admissions and surgery. This study aimed to systematically review the evidence for medical therapy of diverticular disease in reducing symptoms and preventing acute diverticulitis. MEDLINE and Embase databases (1966 to February 2010). The studies selected were prospective clinical trials on uncomplicated diverticular disease of the colon. Four investigators independently reviewed articles, extracted data, and assessed study quality according to standardized criteria. The main outcomes measured were improvement in symptoms, complete remission of symptoms, and prevention of acute diverticulitis. We identified 31 studies, including 6 placebo-controlled trials. The methodological quality of these studies was suboptimal. Only 10 trials provided a detailed description of the patient history, 8 assessed symptoms by the use of a validated questionnaire, and 14 appropriately defined inclusion and exclusion criteria. Only one long-term double-blind placebo-controlled study was identified. This reported a significant improvement in symptoms and greater prevalence of symptom-free patients at 1 year with fiber plus rifaximin in comparison with fiber alone. The efficacy of treatment in preventing acute diverticulitis was evaluated in 11 randomized trials. Four trials compared rifaximin plus fiber vs fiber alone and failed to show a significant difference between treatments. However, cumulative data from these trials revealed a significant benefit following rifaximin and fiber (1-year rate of acute diverticulitis: 11/970 (1.1%) vs 20/690 (2.9%); P = .012), but with a number needed to treat of 57, to prevent an attack of acute diverticulitis. : Heterogeneity of the study design, patients' characteristics, regimens and combination of studied treatment, and outcome reporting precluded the pooling of results and limited
The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037
Bruin Sjoerd C
Full Text Available Abstract Background Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis. Methods/Design In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm. Patients with faecal peritonitis will be randomised 1:1 between Hartmann's procedure and resection with primary anastomosis (DIVA-arm. The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%. Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and power = 90% in favour of the patients with resection with primary anastomosis. Secondary endpoints for both arms are the number of days alive and outside the hospital, health related quality of life, health care utilisation and associated costs. Discussion The Ladies trial is a nationwide multicentre randomised trial on perforated diverticulitis that will provide evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal resectional strategy
Wedel, Thilo; Barrenschee, Martina; Lange, Christina; Cossais, François; Böttner, Martina
Diverticula of the colon are pseudodiverticula defined by multiple outpouchings of the mucosal and submucosal layers penetrating through weak spots of the muscle coat along intramural blood vessels. A complete prolapse consists of a diverticular opening, a narrowed neck, and a thinned diverticular dome underneath the serosal covering. The susceptibility of diverticula to inflammation is explained by local ischemia, translocation of pathogens due to retained stool, stercoral trauma by fecaliths, and microperforations. Local inflammation may lead to phlegmonous diverticulitis, paracolic/mesocolic abscess, bowel perforation, peritonitis, fistula formation, and stenotic strictures. Diverticular bleeding is due to an asymmetric rupture of distended vasa recta at the diverticular dome and not primarily linked to inflammation. Structural and functional changes of the bowel wall in diverticular disease comprise: i) Altered amount, composition, and metabolism of connective tissue; ii) Enteric myopathy with muscular thickening, deranged architecture, and altered myofilament composition; iii) Enteric neuropathy with hypoganglionosis, neurotransmitter imbalance, deficiency of neurotrophic factors and nerve fiber remodeling; and iv) Disturbed intestinal motility both in vivo (increased intraluminal pressure, motility index, high-amplitude propagated contractions) and in vitro (altered spontaneous and pharmacologically triggered contractility). Besides established etiologic factors, recent studies suggest that novel pathophysiologic concepts should be considered in the pathogenesis of diverticular disease.
Gregersen, Rasmus; Andresen, Kristoffer; Burcharth, Jakob
PURPOSE: The aim of the study was to investigate short-term mortality, readmission, and recurrence in a national cohort of patients with Hinchey Ib-II diverticulitis. METHODS: The retrospective cohort-investigation was conducted using a database consisting of the entire Danish population (n = 6......, secondary outcomes were mortality, readmission, and recurrence within 30 days post-discharge. The study was reported using RECORD guidelines. RESULTS: A total of 3148 eligible patients were identified. The cohort had a mean age of 65.1 year, 25.6 % had previously been admitted with diverticulitis, and 48...... was associated with mortality with odds-ratio 1.49 (1.23-1.81) and readmission with odds-ratio 2.91 (1.24-6.80). CONCLUSION: Acute diverticulitis with abscess formation is a severe and life-threatening condition. Direct comparisons of treatment groups were not possible due to possible confounding by indication....
Elisei, Walter; Tursi, Antonio
The incidence of diverticulosis and diverticular disease of the colon is increasing worldwide. Although the majority of patients remains asymptomatic long-life, the prevalence of diverticular disease of the colon, including acute diverticulitis, is substantial and is becoming a significant burden on National Health Systems in terms of direct and indirect costs. Focus is now being drawn on identifying the correct therapeutic approach by testing various treatments. Fiber, non-absorbable antibiotics and probiotics seem to be effective in treating symptomatic and uncomplicated patients, and 5-aminosalicylic acid might help prevent acute diverticulitis. Unfortunately, robust evidence on the effectiveness of a medical strategy to prevent acute diverticulitis recurrence is still lacking. We herein provide a concise review on the effectiveness and future perspectives of these treatments. PMID:26752946
Connelly, Tara M; Khan, Mohammad Shoaib; Victory, Liana; Mehmood, Abeera; Cooke, Fiachra
Although commonly the first port of call for medical information, the internet provides unregulated information of variable quality. We aimed to evaluate commonly accessed web-based patient information on diverticulitis using validated and novel scoring systems. The top internet search engines (Google/Bing/Yahoo) were queried using the keyword 'diverticulitis.' The first 20 websites from each were graded using the DISCERN and Journal of the American Medical Association (JAMA) benchmark criteria. A novel diverticulitis-specific score was devised and applied. Thirty-six unique websites were identified. The mean total DISCERN score for all websites was 39.92 ± 12.44 (range = 18-62). No website achieved the maximum DISCERN score of 75. The mean JAMA and diverticulitis scores were 2.5 ± 1.08 (maximum possible score = 4) and 11.08 ± 4.17 (19 points possible) respectively. Fourteen (35.9%) and 20 (51.2%) did not provide the date of last update and authorship respectively. Thirty-three (84.6%) mentioned surgery as a treatment option; however, the majority (69.7%) did not describe the surgery or the possibility of a stoma. All except two described disease symptoms. Only ten (25.64%) provided information on when to seek further medical advice or help. Web-based information on diverticulitis is of variable content and quality. The majority of top websites describe disease symptoms and aetiology; however, information to prompt seeking medical attention if required, descriptions of surgical procedures and the possibility of stoma creation are poorly described in the majority of websites. These findings should be highlighted to patients utilising the internet to obtain information on diverticulitis. Copyright © 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
Ridgway, P F
Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and \\'bowel rest\\' in clinically diagnosed acute uncomplicated diverticulitis.
O'Leary, D P
Aggressive non-operative intervention and evolving surgical strategies have altered the treatment of perforated diverticulitis in the acute setting. These strategies have predominantly been implemented over the last decade. The aim of this study was to assess the impact of this on patient outcome during their index admission and subsequently.
de Korte, N.; Kuyvenhoven, J.P.; van der Peet, D.L.; Felt-Bersma, R.J.F.; Cuesta, M.A.; Stockmann, H.B.A.C.
Aim Conservative treatment of mild colonic diverticulitis usually consists of observation, restriction of oral intake, intravenous fluids and antibiotics. The beneficiary effect of antibiotics remains unclear. The aim of this study is to evaluate the need for antibiotics in mild colonic
Full Text Available A right-sided aortic arch with an aneurysm of the aberrant subclavian artery is a rare disease. We report a case of Kommerell's diverticulum of an aberrant left subclavian artery in a patient with a right-sided aortic arch. Fewer than 50 cases have been reported in the literature. A number of operative strategies are described. Right thoracotomy provides good exposure and avoids the morbidity associated with bilateral thoracotomy or sternotomy and thoracotomy. In our patient with symptoms of dysphagia, syncope, and left subclavian steal syndrome, a left thoracotomy was used. The repair was accomplished by division of a left ligamentum arteriosum, obliteration of the Kommerell's aneurysm, and an aorto-subclavian bypass. Postoperative complications included left vocal cord palsy and Horner's syndrome. Hoarseness and left ptosis recovered spontaneously 3 months after surgery, and the patient remained symptom-free at the 1-year follow-up. We believe a left thoracotomy for direct repair of Kommerell's diverticulum is a simple and safe method without the increased morbidity found in other procedures.
Gala, T.; Alvi, A.R.; Sheikh, G.M.; Habib, H.Y.; Ghafoor, Z.
To assess the morbidity and mortality associated with complicated diverticulitis in Pakistan. Methods: The retrospective case series was conducted at an urban tertiary care university hospital of Karachi, Pakistan, comprising data from December 1989 to November 2010. International Classification of Diseases codes for diverticular disease and diverticulitis with abscess, fistula, stricture, bowel obstruction and perforation were obtained from the medical record department. SPSS 19 was used for statistical analysis. Results: A total of 60 (1.9%) cases with complicated diverticulitis were located from among 3170 records reviewed. Mean age was 62.7+-13 years with male-to-female ratio being 36:24. In 37 (62%) patients, the diagnosis was established on computed tomography scan of the abdomen, followed by barium enema in 12 (20%) and colonoscopy in 11 (18%). Post-operative morbidity was observed in 24 (40%) and 7 (16%) expired within 28 days of surgery. Post-operative intra-abdominal sepsis, wound dehiscence and incisional hernia were significantly associated with generalised peritonitis (p <0.05), while admission to intensive care unit was associated with age over 60 years and faecal peritonitis. Post-operative mortality was significantly associated with high American Society of Anaesthesiologists-score III and IV and age above 60 years. Conclusion: Complicated diverticulitis carries significant morbidity and mortality in Pakistani population. Since the trend is on the rise, therefore we propose a prospective multi-centre cohort study to understand the spectrum of disease, management and identification of risk factors to achieve the best possible outcomes in patients with complicated diverticulitis. (author)
Kearney, D E
INTRODUCTION: Fournier\\'s gangrene is a rare severe necrotising fasciitis of the genitalia. CASE: A case of Fournier\\'s gangrene caused by perforated sigmoid diverticulitis in a patient with systemic lupus erythematosus is presented along with a review of the relevant literature.
Jamal Talabani, A; Endreseth, B H; Lydersen, S; Edna, T-H
The study investigated the capability of clinical findings, temperature, C-reactive protein (CRP), and white blood cell (WBC) count to discern patients with acute colonic diverticulitis from all other patients admitted with acute abdominal pain. The probability of acute diverticulitis was assessed by the examining doctor, using a scale from 0 (zero probability) to 10 (100 % probability). Receiver operating characteristic (ROC) curves were used to assess the clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain. Of 833 patients admitted with acute abdominal pain, 95 had acute colonic diverticulitis. ROC curve analysis gave an area under the ROC curve (AUC) of 0.95 (CI 0.92 to 0.97) for ages patients. Separate analysis showed an AUC = 0.83 (CI 0.80 to 0.86) of CRP alone. White blood cell count and temperature were almost useless to discriminate acute colonic diverticulitis from other types of acute abdominal pain, AUC = 0.59 (CI 0.53 to 0.65) for white blood cell count and AUC = 0.57 (0.50 to 0.63) for temperature, respectively. This prospective study demonstrates that standard clinical evaluation by non-specialist doctors based on history, physical examination, and initial blood tests on admission provides a high degree of diagnostic precision in patients with acute colonic diverticulitis.
Snyder, Robin M.
HTML provides a platform-independent way of creating and making multimedia presentations for classroom instruction and making that content available on the Internet. However, time in class is very valuable, so that any way to automate or otherwise assist the presenter in Web page navigation during class can save valuable seconds. This paper…
Richards, Robert J; Hammitt, James K
Although surgery is recommended after two or more attacks of uncomplicated diverticulitis, the optimal timing for surgery in terms of cost-effectiveness is unknown. A Markov model was used to compare the costs and outcomes of performing surgery after one, two, or three uncomplicated attacks in 60-year-old hypothetical cohorts. Transition state probabilities were assigned values using published data and expert opinion. Costs were estimated from Medicare reimbursement rates. Surgery after the third attack is cost saving, yielding more years of life and quality adjusted life years at a lower cost than the other two strategies. The results were not sensitive to many of the variables tested in the model or to changes made in the discount rate (0-5%). In conclusion, performing prophylactic resection after the third attack of diverticulitis is cost saving in comparison to resection performed after the first or second attacks and remains cost-effective during sensitivity analysis.
The presented materials consist of presentations of international workshop which held in Warsaw from 4 to 5 October 2007. Main subject of the meeting was progress in manufacturing as well as research program development for neutron detector which is planned to be placed at GANIL laboratory and will be used in nuclear spectroscopy research
Schultz, Johannes Kurt; Yaqub, Sheraz; Wallon, Conny; Blecic, Ljiljana; Forsmo, Håvard Mjørud; Folkesson, Joakim; Buchwald, Pamela; Körner, Hartwig; Dahl, Fredrik A; Øresland, Tom
Perforated colonic diverticulitis usually requires surgical resection, which is associated with significant morbidity. Cohort studies have suggested that laparoscopic lavage may treat perforated diverticulitis with less morbidity than resection procedures. To compare the outcomes from laparoscopic lavage with those for colon resection for perforated diverticulitis. Multicenter, randomized clinical superiority trial recruiting participants from 21 centers in Sweden and Norway from February 2010 to June 2014. The last patient follow-up was in December 2014 and final review and verification of the medical records was assessed in March 2015. Patients with suspected perforated diverticulitis, a clinical indication for emergency surgery, and free air on an abdominal computed tomography scan were eligible. Of 509 patients screened, 415 were eligible and 199 were enrolled. Patients were assigned to undergo laparoscopic peritoneal lavage (n = 101) or colon resection (n = 98) based on a computer-generated, center-stratified block randomization. All patients with fecal peritonitis (15 patients in the laparoscopic peritoneal lavage group vs 13 in the colon resection group) underwent colon resection. Patients with a pathology requiring treatment beyond that necessary for perforated diverticulitis (12 in the laparoscopic lavage group vs 13 in the colon resection group) were also excluded from the protocol operations and treated as required for the pathology encountered. The primary outcome was severe postoperative complications (Clavien-Dindo score >IIIa) within 90 days. Secondary outcomes included other postoperative complications, reoperations, length of operating time, length of postoperative hospital stay, and quality of life. The primary outcome was observed in 31 of 101 patients (30.7%) in the laparoscopic lavage group and 25 of 96 patients (26.0%) in the colon resection group (difference, 4.7% [95% CI, -7.9% to 17.0%]; P = .53). Mortality at 90 days did not
The PARIS meeting held in Cracow, Poland from 14 to 15 May 2007. The main subjects discussed during this meeting were the status of international project dedicated to gamma spectroscopy research. The scientific research program includes investigations of giant dipole resonance, probe of hot nuclei induced in heavy reactions, Jacobi shape transitions, isospin mixing and nuclear multifragmentation. The mentioned programme needs Rand D development such as new scintillations materials as lanthanum chlorides and bromides as well as new photo detection sensors as avalanche photodiodes - such subjects are also subjects of discussion. Additionally results of computerized simulations of scintillation detectors properties by means of GEANT- 4 code are presented
Full Text Available In the present edition of Significação – Scientific Journal for Audiovisual Culture and in the others to follow something new is brought: the presence of thematic dossiers which are to be organized by invited scholars. The appointed subject for the very first one of them was Radio and the invited scholar, Eduardo Vicente, professor at the Graduate Course in Audiovisual and at the Postgraduate Program in Audiovisual Media and Processes of the School of Communication and Arts of the University of São Paulo (ECA-USP. Entitled Radio Beyond Borders the dossier gathers six articles and the intention of reuniting works on the perspectives of usage of such media as much as on the new possibilities of aesthetical experimenting being build up for it, especially considering the new digital technologies and technological convergences. It also intends to present works with original theoretical approach and original reflections able to reset the way we look at what is today already a centennial media. Having broadened the meaning of “beyond borders”, four foreign authors were invited to join the dossier. This is the first time they are being published in this country and so, in all cases, the articles where either written or translated into Portuguese.The dossier begins with “Radio is dead…Long live to the sound”, which is the transcription of a thought provoking lecture given by Armand Balsebre (Autonomous University of Barcelona – one of the most influential authors in the world on the Radio study field. It addresses the challenges such media is to face so that it can become “a new sound media, in the context of a new soundscape or sound-sphere, for the new listeners”. Andrew Dubber (Birmingham City University regarding the challenges posed by a Digital Era argues for a theoretical approach in radio studies which can consider a Media Ecology. The author understands the form and discourse of radio as a negotiation of affordances and
Full Text Available We report the clinical experience of one patient with perforated duodenal diverticulitis who was successfully treated by intra-abdominal drainage and feeding jejunostomy. A 53-year-old male patient visited our hospital due to acute onset of abdominal pain and distension. Physical examination revealed tenderness over the epigastric area and right-lower quadrant of the abdomen without obvious rebound tenderness or muscle guarding. Duodenal diverticulitis with a retroperitoneal abscess was identified by abdominal computed tomography scan. Surgical intervention was performed after the failure of conservative treatment. The operative findings were compatible with perforated duodenal diverticulitis, and intra-abdominal drainage of retroperitoneal abscess with simultaneous feeding jejunostomy was undertaken. The patient was doing well at the 4-month postoperative follow-up visit. We suggest the use of a conservative operative method, as opposed to conventional diverticulectomy and duodenorrhaphy, as an alternative approach for the management of this disorder, especially when conservative treatment has failed.
Chang, Shen-Shong; Hu, Hsiao-Yun
The pathophysiology of diverticulitis is poorly understood. Factors such as physical inactivity, constipation, obesity, smoking, and the use of nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with an increased risk of diverticular disease. To evaluate whether patients exhibiting long-term steroid use are at increased risk of colonic diverticulitis. We conducted a population-based, nested case-control study. Data were retrospectively collected from the National Health Insurance Research Database. The study cohort comprised patients diagnosed with diverticulitis, identified using inpatient discharge records using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes (562.11 and 562.13), and those who were administered one or more prescriptions for corticosteroids for systemic use. Control patients were matched to cases by age, sex, NSAID use, laxative drug use, and index date. We enrolled 690 patients with colonic diverticulitis and 2760 in the control group. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. Compared with steroid nonusers, the adjusted ORs were 0.60 (95% CI = 0.35-1.06) and 0.80 (95% CI = 0.64-1.008) in current steroid users and previous steroid users, respectively. In addition, the adjusted ORs were 0.55 (95% CI = 0.31-0.98), 0.57 (95% CI = 0.31-0.98), and 0.44 (95% CI = 0.22-0.86) for steroid use duration more than half time by an exposure period of 90 days, 180 days, and 365 days before the claim date of colonic diverticulitis, respectively. The results indicated that long-term steroid use within one year is associated with lower risk of colonic diverticulitis.
Full Text Available The pathophysiology of diverticulitis is poorly understood. Factors such as physical inactivity, constipation, obesity, smoking, and the use of nonsteroidal antiinflammatory drugs (NSAIDs have been associated with an increased risk of diverticular disease. To evaluate whether patients exhibiting long-term steroid use are at increased risk of colonic diverticulitis.We conducted a population-based, nested case-control study. Data were retrospectively collected from the National Health Insurance Research Database. The study cohort comprised patients diagnosed with diverticulitis, identified using inpatient discharge records using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM codes (562.11 and 562.13, and those who were administered one or more prescriptions for corticosteroids for systemic use. Control patients were matched to cases by age, sex, NSAID use, laxative drug use, and index date. We enrolled 690 patients with colonic diverticulitis and 2760 in the control group. The adjusted odds ratios (ORs and 95% confidence intervals (CIs were estimated using conditional logistic regression.Compared with steroid nonusers, the adjusted ORs were 0.60 (95% CI = 0.35-1.06 and 0.80 (95% CI = 0.64-1.008 in current steroid users and previous steroid users, respectively. In addition, the adjusted ORs were 0.55 (95% CI = 0.31-0.98, 0.57 (95% CI = 0.31-0.98, and 0.44 (95% CI = 0.22-0.86 for steroid use duration more than half time by an exposure period of 90 days, 180 days, and 365 days before the claim date of colonic diverticulitis, respectively.The results indicated that long-term steroid use within one year is associated with lower risk of colonic diverticulitis.
Brandlhuber, Martina; Genzinger, Christian; Brandlhuber, Bernhard; Sommer, Wieland H; Müller, Mario H; Kreis, Martin E
It is controversial whether patients fare better with conservative or surgical treatment in certain stages of acute diverticulitis (AD), in particular when phlegmonous inflammation or covered micro- or macro-perforation are present. The aim of this study was to determine long-term quality of life (QoL) for AD patients who received either surgery or conservative treatment in different stages. We included patients treated for AD at the University Hospital Grosshadern, Munich, Germany, between January 1, 2000, and December 31, 2010. Patients were classified by the Hansen and Stock (HS) classification, the modified Hinchey classification, and the German classification of diverticular disease (CDD). Pre-therapeutic staging was based on multidetector computed tomography. Long-term QoL was assessed by the Cleveland Global Quality of Life (CGQL) questionnaire, the Short Form 36 (SF-36), and the Gastrointestinal Quality of Life Index (GIQLI). Data are mean ± SEM. Patients with phlegmonous AD (HS type 2a, Hinchey Ia and CDD 1b, respectively) had a better long-term QoL on the GIQLI when they were operated (78.5 ± 2.5 vs. 70.7 ± 2.1; p life, patients fare better after elective sigmoid colectomy when abscess size exceeds 1 cm.
Side effects are problems that occur when cancer treatment affects healthy tissues or organs. Learn about side effects caused by cancer treatment. Know what signs and symptoms to call your doctor about. Learn about treatments for side effects.
Lee, So Hee; Hwang, Sun Hyuk; Park, Jin Soo; Park, Hae Sim; Shin, Yoo Seob
Polyethylene glycols (PEGs) are believed to be chemically inert agents, but larger PEG polymers could have immunogenicity. A 39-year-old man was referred to emergency room for loss of consciousness and dyspnea after taking of PEG-3350 (Colyte®). In laboratory findings, the initial serum tryptase level was increased to 91.9 mg/L (normal range: 0.00-11.40 mg/L) without any other laboratory abnormalities. The intradermal test with 10 mg/mL Colyte® showed a 5 × 5 mm wheal, but basophil activation and histamine releasability tests were negative. PEG-3350 is widely used as an osmotic laxative due to its lack of absorption from the gastrointestinal tract. However, the loss of mucosal integrity at gastrointestinal membrane such as diverticulitis may be a predisposing factor for anaphylaxis to Colyte®. We report a case of anaphylaxis induced by the ingestion of PEG-3350 in a patient with diverticulitis which might be a risk factor of anaphylaxis.
Trenti, Loris; Biondo, Sebastiano; Golda, Thomas; Monica, Millan; Kreisler, Esther; Fraccalvieri, Domenico; Frago, Ricardo; Jaurrieta, Eduardo
Hartmann's procedure (HP) still remains the most frequently performed procedure for diffuse peritonitis due to perforated diverticulitis. The aims of this study were to assess the feasibility and safety of resection with primary anastomosis (RPA) in patients with purulent or fecal diverticular peritonitis and review morbidity and mortality after single stage procedure and Hartmann in our experience. From January 1995 through December 2008, patients operated for generalized diverticular peritonitis were studied. Patients were classified into two main groups: RPA and HP. A total of 87 patients underwent emergency surgery for diverticulitis complicated with purulent or diffuse fecal peritonitis. Sixty (69%) had undergone HP while RPA was performed in 27 patients (31%). At the multivariate analysis, RPA was associated with less post-operative complications (P clinical anastomotic leakage and needed re-operation. RPA can be safely performed without adding morbidity and mortality in cases of diffuse diverticular peritonitis. HP should be reserved only for hemodynamically unstable or high-risk patients. Specialization in colorectal surgery improves mortality and raises the percentage of one-stage procedures.
Watanabe, Jota; Watanabe, Hideo; Tohyama, Taiji; Kushihata, Fumiki; Kobayashi, Nobuaki
It is difficult to differentiate between diverticulitis of the right colon and acute appendicitis based on pathological and hematological findings. This study was designed to investigate the usefulness of CT in differentiation between the both diseases and indications of operation. Eight cases of right colon diverticulitis and 39 cases of acute appendicitis undergone abdominal plain CT scan before surgery were enrolled in the study. As for diverticulitis cases, diverticulum was visualized on abdominal CT scan in seven (87.5%) out of the eight cases. Of 39 cases of acute appendicitis, the appendix vermiformis was able to be visualized on abdominal CT scan in 26 (66.7%) cases. Some correlations between CT findings and postoperative pathological diagnosis of appendicitis were observed. A comparison was made on acute appendicitis cases by dividing them into two groups; namely, the non-surgery group comprising of cases pathologically diagnosed as non-inflammatory and catarrhal' and the surgery group comprising of cases diagnosed as 'phlegmonous and gangrenous' after surgery. Statistically significant difference was noted between both groups in two factors, whole-circumferential thickening of the appendiceal wall and fading panniculus adiposus around the appendix. It is concluded that abdominal CT scan is useful for differential diagnosis between right colon diverticulitis and acute appendicitis, and further that CT diagnosis of acute appendicitis well reflects the severity of the disease and contribute to decide indication of operation. (author)
Sigmoid resection with primary anastomosis and ileostomy versus laparoscopic lavage in purulent peritonitis from perforated diverticulitis: outcome analysis in a prospective cohort of 40 consecutive patients.
Catry, Jonathan; Brouquet, Antoine; Peschaud, Frédérique; Vychnevskaia, Karina; Abdalla, Solafah; Malafosse, Robert; Lambert, Benoit; Costaglioli, Bruno; Benoist, Stéphane; Penna, Christophe
This prospective study aimed to compare outcomes after laparoscopic peritoneal lavage (LPL) and sigmoid resection with primary colorectal anastomosis (RPA). From June 2010 to June 2015, 40 patients presenting with Hinchey III peritonitis from perforated diverticulitis underwent LPL or RPA. Patients with Hinchey II or IV peritonitis and patients who underwent an upfront Hartmann procedure were excluded. Primary endpoint was overall 30-day or in-hospital postoperative morbidity after surgical treatment of peritonitis. Twenty-five patients underwent RPA and 15 LPL. Overall postoperative morbidity and mortality rates were not significantly different after RPA and LPL (40 vs 67 %, p = 0.19; 4 vs 6.7 %, p = 1, respectively). Intra-abdominal morbidity and reoperation rates were significantly higher after LPL compared to RPA (53 vs 12 %, p < 0.01; 40 vs 4 %, p = 0.02, respectively). Multivariate analysis showed that LPL (p = 0.028, HR = 18.936, CI 95 % = 1.369-261.886) was associated with an increased risk of postoperative intra-abdominal septic morbidity. Among 6 patients who underwent reoperation after LPL, 4 had a Hartmann procedure. All surviving patients who had a procedure requiring stoma creation underwent stoma reversal after a median delay of 92 days after LPL and 72 days after RPA (p = 0.07). LPL for perforated diverticulitis is associated with a high risk of inadequate intra-abdominal sepsis control requiring a Hartmann procedure in up to 25 % of patients. RPA appears to be safer and more effective. It may represent the best option in this context.
Full Text Available Abstract Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum.
Aquina, Christopher T; Probst, Christian P; Becerra, Adan Z; Hensley, Bradley J; Iannuzzi, James C; Noyes, Katia; Monson, John R T; Fleming, Fergal J
Colostomy reversal after Hartmann's procedure for diverticulitis is a morbid procedure, and studies investigating factors associated with outcomes are lacking. This study identifies patient, surgeon, and hospital-level factors associated with perioperative outcomes after stoma reversal. The Statewide Planning and Research Cooperative System was queried for urgent/emergency Hartmann's procedures for diverticulitis between 2000-2012 in New York State and subsequent colostomy reversal within 1 year of the procedure. Surgeon and hospital volume were categorized into tertiles based on the annual number of colorectal resections performed each year. Bivariate and mixed-effects analyses were used to assess the association between patient, surgeon, and hospital-level factors and perioperative outcomes after colostomy reversal, including a laparoscopic approach; duration of stay; intensive care unit admission; complications; mortality; and 30-day, unscheduled readmission. Among 10,487 patients who underwent Hartmann's procedure and survived to discharge, 63% had the colostomy reversed within 1 year. After controlling for patient, surgeon, and hospital-level factors, high-volume surgeons (≥40 colorectal resections/yr) were independently associated with higher odds of a laparoscopic approach (unadjusted rates: 14% vs 7.6%; adjusted odds ratio = 1.84, 95% confidence interval = 1.12, 3.00), shorter duration of stay (median: 6 versus 7 days; adjusted incidence rate ratio = 0.87, 95% confidence interval = 0.81, 0.95), and lower odds of 90-day mortality (unadjusted rates: 0.4% vs 1.0%; adjusted odds ratio = 0.30, 95% confidence interval = 0.10, 0.88) compared with low-volume surgeons (1-15 colorectal resections/yr). High-volume surgeons are associated with better perioperative outcomes and lower health care utilization after Hartmann's reversal for diverticulitis. These findings support referral to high-volume surgeons for colostomy reversal. Copyright © 2016
... Examples of items allowed on a clear liquid diet include: Broth Fruit juices without pulp, such as apple juice Ice chips ... and poultry Refined white bread Fruit and vegetable juice with no ... two or three days of starting the diet and antibiotics. If you haven't started feeling ...
Dahl, Camilla; Crichton, Megan; Jenkins, Julie; Nucera, Romina; Mahoney, Sophie; Marx, Wolfgang
In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review the evidence and develop recommendations for dietary fibre modifications, either alone or alongside probiotics or antibiotics, versus any comparator in adults in any setting with or recently recovered from acute, uncomplicated diverticulitis. Intervention and observational studies in any language were located using four databases until March 2017. The Cochrane Risk of Bias tool and GRADE were used to evaluate the overall quality of the evidence and to develop recommendations. Eight studies were included. There was “very low” quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms and reoccurrence. There was “very low” quality of evidence for using a high dietary fibre diet as opposed to a standard or low dietary fibre diet following resolution of an acute episode, to improve reoccurrence and gastrointestinal symptoms. The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. It also strongly recommends a high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, after the acute episode has resolved. PMID:29382074
Binda, G A; Karas, J R; Serventi, A; Sokmen, S; Amato, A; Hydo, L; Bergamaschi, R
This randomized controlled trial (RCT) was performed to test the hypothesis that adverse event rates following primary anastomosis (PRA) are not inferior to those following nonrestorative colon resection for perforated diverticulitis with peritonitis. Patients admitted for perforated diverticulitis with peritonitis were randomly assigned to PRA (left colon resection with PRA and loop ileostomy) or nonrestorative colon resection (left colon resection with end colostomy). The endpoint was adverse events defined as mortality and morbidity following PRA or nonrestorative colon resection and stoma reversal. The estimated sample size was 300 patients in each study arm (alpha 0.10; 90% power). During a 9-year period, 90 patients were randomly assigned to undergo PRA or nonrestorative colon resection in 14 centres in eight countries. Thirty-four PRA patients were comparable to 56 nonrestorative colon resection patients for age (P = 0.481), gender (P = 0.190), APACHE III (P = 0.281), Hinchey stage III vs IV (P = 0.394) and Mannheim Peritonitis Index (P = 0.145). There were no differences in operating time (P = 0.231), surgeries performed at night (P = 0.083), open vs laparoscopic approach (P = 0.419) and litres of peritoneal irrigation (P = 0.096). There was no significant difference in mortality (2.9 vs 10.7%; P = 0.247) and morbidity (35.3 vs 46.4%; P = 0.38) following PRA or nonrestorative colon resection. After a similar lag time (P = 0.43), 64.7% of PRA patients and 60% of nonrestorative colon resection patients underwent stoma reversal (P = 0.659). Adverse event rates following stoma reversal differed significantly after PRA and reversal of nonrestorative resection (4.5 vs 23.5%; P = 0.0589). No conclusions may be drawn on preference of one treatment over another from this RCT because it was prematurely terminated following accrual of 15% of its sample size. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Robin F. Irons
Full Text Available Background Ideal operative timing for non-emergent, acute diverticulitis (AD remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI, pneumonia (PNA, need for blood transfusion, septic shock, return to the operating room, length of stay (LOS, readmission, wound dehiscence, and surgical site infections (SSI. Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR with 95% confidence intervals (CI were calculated for primary and secondary outcomes. Results 32,399 patients underwent colectomy for AD on hospital day 1 - 20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 - 1.057; P < 0.0001 and sepsis (OR = 1.051, 95% CI, 1.035 - 1.067; P < 0.0001. Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion
Lameris, Wytze; Randen, Adrienne van; Bipat, Shandra; Stoker, Jaap; Bossuyt, Patrick M.M.; Boermeester, Marja A.
The purpose was to investigate the diagnostic accuracy of graded compression ultrasonography (US) and computed tomography (CT) in diagnosing acute colonic diverticulitis (ACD) in suspected patients. We performed a systematic review and meta-analysis of the accuracy of CT and US in diagnosing ACD. Study quality was assessed with the QUADAS tool. Summary estimates of sensitivity and specificity were calculated using a bivariate random effects model. Six US studies evaluated 630 patients, and eight CT studies evaluated 684 patients. Overall, their quality was moderate. We did not identify meaningful sources of heterogeneity in the study results. Summary sensitivity estimates were 92% (95% CI: 80%-97%) for US versus 94% (95%CI: 87%-97%) for CT (p = 0.65). Summary specificity estimates were 90% (95%CI: 82%-95%) for US versus 99% (95%CI: 90%-100%) for CT (p = 0.07). For the identification of alternative diseases sensitivity ranged between 33% and 78% for US and between 50% and 100% for CT. The currently best available evidence shows no statistically significant difference in accuracy of US and CT in diagnosing ACD. Therefore, both US and CT can be used as initial diagnostic tool until new evidence is brought forward. However, CT is more likely to identify alternative diseases. (orig.)
André Roncon Dias
Full Text Available Nas últimas décadas a incidência da moléstia diverticular do cólon e de suas complicações tem aumentado. Durante esse período o número de publicações a respeito do tema se expandiu, bem como as opções terapêuticas. Apesar disso, muitas dúvidas persistem e as decisões terapêuticas continuam relativamente imutadas, baseadas muitas vezes em dados antigos e de baixo poder estatístico. Nesta revisão apresentamos as evidências científicas atuais acerca da terapêutica desta complexa patologia.During the past decades the incidence of diverticular disease of the colon and its complications has increased as well as the therapeutic options have expanded. However, there are still remaining doubts about the timing of surgery indication, the access (open vs laparoscopic and the best approach to complicated diverticulitis. The current decisions are mostly based in old data of poor statistic strength. This review shows the present-day evidence about the treatment of diverticular disease.
Tsilimparis, N; Haase, O; Wendling, P; Kipfmüller, K; Schmid, M; Engemann, R; Schwenk, W
The natural course of sigmoid colon diverticulitis during conservative therapy and the assessment of the perioperative morbidity after sigmoid colon resection are differently evaluated by surgeons and gastroenterologists. The "fast-track" rehabilitation accelerates the reconvalescence and reduces the rate of postoperative general complications after colorectal surgery. The results of the laparoscopic "Fast-track" sigmoidectomy should be examined within a quality assurance program to better evaluate the perioperative risks following surgical management of diverticulitis. A prospective data collection within the voluntary quality assurance program "fast-track" Kolon II was performed. All participating clinics agreed on a multimodal, evidence-based standard perioperative treatment in terms of a "fast-track" rehabilitation for elective operations for sigmoid diverticulitis. Data from 846 patients undergoing laparoscopic "fast-track" sigmoid colon resection in 23 surgical departments in Germany were collected and evaluated. The mean age of the patients was 63 years (range 23 - 91). 203 patients (24 %) had severe co-morbidities (ASA classification III - IV). A conversion to conventional open surgery was necessary in 51 cases (6 %). Complications occurred in 93 patients (11 %). 76 patients suffered a surgical complication (8.9 %) and 32 patients (3.8 %) a general complication. Two patients died postoperatively due to multi-organ failure following anastomotic leaks. The patients took solid food in median on day 1 after surgery (range, 0 - 5) and passed stool on day 2 (range, 0 - 22). Predefined discharge criteria (free of pain on oral medication, normal oral feeding, stool) were met on day 4 (range, 1 - 58) and the patients were discharged on day 7 (range, 3 - 72). The 30-day re-admission rate was 3.9 %. Patients undergoing laparoscopic "fast-track" sigmoidectomy had a low rate of general complications and had a rapid reconvalescence with a short postoperative in
Salvador Martínez, Antonio
Diverticulitis aguda. Estado actual y controversias Este término representa un espectro de los cambios inflamatorios que van desde una inflamación local subclínica hasta la peritonitis generalizada con perforación libre. Su mecanismo de aparición gira alrededor de una perforación de un divertículo. El antiguo concepto de obstrucción luminal probablemente represente un hecho raro. El aumento de la presión intraluminal o las partículas espesadas de alimentos pueden erosionar la pared d...
Picchio, Marcello; Elisei, Walter; Brandimarte, Giovanni; Di Mario, Francesco; Malfertheiner, Peter; Scarpignato, Carmelo; Tursi, Antonio
Symptomatic uncomplicated diverticular disease (SUDD) is a common gastrointestinal disease, because it affects about one fourth of the patient harboring colonic diverticula. To assess the effectiveness of mesalazine in improving symptoms (namely abdominal pain) and in preventing diverticulitis occurrence in patients with SUDD. Only randomized clinical trials (irrespective of language, blinding, or publication status) that compared mesalazine with placebo or any other therapy in SUDD were evaluated. The selected endpoints were symptom relief and diverticulitis occurrence at maximal follow-up. Absolute risk reduction (ARR, with 95% confidence interval) and the number needed to treat were used as measures of the therapeutic effect. Six randomized clinical trials enrolled 1021 patients: 526 patients were treated with mesalazine and 495 with placebo or other therapies. Symptom relief with mesalazine was always larger than that with placebo and other therapies. However, absolute risk reduction was significant only when mesalazine was compared with placebo, a high-fiber diet, and low-dose rifaximin. The incidence of diverticulitis with mesalazine was lower than that observed with placebo and other treatments, being significant only when compared with placebo. Mesalazine is effective in achieving symptom relief and primary prevention of diverticulitis in patients with SUDD.
Masri, Najy; Weems, Rikki; Brown, Falon; Andres, Ben; Lopez, Fred
A 49 year-old man with a past medical history significant for essential hypertension, hyperlipidemia, and coronary artery disease status post percutaneous coronary intervention and stent placement in the right coronary artery in 2010 presented for evaluation of left hemiplegia. He was feeling well until three hours prior to presentation, at which time he fell while walking from his bedroom into the kitchen. After falling, he noticed that his left upper and lower extremities felt weak. He denied any symptoms preceding the fall or any loss of consciousness. On initial exam, the temperature was 99°F, the pulse was 93 beats per minute, the blood pressure was 191/100 mmHg, the respiratory rate was 22 breaths per minute, and the oxygen saturation was 100% while breathing room air. His neurological exam revealed diminished strength in the left upper extremity: 4/5 arm abduction and adduction of the left shoulder; 4/5 elbow and wrist extension and flexion; and 4/5 extension, abduction, and adduction of the digits. The patient also exhibited slight left upper extremity pronator drift. The strength was also diminished in the left lower extremity: 2/5 hip flexion, extension, and rotation; 3/5 knee flexion and extension; and 3/5 ankle dorsiflexion and plantar flexion. Initial NIH stroke scale score was 5, otherwise, there were no focal neurological deficits and the remainder of his exam was unremarkable. Initial computed tomography (CT) of the head was negative for any acute intracranial hemorrhage or infarct. A subsequent CT cerebral perfusion scan (Figure 1) was notable for areas of ischemia in the right cingulate gyrus as well as the medial frontal and parietal lobes. CT angiogram of the neck revealed bilateral atherosclerotic plaque in the carotid arteries; however, there was no evidence of any flow-limiting stenosis.
Bridoux, Valerie; Regimbeau, Jean Marc; Ouaissi, Mehdi; Mathonnet, Muriel; Mauvais, Francois; Houivet, Estelle; Schwarz, Lilian; Mege, Diane; Sielezneff, Igor; Sabbagh, Charles; Tuech, Jean-Jacques
About 25% of patients with acute diverticulitis require emergency intervention. Currently, most patients with diverticular peritonitis undergo a Hartmann's procedure. Our objective was to assess whether primary anastomosis (PA) with a diverting stoma results in lower mortality rates than Hartmann's procedure (HP) in patients with diverticular peritonitis. We conducted a multicenter randomized controlled trial conducted between June 2008 and May 2012: the DIVERTI (Primary vs Secondary Anastomosis for Hinchey Stage III-IV Diverticulitis) trial. Follow-up duration was up to 18 months. A random sample of 102 eligible participants with purulent or fecal diverticular peritonitis from tertiary care referral centers and associated centers in France were equally randomized to either a PA arm or to an HP arm. Data were analyzed on an intention-to-treat basis. The primary end point was mortality rate at 18 months. Secondary outcomes were postoperative complications, operative time, length of hospital stay, rate of definitive stoma, and morbidity. All 102 patients enrolled were comparable for age (p = 0.4453), sex (p = 0.2347), Hinchey stage III vs IV (p = 0.2347), and Mannheim Peritonitis Index (p = 0.0606). Overall mortality did not differ significantly between HP (7.7%) and PA (4%) (p = 0.4233). Morbidity for both resection and stoma reversal operations were comparable (39% in the HP arm vs 44% in the PA arm; p = 0.4233). At 18 months, 96% of PA patients and 65% of HP patients had a stoma reversal (p = 0.0001). Although mortality was similar in both arms, the rate of stoma reversal was significantly higher in the PA arm. This trial provides additional evidence in favor of PA with diverting ileostomy over HP in patients with diverticular peritonitis. ClinicalTrials.gov Identifier: NCT 00692393. Copyright © 2017. Published by Elsevier Inc.
Oh, Heung-Kwon; Han, Eon Chul; Ha, Heon-Kyun; Choe, Eun Kyung; Moon, Sang Hui; Ryoo, Seung-Bum; Jeong, Seung-Yong; Park, Kyu Joo
To compare the outcome of the surgical management of left-sided and right-sided diverticular disease. The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed. The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology. Right-sided diverticula were classified as those arising from the cecum, ascending colon, and transverse colon, and those from the descending colon, sigmoid colon, and rectum were classified as left-sided diverticulosis. To assess the changing trend of occurrence of diverticulosis, data were compared with two previous studies of 51 patients. The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001, (27.5% vs 48.1%, P disease. However, patients with right-sided disease were significantly younger (50.9 year vs 64.0 year, P disease was significantly associated with a higher incidence of complicated diverticulitis (89.2% vs 57.5%, P diverticular disease, the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.
Gachabayov, M; Oberkofler, C E; Tuech, J J; Hahnloser, D; Bergamaschi, R
It is still controversial whether the optimal operation for perforated diverticulitis with peritonitis is primary anastomosis (PRA) or nonrestorative resection (NRR). The aim of this systematic review and meta-analysis was to evaluate mortality and morbidity rates following emergency resection for perforated diverticulitis with peritonitis and ostomy reversal, as well as ostomy non-reversal rates. The Pubmed, EMBASE, Cochrane Library, MEDLINE via Ovid, CINAHL, and Web of Science databases were systematically searched. Mortality was the primary endpoint. A subgroup meta-analysis of randomized controlled trials was performed in addition to a meta-analysis of all eligible studies. Odds ratios (OR) and mean difference (MD) were calculated for dichotomous and continuous outcomes, respectively. 17 studies, including 3 randomized controlled trials (RCT), involving 1016 patients (392 PRA vs. 624 NRR) were included. Overall, mortality was significantly lower in patients with PRA as compared to patients with NRR [OR(95%CI)=0.38(0.24, 0.60); p<0.0001]. Organ/space surgical site infection (SSI) [OR(95%CI)=0.25(0.10, 0.63); p=0.003], reoperation [OR(95%CI)=0.48(0.25, 0.91); p=0.02], and ostomy non-reversal rates [OR(95%CI)=0.27(0.09, 0.84); p=0.02] were significantly decreased in PRA. In RCTs, mortality rate did not differ [OR(95%CI)=0.46(0.15, 1.38); p=0.17]. The mean operating time for PRA was significantly longer [MD(95%CI)=19.96(7.40, 32.52); p=0.002]. Organ/space SSI [OR(95%CI)=0.28(0.09, 0.82); p=0.02] was lower after PRA. Ostomy non-reversal rates were lower after PRA. The difference was not statistically significant [OR(95%CI)=0.26(0.06, 1.11); p=0.07]. However, it was clinically significant [NNT(95%CI)=5(3.1, 8.9)]. This meta-analysis found that organ/space SSI rates as well as ostomy non-reversal rates were decreased in PRA at the cost of prolonged operating time. This article is protected by copyright. All rights reserved. This article is protected by copyright. All
Hjern, F.; Jonas, E.; Holmstroem, B.; Josephson, T.; Mellgren, A.; Johansson, C.
Aim: To assess whether computed tomography colonography (CTC) is a viable alternative to colonoscopy or double contrast barium enema in the follow-up of patients after diverticulitis. Material and methods: Fifty patients underwent CTC followed immediately by colonoscopy. Results were blinded to the examiners. Findings of diverticular disease and patient acceptance were evaluated. Results: Bowel preparation and distension were good in the majority of CTC and colonoscopy examinations. Diverticular disease was found in 96% of patients at CTC and in 90% at colonoscopy. The rate of agreement between CTC and colonoscopy for diverticular findings in the sigmoid colon was good (κ = 0.64). No complications were seen. Patients found colonoscopy more uncomfortable (p < 0.03), more painful (p < 0.001), and more difficult (p < 0.01) than CTC. Of the patients favouring one examination, 74% preferred CTC. Conclusion: CTC appears to have a better diagnostic potential for imaging of diverticular disease-specific findings, when compared with colonoscopy. Also, CTC was less uncomfortable and was preferred by a majority of patients. CTC seems to be a reasonable alternative in follow-up of patients with symptomatic diverticular disease
... to fully work. You might feel some side effects of your medication before your feel the benefits – ... as sleepiness, anxiety or headache) is a side effect or a symptom of your illness. Many side ...
Di Saverio, Salomone; Vennix, Sandra; Birindelli, Arianna; Weber, Dieter; Lombardi, Raffaele; Mandrioli, Matteo; Tarasconi, Antonio; Bemelman, Willem A
Modern management of severe acute complicated diverticulitis continues to evolve towards more conservative and minimally invasive strategies. Although open sigmoid colectomy with end colostomy remains the most commonly used procedure for the treatment of perforated diverticulitis with purulent/faeculent peritonitis, recent major advances challenged this traditional approach, including the increasing attitude towards primary anastomosis as an alternative to end colostomy and use of laparoscopic approach for urgent colectomy. Provided an accurate patients selection, having the necessary haemodynamic stability, pneumoperitoneum is established with open Hasson technique and diagnostic laparoscopy is performed. If faeculent peritonitis (Hinchey IV perforated diverticulitis) is found, laparoscopy can be continued and a further three working ports are placed using bladeless trocars, as in traditional laparoscopic sigmoidectomy, with the addition of fourth trocar in left flank. The feacal matter is aspirated either with large-size suction devices or, in case of free solid stools, these can be removed with novel application of tight sealing endobags, which can be used for scooping the feacal content out and for its protected retrieval. After decontamination, a sigmoid colectomy is performed in the traditional laparoscopic fashion. The sigmoid is fully mobilised from the retroperitoneum, and mesocolon is divided up to the origin of left colic vessels. Whenever mesentery has extremely inflamed and thickened oedematous tissues, an endostapler with vascular load can be used to avoid vascular selective ligatures. Splenic flexure should be appropriately mobilised. The specimen is extracted through mini-Pfannenstiel incision with muscle splitting technique. Transanal colo-rectal anastomosis is fashioned. Air-leak test must be performed and drains placed where appropriate. The video shows operative technique for a single-stage, entirely laparoscopic, washout and sigmoid colectomy
The ladies trial: Laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037)
D.J. Swank (Dingeman); J. Vermeulen (Jefrey); J.F. Lange (Johan); I.M. Mulder (Irene); J.A.B. van der Hoeven (Joost); L.P. Stassen (Laurents); R.M.P.H. Crolla (Rogier); M.N. Sosef (Meindert); S.W. Nienhuijs (Simon); R.J.I. Bosker (Robbert); M.J. Boom (Maarten); Ph.M. Kruyt (Philip); W.H. Steup (Willem Hans); E.J.R. de Graaf (Eelco); W.F. Weidema (Wibo); R.E.G.J.M. Pierik (Robert); H.A. Prins (Hubert); H.B.A.C. Stockmann; R.A.E.M. Tollenaar (Rob); B.A. van Wagensveld (Bart); P-P. Coene (Peter Paul); G.D. Slooter (Gerrit); E.C. Consten (Esther); E.B. van Duijn (Eino); M.F. Gerhards (Michael); A.G.M. Hoofwijk; T.M. Karsten (Thomas); P.A. Neijenhuis (Peter); C.F.J.M. Blanken-Peeters (Charlotte); H.A. Cense (Huib); G.H.H. Mannaerts (Guido); S.C. Bruin (Sjoerd); Q.A. Eijsbouts (Quirijn); M.J. Wiezer (Marinus); E.J. Hazebroek (Eric Jasper); A.A. van Geloven (Anna); J.K. Maring (John); A. D'Hoore (André); A. Kartheuser (Alex); C. Remue (Christophe); H.M.U. van Grevenstein (Helma); J.L.M. Konsten (Joop); D.L. van der Peet (Donald); M.J.P.M. Govaert (Marc); A.F. Engel (Alexander); J.B. Reitsma (Johannes); W.A. Bemelman (Willem)
textabstractBackground: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective
The Ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitis and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitis in perforated diverticulitis (NTR2037)
Swank, Hilko A.; Vermeulen, Jefrey; Lange, Johan F.; Mulder, Irene M.; van der Hoeven, Joost A. B.; Stassen, Laurents P. S.; Crolla, Rogier M. P. H.; Sosef, Meindert N.; Nienhuijs, Simon W.; Bosker, Robbert J. I.; Boom, Maarten J.; Kruyt, Philip M.; Swank, Dingeman J.; Steup, Willem H.; de Graaf, Eelco Jr; Weidema, Wibo F.; Pierik, Robert E. G. J. M.; Prins, Hubert A.; Stockmann, Henricus B. A. C.; Tollenaar, Rob A. E. M.; van Wagensveld, Bart A.; Coene, Peter-Paul L. O.; Slooter, Gerrit D.; Consten, Esther C. J.; van Duyn, Eino B.; Gerhards, Michael F.; Hoofwijk, Anton G. M.; Karsten, Thomas M.; Neijenhuis, Peter A.; Blanken-Peeters, Charlotte F. J. M.; Cense, Huib A.; Mannaerts, Guido H. H.; Bruin, Sjoerd C.; Eijsbouts, Quirijn A. J.; Wiezer, Marinus J.; Hazebroek, Eric J.; van Geloven, Anna A. W.; Maring, John K.; D'Hoore, Andre; Kartheuser, Alex; Remue, Christophe; van Grevenstein, Wilhelmina M. U.; Konsten, Joop L. M.; van der Peet, Donald L.; Govaert, Marc J. P. M.; Engel, Alexander F.; Reitsma, Johannes B.; Bemelman, Willem A.; 3d, The Dutch Diverticular Disease Collaborative Study Group
ABSTRACT: BACKGROUND: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective
... cancer care is relieving side effects, called symptom management, palliative care, or supportive care. It is important ... treat them. To learn about the symptoms and management of the long-term side effects of cancer ...
Radiation therapy has side effects because it not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Many people who get radiation therapy experience fatigue. Other side effects depend on the part of the body that is being treated. Learn more about possible side effects.
Full Text Available Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration.
Casanova, Federico; Blümich, Bernhard
Single-Sided NMR describes the design of the first functioning single-sided tomograph, the related measurement methods, and a number of applications. One of the key advantages to this method is the speed at which the images are obtained.
Full Text Available DarkSide-50 at Gran Sasso underground laboratory (LNGS, Italy, is a direct dark matter search experiment based on a liquid argon TPC. DS-50 has completed its first dark matter run using atmospheric argon as target. The detector performances and the results of the first physics run are presented in this proceeding.
Braun, Raffael; Huwiler, Bernhard
Side Effects of Smoking Cessation Abstract. We present the case of a clozapine intoxication associated with aspiration pneumonia due to smoking cessation. Clozapine is mainly metabolized by CYP1A2. CYP1A2 is induced by cigarette smoking, which may change the plasma level of clozapine, especially if consuming habits change.
Casla, S; Hojman, P; Márquez-Rodas, I
The number of breast cancer survivors increases every year, thanks to the development of new treatments and screening techniques. However, patients present with numerous side effects that may affect their quality of life. Exercise has been demonstrated to reduce some of these side effects...... be an integrative complementary intervention to improve physiological, physical and psychological factors that affect survival and quality of life of these patients. For that reason, the main objective of this review is to provide a general overview of exercise benefits in breast cancer patients and recommendations...
Bhuket TP, Stollman NH. Diverticular disease of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 10th ed. Philadelphia, PA: Elsevier ...
... Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información ... Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información ...
芳賀, 駿介; 遠藤, 俊吾; 加藤, 博之; 高橋, 直樹; 吉松, 和彦; 橋本, 雅彦; 石橋, 敬一郎; 梅原, 有弘; 横溝, 肇; 梶原, 哲郎; Shunsuke, HAGA; Shungo, ENDO; Hiroyuki, KATO; Naoki, TAKAHASHI; Kazuhiko, YOSHIMATSU
The present study was aimed to determine the clinicopathological features of cancers of the right-sided colon (cecum, ascending colon, transverse colon) and left-sided colon (descending colon, sigmoid colon) in order to help improve the efficacy of their treatment. Excluding multiple cancer cases, 364 patients with primary colon cancer underwent surgey at our department between 1974 and 1994; they comprised 171 individuals with right-sided colon cancer and 193 with left-sided colon cancer. A ...
Sleep problems are a common side effect during cancer treatment. Learn how a polysomnogram can assess sleep problems. Learn about the benefits of managing sleep disorders in men and women with cancer.
Fatigue is a common side effect of many cancer treatments such as chemotherapy, radiation therapy, immunotherapy, and surgery. Anemia and pain can also cause fatigue. Learn about symptoms and way to manage fatigue.
Diarrhea, a side effect of cancer treatment, may cause symptoms such as loose, watery stools. Diarrhea can lead to dehydration and malnutrition in cancer patients. Learn about ways to treat and manage diarrhea during cancer treatment.
Cancer treatments may lower your appetite. Side effects such as nausea, fatigue, or mouth sores can also making eating difficult. Learn how to eat well to avoid losing weight or becoming dehydrated, so you stay strong during treatment.
Controlling pain is an important part of your cancer treatment plan. Learn how to track levels of pain. Find out how pain, a side effect of cancer treatment, is treated using acupuncture, biofeedback, and physical therapy.
Anemia is a side effect of cancer treatments, including chemotherapy and radiation therapy. It can make women and men feel fatigued, dizzy, and short of breath. Learn how to manage fatigue caused by anemia during cancer treatment.
Edelman, Ya A
A side core lifter is proposed which contains a housing with guide slits and a removable core lifter with side projections on the support section connected to the core receiver. In order to preserve the structure of the rock in the core sample by means of guaranteeing rectilinear movement of the core lifter in the rock, the support and core receiver sections are hinged. The device is equipped with a spring for angular shift in the core-reception part.
A study of psychoanalysis from the perspective of side effects reveals that its history was a succession of measures to deal with its own side effects. This, however, does not merely suggest that, as a treatment method, psychoanalysis is incomplete and weak: rather, its history is a record of the growth and development of psychoanalysis that discovered therapeutic significance from phenomena that were initially regarded as side effects, made use of these discoveries, and elaborated them as a treatment method. The approach of research seen during the course of these developments is linked to the basic therapeutic approach of psychoanalysis. A therapist therefore does not draw conclusions about a patient's words and behaviors from a single aspect, but continues to make efforts to actively discover a variety of meanings and values from them, and to make the patient's life richer and more productive. This therapeutic approach is undoubtedly one of the unique aspects of psychoanalysis. I discuss the issue of psychoanalysis and side effects with the aim of clarifying this unique characteristic of psychoanalysis. The phenomenon called resistance inevitably emerges during the process of psychoanalytic treatment. Resistance can not only obstruct the progress of therapy; it also carries the risk of causing a variety of disadvantages to the patient. It can therefore be seen as an adverse effect. However, if we re-examine this phenomenon from the perspective of transference, we find that resistance is in fact a crucial tool in psychoanalysis, and included in its main effect, rather than a side effect. From the perspective of minimizing the character of resistance as a side effect and maximizing its character as a main effect, I have reviewed logical organization, dynamic evaluation, the structuring of treatment, the therapist's attitudes, and the training of therapists. I conclude by stating that psychoanalysis has aspects that do not match the perspective known as a side
Bjering, Jens Christian Borrebye
A few days after the terror attacks of 9/11, then Vice President Dick Cheney appeared on television with a call for “working the dark side.” While still unclear what this expression entailed at the time, Cheney's comment appears in retrospect to almost have been prophetic for the years to come....... By analyzing official reports and testimonies from soldiers partaking in the War On Terror, the dissertation's second part—dark arts—focuses on the transformation of the dark side into a productive space in which “information” and the hunt for said information overshadowed all legal, ethical, or political...
Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with a nonoperative treatment.
Costi, Renato; Cauchy, François; Le Bian, Alban; Honart, Jean-François; Creuze, Nicolas; Smadja, Claude
In patients presenting with acute diverticulitis (AD) and signs of acute peritonitis, the presence of extradigestive air (EDA) on a computer tomography (CT) scan is often considered to indicate the need for emergency surgery. Although the traditional management of "perforated" AD is open sigmoidectomy, more recently, laparoscopic drainage/lavage (usually followed by delayed elective sigmoidectomy) has been reported. The aim of this retrospective study is to evaluate the results of nonoperative management of emergency patients presenting with AD and EDA. The outcomes of 39 consecutive hemodynamically stable patients (23 men, mean age = 54.7 years) who were admitted with AD and EDA and were managed nonoperatively (antibiotic and supportive treatment) at a tertiary-care university hospital between January 2001 and June 2010 were retrospectively collected and analyzed. These included morbidity (Clavien-Dindo) and treatment failure (need for emergency surgery or death). A univariate analysis of clinical, radiological, and laboratory criteria with respect to treatment failure was performed. Results of delayed elective laparoscopic sigmoidectomy were also analyzed. There was no mortality. Thirty-six of the 39 patients (92.3%) did not need surgery (7 patients required CT-guided abscess drainage). Mean hospital stay was 8.1 days. Duration of symptoms, previous antibiotic administration, severe sepsis, PCR level, WBC concentration, and the presence of abdominal collection were associated with treatment failure, whereas "distant" location of EDA and free abdominal fluid were not. Five patients had recurrence of AD and were treated medically. Seventeen patients (47.2%) underwent elective laparoscopic sigmoidectomy for which mean operative time was 246 min (range = 100-450) and the conversion rate was 11.8%. Mortality was nil and the morbidity rate was 41.2%. Mean postoperative stay was 7.1 days (range = 4-23). Nonoperative management is a viable option in most emergency
The report presents a wide, easily understandable description of presentation technique and man-machine communication. General fundamentals for the man-machine interface are illustrated, and the factors that affect the interface are described. A model is presented for describing the operators work situation, based on three different levels in the operators behaviour. The operator reacts routinely in the face of simple, known problems, and reacts in accordance with predetermined plans in the face of more complex, recognizable problems. Deep fundamental knowledge is necessary for truly complex questions. Today's technical status and future development have been studied. In the future, the operator interface will be based on standard software. Functions such as zooming, integration of video pictures, and sound reproduction will become common. Video walls may be expected to come into use in situations in which several persons simultaneously need access to the same information. A summary of the fundamental rules for the design of good picture ergonomics and design requirements for control rooms are included in the report. In conclusion, the report describes a presentation technique within the Distribution Automation and Demand Side Management area and analyses the know-how requirements within Vattenfall. If different systems are integrated, such as geographical information systems and operation monitoring systems, strict demands are made on the expertise of the users for achieving a user-friendly technique which is matched to the needs of the human being. (3 figs.)
Hansen, Finn Thorbjørn
Artiklen omhandler den ontologiske vending inden for universitetspædagogisk forskning, og redegør for hvorfor en mere personlig og eksistentiel side ved forskningen må medtænkes i universitetspædagogikken og -vejledningen. Udgivelsesdato: 24.11.08...
A side loading filter chamber for use with radioactive gases is described. The equipment incorporates an inexpensive, manually operated, mechanism for aligning filter units with a number of laterally spaced wall openings and for removing the units from the chamber. (U.K.)
Patterson, J.F.; Ewing, R.H.
This patent describes a spacer for restraining the fuel rods of a nuclear fuel assembly, the assembly being formed of a plurality of parallel, elongated fuel rods so arranged that the assembly is bounded by a polygon having an even number of sides, the rods being so arranged as to lie in a plurality of sets of parallel rows, the rows of each set being perpendicular to one of the sides of the polygon. It comprises a number of spacer combs equal to at least half the number of the sides of the polygon, the spacer combs being superposed on each other, each of the spacer combs comprising: a single base strip having a length equal to that of one of the sides of the polygon and grid strips equal in number to the spaces between rows in one of the sets, and at least a majority of the grid strips being of a length sufficient to extend substantially the full length of the rows; the grid strips being provided with spring members positioned to engage each of the rods; the grid strips being provided with spring members positioned to engage each of the rods; the grid strips being secured to and extending at right angles to the base strip; the grid strips of different combs being positioned at angles to each other, so as to occupy the spaces between rows in different sets
Budu, A.R.; Dumitrescu, M.C.
Both authors are currently assistant professors at the University 'Politehnica' of Bucharest - Power Engineering Faculty - Nuclear Power Plant Department. They share the experience of more than 17 years of school from which 5 years in the nuclear power plants department, with the experience they gain in the position of assistant professor. Using the competence given by the new position, they accumulate the expertise necessary to excel in the nuclear power plants domain. They try a harmonized approach for education on nuclear engineering bridging the gap between students and teachers. (author)
M. Cagdas Eker
Full Text Available Lithium is an alkaline ion being used since 19th century. After its widespread use in psychiatric disorders, observed side effects caused skepticism about its therapeutic efficacy. Despite several disadvantages, lithium is one of the indispensible drugs used in affective disorders, especially in bipolar disorder. It became a necessity for physicians to recognize its side effects since lithium is still accepted as a gold standard in the treatment of bipolar disorder. Adverse effects of chronic administration of lithium on several organ systems are widely known. In this article metabolic effects of lithium on thyroid and parathyroid glands, body mass index and kidneys will be discussed along with their mechanisms, clinical findings, possible risk factors and treatment. One of the most common side effect of lithium is hypothyroidism. It has the same clinical and biochemical properties as primary hypothyroidism and observed as subclinical hypothyroidism in the first place. Hypothyroidism, even its subclinical form, may be associated with non-response or inadequate response and is indicated as a risk factor for development of rapid cycling bipolar disorder. Therefore, hypothyroidism should be screened no matter how severe it is and should be treated with thyroid hormone in the presence of clinical hypothyroidism. Weight gain due to lithium administration disturbs the compliance to treatment and negatively affects the course of the illness. Increased risk for diabetes, hypertension, ischemic heart disease and stroke because of weight gain constitute other centers of problem. Indeed, it is of importance to determine the risk factors before treatment, to follow up the weight, to re-organize nutritional habits and to schedule exercises. Another frequent problematic side effect of lithium treatment is renal dysfunction which clinically present as nephrogenic diabetes insipidus with the common symptoms of polyuria and polydipsia. Nephrogenic diabetes
Hernandez, Irene Gonzalez; Jain, Kiran; Hill, Frank; Tobiska, W Kent
Several magnetic indices are used to model the solar irradiance and ultimately to forecast it. However, the observation of such indices are generally limited to the Earth-facing hemisphere of the Sun. Seismic maps of the far side of the Sun have proven their capability to locate and track medium-large active regions at the non-visible hemisphere. We present here the possibility of using the average signal from these seismic far-side maps as a proxy to the non-visible solar activity which can complement the current front-side solar activity indices.
S2k guidelines for diverticular disease and diverticulitis. Diagnosis, classification, and therapy for the radiologist; S2k-Leitlinie Divertikelkrankheit und Divertikulitis. Diagnostik, Klassifikation und Therapie fuer die Radiologie
Schreyer, A.G. [University Hospital Regensburg (Germany). Inst. of Radiology; Layer, G. [Ludwigshafen Hospital (Germany). Central Inst. for Diagnostic and Interventional Radiology
Diverticular disease and diverticulitis represent an increasingly common disease especially in patients with advanced age. The German Society of Digestive and Metabolic Diseases (DGVS) as well as the German Society of General and Visceral Surgery (DGAV) in collaboration with the German Radiology Society (DRG) created and published S2k guidelines regarding this topic. Knowledge of the diagnosis and therapy of this common disease is extremely important for the radiologist for the daily clinical routine. In this article we review and discuss the most important clinical situations and algorithms of this disease focusing on radiological topics. Additionally, we introduce the new CCD (classification of diverticular disease) system regarding radiology.
Erdmann, Detlev; Sweis, Ranya; Heitmann, Christoph; Yasui, Koji; Olbrich, Kevin C; Levin, L Scott; Sharkawy, A Adam; Klitzman, Bruce
vessel wall after several weeks to incorporate the magnets, making the magnetic force unnecessary; and warrants further study in vessels with different sizes, flow rates, and locations. We present a magnet-based device used to perform side-to-side peripheral vascular anastomoses. Its advantages include the ability to anastomose vessels without requiring circumferential surgical exposure. Vascular anastomosis performed with these magnets demonstrated 100% patency in the dog, lacked apparent aneurysm or other potentially catastrophic failure, and demonstrated remodeling of the vessel wall after several weeks, to incorporate the magnets, making indefinite retention of field strength unnecessary. This technique could enable minimally invasive procedures, such as complex reconstructive and revascularizing surgery, and warrants further study in vessels with different sizes, flow rates, and locations.
... medicines, talk to your health care provider about possible side effects. Tell your health care provider about your lifestyle and point out any possible side effects that would be especially hard for you to ...
Santemiz, P.; Spreeuwers, Lieuwe Jan; Veldhuis, Raymond N.J.
Side-view face recognition is a challenging problem with many applications. Especially in real-life scenarios where the environment is uncontrolled, coping with pose variations up to side-view positions is an important task for face recognition. In this paper we discuss the use of side view face
Molderink, Albert; Bakker, Vincent; Hurink, Johann L.; Smit, Gerardus Johannes Maria
Due to increasing energy prices and the greenhouse effect, a more efficient energy supply is desirable, preferably based on renewable sources. To cope with the decrease of flexibility due to the introduction of renewables in production side of the supply chain, a more flexible consumer side is
Full Text Available We present a 31-year-old female with repaired tetralogy of Fallot (TOF and right-sided aortic arch (RAA with left-sided patent ductus arteriosus (PDA originating from the left brachiocephalic artery. This is a rare finding but most common site for a PDA in TOF and a RAA. To the best of our knowledge, this is the first demonstration of this rare finding on MRI in the literature.
Narlikar, Jayant Vishnu
From the drop of an apple to the stately dance of the galaxies, gravity is omnipresent in the Cosmos. Even with its high profile, gravity is the most enigmatic of all the known basic forces in nature. The Lighter Side of Gravity presents a beautifully clear and completely nontechnical introduction to the phenomenon of this force in all its manifestations. Astrophysicist Jayant Narlikar begins with an historical background to the discovery of the law of gravitation by Isaac Newton in the seventeenth century. Using familiar analogies, interesting anecdotes, and numerous illustrations to get across subtle effects and difficult points to readers, he goes on to describe the general theory of relativity and some of its strange and unfamiliar ideas such as curved spacetime, the bending of light, and black holes. Since first publication in 1982 (W.H. Freeman), Dr. Narlikar has brought his book completely up to date and expanded it to include the discovery of gigantic gravitational lenses in space, the findings of the Cosmic Background Explorer (COBE) satellite, the detection of dark matter in galaxies, the investigation of the very early Universe, and other new ideas in cosmology. This lucid and stimulating book presents a clear approach to the intriguing phenomenon of gravity for everyone who has ever felt caught in its grip. Jayant Narlikar is the winner of many astronomical prizes and the author of Introduction to Cosmology (Cambridge University Press, 1993).
Christopher G. Hunt; R. Sam Williams; Mark Knaebe; Peter Sotos; Steven Lacher
Several different studies are compared to assess the effectiveness of commercial water repellent preservatives (WRPâs) in the late 1990âs on vertical and horizontal siding. Besides WRP, variables included wood species, exposure location (Wisconsin or Mississippi), and solid color stain vs. primer + paint. Data on substrate checking and paint flaking are presented....
Gerards, Marco Egbertus Theodorus; Toersche, Hermen; Hoogsteen, Gerwin; van der Klauw, Thijs; Hurink, Johann L.; Smit, Gerardus Johannes Maria
Many Demand Side Management (DSM) approaches use energy prices as steering signals. This paper shows that such steering signals may result in power quality problems and high losses. As an alternative, this paper proposes to use desired (e.g., flat) power profiles as steering signals and presents an
Svegstrup, Rolf Dyre
In algebraic quantum field theory we consider nets of von Neumann algebras indexed over regions of the space time. Wiesbrock [''Conformal quantum field theory and half-sided modular inclusions of von Neumann algebras,'' Commun. Math. Phys. 158, 537-543 (1993)] has shown that strongly additive nets of von Neumann algebras on the circle are in correspondence with standard half-sided modular inclusions. We show that a finite index endomorphism on a half-sided modular inclusion extends to a finite index endomorphism on the corresponding net of von Neumann algebras on the circle. Moreover, we present another approach to encoding endomorphisms on nets of von Neumann algebras on the circle into half-sided modular inclusions. There is a natural way to associate a weight to a Moebius covariant endomorphism. The properties of this weight have been studied by Bertozzini et al. [''Covariant sectors with infinite dimension and positivity of the energy,'' Commun. Math. Phys. 193, 471-492 (1998)]. In this paper we show the converse, namely, how to associate a Moebius covariant endomorphism to a given weight under certain assumptions, thus obtaining a correspondence between a class of weights on a half-sided modular inclusion and a subclass of the Moebius covariant endomorphisms on the associated net of von Neumann algebras. This allows us to treat Moebius covariant endomorphisms in terms of weights on half-sided modular inclusions. As our aim is to provide a framework for treating endomorphisms on nets of von Neumann algebras in terms of the apparently simpler objects of weights on half-sided modular inclusions, we lastly give some basic results for manipulations with such weights
[craniotomy vs. burr hole, aspiration, and drainage. (BAAD)] depends on the ... the dura and the subarachnoid mater within the brain ambient ... presentations. Posterior fossa right-sided SDE was seen ... the left side of the brain, 15 (83.3%).
Douglas, Clay; Fildes, Brian; Gibson, Tom
Far-side impacts are not part of any regulated NCAP, FMVSS, or similar test regime despite accounting for 43 percent of the seriously injured persons and 30 percent of the harm in U.S. side impact crashes. Furthermore, injuries to the head and thorax account for over half of the serious injuries sustained by occupants in far-side crashes. Despite this, there is no regulated or well-accepted anthropomorphic test device (ATD) or computer model available to investigate far-side impacts. As such, this presents an opportunity to assess a computer model that can be used to measure the effect of varying restraint parameters on occupant biomechanics in far-side impacts. This study sets out to demonstrate the modified TASS human facet model's (MOTHMO) capabilities in modeling whole-body response in far-side impacts. MOTHMO's dynamic response was compared to that of postmortem human subjects (PMHS), WorldSID, and Thor-NT in a series of far-side sled tests. The advantages, disadvantages, and differences of using MOTHMO compared to ATDs were highlighted and described in terms of model design and instrumentation. Potential applications and improvements for MOTHMO were also recommended. The results showed that MOTHMO is capable of replicating the seat belt-to-shoulder complex interaction, pelvis impacts, head displacement, neck and shoulder belt loading from inboard mounted belts, and impacts from multiple directions. Overall, the model performed better than Thor-NT and at least as well as WorldSID when compared to PMHS results. Though WorldSID and Thor-NT ATDs were capable of reproducing many of these impact loads, measuring the seat belt-to-shoulder complex interaction and thoracic deflection at multiple sites and directions was less accurately handled. This study demonstrated that MOTHMO is capable of modeling whole-body response in far-side impacts. Furthermore, MOTHMO can be used as a virtual design tool to explore the effect of varying restraint parameters on occupant
Tsuchida, Junko; Fujita, Shouhei; Kawano, Fumihiro; Tsukamoto, Ryoichi; Honjo, Kunpei; Naito, Shigetoshi; Ishiyama, Shun; Miyano, Shozo; Machida, Michio; Kitabatake, Toshiaki; Fujisawa, Minoru; Kojima, Kuniaki; Ogura, Kanako; Matsumoto, Toshiharu
An 85-year-old woman was admitted to our hospital for steroid therapy for relapsing nephrotic syndrome. During hospitalization, she complained of sudden epigastric pain at night. Although there were signs of peritoneal irritation, CT showed a large amount of ascitic fluid, but no free intraperitoneal gas. Gram staining of ascitic fluid obtained by abdominal paracentesis showed Gram-negative rods, which raised a strong suspicion of gastrointestinal perforation and peritonitis. Therefore, emergency surgery was performed. Exploration of the colon showed multiple sigmoid diverticula, one of which was perforated. The patient underwent an emergency Hartmann's procedure. Imaging studies failed to reveal any evidence of gastrointestinal perforation, presenting a diagnostic challenge. However, a physician performed rapid Gram staining of ascitic fluid at night when laboratory technicians were absent, had a strong suspicion of gastrointestinal perforation, and performed emergency surgery. Gram staining is superior in rapidity, and ascitic fluid Gram staining can aid in diagnosis, suggesting that it should be actively performed. We report this case, with a review of the literature on the significance of rapid diagnosis by Gram staining.
... tumors. Donate Now Subscribe for e-updates Please leave this field empty ... tumors and their treatments bring an array of possible side effects in to a patient’s life. Fatigue, cognitive changes, and mood changes are ...
Hair loss, also called alopecia, is a side effect of cancer treatments, such as chemotherapy and radiation therapy. Learn how to cope with and manage hair loss. Listen to tips from others who have experienced hair loss.
Cancer treatment can cause late side effects that may not show up for months or years after treatment. These late effects may include heart and lung problems, bone loss, eye and hearing changes, lymphedema, and other problems
Types of nausea and vomiting caused by cancer treatment include: anticipatory, acute, and delayed. Controlling these side effects will help to prevent serious problems such as malnutrition and dehydration in people with cancer.
Pregnancy - delivery presentation; Labor - delivery presentation; Occiput posterior; Occiput anterior; Brow presentation ... The mother can walk, rock, and try different delivery positions during labor to help encourage the baby ...
Wang, Xiujuan; Thijssen, Bram; Yu, Haiyuan
Author Summary The ultimate goal of medical research is to develop effective treatments for disease with minimal side effects. Currently, about 20% of drug candidates failed at clinical trial phases II and III due to safety issues. Therefore, understanding the determining factors of drug side effects is of paramount importance to human health and the pharmaceutical industry. Here, we present the first systematic study to uncover key factors leading to drug side effects within the framework of...
Since Luna and Lunar Orbiter photographed the far side of the Moon, the mysterious dichotomy between the face of the Moon as we see it from Earth and the side of the Moon that is hidden has puzzled lunar scientists. As we learned more from the Apollo sample return missions and later robotic satellites, the puzzle literally deepened, showing asymmetry of the crust and mantle, all the way to the core of the Moon. This book summarizes the author’s successful search for an ancient impact feature, the Near Side Megabasin of the Moon and the extensions to impact theory needed to find it. The implications of this ancient event are developed to answer many of the questions about the history of the Moon.
Barret, Maximilien; Cuenod, Charles-André; Jian, Raymond; Cellier, Christophe; Berger, Anne
We report on a 32-year-old man with a history of chronic lower abdominal pain and urogenital symptoms, leading to the diagnosis of coloseminal fistula complicating diverticular disease. We reviewed the literature on this rare clinical entity and would like to stress the role of pelvic imaging with rectal contrast to investigate complicated forms of diverticular disease. 2014 S. Karger AG, Basel.
origine de complications respiratoires aigues (détresse respiratoire aigue, pneumopathie d'inha- lation) ou chronique (bronchite chronique, asthme) qui surviennent dans 20 % des cas . L'examen clinique est souvent normal. Cependant une.
Marenco De la Cuadra, Beatriz; Gomez-Rosado, Juan-Carlos; Capitan-Morales, Luis-Cristobal; Valdés Hernández, Javier; Reyes-lopera, N.J. De los
La diverticulosis yeyunal es una enfermedad adquirida rara. Casi el 60-70% keeps asymptomátic or Con síntomas crónicos inespecíficos, aunque puede presentarse como un abdomen agudo. La perforación debida a enterolitos es una causa extremadamente rara do complicación, y puede producirse por la impactación de ésta contra la pared intestinal. Presentamos caso de un varón de 82 años que acude a urgencias por un dolor súbito abdominal, difuso, con irritación peritoneal, leucocitosis con neutro...
Klein, Olivier; Spears, Russell; Reicher, Stephen
This article extends the social identity model of deindividuation effects (SIDE) by considering the various ways in which relations of visibility to an audience can affect the public expression of identity-relevant norms (identity performance). It is suggested that social identity performance can
Full Text Available Retinoids are compounds chemically related to vitamin A, which are frequently used in dermatological practice (1. They are characterized by numerous mechanisms of action leading to normalization of keratinocyte proliferation and maturation. They have anti-seborrhoeic, immunomodulatory and anti-inflammatory effects (1, 2. A number of side effects to retinoid treatment have been recorded; one group of such side effects relates to eyes and vision. Dry eye syndrome and blepharoconjunctivitis are the most common side effects, appearing in 20-50 % of patients treated with retinoids. They often contribute to the occurrence of other side-effects such as eye discomfort and contact lens intolerance. Due to the widespread use in clinical practice, the adverse effects, including ocular side effects, should be studied. To confirm the variety of adverse effects of retinoids, several case reports of rare side-effects are presented.
Lutwak, Nancy; Dill, Curt
The patient was a 48-year-old man who presented to the emergency department with complaints of a left-sided painful neck mass, which changed in size relative to ingestion of meals. He denied voice change, fever, chills, weight loss, dysphagia and hoarseness. Physical examination was unremarkable. CT scan demonstrated a 3.9 mm calculus of the submandibular gland duct. Therapeutic sialendocopy was successfully performed.
Perevertailo V. L.
Full Text Available The problems of design, technology and manufacturing double-sided silicon microstrip detectors using standard equipment production line in mass production of silicon integrated circuits are considered. The design of prototype high-energy particles detector for experiment ALICE (CERN is presented. The parameters of fabricated detectors are comparable with those of similar foreign detectors, but they are distinguished by lesser cost.
Meißner, Tina; Kröger, Knut; Creutzburg, Reiner
IT security and computer forensics are important components in the information technology. In the present study, a client-side Skype forensics is performed. It is designed to explain which kind of user data are stored on a computer and which tools allow the extraction of those data for a forensic investigation. There are described both methods - a manual analysis and an analysis with (mainly) open source tools, respectively.
The Dark Side of the Universe (DSU) workshops bring together a wide range of theorists and experimentalists to discuss current ideas on models of the dark side, and relate them to current and future experiments. This year's DSU will take place in the colorful Norwegian city of Bergen. Topics include dark matter, dark energy, cosmology, and physics beyond the standard model. One of the goals of the workshop is to expose in particular students and young researchers to the fascinating topics of dark matter and dark energy, and to provide them with the opportunity to meet some of the best researchers in these areas .
de Wolff, I.; Janssens, F.
This paper presents an overview of studies into effects and side effects of control mechanisms in education. We focus on effects and side effects of inspection visits and public performance indicators. A first conclusion is that the studies do not provide us with a clear answer to the question of
The Heavy-Ion Collisions in the LHC workshop held in Cracow from 18 to 18 May 2007. The main subject of the workshop was to present the newest results of research provided at CERN LHC collider. Additionally some theoretical models and methods used for presented data analysis were discussed
Eriksen, Kaare; Tollestrup, Christian; Ovesen, Nis
An important competence for designers is the ability to communicate and present ideas and proposals for customers, partners, investors and colleagues. The Pecha Kucha principle, developed by Astrid Klein and Mark Dytham, has become a widely used and easy format for the presentation of new concepts...
Full Text Available Abstract Purpose Coronary artery bypass graft (CABG surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of this paper is to non-invasively quantify hemodynamic parameters, such as mass flow and wall shear stress (WSS, in end-to-side and side-to-side anastomoses of patients with CABG using computational fluid dynamics (CFD. Methods One patient with saphenous CABG and end-to-side anastomosis and one patient with saphenous CABG and side-to-side anastomosis underwent 16-detector row computed tomography (CT. Geometric models of coronary arteries and bypasses were reconstructed for CFD analysis. Blood flow was considered pulsatile, laminar, incompressible and Newtonian. Peri-anastomotic mass flow and WSS were quantified and flow patterns visualized. Results CFD analysis based on in-vivo CT coronary angiography data was feasible in both patients. For both types of CABG, flow patterns were characterized by a retrograde flow into the native coronary artery. WSS variations were found in both anastomoses types, with highest WSS values at the heel and lowest WSS values at the floor of the end-to-side anastomosis. In contrast, the highest WSS values of the side-to-side anastomosis configuration were found in stenotic vessel segments and not in the close vicinity of the anastomosis. Flow stagnation zones were found in end-to-side but not in side-to-side anastomosis, the latter also demonstrating a smoother stream division throughout the cardiac cycle. Conclusion CFD analysis of venous CABG based on in-vivo CT datasets in patients was feasible producing qualitative and quantitative information on mass flow and WSS. Differences were found between the two types of anastomosis
N ational C ancer I nstitute Managing Chemotherapy Side Effects Constipation Take these steps: Eat high-fiber foods such as: ● ● Whole-grain breads and cereals ● ● Fruits and vegetables ● ● Nuts and seeds Turn this ...
Santemiz, P.; Spreeuwers, Lieuwe Jan; Veldhuis, Raymond N.J.; van den Biggelaar, Olivier
As a widely used biometrics, face recognition has many advantages such as being non-intrusive, natural and passive. On the other hand, in real-life scenarios with uncontrolled environment, pose variation up to side-view positions makes face recognition a challenging work. In this paper we discuss
Surace, Cecily J.
This paper discusses current trends in personnel management, with emphasis on performance standards and employee evaluation. Advances in personnel management from the scientific management theory to the application of the "human side of enterprise" approach should be reflected in how library managers review personnel and operate their libraries.…
Bottino, B.; Aalseth, C.E.; Acconcia, G.
DarkSide is a dark matter direct search experiment at Laboratori Nazionali del Gran Sasso (LNGS). DarkSide is based on the detection of rare nuclear recoils possibly induced by hypothetical dark matter particles, which are supposed to be neutral, massive (m > 10 GeV) and weakly interactive (Wimp). The dark matter detector is a two-phase time projection chamber (TPC) filled with ultra-pure liquid argon. The TPC is placed inside a muon and a neutron active vetoes to suppress the background. Using argon as active target has many advantages, the key features are the strong discriminant power between nuclear and electron recoils, the spatial reconstruction and easy scalability to multi-tons size. At the moment DarkSide-50 is filled with ultra-pure argon, extracted from underground sources, and from April 2015 it is taking data in its final configuration. When combined with the preceding search with an atmospheric argon target, it is possible to set a 90% CL upper limit on the WIMP-nucleon spin-independent cross section of 2.0×10"−"44 cm"2 for a WIMP mass of 100 GeV/c"2. The next phase of the experiment, DarkSide-20k, will be the construction of a new detector with an active mass of ∼ 20 tons.
Full Text Available Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects. This article critically examines the evidence available and makes recommendations as to how a physician should counsel a patient while prescribing the drug.
This document is intended to be used by (1) public or private medium/heavy-duty truck fleets considering adding side guards; (2) jurisdictions or customers that require side guards through policy or procurement; (3) manufacturers of side guards; and ...
Warfarin side effects: Watch for interactions Although commonly used to treat blood clots, warfarin (Coumadin, Jantoven) can have dangerous side effects or ... bleeding. Here are precautions to take to avoid warfarin side effects. By Mayo Clinic Staff If you' ...
Sanden, Per-Olof; Edland, Anne; Reiersen, Craig; Mullins, Peter; Ingemarsson, Karl-Fredrik; Bouchard, Andre; Watts, Germaine; Johnstone, John; Hollnagel, Erik; Ramberg, Patric; Reiman, Teemu
An important part of the workshop was a series of invited presentations. The presentations were intended to both provide the participants with an understanding of various organisational approaches and activities as well as to stimulate the exchange of ideas during the small group discussion sessions. The presentation subjects ranged from current organisational regulations and licensee activities to new organisational research and the benefits of viewing organisations from a different perspective. There were more than a dozen invited presentations. The initial set of presentations gave the participants an overview of the background, structure, and aims of the workshop. This included a short presentation on the results from the regulatory responses to the pre-workshop survey. Representatives from four countries (Sweden, Canada, Finland, and the United Kingdom) expanded upon their survey responses with detailed presentations on both regulatory and licensee safety-related organisational activities in their countries. There were also presentations on new research concerning how to evaluate safety critical organisations and on a resilience engineering perspective to safety critical organisations. Below is the list of the presentations, the slides of which being available in Appendix 2: 1 - Workshop Welcome (Per-Olof Sanden); 2 - CSNI Working Group on Human and Organisational Factors (Craig Reiersen); 3 - Regulatory expectations on justification of suitability of licensee organisational structures, resources and competencies (Anne Edland); 4 - Justifying the suitability of licensee organisational structures, resources and competencies (Karl-Fredrik Ingemarsson); 5 - Nuclear Organisational Suitability in Canada (Andre Bouchard); 6 - Designing and Resourcing for Safety and Effectiveness (Germaine Watts); 7 - Organisational Suitability - What do you need and how do you know that you've got it? (Craig Reiersen); 8 - Suitability of Organisations - UK Regulator's View (Peter
Calvo, M; Musy, M
A considerable number of CP violation measurements require the most possible accurate knowledge of the flavour at production of the reconstructed $B$ meson. The performance of different flavour tagging methods will be measured from control channels. One of the possible tagging methods that can be used is the one known as $Same Side kaon$. In this note we present how to calibrate the response of the tagging algorithms using the data and combine the result with the so called $Opposite Side tagging$. Also trigger and selection effects are briefly discussed.
Presentation by CERN (10 minutes each) Rolf Landua - Education and Outreach Salvatore Mele - Open Access Jean-Yves Le Meur - Digital Library in Africa Francois Fluckiger - Open Source/Standards (tbc) Tim Smith - Open Data for Science Tullio Basiglia - tbc
... has entered the pelvis. If the presenting part lies above the ischial spines, the station is reported ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...
Holden, K.L.; Boyer, J.L.; Sandor, A.; Thompson, S.G.; McCann, R.S.; Begault, D.R.; Adelstein, B.D.; Beutter, B.R.; Stone, L.S.
The goal of the Information Presentation Directed Research Project (DRP) is to address design questions related to the presentation of information to the crew. The major areas of work, or subtasks, within this DRP are: 1) Displays, 2) Controls, 3) Electronic Procedures and Fault Management, and 4) Human Performance Modeling. This DRP is a collaborative effort between researchers at Johnson Space Center and Ames Research Center.
Full Text Available During his time as a state senator in Illinois, Barack Obama voted “Present” 129 times, a deliberate act of nonvoting that subsequently became an important campaign issue during the 2008 presidential elections. In this article, I examine the use of Present votes in the Illinois state senate. I find evidence that Present votes can largely be characterized as protest votes used as a legislative tool by the minority party. Incorporating information from Present votes into a Bayesian polytomous item-response model, I find that this information increases the efficiency of ideal point estimates by approximately 35%. There is little evidence of significant moderation by Obama when Present votes are accounted for, though my results suggest that Obama’s voting record may have moderated significantly before his subsequent election to the U.S. Senate. My results also suggest that because legislative nonvoting may occur for a variety of reasons, naive inclusion of nonvoting behavior into vote choice models may lead to biased results.
The Symposium on Physics of Elementary Interactions in the LHC Era held in Warsaw from 21 to 22 April 2008. The main subject of the workshop was to present the progress in CERN LHC collider project. Additionally some satellite activities in field of education, knowledge and technology transfer in the frame of CERN - Poland cooperation were shown
Hanlon, Gerard; Dunne, Stephen; Johnsen, Christian Garmann
Towards the end of 2015, the ephemera collective organised, chaired and participated within two separate Q+A panels celebrating the launch of Gerard Hanlon’s The dark side of management: A secret history of management theory. The events took place in The University of Leicester’s School of Manage...... of Management and Copenhagen Business School’s Management, Politics and Philosophy Department. Each of the events were recorded, transcribed, edited and amalgamated into the following feature....
RADIOSPARES, the leading catalogue distributor of components (electronic, electrical, automation, etc.) and industrial supplies will be at CERN on Friday 3 October 2008 (Main Building, Room B, from 9.00 a.m. to 3.00 p.m.) to introduce its new 2008/2009 catalogue. This will be the opportunity for us to present our complete range of products in more detail: 400 000 part numbers available on our web site (Radiospares France, RS International, extended range of components from other manufacturers); our new services: quotations, search for products not included in the catalogue, SBP products (Small Batch Production: packaging in quantities adapted to customers’ requirements); partnership with our focus manufacturers; demonstration of the on-line purchasing tool implemented on our web site in conjunction with CERN. RADIOSPARES will be accompanied by representatives of FLUKE and TYCO ELECTRONICS, who will make presentations, demonstrate materials and answer any technical questio...
Conto, J.M. de; Carretta, J.M.; Gomez-Martinez, Y.; Micoud, R.
Side coupled Cavities are good candidates for proton accelerations in the 90-180 MeV range, as it has been first proposed for the CERN LINAC4 project. A side coupled Linac is made of a lump chain of resonant cavities, alternatively accelerating and coupling. A side coupled cavity has been designed in a CERN-LPSC collaboration to achieve LINAC4 requirements. After RF studies, a complete thermal study has been done, showing that 10-15% is the absolute maximum duty-cycle achievable by such a cavity. Error studies have been developed. They have shown that a tuning ring is mandatory and that a K equals 3% coupling factor is a good choice. A prototype has been built and each cell has been measured and tuned. A simple and accurate method has been used to get both the resonant frequency and the coupling factor, with a movable tuner and a linear fit. A similar method has been used to get the second order coupling factor. A large dispersion is observed on K. This is mainly due to the shape of the coupling apertures, which are very sensitive to mechanical errors. A future and realistic design must be very careful to guarantee a constant aperture (the important parameter is more the dispersion of k than its exact value). Finally, we analyse how to tune the cavity. This has to checked carefully and probably improved or corrected. Results are expected for mid-2008
... 49 Transportation 4 2010-10-01 2010-10-01 false Side bearings. 229.69 Section 229.69....69 Side bearings. (a) Friction side bearings with springs designed to carry weight may not have more than 25 percent of the springs in any one nest broken. (b) Friction side bearings may not be run in...
Full Text Available In this study, instantaneous and time-averaged flow structures downstream of the sharp-edged single and two and three side-by-side square cylinders (SCs immersed in a uniform open channel water flow were studied by a technique of particle image velocimetry (PIV. Experimental results of wake flow structures were presented for gap ratios (G/D in the range of 1.0G/D3.0 for Reynolds number values of 1050, 2450 and 3400. Flow structures depending on the square cylinder (SC configurations and Reynolds number were discussed. It has been found that the development of the vortex shedding as well as the flow structure were substantially altered for side-by-side SCs comparing to the single SC. Asymmetrical and biased wake structures were observed because of the jetlike flow between the SCs for two SCs cases for the gap ratio less than 2.0. Depending on the gap spacing between the SCs, the interaction results of time2 averaged vorticity, velocity vector field, Reynolds stress correlations and streamline patterns in the wake region form a distinguished flow structure. Strouhal numbers for the single square cylinder for 1050≤Re≤3400 are found in the range of 0.12-0.13. The present results have supported the previous works by providing detailed quantitative experimental information with PIV in the wake region of the SC and might be helpful for validation of numerical studies and designers.
Hart, Robert; Curcija, Charlie; Arasteh, Dariush; Goudey, Howdy; Kohler, Christian; Selkowitz, Stephen
The subject of glass solar reflectance and its contribution to permanent vinyl siding distortion has not been extensively studied, and some phenomena are not yet well understood. This white paper presents what is known regarding the issue and identifies where more research is needed. Three primary topics are discussed: environmental factors that control the transfer of heat to and from the siding surface; vinyl siding properties that may affect heat build-up and permanent distortion; and factors that determine the properties of reflected solar radiation from glass surfaces, including insulating window glass. Further research is needed to fully characterize the conditions associated with siding distortion, the scope of the problem, physical properties of vinyl siding, insulating window glass reflection characteristics, and possible mitigation or prevention strategies.
07 April 2009 Technical presentation by Leuze Electronics: 14.00 – 15.00, Main Building, Room 61-1-017 (Room A) Photoelectric sensors, data identification and transmission systems, image processing systems. We at Leuze Electronics are "the sensor people": we have been specialising in optoelectronic sensors and safety technology for accident prevention for over 40 years. Our dedicated staff are all highly customer oriented. Customers of Leuze Electronics can always rely on one thing – on us! •\tFounded in 1963 •\t740 employees •\t115 MEUR turnover •\t20 subsidiaries •\t3 production facilities in southern Germany Product groups: •\tPhotoelectric sensors •\tIdentification and measurements •\tSafety devices
Fish schools are one of the most common types of collective behaviour observed in nature. One of the reasons why fish swim in groups, is to reduce the cost of transport of the school. In this work we explore the propulsive performance of two foils flapping in a symmetric configuration, i.e. with an out-of-phase flapping motion. Direct thrust measurements and Particle Image Velocimetry (PIV) allowed a detailed examination of the forces and the wake generated by the system, for different kinematics (swept angles and frequencies) and shaft separations. For certain specific cases, volumetric PIV shows major differences on how the different structures in the wake of the system evolve, depending on the imposed kinematics and the side-by-side separation between the foils. Results obtained will be compared against data produced with isolated flapping foils with similar imposed kinematics, with the aim to better understand the interactions between both and the performance of the system as a whole. The author would like to acknowledge the financial support provided by the Spanish Ministerio de Economia y competitividad (MINECO) through Grant DPI2015-71645-P.
Sangheli, M.; Lisnic, V.; Plesca, S.; Odainic, O.; Chetrari, L.
The radiotherapy is one of the most widely spread and commonly used method in treating tumors of different localization. A detailed analysis of benefits and possible side effects along with evaluation of the risk factors allows preventing one of the most difficult complication, and namely the radiation myelopathy. The delayed form of such a disease is distinguished by a pronounced unfavorable prognosis. The presented case provoked the discussion of difficulties in performing differential diagnosis, as well as the importance of determining the localization of vulnerable tissues as regards the target organ exposed to radiotherapy. (authors)
The purpose of this work is to analyze secondary side thermohydraulics response on steam generator tube plugging in order to ensure nominal NPP power. We had established that the additional opening of the governing valve No. 3 and 4 can compensate pressure drop caused by steam generator tube plugging. Two main steam flows with four governing valves were simulated. Steam expansion in turbine and feed water system was modeled separately. All important process point and steam moisture changes impact on nominal NPP power were analysed. (author)
Thiwan, Syed; Drossman, Douglas A; Morris, Carolyn B; Dalton, Chris; Toner, Brenda B; Diamant, Nicholas E; Hu, J B; Whitehead, William E; Leserman, Jane; Bangdiwala, Shrikant I
Patients with functional gastrointestinal disorders treated with tricyclic antidepressants sometimes report nongastrointestinal symptoms; it is unclear whether these are drug side effects or reflect a behavioral tendency to report symptoms. We evaluated whether symptoms reported before treatment with a tricyclic antidepressant (desipramine) increased in number or worsened in severity after 2 weeks of treatment and assessed the baseline factors that predispose patients to report symptoms. Female patients in a multicenter National Institutes of Health trial for functional bowel disorders completed a 15-item symptom questionnaire at baseline (before randomization), 2 weeks after they were given desipramine (n = 81) or placebo (n = 40), and at study completion (12 weeks). Patients were asked about the severity and frequency of 15 symptoms. Results were analyzed from 57 patients given desipramine who completed the questionnaires. Symptoms reported as side effects to have occurred more frequently and also worsened at week 2 in the group given desipramine included dizziness, dry mouth/thirstiness, lightheadedness, jittery feelings/tremors, and flushing. Symptoms that did not change in severity or showed improvement at week 2 in the group given desipramine included morning tiredness, nausea, blurred vision, headaches, appetite reduction, and trouble sleeping. Psychologic distress but not desipramine blood level correlated with symptom reporting. Most symptoms often attributed to side effects of desipramine were present before treatment; only a few, related to anticholinergic effects, worsened 2 weeks after treatment, suggesting that most so-called side effects were not associated specifically with desipramine use. Such symptoms might instead be associated with psychologic distress.
Schechtman, R.; Baum, M.
The several cost and benefit components of the demand side management programs for the society groups, including the concessionaire, consumers and society as a whole are studied. The rule evaluations of management programs by demand side, used by North American concessionaire are also discussed. Finally, the numerical examples, that consolidating the concepts and rules evaluation are presented. (C.G.C.). 5 refs, 1 fig, 3 tabs
Madet, Antoine; Amadio, Roberto M.
Linear logic provides a framework to control the complexity of higher-order functional programs. We present an extension of this framework to programs with multithreading and side effects focusing on the case of elementary time. Our main contributions are as follows. First, we provide a new combinatorial proof of termination in elementary time for the functional case. Second, we develop an extension of the approach to a call-by-value $lambda$-calculus with multithreading and side effects. Thi...
Hussain, Khalid; Masood, Jovaria
Intra-abdominal drains have been used since long to prevent intra-abdominal collection, and detect any anastomotic leaks. We report a case of left sided fallopian tube herniation from a left lower abdominal drain site in a 27-year female who underwent caesarian section for breach presentation. Several complications related to drain usage has been described but left sided fallopian tube prolapse through drain site has not been reported in literature.
Technological progress comes with a dark side where good ideas and intentions produce undesirable results (extreme downsides include atomic and biological weapons). The many and various unexpected outcomes of technology span humorous to bizarre, to situations that threaten human survival. Development can be positive for some, but negative and isolating for others (e.g. older or poorer people). Progress is often transient, as faster electronics and computers dramatically shorten retention time of data, knowledge, and information loss (e.g. even photos may be unreadable within a generation). Progress and globalization are also destroying past languages and cultures. Advances cut across all areas of science and life, and the scope is vast from biology, medicine, agriculture, transport, electronics, computers, long-range communications, to a global economy. Reliance on technology causes unexpected technology-driven vulnerability to natural events (e.g. intense sunspot activity) that could annihilate advanced soci...
... 49 Transportation 4 2010-10-01 2010-10-01 false Side structure. 238.217 Section 238.217 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Equipment § 238.217 Side structure. Each passenger car shall comply with the following: (a) Side posts and...
This paper reviews the past and present situation of the World Oil Market and assumes future trends and possible future evolution. Low oil prices between 1950 and 1973 have contributed to an exceptional growth of oil demand during more than 20 years which was more and more supplied by OPEC. The oil shocks of 1973 and 1979 have dramatically changed this situation. Some of the most important changes have been the emergence of non-OPEC new oil producers, the growth of substitute energies, especially natural gas and nuclear power, on the supply side; and substantial decrease of energy consumption in many industrialized countries which has greatly reduced oil demand to OPEC on the demand side. Today this situation seems somewhat stabilized (after the reversal of world oil prices in 1986) and OPEC is producing around 18 million b/day as against a producing capacity of about 30 million b/day. It is generally considered that in coming years oil prices will remain relatively low (or occasionally even become lower than today) due to excess oil production capacity and relative abundance of other types of energy. However, many experts think that these trends can be reversed when oil supply will more and more concentrate again in the Middle East; but it is hard to say if this will begin in 1995, 2000, 2010.
Marner, W. J.; Suitor, J. W.
Gas-side fouling and corrosion problems occur in all of the energy intensive industries including the chemical, petroleum, primary metals, pulp and paper, glass, cement, foodstuffs, and textile industries. Topics of major interest include: (1) heat exchanger design procedures for gas-side fouling service; (2) gas-side fouling factors which are presently available; (3) startup and shutdown procedures used to minimize the effects of gas-side fouling; (4) gas-side fouling prevention, mitigation, and accommodation techniques; (5) economic impact of gas-side fouling on capital costs, maintenance costs, loss of production, and energy losses; and (6) miscellaneous considerations related to gas-side fouling. The present state-of-the-art for industrial gas-side fouling is summarized by a list of recommendations for further work in this area.
This presentation provides a brief history (1980 to present day) of steam generator secondary side tooling requirements, tooling development, tooling available today and how and where this tooling has been implemented for steam generator secondary side inspections. History of Tooling Development discussion covers the relatively short time period from when the SGSS tooling was required and why as well the associated challenges with development through present day; Available Tooling discussion covers the actual tooling available today, locations in the steam generator where the tooling is used and how the tooling works; Implementation discussion covers where in the world this tooling has been deployed as well the benefits the tooling has provided. (author)
Beaton, Nicholas R; Guttmann, Anthony J; Flajolet, Philippe
We have studied the area-generating function of prudent polygons on the square lattice. Exact solutions are obtained for the generating function of two-sided and three-sided prudent polygons, and a functional equation is found for four-sided prudent polygons. This is used to generate series coefficients in polynomial time, and these are analysed to determine the asymptotics numerically. A careful asymptotic analysis of the three-sided polygons produces a most surprising result. A transcendental critical exponent is found, and the leading amplitude is not quite a constant, but is a constant plus a small oscillatory component with an amplitude approximately 10 -8 times that of the leading amplitude. This effect cannot be seen by any standard numerical analysis, but it may be present in other models. If so, it changes our whole view of the asymptotic behaviour of lattice models. (fast track communication)
Huang, Xin; Brites, C.; Ascenso, J.
Distributed Video Coding (DVC) is a new video coding paradigm which mainly exploits the source statistics at the decoder based on the availability of some decoder side information. The quality of the side information has a major impact on the DVC rate-distortion (RD) performance in the same way...... the quality of the predictions had a major impact in predictive video coding. In this paper, a DVC solution exploiting multiple side information is proposed; the multiple side information is generated by frame interpolation and frame extrapolation targeting to improve the side information of a single...
Sanjay Orathi Patangi
Full Text Available We present a case report of a 55-year-old lady who presented with progressive dysphagia and was diagnosed with a Kommerell′s aneurysm and a right-sided aortic arch. This case report outlines our management strategy and the challenges encountered during the perioperative period in a patient with this rare anomaly.
The US Electric Utility Demand-Side Management report is prepared by the Coal and Electric Data and Renewables Division; Office of Coal, Nuclear, Electric and Alternative Fuels; Energy Information Administration (EIA); US Department of Energy. The report presents comprehensive information on electric power industry demand-side management (DSM) activities in the US at the national, regional, and utility levels. The objective of the publication is to provide industry decision makers, government policy makers, analysts, and the general public with historical data that may be used in understanding DSM as it relates to the US electric power industry. The first chapter, ''Profile: US Electric Utility Demand-Side Management'', presents a general discussion of DSM, its history, current issues, and a review of key statistics for the year. Subsequent chapters present discussions and more detailed data on energy savings, peak load reductions and costs attributable to DSM. 9 figs., 24 tabs
Hopkins, M.F.; Conger, R.L.; Foley, T.J. [and others
This report provides an overview of and rationale for industrial demand side management (DSM) programs. Benefits and barriers are described, and data from the Manufacturing Energy Consumption Survey are used to estimate potential energy savings in kilowatt hours. The report presents types and examples of programs and explores elements of successful programs. Two in-depth case studies (from Boise Cascade and Eli Lilly and Company) illustrate two types of effective DSM programs. Interviews with staff from state public utility commissions indicate the current thinking about the status and future of industrial DSM programs. A comprehensive bibliography is included, technical assistance programs are listed and described, and a methodology for evaluating potential or actual savings from projects is delineated.
Altenburg, A; Augustin, M; Zouboulis, C C
The introduction of biologics has revolutionized the treatment of moderate to severe plaque psoriasis. Due to the continuous expansion of biological therapies for psoriasis, it is particularly important to acknowledge efficacy and safety of the compounds not only in clinical trials but also in long-term registry-based observational studies. Typical side effects and significant risks of antipsoriatic biologic therapies considering psoriatic control groups are presented. A selective literature search was conducted in PubMed and long-term safety studies of the psoriasis registries PsoBest, PSOLAR and BADBIR were evaluated. To assess the long-term safety of biologics, the evaluation of the course of large patient cohorts in long-term registries is of particular medical importance. Newer biologic drugs seem to exhibit a better safety profile than older ones.
Noy, Dominic; Mouta, Sandra; Lamas, Joao; Basso, Daniel; Silva, Carlos; Santos, Jorge A
When people walk side-by-side, they often synchronize their steps. To achieve this, individuals might cross-modally match audiovisual signals from the movements of the partner and kinesthetic, cutaneous, visual and auditory signals from their own movements. Because signals from different sensory systems are processed with noise and asynchronously, the challenge of the CNS is to derive the best estimate based on this conflicting information. This is currently thought to be done by a mechanism operating as a Maximum Likelihood Estimator (MLE). The present work investigated whether audiovisual signals from the partner are integrated according to MLE in order to synchronize steps during walking. Three experiments were conducted in which the sensory cues from a walking partner were virtually simulated. In Experiment 1 seven participants were instructed to synchronize with human-sized Point Light Walkers and/or footstep sounds. Results revealed highest synchronization performance with auditory and audiovisual cues. This was quantified by the time to achieve synchronization and by synchronization variability. However, this auditory dominance effect might have been due to artifacts of the setup. Therefore, in Experiment 2 human-sized virtual mannequins were implemented. Also, audiovisual stimuli were rendered in real-time and thus were synchronous and co-localized. All four participants synchronized best with audiovisual cues. For three of the four participants results point toward their optimal integration consistent with the MLE model. Experiment 3 yielded performance decrements for all three participants when the cues were incongruent. Overall, these findings suggest that individuals might optimally integrate audiovisual cues to synchronize steps during side-by-side walking. Copyright © 2017 Elsevier B.V. All rights reserved.
Shimonis, V.; Ragaishis, V.; Poshkas, P.
Experimental results are presented on the heat transfer from two-side heated helical channels to gas (air) flows. The study covered six configurations and wide ranges of geometrical (D/h=5.5 to 84.2) and performance (Re=10 3 to 2*10 5 ) parameters. Under the influence of Re and of the channel curvature, the heat transfer from both the convex and the concave surfaces for two-side heating (q w1 ≅ q w2 ) is augmented by 20-30% over one-side heating. Improved relations to predict the critical values of Reynolds Re cr1 and Re cr2 are suggested. They enable more exact predictions of the heat transfer from convex surface in transient flows for one-side heating. The relation for annular channels is suggested for the turbulent heat transfer from the convex and concave surfaces of two-side heated helical channels. It can be adapted by introducing earlier expresions for one-side heated helical channels. (author). 6 refs., 2 tabs., 3 figs
Park, Cheol Kyu; Park, Young Ha; Jung, Se Young; Park, Seog Hee; Bahk, Yong Whee
The interrelationship between the etiology of pleural effusion and the side of its occurrence has been a subject of clinical interest for many years. It has often been stated that pleural effusion caused by congestive heart failure tends to occur on the right side. However, some authors contended that such a side proclivity is not reliable. In the present study, the authors investigated the laterally of effusion caused by various cardiovascular diseases complicated by heart failure. We reviewed the chest X-ray films and clinical records of 68 patients with proven pleural effusion resulted from heart failure. 1. There were 34 men and 34 women with the age ranging from 10 to 84 years with the mean of 59. 2. The diagnoses were rheumatic heart disease (2 patients), coronary heart disease (10 patients), hypertensive heart disease (8 patients), mitral valvular disease (18 patients), aortic valvular disease (3 patients), and miscellaneous (27 patients). 3. 34 patients had unilateral pleural effusion, 25 and 9, right and left, respectively. Of the 34 patients with bilateral effusion, 13 patients had predominantly right-sided effusion, 5 patients had predominantly left-sided effusion and 16 patients had evenly distributed bilateral effusion. Thus, 55.8% of effusion was right-sided
Allport, P.P.; Carter, J.R.; Dunwoody, U.C.; Gibson, V.; Goodrick, M.J.; Beck, G.A.; Carter, A.A.; Martin, A.J.; Pritchard, T.W.; Bullough, M.A.; Greenwood, N.M.; Lucas, A.D.; Wilburn, C.D.
The use of the field effect transistor, integrated onto AC-coupled silicon detectors, as a novel technique for biasing the implanted p + strips [P.P. Allport et al., Nucl. Instr. and Meth. A 310 (1991) 155], was first employed for the OPAL microvertex detector. The detector has proved very successful, with ladders of three single-sided detectors showing signal/noise of 22 : 1 with MX5 readout electronics [P.P. Allport et al., Nucl. Instr. and Meth. A 324 (1993) 34; Nucl. Phys. B (Proc. Suppl.) 32 (1993) 208]. This technique has been extended to bias also the n + strips and p strips on the ohmic side of a double-sided detector [P.P. Allport et al., Nucl. Instr. and Meth. A, to be submitted]. Full-size detectors with orthogonal readout have been fabricated by Micron and tested with MX7 readout on both sides. Both the junction and ohmic sides of these detectors have similar signal/noise values to those for single-sided wafers [P.P. Allport et al., Nucl. Instr. and Meth. A, to be submitted]. Test structures have been irradiated with beta particles to study the radiation hardness of the devices, and probe station electrical measurements of the detectors and test structures are presented. ((orig.))
This document presents potential environmental and socioeconomic consequences associated with the proposed project called the West Side Development, Phase 1 South, developing approximately 44 acres...
Gabbett, Tim J; Jenkins, David G; Abernethy, Bruce
This study investigated the physiological and skill demands of 'on-side' and 'off-side' games in elite rugby league players. Sixteen male rugby league players participated in 'on-side' and 'off-side' games. Both small-sided games were played in a 40- × 40-m playing area. The 'off-side' game permitted players to have 3 'plays' while in possession of the ball. Players were permitted to pass backward or forward (to an 'off-side' player). The 'on-side' game also permitted players to have 3 'plays' while in possession of the ball. However, players were only permitted to pass backward to players in an 'on-side' position. Heart rate and movement patterns (via global positioning system) were recorded continuously throughout both games. Data were collected on the distance covered, number of high-acceleration and velocity efforts, and recovery between efforts. Video footage was also taken to track the performance of the players. Post hoc inspection of the footage was undertaken to count the number of possessions and the number and quality of disposals. In comparison to 'on-side' games, 'off-side' games had a greater number of involvements ("touches"), passes, and effective passes. However, the cognitive demands of 'on-side' games were greater than 'off-side' games. 'Off-side' games resulted in a greater total distance covered, greater distance covered in mild and moderate accelerations, and greater distance covered in low, moderate, and high-velocity efforts. There were also a greater number of short duration recovery periods between efforts in 'off-side' games. The results of this study demonstrate that 'off-side' games provide greater physiological and skill demands than 'on-side' games. 'Off-side' games may provide a practical alternative to 'on-side' games for the development of skill and fitness in elite rugby league players.
Holcomb, L. Gary
The subject of determining the inherent system noise levels present in modem broadband closed loop seismic sensors has been an evolving topic ever since closed loop systems became available. Closed loop systems are unique in that the system noise can not be determined via a blocked mass test as in older conventional open loop seismic sensors. Instead, most investigators have resorted to performing measurements on two or more systems operating in close proximity to one another and to analyzing the outputs of these systems with respect to one another to ascertain their relative noise levels.The analysis of side-by-side relative performance is inherently dependent on the accuracy of the mathematical modeling of the test configuration. This report presents a direct approach to extracting the system noise levels of two linear systems with a common coherent input signal. The mathematical solution to the problem is incredibly simple; however the practical application of the method encounters some difficulties. Examples of expected accuracies are presented as derived by simulating real systems performance using computer generated random noise. In addition, examples of the performance of the method when applied to real experimental test data are shown.
The majority of psychotropic drugs entail sexual side effects. The sexual side effects may reduce quality of life and may give rise to non-compliance. For example, 30-60 per cent of patients treated with antidepressants are known to develop a sexual dysfunction. However, some psychotropic drugs...... with no or very few sexual side effects have begun to emerge. The treatment of sexual side effects induced by psychotropic drugs may consist of: modified sexual habits, reduction in dosage, switching to another medication, possibly in combination with different psychotropic agents, other varieties...
Coiras, Enrique; Petillot, Yvan; Lane, David M
In this paper, a new method for the estimation of seabed elevation maps from side-scan sonar images is presented. The side-scan image formation process is represented by a Lambertian diffuse model, which is then inverted by a multiresolution optimization procedure inspired by expectation-maximization to account for the characteristics of the imaged seafloor region. On convergence of the model, approximations for seabed reflectivity, side-scan beam pattern, and seabed altitude are obtained. The performance of the system is evaluated against a real structure of known dimensions. Reconstruction results for images acquired by different sonar sensors are presented. Applications to augmented reality for the simulation of targets in sonar imagery are also discussed.
Song Shaojuan; Qi Hengtao; Zhao Yongxia; Jiao Fanglian
Objective: To assess and compare the difference in image quality and exposure dose between single-sided reading image plate (IP) and dual-sided reading IP. Methods: A contrast-detail phantom CDRAD 2.0 was exposed by single-sided and dual-sided reading IP with different mAs sets. The entrance surface doses were recorded for all images. Images were then presented to two radiologists on a high resolution monitor of diagnosis workstation. The image quality figure (IQF) was measured for each image. Statistical analysis was performed using Spearman's correlation test and Wilcoxon signed-rank test to compare the difference in image quality and exposure dose between single-sided IP and dual-sided reading IP. Results: With different tube current dosage of 5.6, 12.0, 20.0, 25.0, and 40.0 mAs, IQF values of single-sided reading IP were 47.95, 37.68, 34.31, 28.61, and 24.65, respectively, while those of dual- sided reading IP were 38.83, 29.81, 29.65, 25.16, and 21.43, respectively. The IQF difference between them showed statistical significance (P<0.05). Conclusion: Image quality of dual-sided reading IP has been proved to be far superior to that of single-sided reading IP, in particular for low contrast detail. The image quality of single-sided reading IP is similar to that of dual-sided reading IP only at high dose levels. The clinical application of dual-sided reading IP will reduce the exposure dose by about 25% compared with single-sided reading IP. (authors)
Pedersen, Niels Leergaard
and the subject of improving the design. The present paper concentrates on the optimization of splines and the predictions of stress concentrations, which are determined by finite element analysis (FEA). Using design modifications, that do not change the spline load carrying capacity, it is shown that large...
Quaak, Marjolijn S W; Martens, Herm; Hassing, Robert-Jan; van Beek-Nieuwland, Yvonne; van Genderen, Perry J J
A 26-year-old woman was affected with a maculopapular rash because of a jellyfish sting on her right leg while surfing in Indonesia. A locally-prepared liniment was applied on the affected skin. She presented with hyperpigmented linear tracks that she noted a few days later. © 2012 International Society of Travel Medicine.
Zhang, Wen; Yue, Xiang; Liu, Feng; Chen, Yanlin; Tu, Shikui; Zhang, Xining
Drug side effects are one of main concerns in the drug discovery, which gains wide attentions. Investigating drug side effects is of great importance, and the computational prediction can help to guide wet experiments. As far as we known, a great number of computational methods have been proposed for the side effect predictions. The assumption that similar drugs may induce same side effects is usually employed for modeling, and how to calculate the drug-drug similarity is critical in the side effect predictions. In this paper, we present a novel measure of drug-drug similarity named "linear neighborhood similarity", which is calculated in a drug feature space by exploring linear neighborhood relationship. Then, we transfer the similarity from the feature space into the side effect space, and predict drug side effects by propagating known side effect information through a similarity-based graph. Under a unified frame based on the linear neighborhood similarity, we propose method "LNSM" and its extension "LNSM-SMI" to predict side effects of new drugs, and propose the method "LNSM-MSE" to predict unobserved side effect of approved drugs. We evaluate the performances of LNSM and LNSM-SMI in predicting side effects of new drugs, and evaluate the performances of LNSM-MSE in predicting missing side effects of approved drugs. The results demonstrate that the linear neighborhood similarity can improve the performances of side effect prediction, and the linear neighborhood similarity-based methods can outperform existing side effect prediction methods. More importantly, the proposed methods can predict side effects of new drugs as well as unobserved side effects of approved drugs under a unified frame.
Lifka, H.; Verschuren, C.A.; Bruls, D.M.; Tanase, C.
Transparent OLEDs offer great potential for novel applications. Preferably, the light should be emitted from one side only. This can bedone to some extent by modifying electrode thicknesses, but at the cost of reduced transparency. Here, we demonstrate a new approach tomake single side emissive
Weiss, Jonathan D [Albuquerque, NM
A side-emitting fiber optic position sensor and method of determining an unknown position of an object by using the sensor. In one embodiment, a concentrated beam of light source illuminates the side of a side-emitting fiber optic at an unknown axial position along the fiber's length. Some of this side-illuminated light is in-scattered into the fiber and captured. As the captured light is guided down the fiber, its intensity decreases due to loss from side-emission away from the fiber and from bulk absorption within the fiber. By measuring the intensity of light emitted from one (or both) ends of the fiber with a photodetector(s), the axial position of the light source is determined by comparing the photodetector's signal to a calibrated response curve, look-up table, or by using a mathematical model. Alternatively, the side-emitting fiber is illuminated at one end, while a photodetector measures the intensity of light emitted from the side of the fiber, at an unknown position. As the photodetector moves further away from the illuminated end, the detector's signal strength decreases due to loss from side-emission and/or bulk absorption. As before, the detector's signal is correlated to a unique position along the fiber.
Nishiyama, S [Hiroshima City Industrial Technology Institute, Hiroshima (Japan); Harada, S; Harada, K
This paper presents a new development of roller type side slip tester (RTSSI). The test equipment consists of four parts, which are developed in this research. These are a roller part, a control part, a remote control part and a CRT part. In this study, we especially investigated the mechanism and performance between tire and roller. We analyzed the amount of side slip with various toe angles. The developed tester is examined under the conditions that is considered in industrial applications. We investigated the influences of toe angle, size of tire, pressure of tire, coefficient of friction between tire and roller, pushing force of tire, revolution velocity of roller, axle load and so on. The validity of the developed RTSST is confirmed under these conditions. It was found that the RTSST can be used in practical use. Some measurement results are presented in the form of parametric plots. And we also compared measurements data between the RTSST and that of flat type using several automobiles. 4 refs., 8 figs., 4 tabs.
Grieu, Stéphane; Faugeroux, Olivier; Traoré, Adama; Claudet, Bernard; Bodnar, Jean-Luc
In the present paper, an artificial intelligence-based approach dealing with the estimation of correlated thermophysical properties is designed and evaluated. This new and "intelligent" approach makes use of photothermal responses obtained when homogeneous materials are subjected to a light flux. Commonly, gradient-based algorithms are used as parameter estimation techniques. Unfortunately, such algorithms show instabilities leading to non-convergence in case of correlated properties to be estimated from a rebuilt impulse response. So, the main objective of the present work was to simultaneously estimate both the thermal diffusivity and conductivity of homogeneous materials, from front-face or rear-face photothermal responses to pseudo random binary signals. To this end, we used side-by-side neuro-fuzzy systems (adaptive network-based fuzzy inference systems) trained with a hybrid algorithm. We focused on the impact on generalization of both the examples used during training and the fuzzification process. In addition, computation time was a key point to consider. That is why the developed algorithm is computationally tractable and allows both the thermal diffusivity and conductivity of homogeneous materials to be simultaneously estimated with very good accuracy (the generalization error ranges between 4.6% and 6.2%).
Hoogsteen, Gerwin; van der Klauw, Thijs; Molderink, Albert; Hurink, Johann L.; Smit, Gerardus Johannes Maria; Feng, Xianyong; Hebner, Robert E.
Now that the internet of things is emerging, control of domestic assets within the smart micro grids is also gaining interest. Furthermore, these micro grids may operate in islanded mode for short periods. Various demand side management approaches are presented in literature to control these assets.
Passchier, I.; Driessen, B.J.F.; Heijligers, B.M.R.; Netten, B.D.; Schackmann, P.P.M.
The design and implementation of the Road Side Unit for the A270 Test Site is presented. It consists of a sensor platform and V2I communication platform with full coverage of the test site. A service platform enables applications to make use of these facilities. The RSU will be used both for the
Vasquez, William F.
This paper presents estimates of production functions of reading and mathematics test scores to assess the effects of supply-side interventions, such as the provision of a community-based school management programme, bilingual education and multigrade teaching, on student learning in Guatemala. The efficiency and consistency of the estimates is…
Gong, Z.; Makkes, M.X.; Ardagna, C.A.; Zhou, J.
The separation design and fabrication process in the semiconductor industry leads to potential threats such as trojan side-channels (TSCs). In this paper we design a new family of TSCs from physical unclonable functions (PUFs). In particular, a dedicated attack on the PRESENT block cipher is
In the present study, a 3-D coupled transient thermal analysis model with auxiliary side heating (parallel heating) is developed to control angular distortion. During analysis, parallel heating flames are placed at several locations from weld line in cross direction. A user defined subroutine is used to apply transient heat source ...
Silvestro, Federico; Baitch, Alex; Pilo, Fabrizio
will be implemented in practice? How will regulatory frameworks and connection agreements evolve to support ADSs? The present work provides some information about the closer and closer integration between network planning and Demand Side Integration that is foreseen in the future and shows the necessity to develop...
... perspective. However, the determinants of maternal mortality are a complex web of biology and culture. This paper presents the 'other side' of the story: a wider overview of the casual pathways by which simple interventions may produce the desired effect. (Institute of African Studies Research Review: 2003 19(1): 47-56) ...
Ali, T.; Mudasser, S.; Mudsser, S.; Sarwar, M.
Caecal and right sided colonic cancers mostly present with fatigue, weakness and iron deficiency anemia. Such tumours rarely perforate posteriorly and involve the retroperitoneum. We report a case of an old Omani lady who came with insidious sign and symptoms of perforated caecum leading to retroperitoneal collection and necrotizing fasciitis of abdominal wall due to carcinoma of caecum. She underwent surgery but despite active intervention, she died because of septicemic shock. (author)
Ray, Sudatta; Bisoi, A.; Kshetri, R.; Goswami, A.; Saha Sarkar, M.; Pramanik, D.; Sarkar, S.; Nag, S.; Selva Kumar, K.; Singh, P.; Saha, S.; Sethi, J.; Trivedi, T.; Naidu, B.S.; Donthi, R.; Nanal, V.; Palit, R.
Precise determination of level lifetime is of utmost importance in nuclear γ-spectroscopy. Doppler Shift Attenuation (DSA) method suitable for measuring sub-pico second lifetimes, involves inclusion of proper correction for side-feeding which is synonymous to unknown feeding of the level under consideration. It is possible to avoid a sidefeeding contribution by gating on Doppler shifted gamma lines above (GTA) the level being studied in the cascade. In the present work, an empirical approach has been adopted to find the dependence of side-feeding times in nuclei in A ≅ 40 region as function of level energies
Games allow players to experiment and play with subject positions, values and moral choice. In game worlds players can take on the role of antagonists; they allow us to play with behaviour that would be offensive, illegal or immoral if it happened outside of the game sphere. While contemporary ga...... for what can be presented in a games? Are these boundaries different from other media such as film and books, and if so why? What is the allure of dark play and why do players engage in these practices?...
van Denderen, Pepijn; Schielen, Ralph; Hulscher, Suzanne
Side channels have been constructed to reduce the flood risk and to increase the ecological value of the river. In various Dutch side channels large aggradation in these channels occurred after construction. Measurements show that the grain size of the deposited sediment in the side channel is smaller than the grain size found on the bed of the main channel. This suggest that sorting occurs at the bifurcation of the side channel. The objective is to reproduce with a 2D morphological model the fining of the bed in the side channel and to study the effect of the sediment sorting on morphodynamic development of the side channel. We use a 2D Delft3D model with two sediment fractions. The first fraction corresponds with the grain size that can be found on the bed of the main channel and the second fraction corresponds with the grain size found in the side channel. With the numerical model we compute several side channel configurations in which we vary the length and the width of the side channel, and the curvature of the upstream channel. From these computations we can derive the equilibrium state and the time scale of the morphodynamic development of the side channel. Preliminary results show that even when a simple sediment transport relation is used, like Engelund & Hansen, more fine sediment enters the side channel than coarse sediment. This is as expected, and is probably related to the bed slope effects which are a function of the Shields parameter. It is expected that by adding a sill at the entrance of the side channel the slope effect increases. This might reduce the amount of coarse sediment which enters the side channel even more. It is unclear whether the model used is able to reproduce the effect of such a sill correctly as modelling a sill and reproducing the correct hydrodynamic and morphodynamic behaviour is not straightforward in a 2D model. Acknowledgements: This research is funded by STW, part of the Dutch Organization for Scientific Research under
Lassen, Claus C.; Galland, Daniel
Land-use conflicts, noise and health problems, local air pollution, decreased urban quality and affected liveability are considered amongst the core impacts and consequences associated with global airports, all of which have largely been individually documented. Through a case study of Mexico City...... urban surroundings and globalisation. The present study of Mexico City International Airport suggests that local players and airports are not just passively influenced by processes of globalisation and aeromobilities, but also that such processes disentangle a wide array of socio......-spatial and environmental consequences that depend on ad hoc local contexts. Hence, the article follows the argument that a much stronger focus on the planning process of airports is needed at local and regional scales, while a larger debate regarding the regulation of increased global aviation ought to be raised...
Full Text Available Two independent spheres were placed in a side by side arrangement and flow structure in the wake region of the spheres was investigated with a Particle Image Velocimetry (PIV system when the spheres were in a boundary layer over a flat plate as a special case. Reynolds number was 5000 based on the sphere diameter which was 42.5 mm. Boundary layer was tripped 8mm away from the leading edge of the flat plate with a 5 mm trip wire. The thickness of the hydrodynamically developed boundary layer was determined as 63mm which was larger than the sphere diameter of D=42.5mm. Wake region of the spheres was examined from point of flow physics for the different sphere locations in the ranges of 0≤G/D ≤1.5 and 0≤S/D ≤1.5 where G and S were the distance between the spheres and the distance between the bottom point of the spheres and the flat plate surface, respectively. Depending on the different sphere locations, instantaneous and time averaged vorticity data, scalar values of time-averaged velocity components and their root mean square (rms values and time averaged vorticity data are presented in the study for the evaluation of wake region of the spheres. It is demonstrated that the gap between the two spheres and the interaction between the gap and the boundary layer greatly affects flow pattern, especially when spheres are located near to the flat plate surface, i.e. S/D=0.1 for 0≤G/D ≤1.5. Different distances between the spheres resulted in various flow patterns as the spheres were approached to the flat plate. The distance S/D=0.1 for all gap values has the strongest effect on the wake structures. Beyond G/D=1.0, the sphere wakes tend to be similar to single sphere case. The instantaneous vorticity fields of the side by side arrangements comprised wavy structures in higher level comparing to an individual sphere case. The gap flow intensifies the occurrence of small scale eddies in the wake region. The submersion rate of the spheres
Wright, Alex; Collaboration, for the DarkSide
DarkSide is a direct detection dark matter program based on two phase time projection chambers with depleted argon targets. The DarkSide detectors are designed, using novel low background techniques and active shielding, to be capable of demonstrating in situ a very low level of residual background. This means that each detector in the DarkSide program should have the ability to make a convincing claim of dark matter detection based on the observation of a few nuclear recoil events. The colla...
Acevedo-Escalante, M. F.; Caballero-Robledo, G. A.
Obstacles within fluids have been widely used in engineering and in physics to study hydrodynamic interactions. In granular matter, objects within a granular flow have helped to understand fundamental features of drag and lift forces. In our group, we have studied numerically the flow mediated interaction between two static disks within a vertical granular flow in a two-dimensional container where the flow velocity and the distance between obstacles were varied. Attractive and repulsive forces were found depending on flow velocity and separation between intruders. The simulations evidenced a relationship between the average flow velocity in a specific section ahead of the obstacles and the attractive-repulsive lift. On the other hand, it was showed that the lift force on an object dragged within a granular medium depends on the shape of the intruder. Here we present experimental results of the interaction between two side-by-side intruders of different shapes within a vertical granular flow. We built a quasi-two-dimensional container in which we placed the intruders and using load cells we measured lift and drag forces during the discharge process for different flow velocities.
Tian, Fang-Bao; Luo, Haoxiang; Zhu, Luoding; Lu, Xi-Yun
Flexible filaments flapping in a surrounding flow are useful models for understanding the flow-induced vibration and mimicking the schooling behavior of fish. In the present work, the coupled modes of three identical filaments in a side-by- side arrangement are studied using the linear stability analysis and also an immersed boundary--lattice Boltzmann method for low Reynolds numbers (Re on order of 100). The numerical simulations show that the system dynamics exhibits several patterns that depend on the spacing between the filaments. Among these patterns, three can be predicted by the linear analysis and have been reported before. These modes are: (1) the three filaments all flap in phase; (2) the two outer filaments are out of phase while the middle one is stable; (3) the two outer filaments are in phase while the middle one is out of phase. The simulations also identified two additional modes: (1) the outer two filaments are out of phase while the middle one flaps at a frequency reduced by half; (2) the outer two filaments are out of phase while the middle one flaps at a slightly different frequency. In addition to the vibratory modes, the drag force and the flapping amplitude are also computed, and the implication of the result will be discussed.
Baryshev, AM; Kooi, J; Mena, FR; Lodewijk, CRJ; Wild, W
A side-band-separating (SBS) heterodyne mixer has been designed for the Atacama Large Millimeter Array (ALMA) 602-720 GHz band, as it will present a great improvement over the current double-side-band configuration under development at the moment. Here we present design details and the results of
Alicia TAPIA LÓPEZ
Full Text Available On October 30, 1938, Orson Welles aired the radio drama The War of the Worlds on the CBS Radio network, adapting the science-fiction novel by the British writer H. G. Wells. During the broadcast, listeners became stricken with panic, believing that the Earth was actually being invaded by giant snake-like Martians launching rays of fire down on humans. Welles was a groundbreaking figure whose trickery exploited the technological novelty of the radio to its fullest, adapting classic texts in ways that exploited the opportunities afforded by this new medium. Over the years, this radio classic has been adapted a number of times, though none has seized on the technological advances of our times. Drawing on the most salient innovations seen in Internet radio, this article creates an imaginary scenario that replicates Orson Welles’s work in the present day, when the Internet has become a channel for broadcasting and hyperlinks have brought different media together. The text is an exploration of the other side of time, where transmedia storytelling facilitates the exchange of stories among consumers, and broadcast programming is no longer linear.
In this paper, the major benefits and challenges of electricity demand side management (DSM) are discussed in the context of the UK electricity system. The relatively low utilisation of generation and networks (of about 50%) means that there is significant scope for DSM to contribute to increasing the efficiency of the system investment. The importance of the diversity of electricity load is discussed and the negative effects of DSM on load diversity illustrated. Ageing assets, the growth in renewable and other low-carbon generation technologies and advances in information and communication technologies are identified as major additional drivers that could lead to wider applications of DSM in the medium term. Potential benefits of DSM are discussed in the context of generation and of transmission and distribution networks. The provision of back-up capacity by generation may not be efficient as it will be needed relatively infrequently, and DSM may be better placed to support security. We also present an analysis of the value of DSM in balancing generation and demand in a future UK electricity system with significant variable renewable generation. We give a number of reasons for the relatively slow uptake of DSM, particularly in the residential, commercial and small business sectors. They include a lack of metering, information and communication infrastructure, lack of understanding of the benefits of DSM, problems with the competitiveness of DSM when compared with traditional approaches, an increase in the complexity of system operation and inappropriate market incentives. (author)
... Considerations How Cancer is Treated Side Effects Dating, Sex, and Reproduction Advanced Cancer For Children For Teens For Young Adults For Older Adults Prevention and Healthy Living Cancer.Net Videos Coping With Cancer Research and Advocacy Survivorship Blog ...
... C ancer I nstitute Managing Chemotherapy Side Effects Bleeding Problems “My nurse said that chemotherapy could make ... with a clean cloth. Keep pressing until the bleeding stops. If you bruise: Put ice on the ...
... C ancer I nstitute Managing Chemotherapy Side Effects Hair Loss (Alopecia) “Losing my hair was hard at first. ... and anywhere on your body may fall out. Hair loss is called alopecia. When will my hair start ...
N ational C ancer I nstitute Managing Chemotherapy Side Effects U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Nausea and Vomiting “I take medicine so I won’t feel sick ...
N ational C ancer I nstitute Managing Chemotherapy Side Effects Swelling (Fluid retention) “My hands and feet were swollen and puffy. My nurse helped me understand why I had to stop eating salty ...
Ilmunud ka: 2003 : annual report : [Eesti Raudtee]. - Tallinn, 2004, lk. 34-35; 2003 : godovoi ottshjot : [Eesti Raudtee]. - Tallinn, 2004, lk. 34-35. Ülevaade AS-i Eesti Raudtee side- ja turvanguameti tegevusest 2003. aastal. Skeem
Booth, A.W.; Forster, R.; Gustafsson, L.; Ho, N.
It is well known that the FASTBUS Segment Interconnect (SI) provides a communication path between two otherwise independent, asynchronous bus segments. The SI is probably the most important module in any FASTBUS data acquisition network since it's failure to function can cause whole segments of the network to be inaccessible and sometimes inoperable. This paper describes SIDES, an intelligent program designed to diagnose SI's both in situ as they operate in a data acquisition network, and in the laboratory in an acceptance/repair environment. The paper discusses important issues such as knowledge acquisition; extracting knowledge from human experts and other knowledge sources. SIDES can benefit high energy physics experiments, where SI problems can be diagnosed and solved more quickly. Equipment pool technicians can also benefit from SIDES, first by decreasing the number of SI's erroneously turned in for repair, and secondly as SIDES acts as an intelligent assistant to the technician in the diagnosis and repair process
This technology evaluation assesses side stream filtration options for cooling towers, with an objective to assess key attributes that optimize energy and water savings along with providing information on specific technology and implementation options. This information can be used to assist Federal sites to determine which options may be most appropriate for their applications. This evaluation provides an overview of the characterization of side stream filtration technology, describes typical applications, and details specific types of filtration technology.
Brodsky, Jason Philip [Princeton Univ., NJ (United States)
The DarkSide-50 experiment seeks to directly detect dark matter in a liquid argon time projection chamber. In this dissertation, I present an algorithm of my design that determines the position of particle interactions with the liquid argon. This position reconstruction algorithm will be used by DarkSide-50 to reject backgrounds, particularly backgrounds from radioactive elements on the detector surface. The position reconstruction algorithm functions by constructing light response functions (LRFs) that map locations in the detector to the expected distribution of signal in DarkSide-50's 38 photomultiplier tubes. Accurate LRFs cannot be produced by simulations of DarkSide-50's optics because such simulations are known to be awed. Instead, this algorithm constructs LRFs using an iterative process driven by data. Initial, awed LRFs are produced using simulated events but then used to produce new LRFs from data events. Multiple generations of LRFs are created from data with each generation driven to better satisfy a known feature of the detector: the dominant argon-39 background is uniformly distributed. I also discuss a method of discriminating against surface background as an alternative to the common approach of ducialization. This method considers the di erence in goodnessof- t between the best- t reconstructed position and the best- t position at the detector's surface. I conclude by presenting results on the performance and validity of this algorithm, including some discussion of reconstruction errors.
Balakrishnan, Shankar K.; Shariff, Karim R.
Detached Eddy Simulation (DES) of flap side-edge flow was performed with a wing and half-span flap configuration used in previous experimental and numerical studies. The focus of the study is the unsteady flow features responsible for the production of far-field noise. The simulation was performed at a Reynolds number (based on the main wing chord) of 3.7 million. Reynolds Averaged Navier-Stokes (RANS) simulations were performed as a precursor to the DES. The results of these precursor simulations match previous experimental and RANS results closely. Although the present DES simulations have not reached statistical stationary yet, some unsteady features of the developing flap side-edge flowfield are presented. In the final paper it is expected that statistically stationary results will be presented including comparisons of surface pressure spectra with experimental data.
The publication presents and explains verified, international classification and documentation systems for side effects induced by cancer treatments, applicable in general and clinical practice and clinical research, and covers in a clearly arranged manner the whole range of treatments, including acute and chronic side effects of chemotherapy and radiotherapy, surgery, or combined therapies. The book fills a long-felt need in tumor documentation and is a major contribution to quality assurance in clinical oncology in German-speaking countries. As most parts of the book are bilingual, presenting German and English texts and terminology, it satisfies the principles of interdisciplinarity and internationality. The tabulated form chosen for presentation of classification systems and criteria facilitate the user's approach as well as application in daily work. (orig./CB) [de
Shiroyama, Hironobu; Matsuo, Hirofumi; Ishizuka, Yoichi
This paper presents a quasi-resonant converter with divided resonant capacitor on primary and secondary side of the isolation transformer. A conventional quasi-resonant converter using flyback topology can realize soft switching with simple circuit. However, relatively large surge voltage is generated in the switching device. To suppress such surge voltage, resonant capacitor is divided on primary side and secondary side in the proposed converter. In case of prototype 95W converter, the volta...
Waters, Erika A; Pachur, Thorsten; Colditz, Graham A
Side effects prompt some patients to forego otherwise-beneficial therapies. This study explored which characteristics make side effects particularly aversive. We used a psychometric approach, originating from research on risk perception, to identify the factors (or components) underlying side effect perceptions. Women ( N = 149) aged 40 to 74 years were recruited from a patient registry to complete an online experiment. Participants were presented with hypothetical scenarios in which an effective and necessary medication conferred a small risk of a single side effect (e.g., nausea, dizziness). They rated a broad range of side effects on several characteristics (e.g., embarrassing, treatable). In addition, we collected 4 measures of aversiveness for each side effect: choosing to take the medication, willingness to pay to avoid the side effect (WTP), negative affective attitude associated with the side effect, and how each side effect ranks among others in terms of undesirability. A principal components analysis (PCA) was used to identify the components underlying side effect perceptions. Then, for each aversiveness measure separately, regression analyses were used to determine which components predicted differences in aversiveness among the side effects. The PCA revealed 4 components underlying side effect perceptions: affective challenge (e.g., frightening), social challenge (e.g., disfiguring), physical challenge (e.g., painful), and familiarity (e.g., common). Side effects perceived as affectively and physically challenging elicited the highest levels of aversiveness across all 4 measures. Understanding what side effect characteristics are most aversive may inform interventions to improve medical decisions and facilitate the translation of novel biomedical therapies into clinical practice.
Rivera-Sanfeliz, G. M.; Assar, O. S. A.; LaBerge, J. M.; Wilson, M. W.; Gordon, R. L.; Ring, E. J.; Kerlan, R. K. Jr.
Our purpose here is to describe our experience with important hemobilia following PTBD and to determine whether left-sided percutaneous transhepatic biliary drainage (PTBD) is associated with an increased incidence of important hemobilia compared to right-sided drainages. We reviewed 346 transhepatic biliary drainages over a four-year period and identified eight patients (2.3%) with important hemobilia requiring transcatheter embolization. The charts and radiographic files of these patients were reviewed. The side of the PTBD (left versus right), and the order of the biliary ductal branch entered (first, second, or third) were recorded. Of the 346 PTBDs, 269 were right-sided and 77 were left-sided. Of the eight cases of important hemobilia requiring transcatheter embolization, four followed right-sided and four followed left-sided PTBD, corresponding to a bleeding incidence of 1.5% (4/269) for right PTBD and 5.2% (4/77) for left PTBD. The higher incidence of hemobilia associated with left-sided PTBD approached, but did not reach the threshold of statistical significance (p = 0.077). In six of the eight patients requiring transcatheter embolization, first or second order biliary branches were accessed by catheter for PTBD. All patients with left-sided bleeding had first or proximal second order branches accessed by biliary drainage catheters. In conclusion, a higher incidence of hemobilia followed left- versus right-sided PTBD in this study, but the increased incidence did not reach statistical significance
Full Text Available Coccidioidomycosis is a fungal disease found in the desert soils of Western Hemisphere. Histopathological examination is the key to the diagnosis when fungal culture and molecular studies are not available. Disease in non-endemic area is usually imported. But here we have reported a case of coccidioidomycosis found indigenous in Jharkhand, to our best of knowledge, where the patient had no history of travel to endemic regions.
The main objective of this high level meeting is to identify and share recent experience, relevant factors and approaches influencing safety and performance improvements, as well as long-term strategies of the nuclear industry, taking into consideration the Fukushima accident to the extent
Results are presented on in situ irradiation of silicon detector's at cryogenic temperature. The results show that irradiation at cryogenic temperatures does not detrimentally effect a silicon detectors performance when compared to its irradiation at room temperature. Operation of silicon devices at cryogenic temperatures offers the advantage of reducing radiation-induced leakage current to levels of a few pA, while at 130K the Lazarus Effect plays an important role i.e. minimum voltage required for full depletion. Performing voltage scans on a 'standard' silicon pad detector pre- and post annealing, the charge collection efficiency was found to be 60% at 200V and 95% at 200V respectively. Time dependence measurements are presented, showing that for a dose of 6.5x10 14 p/cm 2 (450GeV protons) the time dependence of the charge collection efficiency is negligible. However, for higher doses, 1.2x10 15 p/cm 2 , the charge collection efficiency drops from an initial measured value of 67% to a stable value of 58% over a period of 15 minutes for reversed biased diodes. An analysis of the 'double junction' effect is also presented. A comparison between the Transient Current Technique and an X-ray technique is presented. The double junction has been observed in p + /n/n + silicon detectors after irradiation beyond 'type inversion', corresponding to a fluence equivalent to ∼3x10 13 cm -2 1MeV neutrons, producing p + /p/n + and essentially two p-n junctions within one device. With increasing bias voltage, as the electric field is extending into the detector bulk from opposite sides of the silicon detector, there are two distinct depletion regions that collect charge signal independently. Summing the signal charge from the two regions, one is able to reconstruct the initial energy of the incident particle. From Transient Current measurements it is apparent that E-field manipulation is possible by excess carrier injection, enabling a high enough E-field to extend across the
Santana-Mora, Urbano; López-Cedrún, José; Mora, María J.; Otero, Xosé L.; Santana-Penín, Urbano
Background Temporomandibular disorders are the most common cause of chronic orofacial pain, but, except where they occur subsequent to trauma, their cause remains unknown. This cross-sectional study assessed chewing function (habitual chewing side) and the differences of the chewing side and condylar path and lateral anterior guidance angles in participants with chronic unilateral temporomandibular disorder. This is the preliminary report of a randomized trial that aimed to test the effect of a new occlusal adjustment therapy. Methods The masticatory function of 21 randomly selected completely dentate participants with chronic temporomandibular disorders (all but one with unilateral symptoms) was assessed by observing them eat almonds, inspecting the lateral horizontal movement of the jaw, with kinesiography, and by means of interview. The condylar path in the sagittal plane and the lateral anterior guidance angles with respect to the Frankfort horizontal plane in the frontal plane were measured on both sides in each individual. Results Sixteen of 20 participants with unilateral symptoms chewed on the affected side; the concordance (Fisher’s exact test, P = .003) and the concordance-symmetry level (Kappa coefficient κ = 0.689; 95% confidence interval [CI], 0.38 to 0.99; P = .002) were significant. The mean condylar path angle was steeper (53.47(10.88) degrees versus 46.16(7.25) degrees; P = .001), and the mean lateral anterior guidance angle was flatter (41.63(13.35) degrees versus 48.32(9.53) degrees P = .036) on the symptomatic side. Discussion The results of this study support the use of a new term based on etiology, “habitual chewing side syndrome”, instead of the nonspecific symptom-based “temporomandibular joint disorders”; this denomination is characterized in adults by a steeper condylar path, flatter lateral anterior guidance, and habitual chewing on the symptomatic side. PMID:23593156
Full Text Available BACKGROUND: Temporomandibular disorders are the most common cause of chronic orofacial pain, but, except where they occur subsequent to trauma, their cause remains unknown. This cross-sectional study assessed chewing function (habitual chewing side and the differences of the chewing side and condylar path and lateral anterior guidance angles in participants with chronic unilateral temporomandibular disorder. This is the preliminary report of a randomized trial that aimed to test the effect of a new occlusal adjustment therapy. METHODS: The masticatory function of 21 randomly selected completely dentate participants with chronic temporomandibular disorders (all but one with unilateral symptoms was assessed by observing them eat almonds, inspecting the lateral horizontal movement of the jaw, with kinesiography, and by means of interview. The condylar path in the sagittal plane and the lateral anterior guidance angles with respect to the Frankfort horizontal plane in the frontal plane were measured on both sides in each individual. RESULTS: Sixteen of 20 participants with unilateral symptoms chewed on the affected side; the concordance (Fisher's exact test, P = .003 and the concordance-symmetry level (Kappa coefficient κ = 0.689; 95% confidence interval [CI], 0.38 to 0.99; P = .002 were significant. The mean condylar path angle was steeper (53.47(10.88 degrees versus 46.16(7.25 degrees; P = .001, and the mean lateral anterior guidance angle was flatter (41.63(13.35 degrees versus 48.32(9.53 degrees P = .036 on the symptomatic side. DISCUSSION: The results of this study support the use of a new term based on etiology, "habitual chewing side syndrome", instead of the nonspecific symptom-based "temporomandibular joint disorders"; this denomination is characterized in adults by a steeper condylar path, flatter lateral anterior guidance, and habitual chewing on the symptomatic side.
Full Text Available Surgical pancreatic duct (PD drainage for chronic pancreatitis in children is relatively rare. It is indicated in cases of recurrent pancreatitis and PD dilatation that have not responded to medical therapy and therapeutic endoscopy. We performed laparoscopic side-to-side pancreaticojejunostomy for two paediatric patients with chronic pancreatitis. The main PD was opened easily by electrocautery after locating the dilated PD by intraoperative ultrasonography. The dilated PD was split longitudinally from the pancreatic tail to the pancreatic head by laparoscopic coagulation shears or electrocautery after pancreatography. A laparoscopic side-to-side pancreaticojejunostomy was performed by a one-layered technique using continuous 4-0 polydioxanone (PDS sutures from the pancreatic tail to the pancreatic head. There were no intraoperative or postoperative complications or recurrences. This procedure has cosmetic advantages compared with open surgery for chronic pancreatitis. Laparoscopic side-to-side pancreaticojejunostomy in children is feasible and effective for the treatment of chronic pancreatitis.
Full Text Available While algebraic side-channel attack (ASCA has been successful in breaking simple cryptographic algorithms, it has never been done on larger or more complex algorithms such as Twofish. Compared to other algorithms that ASCA has been used on, Twofish is more difficult to attack due to the key-dependent S-boxes as well as the complex key scheduling. In this paper, we propose the first algebraic side-channel attack on Twofish, and examine the importance of side-channel information in getting past the key-dependent S-boxes and the complex key scheduling. The cryptographic algorithm and side-channel information are both expressed as boolean equations and a SAT solver is used to recover the key. While algebraic attack by itself is not sufficient to break the algorithm, with the help of side-channel information such as Hamming weights, we are able to correctly solve for 96 bits of the 128 bits key in under 2 hours with known plaintext/ciphertext.
McIntosh, Andrew S; Kallieris, Dimitrios; Frechede, Bertrand
Neck injury remains a major issue in road safety. Current side impact dummies and side impact crashworthiness assessments do not assess the risk of neck injury. These assessments are limited by biofidelity and knowledge regarding neck injury criteria and tolerance levels in side impacts. Side impact tests with PMHS were performed at the Heidelberg University in the 1980s and 1990s to improve primarily the understanding of trunk dynamics, injury mechanisms and criteria. In order to contribute to the definition of human tolerances at neck level, this study presents an analysis of the head/neck biomechanical parameters that were measured in these tests and their relationship to neck injury severity. Data from 15 impact tests were analysed. Head accelerations, and neck forces and moments were calculated from 9-accelerometer array head data, X-rays and anthropometric data. Statistically significant relationships were observed between resultant head acceleration and neck force and neck injury severity. The average resultant head acceleration for AIS 2 neck injuries was 112 g, while resultant neck force was 4925 N and moment 241 Nm. The data compared well to other test data on cadavers and volunteers. It is hoped that the paper will assist in the understanding of neck injuries and the development of tolerance criteria.
Wang, Zhengzhi; Gu, Ping; Wu, Xiaoping
A new concept of gecko-inspired double-sided adhesives (DSAs) is presented. The DSAs, constructed by dual-angled (i.e. angled base and angled tip) micro-pillars on both sides of the backplane substrate, are fabricated by combinations of angled etching, mould replication, tip modification, and curing bonding. Two types of DSA, symmetric and antisymmetric (i.e. pillars are patterned symmetrically or antisymmetrically relative to the backplane), are fabricated and studied in comparison with the single-sided adhesive (SSA) counterparts through both non-conformal and conformal tests. Results indicate that the DSAs show controllable and bidirectional adhesion. Combination of the two pillar-layers can either amplify (for the antisymmetric DSA, providing a remarkable and durable adhesion capacity of 25.8 ± 2.8 N cm⁻² and a high anisotropy ratio of ∼8) or counteract (for the symmetric DSA, generating almost isotropic adhesion) the adhesion capacity and anisotropic level of one SSA (capacity of 16.2 ± 1.7 N cm⁻² and anisotropy ratio of ∼6). We demonstrate that these two DSAs can be utilized as a facile fastener for two individual objects and a small-scale delivery setup, respectively, complementing the functionality of the commonly studied SSA. As such, the double-sided patterning is believed to be a new branch in the further development of biomimetic dry adhesives.
Full Text Available Objective: It is accepted that sugammadex show its effectsmore rapidly than the other neuromuscular block antagonistsin many studies, however especially in pediatriccases, it is seen that about its reliability and side effectsare limited in some studies. In our retrospective study,we aimed to present our experiences on sugammadexin terms of its side effects in the pediatric cases in ourhospital for a 1-year period.Methods: The patient files and intraoperative anesthesiarecords, postoperative 24th hour and after postoperative24th hour of the cases that underwent the application ofsugammadex under general anesthesia in pediatric surgeryoperating room in a 1-year period were analyzed.Results: Totally 46 patients received sugammadex; infants(28 days-23 months (n=24, children (2 years-11years (n=16 and adolescent (11-17 years (n=6. Noneof the patients showed hypersensitivity and statisticallysignificant side effects correlated to sugammadex.Conclusion: We think that sugammadex may open newdoors in pediatric patient group with its features. However,more documentation is needed about the safety inpediatric patient group, particularly in infants. J Clin ExpInvest 2013; 4 (3: 265-268Key words: Sugammadex, pediatric patient, side effect
Baier, Bernhard; Vucurevic, Goran; Müller-Forell, Wibke; Glassl, Oliver; Geber, Christian; Dieterich, Marianne; Karnath, Hans-Otto
In patients with left-sided lesions, anosognosia for hemiparesis (AHP) seems to be a rare phenomenon. It has been discussed whether this rareness might be due to an inevitable bias due to language dysfunction and whether the left hemisphere's role for our self-awareness of motor actions thus is underestimated. By applying functional magnetic resonance imaging (fMRI) we examined whether patients with AHP following a left hemisphere stroke show a regular, left-sided or a reversed, right-sided lateralization of language functions. Only the former observation would argue for an original role of the left hemisphere in self-awareness about limb function. In a consecutive series of 44 acute left-sided stroke patients, only one patient (=2%) was identified showing AHP. In this case, we could verify by using fMRI that lateralization of AHP and spatial neglect on the one hand and of language functions on the other hand were reversed. The present single case observation thus argues against an original role of the left hemisphere in self-awareness about limb function. We discuss the data in the context of previous observations in the literature. Copyright © 2014 Elsevier Ltd. All rights reserved.
This comprehensive report published by the Swiss Federal Office of Energy (SFOE) presents a number of side-notes pertaining to the first three volumes of the Energy Perspectives series of reports. Various topics are discussed by the authors of the first three volumes of the perspectives in the meetings held by the Energy Perspectives Working Group. The sixteen side-notes presented here cover the following topics: General conditions, fossil resources, the influence of climate warming, CO 2 emissions trading (Joint Implementation JI and Clean Development Mechanism CDM), definition of potentials, air traffic, imported renewable electricity, hydro power, electricity cost calculation, sensitivity analysis of centralised power production facilities, heat-pumps and their power consumption, cold spells and heat-waves, risk and its perception, the 2000-Watt society and international and national energy perspectives
Vezeridis, Peter S.; Blazar, Philip; Yoshioka, Hiroshi; Han, Roger
Ulnar-sided wrist pain is a common complaint, and it presents a diagnostic challenge for hand surgeons and radiologists. The complex anatomy of this region, combined with the small size of structures and subtle imaging findings, compound this problem. A thorough understanding of ulnar-sided wrist anatomy and a systematic clinical examination of this region are essential in arriving at an accurate diagnosis. In part I of this review, ulnar-sided wrist anatomy and clinical examination are discussed for a more comprehensive understanding of ulnar-sided wrist pain. (orig.)
Alexander, T.; Alton, D.; Arisaka, K.; Back, H. O.; Beltrame, P.; Benziger, J.; Bonfini, G.; Brigatti, A.; Brodsky, J.; Bussino, S.; Cadonati, L.; Calaprice, F.; Candela, A.; Cao, H.; Cavalcante, P.; Chepurnov, A.; Chidzik, S.; Cocco, A. G.; Condon, C.; D' Angelo, D.; Davini, S.; Vincenzi, M. De; Haas, E. De; Derbin, A.; Pietro, G. Di; Dratchnev, I.; Durben, D.; Empl, A.; Etenko, A.; Fan, A.; Fiorillo, G.; Franco, D.; Fomenko, K.; Forster, G.; Gabriele, F.; Galbiati, C.; Gazzana, S.; Ghiano, C.; Goretti, A.; Grandi, L.; Gromov, M.; Guan, M.; Guo, C.; Guray, G.; Hungerford, E. V.; Ianni, Al; Ianni, An; Joliet, C.; Kayunov, A.; Keeter, K.; Kendziora, C.; Kidner, S.; Klemmer, R.; Kobychev, V.; Koh, G.; Komor, M.; Korablev, D.; Korga, G.; Li, P.; Loer, B.; Lombardi, P.; Love, C.; Ludhova, L.; Luitz, S.; Lukyanchenko, L.; Lund, A.; Lung, K.; Ma, Y.; Machulin, I.; Mari, S.; Maricic, J.; Martoff, C. J.; Meregaglia, A.; Meroni, E.; Meyers, P.; Mohayai, T.; Montanari, D.; Montuschi, M.; Monzani, M. E.; Mosteiro, P.; Mount, B.; Muratova, V.; Nelson, A.; Nemtzow, A.; Nurakhov, N.; Orsini, M.; Ortica, F.; Pallavicini, M.; Pantic, E.; Parmeggiano, S.; Parsells, R.; Pelliccia, N.; Perasso, L.; Perasso, S.; Perfetto, F.; Pinsky, L.; Pocar, A.; Pordes, S.; Randle, K.; Ranucci, G.; Razeto, A.; Romani, A.; Rossi, B.; Rossi, N.; Rountree, S. D.; Saggese, P.; Saldanha, R.; Salvo, C.; Sands, W.; Seigar, M.; Semenov, D.; Shields, E.; Skorokhvatov, M.; Smirnov, O.; Sotnikov, A.; Sukhotin, S.; Suvarov, Y.; Tartaglia, R.; Tatarowicz, J.; Testera, G.; Thompson, J.; Tonazzo, A.; Unzhakov, E.; Vogelaar, R. B.; Wang, H.; Westerdale, S.; Wojcik, M.; Wright, A.; Xu, J.; Yang, C.; Zavatarelli, S.; Zehfus, M.; Zhong, W.; Zuzel, G.
The DarkSide staged program utilizes a two-phase time projection chamber (TPC) with liquid argon as the target material for the scattering of dark matter particles. Efficient background reduction is achieved using low radioactivity underground argon as well as several experimental handles such as pulse shape, ratio of ionization over scintillation signal, 3D event reconstruction, and active neutron and muon vetos. The DarkSide-10 prototype detector has proven high scintillation light yield, which is a particularly important parameter as it sets the energy threshold for the pulse shape discrimination technique. The DarkSide-50 detector system, currently in commissioning phase at the Gran Sasso Underground Laboratory, will reach a sensitivity to dark matter spin-independent scattering cross section of 10-45 cm2 within 3 years of operation.
Uuspaeae, P [VTT Energy, Espoo (Finland)
The scope of this research is data communications for electric utilities, specifically for the purposes of Demand Side Management (DSM). Demand Side Management has the objective to change the customer`s end use of energy in a manner that benefits both the customer and the utility. For example, peak demand may be reduced, and the peak demand may be relocated to off peak periods. Thus additional investments in generation and network may be avoided. A number of Demand Side Management functions can be implemented if a communication system is available between the Electric Utility and the Customer. The total communication capacity that is needed, will depend on several factors, such as the functions that are chosen for DSM, and on the number and type of customers. Some functions may be handled with one-way communications, while some other functions need to have two-way communication
Fernando Costa Nunes
Full Text Available The authors present three cases report of appendicular diverticulum with associated diverticulitis, one of them asymptomatic. The clinical distinction between acute apendicitis and apendical diverticulitis is very difficult, the later usually with earlier suppuration. The are no consensus regarding preventive surgery for apendical diverticulitis. It is possible that incidence of apendicular diverticulum depends on careful anatomopathological exams.
In the present study, the effect of electroecupuncture (EA) of acupoints of Ren, Spleen and Stomach Meridians on artificial abortion-induced side effects was observed in 100 artificial abortion women. In comparison with 45 artificial abortion women in the control group (who had not accepted EA treatment), EA possessed significant effects in relieving abdominal pain, reducing vaginal bleeding duration, lowering infection rate and infertility rate after artificial abortion operation.
Ramanujam, P.S.; Holme, Christian; Hvilsted, Søren
and holographic storage in one particular polyester are described in detail and polarized Fourier transform infrared spectroscopic data complementing the optical data are presented. Optical and atomic force microscope investigations point to a laser-induced aggregation as responsible for permanent optical storage.......Azobenzene side-chain liquid crystalline polyester structures suitable for permanent optical storage are described. The synthesis and characterization of the polyesters together with differential scanning calorimetry and X-ray investigations are discussed. Optical anisotropic investigations...
Sohár, Gábor; Kovács, Mónika; Györkös, Andrea; Gasztonyi, Beáta
The authors present the case history of a patient suffering from hyperthyroidism. The diagnostic procedures revealed the presence of propylthiouracyl induced vasculitis with renal involvement, that recovered completely after the withdrawal of propylthiouracyl and corticosteroid treatment. Thereafter, the patient was treated with thiamasol, that caused agranulocytosis with fever. After transient litium carbonate therapy a succesful thyreoidectomy was performed. Cumulative serious side effects of antithyroid drugs are rare. This case highlights some of the challenges and complications encountered in the management of hyperthyroidism.
Central nervous system (CNS) tuberculoma can have variable presentation depending upon the site and number of tuberculomata. We are reporting a rare case of a 15 years old girl who presented to our hospital with binocular diplopia on right gaze. Clinical examination revealed left sided internuclear ophthalmoplegia ...
Ballard, D H; Alexander, J S; Weisman, J A; Orchard, M A; Williams, J T; D'Agostino, H B
To evaluate the influence of number and location of catheter shaft side holes regarding drainage efficiency in an in vitro model. Three different drainage catheter models were constructed: open-ended model with no side holes (one catheter), unilateral side hole model (six catheters with one to six unilateral side holes), and bilateral side hole model (six catheters with one to six bilateral side holes). Catheters were inserted into a drainage output-measuring device with a constant-pressure reservoir of water. The volume of water evacuated by each of the catheters at 10-second intervals was measured. A total of five trials were performed for each catheter. Data were analysed using one-way analysis of variance. The open-ended catheter had a mean drainage volume comparable to the unilateral model catheters with three, four, and five side holes. Unilateral model catheters had significant drainage volume increases up to three side holes; unilateral model catheters with more than three side holes had no significant improvement in drainage volume. All bilateral model catheters had significantly higher mean drainage volumes than their unilateral counterparts. There was no significant difference between the mean drainage volume with one, two, or three pairs of bilateral side holes. Further, there was no drainage improvement by adding additional bilateral side holes. The present in vitro study suggests that beyond a critical side hole number threshold, adding more distal side holes does not improve catheter drainage efficiency. These results may be used to enhance catheter design towards improving their drainage efficiency. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Zhezherun, A; Flynn, D
We consider ordinary Differential equations with a Preisach operator under the derivative. A special case when the right-hand side has discontinuities in time is studied. We present theorems about the existence and uniqueness of solutions. We also prove a theorem which describes the behavior of a solution at the points of discontinuity of the right-hand side
de Wolf, Inge F.; Janssens, F.J.G.
This paper presents an overview of studies into effects and side effects of control mechanisms in education. We focus on effects and side effects of inspection visits and public performance indicators. A first conclusion is that the studies do not provide us with a clear answer to the question of
Sandvig, J. Christopher
The rapid growth of e-business and e-commerce has made server-side programming an increasingly important topic in information systems (IS) and computer science (CS) curricula. This article presents an overview of the major features of several popular server-side programming technologies and discusses the factors that influence the selection of…
Tanis, E.; van Geloven, A. A. W.; Bemelman, W. A.; Wind, J.
The aim of the present study was to compare the laparoscopy, transverse, and midline laparotomy in right-sided colectomies with respect to short- and long-term outcome. The short- and long-term results of all patients who had an elective right-sided hemicolectomy, from January 2006 to April 2009 for
Full Text Available Scaled-down Savonius turbine rotors arrayed side-by-side are introduced to analyze the effects of design parameters on the performance between turbine rotors. Unsteady flow simulation and experimental measurement have been performed to compare turbine performance and validate the numerical simulation of the turbine rotor. Commercial code, SC/Tetra, which uses an unstructured grid system, has been used to solve the three-dimensional unsteady Reynolds-averaged Navier–Stokes equations. Single turbine rotors and two turbine rotors arrayed side-by-side were numerically analyzed. The distance between rotor tips is 0.5 times the rotor diameter. Throughout the numerical simulation, the power coefficient obtained by the time-averaged result of unsteady flow simulation was found to be in good agreement with the experimental result. A discussion on the design parameters using both a single and arrayed turbine rotors is presented based on the results of the unsteady flow simulation, including the flow field, power coefficient, velocity and vorticity contours.
Supply chain management; dynamic pricing; partner selection; supply chain planning; electronic marketplaces. Abstract. In this paper we develop a quadratic programming model for partner selection and planning in integrated supply chain networks embedded with both sell-side and buy-side electronic marketplaces.
Spears, R; Lea, M; Corneliussen, RA; Postmes, T; Ter Haar, W
In two studies, the authors tested predictions derived from the social identity model of deindividuation effects (SIDE) concerning the potential of computer-mediated communication (CMC) to serve as a means to resist powerful out-groups. Earlier research using the SIDE model indicates that the
Full Text Available The behavior of the flow around two circular cylinders arranged in a side-by-side configuration strongly depends on the transverse center-to-center gap spacing ratio (T/D) where D is the cylinder diameter. Based on the observed wake structure [13...
Lopez Arteaga, I.; Nijmeijer, H.; Busturia, J.M.; Sas, P.; Munck, de M.
Friction is frequently seen as an unwanted phenomenon whose influence has to be either minimised or controlled. In this work one of the positive sides of friction is investigated: friction damping. Friction dampers can be a cheap and efficient way to reduce the vibration levels of a wide range of
Gil, Mariana; Menzel, Randolf; De Marco, Rodrigo J.
We report a hitherto unknown form of side-specific learning in honeybees. We trained bees individually by coupling gustatory and mechanical stimulation of each antenna with either increasing or decreasing volumes of sucrose solution offered to the animal's proboscis along successive learning trials. Next, we examined their proboscis extension…
Steen, M.S. van der; Lenders, J.W.M.; Thien, Th.
OBJECTIVE: To study the experiences and complaints of patients who underwent 24 h blood pressure monitoring. METHODS: Two groups of hypertensive patients of a tertiary outpatient clinic were asked to fill in a nine-item questionnaire about the side effects of ambulatory blood pressure monitoring
Molderink, Albert; Bakker, Vincent; Smit, Gerardus Johannes Maria
Steering a heterogeneous set of devices in a Smart Grid using cost functions: Demand Side Management (DSM) is an important element in smart grids. DSM is already in operation for large consumers, but thorough research is required into DSM on a building level within the distribution grid.
Frey, Anders Ullmann; Sønksen, Jens; Fode, Mikkel
INTRODUCTION: A series of previously neglected sexually related side effects to radical prostatectomy (RP) has been identified over the recent years. These include orgasm-associated incontinence (OAI), urinary incontinence in relation to sexual stimulation (UISS), altered perception of orgasm, or...
J Gordon Millichap
Full Text Available Clinical trial and postmarketing surveillance data for drugs used in treatment of attention deficit hyperactivity disorder were analyzed to determine the frequency of hallucinations and other psychotic side effects, in a study at the US Food and Drug Administration, and Department of Health and Human Services, Maryland.
Nielson, Gregory N; Okandan, Murat; Cruz-Campa, Jose Luis; Resnick, Paul J; Wanlass, Mark Woodbury; Clews, Peggy J
A III-V solar cell is described herein that includes all back side contacts. Additionally, the positive and negative electrical contacts contact compoud semiconductor layers of the solar cell other than the absorbing layer of the solar cell. That is, the positive and negative electrical contacts contact passivating layers of the solar cell.
An abdominal ultrasound scan showed multiple stones in the gallbladder with no evidence of acute cholecystitis and a common bile duct (CBD) diameter of 4 mm. Owing to the atypical nature of her pain, a computed tomography (CT) scan was requested which showed a left-sided gallbladder containing gallstones (Fig. 1).
Full Text Available The use of a price discrimination strategy is an important tool in competition. It can hurt firms and benefit consumers in a one-sided market. However, in two-sided markets, its primary goal is to attract more agents or increase profits. Here, the performance of a second-degree price discrimination strategy in the context of duopoly two-sided platforms is analysed. Two exogenous variables, which include the discount rate and the price discrimination threshold, are used in order to examine whether the price discrimination strategy could help two-sided platforms achieve their objective, which is to maximise their market value. Three cases are considered, and we demonstrate that the price discrimination strategy cannot attract more agents and at the same time increase the profits; a lower price discrimination threshold cannot ensure larger markets shares; a higher discount rate is detrimental to the profit of a platform. However, this is good for its market shares. Moreover, discriminative pricing increases the competition.
Gerson, Richard F.
Discusses 11 keys to the personal side of performance improvement, including positive attitude, high self esteem and positive self-image, communication skills, lifelong learning, caring about other people, health and well-being, motivation, goal setting, relaxation, visualization, and personal value system. (LRW)
Leth, Peter Mygind; Boldsen, Jesper Lier
The Danish King Canute the Saint was killed in St Alban church in Odense July 1086. According to a legend the king was kneeling in prayers when a lance thrust to his side killed him. Our re-examination of the skeleton presumed to belong to Canute showed a slimly build man with an approximate stat...
Conclusions: In every case of left-sided portal hypertension, upper digestive endoscopy and close follow-up are recommended. Besides, computed tomography can demonstrate particular conditions directly favoring gastroesophageal varices, and aid in selection of the appropriate therapeutic decisions. [Arch Clin Exp Surg 2016; 5(4.000: 211-215
... Cancer treatment: fertility and sexual side effects in women To use the sharing features on this page, ... Bladder cancer Types of Sexual Side Effects For women, the most common sexual side effects include: Loss ...
Mei, Jianguo; Bao, Zhenan
Side chains in conjugated polymers have been primarily utilized as solubilizing groups. However, these side chains have roles that are far beyond. We advocate using side chain engineering to tune a polymer's physical properties, including absorption
Silicon technology state of the art for single crystalline was given to be limited to less than 20% efficiency. A proposed new form of photovoltaic solar cell of high current high efficiency with double sided structures has been given. The new forms could be n ++ pn ++ or p ++ np ++ double side junctions. The idea of double sided devices could be understood as two solar cells connected back-to-back in parallel electrical connection, in which the current is doubled if the cell is illuminated from both sides by a V-shaped reflector. The cell is mounted to the reflector such that each face is inclined at an angle of 45 deg. C to each side of the reflector. The advantages of the new structure are: a) High power devices. b) Easy to fabricate. c) The cells are used vertically instead of horizontal use of regular solar cell which require large area to install. This is very important in power stations and especially for satellite installation. If the proposal is made real and proved to be experimentally feasible, it would be a new era for photovoltaic solar cells since the proposal has already been extended to even higher currents. The suggested structures could be stated as: n ++ pn ++ Vp ++ np ++ ;n ++ pn ++ Vn ++ pn ++ ORp ++ np ++ Vp ++ np ++ . These types of structures are formed in wedged shape to employ indirect illumination by either parabolic; conic or V-shaped reflectors. The advantages of these new forms are low cost; high power; less in size and space; self concentrating; ... etc. These proposals if it happens to find their ways to be achieved experimentally, I think they will offer a short path to commercial market and would have an incredible impact on solar cell technology and applications. (author). 12 refs, 5 figs
About 23% of all adults in the US take acetaminophen during an average week (Kaufman, Kelly, Rosenberg, Anderson, & Mitchell, 2002) because acetaminophen is an effective physical painkiller and easily accessible over the counter. The physiological side effects of acetaminophen are well documented and generally mild when acetaminophen is consumed in the appropriate dosage. In contrast, the psychological and social side effects of acetaminophen are largely unknown. Recent functional neuroimaging research suggests that the experience of physical pain is fundamentally related to the experience of empathy for the pain of other people, indicating that pharmacologically reducing responsiveness to physical pain also reduces cognitive, affective, and behavioral responsiveness to the pain of others. I tested this hypothesis across three double-blind between-subjects drug intervention studies. Two experiments showed that acetaminophen had moderate effects on empathic affect, specifically personal distress and empathic concern, and a small effect on empathic cognition, specifically perceived pain, when facing physical and social pain of others. The same two experiments and a third experiment also showed that acetaminophen can increase the willingness to inflict pain on other people, i.e., actual aggressive behavior. This effect was especially pronounced among people low in dispositional empathic concern. Together, these findings suggest that the physical pain system is more involved in the regulation of social cognition, affect, and behavior than previously assumed and that the experience of physical pain and responsiveness to the pain of others share a common neurochemical basis. Furthermore, these findings suggest that acetaminophen has unappreciated but serious social side effects, and that these side effects may depend on psychological characteristics of the drug consumer. This idea is consistent with recent theory and research on the context-dependency of neurochemical
Full Text Available Introduction. Vemurafenib is a selective inhibitor of serine-threonine kinase BRAF used in the treatment of advanced melanoma with BRAF mutation. Effectiveness of this drug was confirmed in a large clinical trial, which led to the increase of its usage. During treatment with vemurafenib, particular attention should be paid to the numerous side effects, including those concerning the skin. Vemurafenib is highly toxic to the skin. Skin lesions occurring during the treatment of melanoma with this medicament can be divided into: early (observed 3 to 6 weeks after beginning treatment, late (observed 6 weeks after beginning treatment and hypersensitivity reactions to vemurafenib. Objective. Presentation of vemurafenib toxic effects on the skin and side effects that can be caused by this drug. Case report. We present a 58-year-old woman with metastatic melanoma who was treated with vemurafenib. During the course of therapy, numerous adverse reactions, including inflammatory tumors, emergence of a number of melanocytic naevi, skin horns, alopecia, hyperkeratosis of the palms and soles, and palmar erythrodysesthesia were observed. She was treated with anti-inflammatory drugs, an antibiotic, circulation-improving preparations and local moisturizing and keratolytic treatment. The patient remains under the care of oncologists and dermatologists. Conclusions. The new generation anti-cancer drugs bring hope for a cure or prolongation of life, but can also significantly reduce the quality of life by inducing both general and local adverse side effects. Oncological patients should also be taken care of by dermatologists.
Gamulin, M.; Grgic, M.
In the present study the side effects of adjuvant radiotherapy of testicular seminoma stage I patients were followed up in the period between 13 to 84 months (median 28 months). The most frequent side effects in these patients during radiotherapy were gastrointestinal problems (nausea/vomiting), psychologic and cognitive problems and minor sexual problems. The reported side effects were treated by antimmimetics and anxiolytics. After radiotherapy, the side effects persisted in 6 % of patients but therapy was needed only in few. Healthy children were born to 76 % of patients in the age group 18 - 39 years after radiotherapy. The present study shows that adjuvant irradiation of paraaortal lymph nodes with total a dose of 24 Gy in 16 daily fractions in testicular seminoma patients causes acceptable side effects with acceptable quality of life and fertility, however in conditions of individual approach and family consulting. (author)
Dong, Qingming; Sau, Amalendu
The gaseous SO2 entrainment from outer air stream and dispersion in binary and ternary liquid micro-cylinders appearing side-by-side are examined hereby. The separation/attachment regulated non-uniform interfacial momentum exchange creates main stream driven "primary" and shear reversed "secondary" vortices in the liquid cylinders. At separation points, the sense of rotation of the generated "primary-secondary" vortex pair remains inward directed. We define such a vortex pair as the "inflow" type. However, at stagnation or attachment points, the sense of rotation of a "primary-primary" or "secondary-secondary" vortex pair remains outward directed, and such a vortex pair is defined as the "outflow" type. For the coupled water cylinders facing an oncoming stream contaminated by gaseous SO2, its absorption and internal transport are effectively controlled by dominant "inflow" and "outflow" natured dynamics of the said vortex pairs, besides by diffusion. The evolving "inflow" natured "primary-secondary" vortex pairs at separation points actively entrain the outer SO2, whereas the "outflow" natured vortex-pairs oppose SO2 entry through the stagnation regions. Moreover, the blockage induced steady-symmetric, steady-deflected, and flip-flopping air-jets through gaps, for varied gap-ratio (1 ≤ G/R ≤ 4) and Reynolds number (30 ≤ Re ≤ 160), create distinctive impact both on quantitative SO2 absorption (mso2 ') and convective nature of the SO2 transport in upper, lower, and middle cylinders, by virtue of modified strength and size of the inflow and outflow paired vortices. The present study shows that the tiny "secondary vortices" play important roles in SO2 entrainment and in effectively controlling the local absorption rate Rs o2. The sudden acceleration and upward/downward deflection of gap-flows enhanced near-neck advective SO2 entrainment by suitably strengthening the "inflow" natured local vortex dynamics. Conversely, for the reduced size of secondary vortices
van de Wall, Bryan Joost Marinus
Diverticula are outpouchings that occur at week points in the colonic wall where small blood vessels enter the circular muscle layer. Diverticula are most frequently found in the distal part of the colon, with 90% of patients having the sigmoid colon involved. Most patients who have diverticulosis
Bhuket TP, Stollman NH. Diverticular disease of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease . 10th ed. Philadelphia, PA: Elsevier Saunders; ...
Du, Yi; Zou, Chunhua; Liu, Xianxing
The purpose of this paper is to present a new double-sided linear primary permanent magnet (PM) vernier (DSLPPMV) machine, which can offer high thrust force, low detent force, and improved power factor. Both PMs and windings of the proposed machine are on the short translator, while the long stator is designed as a double-sided simple iron core with salient teeth so that it is very robust to transmit high thrust force. The key of this new machine is the introduction of double stator and the elimination of translator yoke, so that the inductance and the volume of the machine can be reduced. Hence, the proposed machine offers improved power factor and thrust force density. The electromagnetic performances of the proposed machine are analyzed including flux, no-load EMF, thrust force density, and inductance. Based on using the finite element analysis, the characteristics and performances of the proposed machine are assessed.
Moorhead, Althea V.
Long-period comet C/2013 A1 (Siding Spring) is headed for a close encounter with Mars on 2014 Oct 19. A collision between the comet and the planet has been ruled out, but the comets coma may envelop Mars and its man-made satellites. We present an analytic model of the dust component of cometary comae that describes the spatial distribution of cometary dust and meteoroids and their size distribution. If the coma reaches Mars, we estimate a total incident particle fluence on the planet and its satellites of 0.01 particles per square meter. We compare our model with numerical simulations, data from past comet missions, and recent Siding Spring observations.
Aslam, S.; Bashir, M.S.; Hussain, S.I.
Congenital torticollis is an intriguing condition of unknown origin, characterized by unilateral shortening and tightness of the sternocleidomastoid muscle. Patients usually present with head tilt, facial asymmetry and plagiocephaly. A sternomastoid mass or tumor may or may not be clinically apparent. Untreated, cervical function and facial cosmesis may be severely compromised. Objective: My study is aimed at establishing a comparison between the incidence of right versus left sided congenital torticollis. Method: This observational study included 30 patients of congenital torticollis that completed the questionnaire. The data was collected from patients coming to the Physiotherapy and Orthopedic departments of Children Hospital, Lahore. Results: Results showed that right side was involved in 19 (63.3%) patients and left side was involved in 11 (36.7%) patients. Out of 30 patients, 14 (46.7%) were male, of which 8 had right sided congenital torticollis and 6 had left sided congenital torticollis, and 16 (53.3%) were female, of which right sided congenital torticollis and 5 had left sided congenital torticollis. Conclusion: Hence it is concluded that incidence of right sided congenital torticollis is more common than left sided congenital torticollis. The incidence of con-genital torticollis is higher in females than in males. (author)
de Andrade, Luiz Carlos; Ceneviva, Reginaldo; Coutinho-Netto, Joaquim; Silva Júnior, Orlando de Castro e; dos Santos, José Sebastião; Sukeda, Daniel Hirochi
To asses the morphological features of the behavior of a double-sided prostheses using inguinoplasty laparotomy in dogs with latex side turned to the visceras. Twenty dogs were divided into two groups of 10 and submitted into infraumbilical laparotomy with double-sided prostheses fixed in an inguinal area and in the other side area a control prostheses of polipropilene (PPL). Macroscopics itens were studied on the 14th and 28th day post-operatory, and they were related to obstruction and intestinal fistulas, encystation, fusion and especially sticker. The microscopic analysis covered the inflammatory process in its acute, chronic and restored phase Infectious process, obstruction or intestinal fistula did not happen. The prostheses presented good accommodation and incorporation. The stickers happened with more prevalent and intensity with the PPL (p0,05). The double-sided prostheses in its parietal side adds the advantages of the incorporation's potential to the noticed material with PPL to the biocompatibility from the latex in its visceral side. The little distance between the PPL disc and the edge of the double-sided prostheses (2 cm) allied to its sticking with just five staples is not enough to avoid gaps, through which the epíploon migrated towards to the inflammatory process provoked by PPL in the parietal side.
Nijholt, Antinus; Cappellini, V.; Hemsley, J.
We discuss having virtual presenters in virtual environments that present information to visitors of these environments. Some current research is surveyed and we will look in particular to our research in the context of a virtual meeting room where a virtual presenter uses speech, gestures, pointing
Jan de Leeuw
Wadhwa, Somin; Gupta, Aishwarya; Dokania, Shubham; Kanji, Rakesh; Bagler, Ganesh
Prediction of adverse drug reactions is an important problem in drug discovery endeavors which can be addressed with data-driven strategies. SIDER is one of the most reliable and frequently used datasets for identification of key features as well as building machine learning models for side effects prediction. The inherently unbalanced nature of this data presents with a difficult multi-label multi-class problem towards prediction of drug side effects. We highlight the intrinsic issue with SIDER data and methodological flaws in relying on performance measures such as AUC while attempting to predict side effects.We argue for the use of metrics that are robust to class imbalance for evaluation of classifiers. Importantly, we present a 'hierarchical anatomical classification schema' which aggregates side effects into organs, sub-systems, and systems. With the help of a weighted performance measure, using 5-fold cross-validation we show that this strategy facilitates biologically meaningful side effects prediction at different levels of anatomical hierarchy. By implementing various machine learning classifiers we show that Random Forest model yields best classification accuracy at each level of coarse-graining. The manually curated, hierarchical schema for side effects can also serve as the basis of future studies towards prediction of adverse reactions and identification of key features linked to specific organ systems. Our study provides a strategy for hierarchical classification of side effects rooted in the anatomy and can pave the way for calibrated expert systems for multi-level prediction of side effects.
Li, Kuei-An; Yeh, Su-Ling
The human visual system can estimate mean size of a set of items effectively; however, little is known about whether information on each visual field contributes equally to the mean size estimation. In this study, we examined whether a left-side bias (LSB)-perceptual judgment tends to depend more heavily on left visual field's inputs-affects mean size estimation. Participants were instructed to estimate the mean size of 16 spots. In half of the trials, the mean size of the spots on the left side was larger than that on the right side (the left-larger condition) and vice versa (the right-larger condition). Our results illustrated an LSB: A larger estimated mean size was found in the left-larger condition than in the right-larger condition (Experiment 1), and the LSB vanished when participants' attention was effectively cued to the right side (Experiment 2b). Furthermore, the magnitude of LSB increased with stimulus-onset asynchrony (SOA), when spots on the left side were presented earlier than the right side. In contrast, the LSB vanished and then induced a reversed effect with SOA when spots on the right side were presented earlier (Experiment 3). This study offers the first piece of evidence suggesting that LSB does have a significant influence on mean size estimation of a group of items, which is induced by a leftward attentional bias that enhances the prior entry effect on the left side.
Sand, T.; Myhr, G.; Stovner, L.J.; Dale, L.G.; Tangerud, A.
Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n=107) as compared to nonambulatory myelography (26%, n=58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant. Serious adverse reactions did not occur and none of the ambulatory patients required readmission because of side effects. The headache was predominantly postural and occurred significantly earlier in the ambulatory group. Headache incidence was significantly greater after 20G needle myelography (44%, n=97) as compared to 22G needle iohexol myelography (26%, n=58). The results support the hypothesis that CSF leakage is a major cause of headache after lumbar iohexol myelography. (orig.)
Bruzell, E.M.; Pallesen, Ulla; Thoresen, N.R.
Objective The study was performed to assess the risk of at-home and in-office bleaching procedures, and to recognise potential predictors for side effects. Design Multi-centre, questionnaire-based prospective study with follow-ups at around 14 days and around one year post-treatment. Setting...... General practices and university clinics during the years 2007‑2009 in Scandinavia. Subjects Patients with tooth bleaching as part of the treatment plan. Results The prevalence of experienced tooth sensitivity at first follow-up was independent of bleaching procedure (at-home = 50.3% [n = 143]; in...... attributed to the bleaching treatment in the at-home and in-office groups, respectively. Predictors for side effects were tooth sensitivity, surface loss and gingivitis when observed at inclusion. Treatment-related predictors were bleaching concentration and contact between tray and gingiva. Conclusions...
Abboud, Georges; Midulla, Marco; Lions, Christophe; El Ngheoui, Ziad; Gengler, Laurent; Martinelli, Thomas; Beregi, Jean-Paul
The May-Thurner syndrome is a well-known anatomical anomaly where the left common iliac vein (LCIV) is compressed between the right common iliac artery and the fifth vertebral body. This report describes the case of a 'right-sided' May-Thurner syndrome where the right common iliac vein (RCIV) is compressed by the left common iliac artery in a patient with a left-sided inferior vena cava (IVC). A 26-year-old woman was admitted to our institution with acute edema of the right lower limb. The diagnosis of May-Thurner syndrome was done by CT scan and confirmed by phlebography. An endovascular treatment with stenting was carried out, with good patency and clinical result at 12-month follow-up.
Van der Poorten, Olivier; Knuhtsen, Astrid; Sejer Pedersen, Daniel
Constraining the conformation of flexible peptides is a proven strategy to increase potency, selectivity, and metabolic stability. The focus has mostly been on constraining the backbone dihedral angles; however, the correct orientation of the amino acid side chains (χ-space) that constitute...... the peptide pharmacophore is equally important. Control of χ-space utilizes conformationally constrained amino acids that favor, disfavor, or exclude the gauche (-), the gauche (+), or the trans conformation. In this review we focus on cyclic aromatic amino acids in which the side chain is connected...... to the peptide backbone to provide control of χ(1)- and χ(2)-space. The manifold applications for cyclized analogues of the aromatic amino acids Phe, Tyr, Trp, and His within peptide medicinal chemistry are showcased herein with examples of enzyme inhibitors and ligands for G protein-coupled receptors....
Sand, T.; Stovner, L.J.; Myhr, G.; Dale, L.G.
Side effects of iohexol lumbar myelography have been analyzed with respect to the influence of the type of radiological abnormality, sex and age in a group of 200 patients. Headache, postural headache, nausea and back/leg pain were significantly more frequent in patients without definite radiological abnormalities. Postural headache, nausea, dizziness and mental symptoms were more frequent in women, while headache, postural headache, nausea, dizziness, minor mental symptoms (i.e. anxiety or depression) and pain became less frequent with age. This pattern is similar to that reported after lumbar puncture. Young women without definite clinical signs of nerve root lesions probably have the greatest risk of experiencing side effects after iohexol lumbar myelography. (orig.)
Corrosion may be defined as a naturally occurring physical and chemical deterioration of a material due to reaction with the environment or surrounding atmosphere. In boilers the material is subjected on both sides to two different media which may cause severe corrosion. At the water side the content of O 2 considered one of the principal factors which determine the extent of corrosion in the boiler tubes. This paper deals with certain conditions that result in the increase of O 2 in the boiler water and hence increase the corrosion rate, to minimize the effect of these conditions a chemical treatment was carried out the results obtained indicated the success of the treatment procedure in corrosion prevention and boiler material protection. The treatment is traditional. But the study indicates how a simple mean could be applied to solve a serious problem. 4 tab
Tanaka, T.; Hayakawa, K.; Yatoh, H.; Yoshida, K.; Takeda, O.; Sato, K.; Torizuka, Y.
Construction of a 35 MeV cw double-sided microtron (DSM) at Nihon University was started in 1984 and completed in the spring of 1989. This machine was constructed as a proto-type of an 1 GeV cw double sided microtron for a medical pion facility and test accelerator for FEL and other applications. The 4.55 MeV electron beam from 5 MeV injector linac is injected to the DSM. The energy gain is 6 MeV at each turn acceleration. After recirculated 5 times, the electron beam with 34.5 MeV is extracted at the final short straight section. The DAW structure is used for all the accelerating tubes including the injector linac. Total rf power of 200 kW is provided by four 50 kW klystrons of 2450 MHz. (author)
Firdous Kausar; Bushra Al-Otaibi; Asma Al-Qadi; Nwayer Al-Dossari
Phishing tricks to steal personal or credential information by entering victims into a forged website similar to the original site, and urging them to enter their information believing that this site is legitimate. The number of internet users who are becoming victims of phishing attacks is increasing beside that phishing attacks have become more sophisticated. In this paper we propose a client-side solution to protect against phishing attacks which is a Firefox extension integrated as a tool...
Francaux, Marc; Poortmans, Jacques R
Context: Allegations about side effects of creatine supplementation by athletes have been published in the popular media and scientific publications. Purpose: To examine the experimental evidence relating to the physiological effects of creatine supplementation. Results: One of the purported effects of oral creatine supplementation is increased muscle mass. A review of the literature reveals a 1.0% to 2.3% increase in body mass, which is attributed to fat-free mass and, more specifically, to ...
This paper reviews several applications of photonic side bands, used by Buttiker and Landauer (Phys. Rev. Lett. 49, 1739 (1982)) in their theory of traversal time in tunneling, in transport and optics of mesoscopic systems. Topics include generalizations of the transmission theory of transport...... to time-dependent situations, optics and transport of mesoscopic systems in THz electromagnetic fields, and phase-measurements of photon-assisted tunneling through a quantum dot. (C) 1998 Academic Press Limited....
This article examines the effect that increased competition among electric power suppliers will have on overall service to the customer and to profits. Some topics discussed are the coexistence of competition and cooperation, electric utility profits at risk and the dark side of competition - business failures. The author feels there is a basic conflict between some of the features of the competitive market model and the obligation to serve
National Aeronautics and Space Administration — In this paper we present a framework for forming interests-based Peer-to-Peer communities using client-side web browsing history. At the heart of this framework is...
Lian-guo Wang; Yang Song; Xing-hua He; Jian Zhang [State Key Laboratory for Geomechanics and Deep Underground Engineering, Xuzhou (China)
Given the 7123 working face in the Qidong Coal Mine of the Wanbei Mining Group, nine dynamic roof monitors were installed in the crossheading to measure the amount and velocity of roof convergence in different positions and at different times and three steel bored stress sensors were installed in the return airway to measure rock stress at depth. On the basis of this arrangement, the rule of change of the distribution of the side abutment pressure with the advance of the working face and movement of overlying strata was studied. The rule of change and the stability of rock stress at depth were measured. Secondly, the affected area and stability time of the side abutment pressure were also studied. The results show that: 1) During working, the face advanced distance was from 157 m to 99 m, the process was not effected by mining induced pressure. When the distance was 82 m, the position of peak stress was 5 m away from the coal wall. When the distance was 37 m, the position of peak stress away from the coal wall was about 15 m to 20 m and finally reached a steady state; 2) the time and the range of the peak of side rock pressure obtained from stress sensors were consistent with the results from the dynamic roof monitors; 3) the position of the peak pressure was 25 m away from the coal wall. 14 refs., 6 figs.
Gao, Y Y; Wang, X K; Tan, S K
Two-dimensional laminar flow about two side-by-side unequal cylinders with different diameter ratios d/D and centre-to-centre spacing ratios T/D at Re=300 (based on the larger cylinder diameter) was simulated using a CFD software. Comparisons of experimental and numerical results were made to elucidate the degree of interference due to d/D and T/D and their effects on the flow patterns and vortex shedding frequencies. The findings showed that the flow patterns behind two unequal cylinders were distinctly different from that behind two equal side-by-side cylinders, with distinct in-phase and anti-phase vortex shedding, and random switching of modes of vortex shedding.
Bulatova, Regina; Bahl, Christian; Andersen, Kjeld Bøhm
Functionally graded ceramic tapes have been fabricated by a side-by-side tape casting technique. This study shows the possibility and describes the main principles of adjacent coflow of slurries resulting in formation of thin plates of graded ceramic material. Results showed that the small...... variations of solvent and binder system concentrations have a substantial effect on slurry viscosity. Varying these parameters showed that side-by-side tape casting with a well-defined interface area is possible for slurries with viscosities above 3500 mPa s at a casting shear rate of 3.3 s -1...... of developing this graded ceramic tape casting was applications of these specific magnetocaloric properties within the magnetic refrigeration technology....
Abeygunawardane, Saranga Kumudu
Any electrical utility prefers to implement demand side management and change the shape of the demand curve in a beneficial manner. This paper aims to assess the financial gains (or losses) to the generating sector through the implementation of demand side management programs. An optimization algorithm is developed to find the optimal generation mix that minimizes the daily total generating cost. This daily total generating cost includes the daily generating cost as well as the environmental damage cost. The proposed optimization algorithm is used to find the daily total generating cost for the base case and for several demand side management programs using the data obtained from the Sri Lankan power system. Results obtained for DSM programs are compared with the results obtained for the base case to assess the financial benefits of demand side management to the generating sector.
Holder, Jourdan T; O'Connell, Brendan; Hedley-Williams, Andrea; Wanna, George
To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory. The study included 12 patients with unilateral tinnitus who were undergoing cochlear implantation for single-sided deafness. The Tinnitus Handicap Inventory was administered at the patient's cochlear implant candidacy evaluation appointment prior to implantation and every cochlear implant follow-up appointment, except activation, following implantation. Patient demographics and speech recognition scores were also retrospectively recorded using the electronic medical record. A significant reduction was found when comparing Tinnitus Handicap Inventory score preoperatively (61.2±27.5) to the Tinnitus Handicap Inventory score after three months of cochlear implant use (24.6±28.2, p=0.004) and the Tinnitus Handicap Inventory score beyond 6months of CI use (13.3±18.9, p=0.008). Further, 45% of patients reported total tinnitus suppression. Mean CNC word recognition score improved from 2.9% (SD 9.4) pre-operatively to 40.8% (SD 31.7) by 6months post-activation, which was significantly improved from pre-operative scores (p=0.008). The present data is in agreement with previously published studies that have shown an improvement in tinnitus following cochlear implantation for the large majority of patients with single-sided deafness. Copyright © 2017 Elsevier Inc. All rights reserved.
What possesses someone to volunteer and go through hoops and red tape to make a presentation at a conference? For that matter, why does anyone ever present anything to anyone? Actually, presentations are a fact of life and there are many reasons for doing a presentation and doing it well. New and existing staff need training and orientation to the way things are done here. Handing all of them a manual and hoping they read it is pretty much a waste of paper. On the other hand, an effective, entertaining and upbeat presentation on the relevant topics is more likely to stick with those people. They will even have a name and face to remember and seek out when they have an issue on or with that topic. This can be a very effective beginning for networking with new peers. The presenter is seen as knowledgeable, as a source of information on company topics and possibly evaluated as a potential mentor or future manager. Project staff and/or peers benefit from clear, concise, presentations of topical knowledge. This is one way that a group working on various aspects of the same project or program can stay in touch and in step with each other. Most importantly, presentations may be the best or only door into the minds (and budgets) of management and customers. These presentations are a wonderful opportunity to address legal and compliance issues, budget, staffing, and services. Here is a chance, maybe the only one, to demonstrate and explain the wonderfulness of a program and the benefit they get by using the services offered most effectively. An interactive presentation on legal and compliance issues can be an effective tool in helping customers and/or management make good risk management decisions.
Bruun, Louise E; Tønder, Niels; Hansen, Thomas Fritz
Treatment of infectious endocarditis (IE) comprises intravenously administered antibiotic medications given at high doses for 4-6 weeks--sometimes even longer. Approximately 50% of patients referred to tertiary care centres require additional surgical intervention. At present there are few papers...... describing the effects of oral antibiotic treatment in IE, and only in patients with right-sided endocarditis. In this case report we present a patient with left-sided Streptococcus endocarditis successfully treated with oral antibiotic drugs....
MANNES, GPM; GOUW, ASH; BERENDSEN, HH; VERHOEFF, AJ; POSTMUS, PE
A patient presented with a pneumothorax, a parahilar mass and a pleural effusion on the left side. Histology proved that this was caused by a malignant mesothelioma, epithelial type. The pneumothorax persisted, even after chest drainage and pleurodesis with talc powder and tetracycline.
This is a report of a maxillary brown tumour caused by primary hyperparathyroidism (HPT) secondary to parathyroid carcinoma. A 62-year-old man presented with a large swelling in the right maxilla, which caused right-sided nasal obstruction, intermittent bleeding and diplopia. A computed tomography scan demonstrated ...
Full Text Available A concrete artificial side (AS is introduced to stabilize a gob-side entry (GSE. To evaluate the stability of the AS, a uniaxial compression failure experiment was conducted with large and small-scale specimens. The distribution characteristics of the shear stress were obtained from a numerical simulation. Based on the failure characteristics and the variation of the shear stress, a failure criterion was determined and implemented in the strengthening method for the artificial side. In an experimental test, the distribution pattern of the maximum shear stress showed an X shape, which contributed to the failure shape of the specimen. The shear stress distribution and failure shape are induced by a combination of two sets of shear stresses, which implies that failure of the AS follows the twin shear strength theory. The use of anchor bolts, bolts, and anchor bars enhances the shear strength of the artificial side. When this side is stable, the components can constrain the lateral deformation as well as improve the internal friction angle and cohesion. When the AS is damaged, the components prevent the sliding of broken blocks along the shear failure plane and improve the residual strength of the artificial side. When reinforced with an anchor bar, the AS is still stable even after mining operations for three years.
The requirement for demand-side management brought on by increased competitiveness, a consequence of the deregulation of Canadian electric utilities, was discussed. Options for demand-side management were presented. The effect of deregulation on making demand-side management and energy efficiency high priorities in industry was discussed. Coordinated efforts of Power Smart Inc. and utilities in promoting energy efficiency were claimed to be the key to the success of demand-side management in the electric power industry in Canada. Demand-side management programs were expected to enhance productivity of industry by maximizing the value of plant energy use, and by providing industrial customers with a higher level of customer service
... cars. 231.4 Section 231.4 Transportation Other Regulations Relating to Transportation (Continued... Fixed-end low-side gondola and low-side hopper cars. (Cars with sides 36 inches or less above the floor are low-side cars.) (a) Hand brakes—(1) Number. Same as specified for “Box and other house cars” (see...
Acharya, Priti N; Gill, Daljit; Lloyd, Tim
This case report discusses a rare side effect associated with the use ofa fixed quad helix orthodontic appliance. A 14-year-old healthy girl presented with a painful enlarging mass on her tongue, which was causing distress to both her and her parents. Investigations confirmed that the mass was a pyogenic granuloma and management involved surgical excision of the mass and removal of the quad helix appliance. At least once previous case associated with an orthodontic quad helix appliance has been reported in the literature.
Sonoda, Hiroshi; Yoshida, Akimasa; Ohtsuka, Tadahiro; Takaki, Shuichi; Matsukado, Yasuhiko
We have presented a case showing a major side-effect following metrizamide CT cisternography. The patient was a 68-year-old woman who developed anaphylactic shock and a disturbance of consciousness 6 hours after metrizamide CT cisternography with a dose of 850 mg of iodine. In spite of vigorous therapy, she died 60 hours after the shock. Examples of anaphylactic shock by metrizamide administered intrathecally have been reported very rarely. The pathogenesis of this case was presumably due to anaphylactic shock, but other etiological factors, such as a hypothalamic dysfunction due to a disturbed glucose metabolism of the brain, may also be suspected.
Rios, Ilka A.; Andrade, Delvonei A.; Domingos, Douglas B.; Umbehaun, Pedro E.
During operation of IEA-R1 research reactor, located at Instituto de Pesquisas Energeticas e Nucleares, IPEN - CNEN/SP, an abnormal oxidation on some fuel elements was noted. It was also verified, among the possible causes of the problem, that the most likely one was insufficient cooling of the elements in the core. One of the propositions to solve or minimize the problem is to reduce uranium density on fuel elements side plates. In this paper, the influence of this change on neutronic and thermal hydraulic parameters for IEA-R1 reactor is verified by simulations with the codes HAMMER and CITATION. Results are presented and discussed. (author)
Rios, Ilka A. [Centro Tecnologico da Marinha em Sao Paulo (CTMSP), Sao Paulo, SP (Brazil); Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Andrade, Delvonei A.; Domingos, Douglas B.; Umbehaun, Pedro E. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)
During operation of IEA-R1 research reactor, located at Instituto de Pesquisas Energeticas e Nucleares, IPEN - CNEN/SP, an abnormal oxidation on some fuel elements was noted. It was also verified, among the possible causes of the problem, that the most likely one was insufficient cooling of the elements in the core. One of the propositions to solve or minimize the problem is to reduce uranium density on fuel elements side plates. In this paper, the influence of this change on neutronic and thermal hydraulic parameters for IEA-R1 reactor is verified by simulations with the codes HAMMER and CITATION. Results are presented and discussed. (author)
Full Text Available Side chain polysiloxane with 5-(pentyloxy-3-methyloxy-9,10,16,17,23,24-hexakis(octenyloxyphthalocyanine moieties is synthesized by hydrosilylation reaction. The phase behavior and thermooptical properties of the polysiloxane and starting 2-(pent-4-enyloxy-3-methyloxy-9,10,16,17,23,24-hexakis(octenyloxyphthalocyanine is examined by POM (Polarizing optical microscopy, TOA (thermooptical analysis, DSC (differential scanning calorimetry, AFM (atomic force microscopy and SAXS (small angle X-ray scattering studies. The effect of the attachment of phthalocyanine to polysiloxane chains over phase transitions and phase morphology is discussed in details.
Solheim, Magnus Tovsen; Tovsen, Ole Kristoffer Solheim
Two-sided platforms, such as Airbnb, Uber and eBay, have all revolutionized their industries. Despite having colossal potential, they are very difficult to launch. This is due to what s referred to as network effects, which imply that the value of the platform becomes larger as more people use it. Network effects lead to a chicken-or-egg-problem , where it is difficult to convince sellers to join if there are no buyers and vice versa, in addition to the need to reach a critical mass of users...
Full Text Available This work explores an innovative strategy for increasing the efficiency of compressed sensing applied on mm-wave SAR sensing using multiple weighted side information. The approach is tested on synthetic and on real non-destructive testing measurements performed on a 3D-printed object with defects while taking advantage of multiple previous SAR images of the object with different degrees of similarity. The tested algorithm attributes autonomously weights to the side information at two levels: (1 between the components inside the side information and (2 between the different side information. The reconstruction is thereby almost immune to poor quality side information while exploiting the relevant components hidden inside the added side information. The presented results prove that, in contrast to common compressed sensing, good SAR image reconstruction is achieved at subsampling rates far below the Nyquist rate. Moreover, the algorithm is shown to be much more robust for low quality side information compared to coherent background subtraction.
Full Text Available Walter Brand,1,* Cornelle W Noorlander,1,* Christina Giannakou,2,3 Wim H De Jong,2 Myrna W Kooi,1 Margriet VDZ Park,2 Rob J Vandebriel,2 Irene EM Bosselaers,4 Joep HG Scholl,5 Robert E Geertsma2 1Centre for Safety of Substances and Products, 2Centre for Health Protection, National Institute for Public Health and the Environment (RIVM, Bilthoven, 3Department of Toxicogenomics, Maastricht University, Maastricht, 4Section Pharmacology, Toxicology and Pharmacokinetics, Medicines Evaluation Board (CBG-MEB, Utrecht, 5Research & Analysis Department, Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, the Netherlands *These authors contributed equally to this work Abstract: Due to their specific properties and pharmacokinetics, nanomedicinal products (NMPs may present different toxicity and side effects compared to non-nanoformulated, conventional medicines. To facilitate the safety assessment of NMPs, we aimed to gain insight into toxic effects specific for NMPs by systematically analyzing the available toxicity data on approved NMPs in the European Union. In addition, by comparing five sets of products with the same active pharmaceutical ingredient (API in a conventional formulation versus a nanoformulation, we aimed to identify any side effects specific for the nano aspect of NMPs. The objective was to investigate whether specific toxicity could be related to certain structural types of NMPs and whether a nanoformulation of an API altered the nature of side effects of the product in humans compared to a conventional formulation. The survey of toxicity data did not reveal nanospecific toxicity that could be related to certain types of structures of NMPs, other than those reported previously in relation to accumulation of iron nanoparticles (NPs. However, given the limited data for some of the product groups or toxicological end points in the analysis, conclusions with regard to (a lack of potential nanomedicine-specific effects need to be
Yamamoto, K.; Sato, K.; Yamada, R., E-mail: firstname.lastname@example.org; Hosokawa, N.; Nagano, T.; Hayatsu, K.; Shimohara, T.; Ohkuwa, Y.; Oguri, A.
The multi-pixel photon counter (MPPC) is a solid-state photon counting device consisting of a Geiger-mode APD and a quenching resistor. Through-silicon via technology (TSV) allows for the production of a discrete array version of the MPPC, creating a detector with the advantages of a larger active area and less dead space in its overall packaging when compared to other package types commonly used to produce MPPCs. Eliminating the need for a wire-bonding pad allows individual MPPCs to be tiled with minimum dead-space between individual detectors to form a four-sided buttable array. Selecting MPPCs that behave and perform very similarly to each other, especially when an operating voltage is applied, minimizes variation in performance between each channel and enhances channel uniformity. The output of discrete arrays of MPPCs can be easily readout with ASICs (application specific integrated circuits) due to their excellent channel uniformity characteristics, with minimum adjustment required by the ASIC. -- Author-Highlights: • TSV-MPPC and assembly technology are developed. • TSV-MPPC array is tiled in 4-sided buttable and has large and dense active area. • The output pulse of MPPC may have sharp rising edge by virtue of TSV. • The uniformity of the array can be maximized by neat inspection technology.
Turillazzi, E; Perilli, G; Di Paolo, M; Neri, M; Riezzo, I; Fineschi, V
Anabolic - androgenic steroids (AAS) were originally developed to promote growth of skeletal muscle. AAS abuse is commonly associated with bodybuilders, weightlifters, and other athletes. The issue of AAS toxicity is not yet completely understood since the adverse effects outline a varied scenario with side effects reported affecting many organs and systems in humans. The true incidence of AAS related medical problems is not known, due to several drawbacks in human studies. The entity of side effects depends on the sex, the dose, the duration of treatment, whether they are taken during exercise training or under sedentary conditions, and the susceptibility of the individuals themselves to androgen exposure partly depending on genetic factors. Both the acute and the chronic effects can lead to toxicity, but generally the serious and even fatal effects depend on the time and the duration of AAS administration. A limitation of human studies is represented by the fact that information about the intake of steroids are, generally, self reported and it is hardly possible to assess the exact dosage. AAS are often used in combination with other dugs or substances, so it is difficult to separate their toxic effects from those caused by the other drugs abused. Hence experimental studies conducted on animal models are mandatory to investigate the mechanisms underlying to AAS toxicity and the organ alterations due to these substances. Finally, clinicians should be aware of the complex and varied pattern of toxicity so as to be able to perform correct diagnoses and treatments.
Corina – Maria ENE
Full Text Available The mainly goal of money laundering is to carry out more and more illegal economic transactions or activities to produce individual or groups gains and then to legitimate them. Money laundering converts illicit source of money generated by criminal activities in order to hide the connection between money and their original illegal activities. This is one of money laundering side. The second side implies corruption. While money laundering is a passing channel for illicit funds due to its criminal origin source, such funds may derive from corruption offences. All corruption’s forms represent the most important illicit funds branches for money laundering process. Corrupt people methods used to exploit the national and international financial system reflect the relationship between those two criminal activities. Criminals achieve their personal interests by hiding their corruption proceeds and transfer these gains to official economies. Corruption spread in any society entails money laundering spread, and the converse, too. There is a quite “indecent” relationship between money laundering and corruption. This paper tries to identify the multiple connections between the two phenomenons showing the negative impacts these criminal behaviours are having on the national and international economy. We conclude by highlighting the necessity of a multidisciplinary approach in order to fight against money laundering and corruption by integrating these problem frameworks at national level. International community must focus their resources on money laundering and corruption risks areas and maximize their response impact.
A. S. Kozeruk
Full Text Available The purpose of the paper is to modernize technology for obtaining high-accuracy lenses with fine centre. Presently their operating surfaces are fixed to an accessory with the help of adhesive substance that leads to elastic deformation in glass and causes local errors in lens parts.A mathematical model for concurrent two-sided processing of high-accuracy optical parts with spherical surfaces has been developed in the paper. The paper presents analytical expressions that permit to calculate sliding speed at any point on the processed spherical surface depending on type and value of technological equipment settings. Calculation of parameter Q = Pv in a diametric section of the convexo-concave lens has been carried out while using these expressions together with functional dependence of pressure on contact zone еarea of tool and part bedding surfaces.Theoretical and experimental investigations have been carried out with the purpose to study changes in Q parameter according to the processed lens surface for various setting parameters of the technological equipment and their optimum values ensuring preferential stock removal in the central or boundary part zone or uniform distribution of the removal along the whole processed surface have been determined in the paper.The paper proposes a machine tool scheme for concurrent two-sided grinding and polishing of lenses while fixing their side (cylindrical surface. Machine tool kinematics makes it possible flexibly and within wide limits to change its setting parameters that significantly facilitates the control of form-building process of parts with highly-precise spherical surfaces.Methodology for investigations presupposes the following: mathematical simulation of highly-precise spherical surface form-building process under conditions of forced closing, execution of numerical and experimental studies.
Full Text Available Measurement system analysis is carried out in order to determine if a capability to perform measurements in terms of product and process control is sufficient, indicating that the type I and the type II appraisal errors probability are acceptable. Statistical analyses for measurement system evaluation presented in the literature and the industrial manuals are not applicable for all complex and unusual applications. Therefore, the purpose of this study was to develop a robust statistical analysis method for measurement system variability analysis, in terms of product control scenario applied to one-sided tolerance. In the hereby presented study, the authors presented the theoretical principles of statistical techniques for measurement variations evaluation. Subsequently, the formula of gauge repeatability and reproducibility in terms of lower specification limit was proposed. The research hypothesis was tested using the statistical analysis.
Full Text Available We present a 5-year-old boy who had the complaint of swelling and pain on the right vaccine shot and right axillary areas. The right axillary area was diagnosed as reactive lymphadenitis, which we believe is a rare local side effect of the swine flu vaccine. The key message to take away from this case is that the patient had lymphadenitis as a local side effect of the swine flu vaccine. Lymphadenitis should be reported as a possible local side effect of the swine flu vaccine.
Gundogdu, Zuhal; Seyhogullari, Mualla
We present a 5-year-old boy who had the complaint of swelling and pain on the right vaccine shot and right axillary areas. The right axillary area was diagnosed as reactive lymphadenitis, which we believe is a rare local side effect of the swine flu vaccine. The key message to take away from this case is that the patient had lymphadenitis as a local side effect of the swine flu vaccine. Lymphadenitis should be reported as a possible local side effect of the swine flu vaccine. PMID:21209734
Rossi, Federica; Romano, Nicola; Muda, Alessandro; Martinoli, Carlo; Tagliafico, Alberto
In ultrasound (US) examinations of clinically relevant very small structures of the wrist and hand, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intraindividual side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side US evaluations of very small structures of the wrist and hand. Forty-one healthy volunteers were prospectively studied. Small structures of the wrist and hand were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The first annular pulleys of the second finger and the thumb, sagittal band of the third finger, extensor and flexor retinacula, ulnar collateral ligament of the thumb, radial collateral ligament of the second finger, and palmar cutaneous branches of the median and ulnar nerves were considered. To assess intra- and inter-reader agreement, 10 of 41 (24%) examinations were repeated. Nonparametric statistics were used. Data were not normally distributed (P > .001). Intra-reader agreement was κ = 0.674 (95% confidence interval [CI], 0.57-0.78), and inter-reader agreement was κ = 0.935 (95% CI, 0.92-0.95). The mean value ± SD for all of the structures was 0.78 ± 0.44 mm. The overall coefficient of variation was 9.8% ± 0.07%. The intraclass correlation coefficient was 0.97 (95% CI, 0.96-0.98). In clinical practice, the healthy contralateral side can be used as a reference during a real-time musculoskeletal US evaluation of small (structures. © 2018 by the American Institute of Ultrasound in Medicine.
Full Text Available Abstract Background Right-sided endocarditis occurs predominantly in intravenous drug users, patients with pacemakers or central venous lines and with congenital heart diseases. The vast majority of cases involve the tricuspid valve. Case presentation A case of a 31-year-old woman with intravenous drug abuse who had a right-sided vegetation attached to the muscular bundle of the right ventricle is presented. Transthoracic echocardiography revealed a vegetation in the right ventricular outflow tract. Transesophageal echocardiography clearly showed that the 1.8 cm vegetation was not adherent to the pulmonary valve but attached to a muscular bundle. Conclusions Our case points to an unusual location of right-sided endocarditis in intravenous drug users. It confirms that TTE remains an easy and highly sensitive first-line examination for the diagnosis of right-sided endocarditis.
Xia, Hong-Tian; Liu, Yang; Yang, Tao; Liang, Bin; Wang, Jing; Dong, Jia-Hong
Whether a wide hilar hepaticojejunostomy after bile duct cyst (BDC) excision can prevent the development of postoperative complications remains an unanswered question. We compared our outcomes after a minimum of 2-y follow-up in patients with Todani type Ia choledochal cyst treated with hilar ductoplasty followed by a side-to-side Roux-en-Y hepaticojejunostomy (ductoplasty group) or radical cyst resection with an end-to-side Roux-en-Y hepaticojejunostomy (conventional group). We retrospectively reviewed the records of patients with Todani type Ia choledochal cyst who received radical cyst excision from January 1997 to December 2012, and we compared the groups' postoperative complications and surgical outcomes. The groups' baseline demographics were similar, except for age. The gender distribution and preoperative presenting symptoms were comparable in the ductoplasty (n = 72) and conventional (n = 53) groups (all P > 0.05). Average age was 37.0 y for the ductoplasty group and 41.8 y for the conventional group (P = 0.024). The short-term complication rate of the groups was not significantly different (conventional group, 13.2% [7/53]; ductoplasty group, 8.3% [6/72]; all P > 0.05). A significant between-group difference was found in the long-term complication rate of biliary-enteric anastomotic strictures (9.4% in the conventional group and 0% in the ductoplasty group, P = 0.012). The rates of satisfactory surgical outcomes were 91.1% and 77.1% in the ductoplasty and conventional groups, respectively (P = 0.036). The application of hilar ductoplasty with a side-to-side Roux-en-Y hepaticojejunostomy as the primary surgery for bile duct cyst excision significantly reduced the postoperative complication of biliary-enteric anastomotic stricture and greatly improved our patients' prognosis with regard to biliary function. Copyright © 2017 Elsevier Inc. All rights reserved.
Wang, Z.J.; Zhou, Y.
The flow behind two side-by-side circular cylinders is experimentally investigated based on laser-illuminated flow-visualization, particle image velocimetry and hot-wire measurements. The flow is classified as three regimes: single street (the cylinder center-to-center spacing T/d 2.0). Special attention is given to the regime of 1.2 2.0, the flow structure change from the anti-phase to in-phase mode starts with a phase shift between gap vortices. The dynamical role of gap bleeding between cylinders for L/d < 1.2 is also examined
Bulatova, Regina; Jabbari, Masoud; Andersen, Kjeld Bøhm
Homogenous and flexible adjacently graded tapes were produced by casting the organic-based slurries simultaneously. To develop side-by-side tape casing (SBSTC), the material optimization, modernization of the doctor blade design, and parameters control of such processes as casting, drying, de......-bindering and sintering were studied. Solvent and binder concentrations were varied in order to optimize co-casting flow, as well as the drying and sintering shrinkage. Tapes were evaluated in terms of rheological behavior of the slurries, the green and sintered tape microstructure, the quality of the interface area...
Newbolt, Joel; Zhang, Jun; Ristroph, Leif
As an example of collective motion in active swimmers we study the fluid-mediated interaction between two heaving hydrofoils that swim with a fixed transverse separation (between the heaving mid-heights) but are free to independently choose their forward swimming speeds and positions. Experiments reveal that out-of-phase foils are attracted to a side-by-side configuration which also increases the swimming speed of the pair (up to 59% faster for our parameters), while in-phase foils are repelled from this configuration. Because this type of swimming is qualitatively similar to that of fish and birds this interaction could be important to schooling and flocking.
Going beyond handling nerves and presenting PowerPoint slides, the third edition of "Develop Your Presentation Skills "offers practical advice on developing a captivating presentation, constructing compelling content, and boosting self-confidence. The book includes three new chapters on delivering a "stripped down"presentation, using new media to engage with the audience, and handling being asked to present on short notice."
Ming Dengming; Brueschweiler, Rafael
A simple analytical model is presented for the prediction of methyl-side chain dynamics in comparison with S 2 order parameters obtained by NMR relaxation spectroscopy. The model, which is an extension of the local contact model for backbone order parameter prediction, uses a static 3D protein structure as input. It expresses the methyl-group S 2 order parameters as a function of local contacts of the methyl carbon with respect to the neighboring atoms in combination with the number of consecutive mobile dihedral angles between the methyl group and the protein backbone. For six out of seven proteins the prediction results are good when compared with experimentally determined methyl-group S 2 values with an average correlation coefficient r-bar=0.65±0.14. For the unusually rigid cytochrome c 2 no significant correlation between prediction and experiment is found. The presented model provides independent support for the reliability of current side-chain relaxation methods along with their interpretation by the model-free formalism
Full Text Available Spreading of the multijet in terms of both the velocity and temperature field depends strongly on the flow type related to the velocity and temperature ratios between the cold side jets to the hot central one. This is the reason why the present work focuses on numerical investigation of non isothermal three parallel non-ventilated turbulent plane jets. As well, it seems natural to pick as reference the available experimental data. The numerical predictions confirm the three types (A, B, C of flow patterns given by the available flow visualization and reveal a fourth that will be called type D. The purpose of the present study is to explore the effect of the velocity ratio on the decay rates of the velocity and temperature in the fully developed region. It is found that the addition of side jets increase the rate of decrease of the centerline velocity for the flow of type A and decreases in the other cases. The effect of various types of flow on the rate of decrease of the velocity and the temperature in the fully developed flow region are investigated in details: This led to establish several correlations of the rate of decrease that play an important role in the diffusion of momentum and temperature.
Fronk, Ryan G.; Bellinger, Steven L.; Henson, Luke C.; Ochs, Taylor R.; Smith, Colten T.; Kenneth Shultis, J.; McGregor, Douglas S.
Microstructured semiconductor neutron detectors (MSNDs) have in recent years received much interest as high-efficiency replacements for thin-film-coated thermal neutron detectors. The basic device structure of the MSND involves micro-sized trenches that are etched into a vertically-oriented pvn-junction diode that are backfilled with a neutron converting material. Neutrons absorbed within the converting material induce fission of the parent nucleus, producing a pair of energetic charged-particle reaction products that can be counted by the diode. The MSND deep-etched microstructures produce good neutron-absorption and reaction-product counting efficiencies, offering a 10× improvement in intrinsic thermal neutron detection efficiency over thin-film-coated devices. Performance of present-day MSNDs are nearing theoretical limits; streaming paths between the conversion-material backfilled trenches, allow a considerable fraction of neutrons to pass undetected through the device. Dual-sided microstructured semiconductor neutron detectors (DSMSNDs) have been developed that utilize a complementary second set of trenches on the back-side of the device to count streaming neutrons. DSMSND devices are theoretically capable of greater than 80% intrinsic thermal neutron detection efficiency for a 1-mm thick device. The first such prototype DSMSNDs, presented here, have achieved 29.48±0.29% nearly 2× better than MSNDs with similar microstructure dimensions.
EPA has produced the following training presentation(s) for reporters subject to this subpart. Generally, these presentations explain the rule or show how to use the reporting system e-GGRT to submit annual GHG reports to EPA.
EPA has produced the following training presentation(s) for reporters subject to this subpart. Generally, these presentations explain how to use the reporting system e-GGRT to submit annual GHG reports to EPA.
EPA has produced the following training presentation(s) for reporters subject to this subpart. Generally, these presentations explain the rule or show how to use the reporting system e-GGRT to submit annual GHG reports to EPA.
Yoganandan, Narayan; Pintar, Frank A.; Stemper, Brian D.; Gennarelli, Thomas A.; Weigelt, John A.
This paper presents a survey of side impact trauma-related biomedical investigations with specific reference to certain aspects of epidemiology relating to the growing elderly population, improvements in technology such as side airbags geared toward occupant safety, and development of injury criteria. The first part is devoted to the involvement of the elderly by identifying variables contributing to injury including impact severity, human factors, and national and international field data. T...
Kenneth E. Vail, III; Jacob Juhl
Physical death is an inevitable part of life. From the perspective of terror management theory (TMT), people’s efforts to manage the awareness of death can sometimes have harmful social consequences. However, those negative consequences are merely one side of the existential coin. In considering the other side of the coin, the present article highlights the more beneficial trajectories of the terror management process. For example, the awareness of mortality can motivate people to prioritize ...
Raju, Ivatury S.; Knight, Norman F., Jr.; Song, Kyongchan; Phillips, Dawn R.
The Space Shuttle wing-leading edge consists of panels that are made of reinforced carbon-carbon. Coating spallation was observed near the slip-side region of the panels that experience extreme heating. To understand this phenomenon, a root-cause investigation was conducted. As part of that investigation, fracture mechanics analyses of the slip-side joggle regions of the hot panels were conducted. This paper presents an overview of the fracture mechanics analyses.
Madet, Antoine; Amadio, Roberto M.
Linear logic provides a framework to control the complexity of higher-order functional programs. We present an extension of this framework to programs with multithreading and side effects focusing on the case of elementary time. Our main contributions are as follows. First, we provide a new combinatorial proof of termination in elementary time for the functional case. Second, we develop an extension of the approach to a call-by-value $lambda$-calculus with multithreading and side effects. Thi...
Racz, A.; Lux, I. [Hungarian Academy of Sciences, Budapest (Hungary). Atomic Energy Research Inst.
The applicability of the classical sequential probability ratio testing (SPRT) for early failure detection problems is limited by the fact that there is an extra time delay between the occurrence of the failure and its first recognition. Chien and Adams developed a method to minimize this time for the case when the problem can be formulated as testing the mean value of a Gaussian signal. In our paper we propose a procedure that can be applied for both mean and variance testing and that minimizes the time delay. The method is based on a special parametrization of the classical SPRT. The one-sided sequential tests (OSST) can reproduce the results of the Chien-Adams test when applied for mean values. (author).
Full Text Available In a recent paper (M. Barash, A. Okhotin, "Defining contexts in context-free grammars", LATA 2012, the authors introduced an extension of the context-free grammars equipped with an operator for referring to the left context of the substring being defined. This paper proposes a more general model, in which context specifications may be two-sided, that is, both the left and the right contexts can be specified by the corresponding operators. The paper gives the definitions and establishes the basic theory of such grammars, leading to a normal form and a parsing algorithm working in time O(n^4, where n is the length of the input string.
Wu, Hunter; Sealy, Kylee; Gilchrist, Aaron
An apparatus for dual side control includes a measurement module that measures a voltage and a current of an IPT system. The voltage includes an output voltage and/or an input voltage and the current includes an output current and/or an input current. The output voltage and the output current are measured at an output of the IPT system and the input voltage and the input current measured at an input of the IPT system. The apparatus includes a max efficiency module that determines a maximum efficiency for the IPT system. The max efficiency module uses parameters of the IPT system to iterate to a maximum efficiency. The apparatus includes an adjustment module that adjusts one or more parameters in the IPT system consistent with the maximum efficiency calculated by the max efficiency module.
Full Text Available The article focuses on the relevant technology of environmental protection which includes an effective collection, disposal and control of aerosol and gases contaminants removed from the evaporating surfaces of electroplating tanks. The task of the paper is to help with finding the new ways of collecting and disposing aerosol pollution and to reduce the quantity of equipment and service costs. The article also discusses pollution formation and sorts and performance of side draft and slot hoods for vapour capture. Besides, the paper deals with the formation of vapour over the tank and the features of benefit that depend on absorber‘s shape. Exhaust velocity and its dependencies are analyzed.Article in Lithuanian
Full Text Available Demand Side Management (DSM is a portfolio of measures to improve the energy system mainly at the consumption level. In this paper we propose a data model for DSM stating from the optimization methods approach in SMARTRADE project from different perspectives of several entities that include: Transmission System Operator (TSO/Distribution System Operators (DSOs perspectives in case of security/reliability concerns: minimum amount of load (or generation shedding; aggregators perspective in case of demand or generation shedding request: Which demand (or generators should be shed?; consumers perspective: load shifting (time-of-use (ToU tariffs and optimum contract strategies with the aggregators (also known as balancing responsible parties- BRP for load shedding.
Coloma, Pilar; Gonzalez-Garcia, M. C.; Maltoni, Michele; Schwetz, Thomas
In the presence of nonstandard neutrino interactions (NSI), oscillation data are affected by a degeneracy which allows the solar mixing angle to be in the second octant (also known as the dark side) and implies a sign flip of the atmospheric mass-squared difference. This leads to an ambiguity in the determination of the ordering of neutrino masses, one of the main goals of the current and future experimental neutrino program. We show that the recent observation of coherent neutrino-nucleus scattering by the COHERENT experiment, in combination with global oscillation data, excludes the NSI degeneracy at the 3.1 σ (3.6 σ ) C.L. for NSI with up (down) quarks.
The main purpose of this talk is to use the observational evidences pointing out to the existence of a dark side in the universe in order to infer some of the properties of the unseen material. We will work within the Unified Dark Matter models, in which both, Dark Matter and Dark Energy appear as the result of one unknown component. By modeling effectively this component with a classical scalar field minimally coupled to gravity, we will use the observations to constrain the form of the dark action. Using the flat rotation curves of spiral galaxies we will see that we are restringed to the use of purely kinetic actions, previously studied in cosmology by Scherrer. Finally we arrive to a simple action which fits both cosmological and astrophysical observations
Diez-Tejedor, Alberto [Dpto. de Fisica Teorica, Universidad del PaIs Vasco, Apdo. 644, 48080, Bilbao (Spain)
The main purpose of this talk is to use the observational evidences pointing out to the existence of a dark side in the universe in order to infer some of the properties of the unseen material. We will work within the Unified Dark Matter models, in which both, Dark Matter and Dark Energy appear as the result of one unknown component. By modeling effectively this component with a classical scalar field minimally coupled to gravity, we will use the observations to constrain the form of the dark action. Using the flat rotation curves of spiral galaxies we will see that we are restringed to the use of purely kinetic actions, previously studied in cosmology by Scherrer. Finally we arrive to a simple action which fits both cosmological and astrophysical observations.
Thaysen-Petersen, Daniel; Erlendsson, Andres M; Nash, J F
BACKGROUND AND OBJECTIVE: Intense pulsed light (IPL) is a mainstream treatment for hair removal. Side effects after IPL are known, but risk factors remain to be investigated. The objective of this study was to assess the contribution of skin pigmentation, fluence level, and ultraviolet radiation...... stacking of 46 J/cm2. Areas were subsequently randomized to no UVR or single solar-simulated UVR exposure of 3 Standard Erythema Dose at 30 minutes or 24 hours after IPL. Each area had a corresponding control, resulting in 15 treatment sites. Follow-up visits were scheduled up to 4 weeks after IPL. Outcome...... measures were: (i) blinded clinical skin reactions; (ii) objectively measured erythema and pigmentation; (iii) pain measured by visual analog scale (VAS); (iv) histology (H&E, Fontana-Masson); and (v) mRNA-expression of p53. RESULTS: Fifteen subjects with FST II-IV completed the protocol. IPL induced...
Wang, Qian; Zhang, Yichi; Yun, Zejian; Wang, Xuguang; Zhang, Dong; Bian, Di
This paper introduces the effect of user side energy storage on the user side and the network side, a battery energy storage system for the user side is designed. The main circuit topology of the battery energy storage system based on the user side is given, the structure is mainly composed of two parts: DC-DC two-way half bridge converter and DC-AC two-way converter, a control strategy combining battery charging and discharging characteristics is proposed to decouple the grid side and the energy storage side, and the block diagram of the charging and discharging control of the energy storage system is given. The simulation results show that the battery energy storage system of the user side can not only realize reactive power compensation of low-voltage distribution network, but also improve the power quality of the users.
... Safe Videos for Educators Search English Español Side Effects of Chemotherapy and Radiation KidsHealth / For Parents / Side Effects of Chemotherapy and Radiation What's in this article? What to ...
National Oceanic and Atmospheric Administration, Department of Commerce — Side Scan Point Files. These points correspond to individual pings which produced hte side-scan-sonar backscatter imagery. Sonar data were collected November 6 to...
... Can chemotherapy side effects increase the risk of heart disease? Answers from Timothy J. Moynihan, M.D. Chemotherapy side effects may increase the risk of heart disease, including weakening of the heart muscle (cardiomyopathy) and ...
Suzuki, H; Iyoda, I [Mitsubishi Electric Corp., Tokyo (Japan)
This paper explains the latest situation in hardware technologies to realize the demand side management, divided into the following technologies: communications technology, measurement technology, client information system technology, load controlling technology, home automation technology, and energy storing and saving technologies. Speaking of the communications technology, information exchange between the supply side and the demand side is important in the demand side management, whereas a technology intended of automatic power distribution and automatic meter-reading is advancing in development. The technology covers transmissions using from power lines and telephone lines to optical cables and wireless communications. Power line communications using power transmission lines as communication lines are simple and economical, but weak against noise, and not suitable for long-distance communications. Wireless communications have been drawing attentions along with the development of mobile communication device technologies. These technologies will give benefits to electric power companies in the initial stage of their use, such as for load investigation and general automation in power distribution. They would shift to benefiting users in about 2010 covering from security information such as about power interruption to publicity information and educations. 8 refs., 8 figs., 1 tab.
Keane, A.; Tuohy, A.; Meibom, P.; Denny, E.; Flynn, D.; Mullane, A.; O'Malley, M.
The utilisation of demand side resources is set to increase over the coming years with the advent of advanced metering infrastructure, home area networks and the promotion of increased energy efficiency. Demand side resources are proposed as an energy resource that, through aggregation, can form part of the power system plant mix and contribute to the flexible operation of a power system. A model for demand side resources is proposed here that captures its key characteristics for commitment and dispatch calculations. The model is tested on the all island Irish power system, and the operation of the model is simulated over one year in both a stochastic and deterministic mode, to illustrate the impact of wind and load uncertainty. The results illustrate that demand side resources can contribute to the efficient, flexible operation of systems with high penetrations of wind by replacing some of the functions of conventional peaking plant. Demand side resources are also shown to be capable of improving the reliability of the system, with reserve capability identified as a key requirement in this respect. - Highlights: → Demand side resource model presented for use in unit commitment and dispatch calculations. → Benefits of demand side aggregation demonstrated specifically as a peaking unit and provider of reserve. → Potential to displace or defer construction of conventional peaking units.
This paper presents results from a new unique microscopic molecular theory for side-chain liquid-crystalline polymers (LCPs) in the nematic (N) and multiple smectic-A (SA) LC phases and the isotropic (I) liquid phase. There are no ad hoc or arbitrarily adjustable parameters in this theory. The agreement between the theoretical and experimental values for various properties (including transition temperatures and quadratic characteristic radii) is very good (relative deviations between 0% and less than 6.2%). The theoretical results also show--for the first time--that the N and I phases for these LCPs involve the packing of plate-like sections of backbones and side chains and that the local bilayer SA phase involves packing of side-chains within a plate-like section. This type of packing is predicted to be typical for side-chain LCPs. This theory can predict--for the first time--whether the side chains of a molecule pack on the same or alternating opposite sides of the backbone and whether side chains on different molecules interdigitate (overlap) with each other. 13 refs., 1 fig., 4 tabs
Aszmann, O C; Moser, V; Frey, M
Management of the painful neuroma has been subject to controversy since the earliest descriptions of this disabling problem. Today, treatment is limited to resection of the neuroma and implantation of the nerve in a muscle at a location where it is safe from irritation and trauma. This however is not attainable in many cases and it is our clinical experience, that nerves without a target remain a source of constant discomfort and pain. Recently we reported of the feasibility of neuroma prevention through end-to-side neurorraphy into adjacent sensory and/or motor nerves to provide a target for axons deprived of their endorgan. Here we report of our first clinical experience with this method in sixteen patients with longstanding upper and lower extremity neuromas. 16 patients were included in this study. All had neuromas of different sensory nerves of both the upper and lower extremity. 11 were of iatrogenic origin, 5 were caused by different traumas. 8 had previous attempts to surgically treat the neuroma. Finally, all were treated by end-to-side neurorraphy into adjacent nerves. Postoperatively quantitative sensorymotor testing was performed to evaluate possible changes of nerve function of the recipient nerves. Pain was evaluated by visual analogue score and changes in pain medication. In no patient a sensory or motor deficit or painful sensations were induced in the target area of the recipient nerve. Some had dysaesthesias for about 6 months, which finally subsided. All but 1 patient improved in their symptoms at a follow-up of more than 2 years. Previous experimental work and present clinical results suggest that axons of a severed peripheral nerve that are provided with a pathway and target through an end-to-side coaptation will either be pruned or establish some type of end-organ contact so that a neuroma can be prevented without inducing sensory or motor dysfunctions in the recipient nerve. Georg Thieme Verlag KG Stuttgart New York.
Full Text Available A coordinated centralized energy management system (ConCEMS is presented in this paper that seeks to integrate for optimal grid operation—the supply side energy management system (SSEMS, home energy management system (HEMS and transmission line management system (TLMS. ConCEMS in ensuring the optimal operation of an IEEE 30-bus electricity network harmonizes the individual objective function of SSEMS, HEMS and TLMS to evolve an optimal dispatch of participating demand response (DR loads that does not violate transmission line ampacity limits (TLMS constraint while minimizing consumer cost (HEMS constraint and supply side operations cost (SSEMS constraint. An externally constrained genetic algorithm (ExC-GA that is influenced by feedback from TLMS is also presented that intelligently varies the dispatch time of participating DR loads to meet the individual objective functions. Hypothetical day ahead dynamic pricing schemes (Price1, Price2 and Price3 have also been adopted alongside an existing time of use (Price0 pricing scheme for comparison and discussion while a dynamic thermal line rating (DTLR algorithm has also been incorporated to dynamically compute power limits based on real time associated data.
Full Text Available Modeling of supermarket refrigeration systems for supervisory control in the smart grid is presented in this paper. A modular modeling approach is proposed in which each module is modeled and identified separately. The focus of the work is on estimating the power consumption of the system while estimating the cold reservoir temperatures as well. The models developed for each module as well as for the overall integrated system are validated by real data collected from a supermarket in Denmark. The results show that the model is able to estimate the actual electrical power consumption with a high fidelity. Moreover a simulation benchmark is introduced based on the produced model for demand-side management in smart grid. Finally, a potential application of the proposed benchmark in direct control of the power/energy consumption is presented by a simple simulation example.
Hussain, Syed T; Shrestha, Nabin K; Witten, James
OBJECTIVE: The rarity of invasiveness of right-sided infective endocarditis (IE) compared with left-sided has not been well recognized and evaluated. Thus, we compared invasiveness of right- versus left-sided IE in surgically treated patients. PATIENTS AND METHODS: From January 2002 to January 20...
Blaauwbroek, N.; Nguyen, H.P.; Slootweg, J.G.
Demand side management is often seen as a promising tool for distribution network operators to mitigate network operation limit violations. Many demand side management applications have been proposed, each with their own objectives and methodology. Quite often, these demand side management
Creutzig, Felix; Roy, Joyashree; Lamb, William F.; Azevedo, Inês M. L.; Bruine de Bruin, Wändi; Dalkmann, Holger; Edelenbosch, Oreane Y.; Geels, Frank W.; Grubler, Arnulf; Hepburn, Cameron; Hertwich, Edgar G.; Khosla, Radhika; Mattauch, Linus; Minx, Jan C.; Ramakrishnan, Anjali; Rao, Narasimha D.; Steinberger, Julia K.; Tavoni, Massimo; Ürge-Vorsatz, Diana; Weber, Elke U.
Research on climate change mitigation tends to focus on supply-side technology solutions. A better understanding of demand-side solutions is missing. We propose a transdisciplinary approach to identify demand-side climate solutions, investigate their mitigation potential, detail policy measures and assess their implications for well-being.
Raveendran, Janani A; Chao, Jerry W; Rogers, Gary F; Boyajian, Michael J
Congenital macrostomia, or Tessier number 7 cleft, is a rare craniofacial anomaly. We present a unique patient with bilateral macrostomia that consisted of a "double" transverse cleft on the left side and a single transverse cleft on the right side. A staged reconstructive approach was used to repair the "double" left-sided clefts. This staged technique produced a satisfactory aesthetic and functional outcome.
I am pleased to be here today as one of the U.S. Co-Chairs for the Second U.S./Japan Workshop on Global Change. This series of workshops is an outgrowth of the 1988 bilateral agreement between the U.S. and Japanese governments on scientific and technological cooperation. That agreement called for comparable access to, and exchange of, information in scientific and technological fields, as well as the joint undertaking of cooperative activities for peaceful purposes in nationally important areas of science and technology. Meetings such as this were envisioned under the agreement to allow experts from both sides to discuss and exchange information on scientific and technological aspects of important problems and to identify research and development projects that might usefully be undertaken on a cooperative basis. The first U.S./Japan Workshop on Global Change focused on research needed to better understand how the global climate system operates, what the interactions are between the climate system and marine and terrestrial ecosystems, and how Earth systems might respond to global climatic changes.
Eisenberg, Rebecca S.
Abstract Innovation policy often focuses on fortifying the incentives of firms that develop and sell new products by offering them lucrative rights to exclude competitors from the market. Regulators also rely on these same firms—and on similar incentives—to develop information about the effects of their products in patients, despite their obvious conflict of interest. The result may be a distorted understanding that leads to overuse of expensive new medical technologies. Recent technological advances have put healthcare payers in an excellent position to play a larger role in future innovation to improve healthcare and reduce its costs. Insurance companies and integrated healthcare providers have custody of treasure troves of data about healthcare provision and outcomes that can yield valuable insights about the effects of medical treatment without the need to conduct costly clinical trials. Some integrated healthcare systems have seized upon this advantage to make notable discoveries about the effects of particular products that have changed the standard of care. Moreover, to the extent that healthcare payers can profit from reducing costs, they will seek to avoid inappropriate use of costly technologies. Greater involvement of payers in healthcare innovation thus offers a potential counterweight to the incentives of product sellers to promote excessive use of costly new products. In recent years, the federal government has sought to promote innovation through analysis of healthcare records in a series of initiatives; some picture insurers as passive data repositories, while others provide opportunities for insurers to take a more active role in innovation. In this paper, we examine the role of health insurers in developing new knowledge about the provision and effects of healthcare—what we call ‘demand-side innovation’. We address the contours of this underexplored area of innovation and describe the behavior of participating firms. We examine the
Esmat, Ayman; Pinson, Pierre; Usaola, Julio
In the past decades, Distribution System Operators (DSOs) have been mitigating distribution networks (DNs) contingencies by opting to grid reinforcements. However, this approach is not always cost and time efficient. Demand Side Flexibility (DSF) is one of the recent alternatives used in DNs cong...... effect is taken into consideration as well as the uncertain behavior of customers. Finally, the distribution grid of the Danish Bornholm Island is used to illustrate the merits of the DSP. The total cost incurred by the DSO is calculated and presented.......In the past decades, Distribution System Operators (DSOs) have been mitigating distribution networks (DNs) contingencies by opting to grid reinforcements. However, this approach is not always cost and time efficient. Demand Side Flexibility (DSF) is one of the recent alternatives used in DNs...... congestion management. Consequently, new market players such as aggregators are needed to handle DSF transaction between customers and DSOs. This paper proposes and models a decision support program (DSP) to optimize the total cost charged by the DSO for using DSF services. Moreover, the energy rebound...
Fulker, Dave; Gallagher, James
During the upcoming Summer 2016 meeting of the ESIP Federation (July 19-22), OpenDAP will hold a Developers and Users Workshop. While a broad set of topics will be covered, a key focus is capitalizing on recent EOSDIS-sponsored advances in Hyrax, OPeNDAPs own software for server-side realization of the DAP2 and DAP4 protocols. These Hyrax advances are as important to data users as to data providers, and the workshop will include hands-on experiences of value to both. Specifically, a balanced set of presentations and hands-on tutorials will address advances in1.server installation,2.server configuration,3.Hyrax aggregation capabilities,4.support for data-access from clients that are HTTP-based, JSON-based or OGC-compliant (especially WCS and WMS),5.support for DAP4,6.use and extension of server-side computational capabilities, and7.several performance-affecting matters.Topics 2 through 7 will be relevant to data consumers, data providers andnotably, due to the open-source nature of all OPeNDAP softwareto developers wishing to extend Hyrax, to build compatible clients and servers, andor to employ Hyrax as middleware that enables interoperability across a variety of end-user and source-data contexts. A session for contributed talks will elaborate the topics listed above and embrace additional ones.
There are two facets to the central dogma proposed by Francis Crick in 1957. One concerns the relation between the sequence of nucleotides and the sequence of amino acids, the second is devoted to the relation between the sequence of amino acids and the native three-dimensional structure of proteins. 'Folding is simply a function of the order of the amino acids,' i.e. no information is required for the proper folding of a protein other than the information contained in its sequence. This protein side of the central dogma was elaborated in a scientific context in which the characteristics and functions of proteins, and the mechanisms of protein folding, were seen very differently. This context, which made the folding problem a simple one, supported the bold proposition of Francis Crick. The protein side of the central dogma was not challenged by the discovery of prions if one adopts the definition of information given by Francis Crick. It might have been challenged by the discovery that regulatory enzymes exist in different conformations, and the evidence for the existence of chaperones assisting protein folding. But it was not, and folding remains what it was for Francis Crick, 'simply a function of the order of amino acids'. But the meaning of 'function' has dramatically changed. It is no longer the result of simple physicochemical laws, but that of a long evolutionary process which has optimized protein folding. Molecular mechanistic explanations have to be allied with evolutionary explanations, in a way characteristic of present biology.
Long-period comet C/2013 A1 (Siding Spring) will pass at a distance of ~140 thousand km (9e-4 AU) - about a third of a lunar distance - from the centre of Mars, closer to this planet than any known comet has come to the Earth since records began. Closest approach is expected to occur at 18:30 UT on the 19th October. This provides an opportunity for a ``free'' flyby of a different type of comet than those investigated by spacecraft so far, including comet 67P/Churyumov-Gerasimenko currently under scrutiny by the Rosetta spacecraft. At the same time, the passage of the comet through Martian space will create the opportunity to study the reaction of the planet's upper atmosphere to a known natural perturbation. The flip-side of the coin is the risk to Mars-orbiting assets, both existing (NASA's Mars Odyssey & Mars Reconnaissance Orbiter and ESA's Mars Express) and in transit (NASA's MAVEN and ISRO's Mangalyaan) by high-speed cometary dust potentially impacting spacecraft surfaces. Much work has already gone into assessing this hazard and devising mitigating measures in the precious little warning time given to characterise this object until Mars encounter. In this presentation, we will provide an overview of how the meteoroid stream and comet coma dust impact models evolved since the comet's discovery and discuss lessons learned should similar circumstances arise in the future.
Kim, Do Hyung; Kang, Ki Ju; Kim, Dong Hak
Generally, fracture of a material is influenced by plastic zone size developed near the crack tip. Hence, according to the relative size of plastic zone in the material, the mechanics as a tool for analyzing the fracture process are classified into three kinds, that is, Linear Elastic Fracture Mechanics, Elastic Plastic Fracture Mechanics, Large Deformation Fracture Mechanics. Even though the plastic zone size is such an important parameter, the practical measurement techniques are very limited and the one for in-situ measurement is not virtually available. Therefore, elastic-plastic FEA has been performed to estimate the plastic zone size. In this study, it is noticed that side necking at the surface is a consequence of plastic deformation and lateral contraction and the relation between the plastic zone and side necking is investigated. FEA for modified boundary layer models with finite thickness, various mode mixes 0 .deg., 30 deg., 60 deg., 90 .deg. and strain hardening exponent n=3, 10 are performed. The results are presented and the implication regarding to application to experiment is discussed
This report concludes an effort to examine and assess from the secondary side, the condition of the retired-from-service Surry 2A steam generator. It is includes photographs of degradation of various components or regions in a generic recirculating type steam generator. The photographic detail given in the text (and the previous report NUREG/CR-3843, PNL-5033) have not been readily available to many investigators outside the Nuclear Steam Supply Vendors and Users. The photographs include views of Inconel 600 heat exchanger tubes (0.875 diameter [nominal] x 0.050 inch wall) showing deformed and intergranularly stress-corrosion cracked U-bends, tube denting in the support plate, intergranular attack and thinning (both in the tube sheet region), support plat deformation and cracking at flow slots and in ligaments between flow holes and tube holes. In addition, photographs of tube pitting, anti-vibration bar fretting, and the sludge pile are presented. An experimental stress analysis was conducted on a distorted Row 1 tube in the region of a compressed flow slot between the 6th and 7th (top) support plates. During removal of the tube, relaxation strains were measured and residual stresses calculated. Finally a cursory metallurgical failure analysis was conducted on a broken U-bend (R1C91) to determine its mode of failure. A rotabroach boring technique was used to make multiple penetrations with minimal damage to the secondary side, at various locations on the shell
Background: Pleural effusion secondary to pancreatic tumour is a relatively rare clinical presentation. Aim of study: To present a case of a patient that had pancreatic tumour who presented with features of left sided pleural effusion with a view to highlighting the clinical features of the presentation. Method of study: The case ...
Teodor, D; Teodor, Andra; Grigore, Lucia; Jugănariu, Gabriela; Dorobăţ, Carmen Mihaela; Miftode, Egidia; Azoicăi, Doina
Standard therapy in chronic hepatitis C virus infection is still a combination of peginterferon alfa2a/2b and ribavirin for 48 weeks. As of side effects, there are organic side effects, such as hematologic disorders, and functional side effects, reflected in the quality of life of hepatitis C patients. Up to 30% of the patients develop specific side effects such as headache, fever, fatigue. Sarcoidosis, known as a granulomatous disease of uncertain cause, is an uncommon finding in this category of patients. This cause-effect relation is accounted for by the convergent action of peginterferon and ribavirin of stimulating type 1 T helper cells and reducing type 2 helper T cells activation. We present the case of male patient known with chronic hepatitis C who developed pulmonary sarcoidosis following antiviral therapy. The first manifestation of the disease was unexplained fever accompanied by pulmonary tract disease. The diagnosis was established by immunophenotyping in bronchial aspirate
Lagares, Manuel; Reisenleutner, Sandra
Oral presentations are a common practice in foreign language classes, often used to assess students' speaking skills. Usually, the presentations are delivered by students in front of the class, often with PowerPoint slides or Prezi as support. However, frequently the audience does not engage with the presentation and thus, the benefits of this…
Winter, Carl K.
While the need to present food science information effectively is viewed as a critical competency for food scientists by the Institute of Food Technologists, most food scientists may not receive adequate training in this area. Effective presentations combine both scientific content and delivery mechanisms that demonstrate presenter enthusiasm for…
Full Text Available We describe a male patient who presented with sudden onset severe headache and right sided ptosis that was diagnosed to be secondary to pituitary apoplexy on the background of diabetes mellitus. This was complicated by left ventricular failure and acute coronary syndrome. The case highlights the importance of considering hypocortisolism/hypopituitarism as an important and rare precipitant of an acute coronary event as occurred in the case.
Liu, Le; Li, Zhaohua; Xi, Jingyu; Zhou, Haipeng; Wu, Zenghua; Qiu, Xinping
Highlights: • A method for rapid measurement of the positive side reactions in VFB is presented. • The SOC of positive electrolytes can be detected with resolution of 0.002%. • Side reaction ratios at different charge currents, flow rates are obtained. - Abstract: We present an optical detection method for rapid measurement of the positive side reactions in vanadium flow batteries (VFB). By measuring the transmittance of the positive electrolytes in VFB, the states of charge (SOC) of the positive electrolytes can be detected at very high resolution (better than 0.002% in the SOC range from 98% to 100%), due to the nonlinear transmittance spectra caused by the interactions between V(IV) and V(V) ions. The intensity of the positive side reactions of a VFB can be rapidly measured by a few steps, attributing to the fact that the positive side reactions occur only during the high voltage charging process. The ratios of the positive side reactions at different charge currents and different flow rates are obtained while causing no damage to the battery. This optical detection method can rapidly determine the optimal parameters of the VFB system, providing new means for studying the electrochemical reactions in the VFB system and rapid test in industrial production of VFBs.
Side chains in conjugated polymers have been primarily utilized as solubilizing groups. However, these side chains have roles that are far beyond. We advocate using side chain engineering to tune a polymer\\'s physical properties, including absorption, emission, energy level, molecular packing, and charge transport. To date, numerous flexible substituents suitable for constructing side chains have been reported. In this Perspective article, we advocate that the side chain engineering approach can advance better designs for next-generation conjugated polymers. © 2013 American Chemical Society.
Gautier, R; Camproux, A-C; Tufféry, P
SCit is a web server providing services for protein side chain conformation analysis and side chain positioning. Specific services use the dependence of the side chain conformations on the local backbone conformation, which is described using a structural alphabet that describes the conformation of fragments of four-residue length in a limited library of structural prototypes. Based on this concept, SCit uses sets of rotameric conformations dependent on the local backbone conformation of each protein for side chain positioning and the identification of side chains with unlikely conformations. The SCit web server is accessible at http://bioserv.rpbs.jussieu.fr/SCit.
Full Text Available Lichen planus pigmentosus (LPP is a chronic pigmentary disorder with variable pattern of presentation. We here by present two cases of LPP one with parallel band like pigmentation over abdomen sparing the abdominal skin creases and other with parallel band like pattern following the Blaschko’s lines over left side of the abdomen. Our cases are unique not only for its presentation but also for the pattern of distribution and LPP should be the differential diagnosis in any pigmentary disorders.
Be the speaker they follow with breakthrough innovative presentations Innovative Presentations For Dummies is a practical guide to engaging your audience with superior, creative, and ultra-compelling presentations. Using clear language and a concise style, this book goes way beyond PowerPoint to enable you to reimagine, reinvent, and remake your presentations. Learn how to stimulate, capture, and hold your audience in the palm of your hand with sound, sight, and touch, and get up to speed on the latest presentation design methods that make you a speaker who gets audiences committed and acting
This paper discusses alarm filtering and presentation in the control room of nuclear and other process control plants. Alarm generation and presentation is widely recognized as a general process control problem. Alarm systems often fail to provide meaningful alarms to operators. Alarm generation and presentation is an area in which computer aiding is feasible and provides clear benefits. Therefore, researchers have developed several computerized alarm filtering and presentation approaches. This paper discusses problems associated with alarm generation and presentation. Approaches to improving the alarm situation and installation issues of alarm system improvements are discussed. The impact of artificial intelligence (AI) technology on alarm system improvements is assessed. (orig.)
Full Text Available Innovation and development paradigm has dominated the world since the 19th century. In the era of industry 4.0, innovation ecosystem has been advocated globally. There are different innovation paradigms in history. Before 1960s, the competitive and monopolized paradigm was dominative, while between the 1970s and 1990s, the cluster and innovation valley paradigm had played a key role. In the 21st century, with the advent of industry 4.0, the innovation ecosystem paradigm is advocated globally. Accordingly, there exist different innovation strategies, in reality, considering different economic and social context. However, no matter if having in mind developed or developing countries, the ecosystem paradigm has high rewards for different companies and society. There is also evidence showing that research and development by top universities and research institutes have high productivity and benefits for enterprises and society nowadays, no matter the development state of the areas considered. The author analyzes by literature review and case study the necessity, feasibility, strategy and approaches of innovation ecosystem from a knowledge supplying side. The strategy and approaches include collaboration between university, industry, agriculture and government, talents education, knowledge diffusion, patent purchasing, technology tailoring, consulting, human resource training and platform construction. Science community also takes the role of standards development and maintaining, high technology forecasting and innovation monitoring. The patent office, start-ups, spin-offs and innovation labs act as the links between science, technology, and application.
Landry, James W.; Grest, Gary Stephen
The effects of movement of the side walls of a confined granular packing are studied by discrete element, molecular dynamics simulations. The dynamical evolution of the stress is studied as a function of wall movement both in the direction of gravity as well as opposite to it. For all wall velocities explored, the stress in the final state of the system after wall movement is fundamentally different from the original state obtained by pouring particles into the container and letting them settle under the influence of gravity. The original packing possesses a hydrostaticlike region at the top of the container which crosses over to a depth-independent stress. As the walls are moved in the direction opposite to gravity, the saturation stress first reaches a minimum value independent of the wall velocity, then increases to a steady-state value dependent on the wall velocity. After wall movement ceases and the packing reaches equilibrium, the stress profile fits the classic Janssen form for high wall velocities, while some deviations remain for low wall velocities. The wall movement greatly increases the number of particle-wall and particle-particle forces at the Coulomb criterion. Varying the wall velocity has only small effects on the particle structure of the final packing so long as the walls travel a similar distance.
Annechino, Rachelle; Antin, Tamar
In the last ten years, an eclectic mix of electronic nicotine delivery products ('e-cigarettes') and practices have proliferated in the US with little restriction, producing a vast array of vaping mechanisms, flavors, and styles. At the same time, anti-tobacco movements have targeted e-cigarettes as a threat to public health and advocated for restricting e-cigarettes in much the same way as conventional cigarettes. While anti-vaping proponents associated with public health movements have typically regarded e-cigarettes as primarily harmful products that should be suppressed, vaping advocates regard e-cigarettes as harm reduction products that should be readily accessible to smokers. Distrust between these two warring "sides" animates the controversy over e-cigarettes. In our role as researchers conducting a qualitative study on e-cigarette use, we encountered suspicion and anger from members of an e-cigarette forum who felt that pro-vaping perspectives were often misrepresented by researchers. As a result, we dropped our initial plan to host a group discussion of questions directly related to our study on the forum. Nevertheless, the incident illuminated how vaping advocates have resisted dominant narratives regarding tobacco and nicotine use, destabilized nicotine product categories and challenged interpretations of nicotine use that dichotomize pleasure and health.
Kolbe, A.L.; O'Loughlin, M.P.
Over the past few years, the attention accorded to demand-side management (DSM) measures has called into question the traditional cost minimization approach for evaluating such programs. Two broad approaches to DSM seem to be generally used: one examining the problem from multiple perspectives and the other including various practical methods used in-house by utility planners. Whatever the standard used to evaluate DSM, there remains at least one problem which cannot be quantified. The customers who participate in a DSM program cannot only take into account the effects of DSM on their electricity bills; their comfort can also be affected. This lowering of comfort constitutes a legitimate cost which can explain why some apparently sensible DSM measures are not adopted. A method is proposed to incorporate this cost. It establishes a way to evaluate DSM program tradeoffs that, from the perspective of standard economic theory, maximizes social welfare; explains why at least one of the perspectives in the multiple perspective approach needs to be modified to incorporate all customer costs; and outlines how the proposed standard can be implemented. 8 refs
Suspicion towards technological advances has progressively grown during the xx(th) century. However, in the XXI(st) century, reading the NBIC (nanotechnology, biotechnology, information technology and cognitive science) report of the National Science Foundation, we can note that science has caught up with science fiction. These changes in public mentality on one side and in scientific capacities on the other argue for an evolution of the debate on sciences. The recent example of the national debate on nanotechnology in France has clearly shown that the public is no longer waiting for additional sources of scientific knowledge but rather waiting for the recognition of its authority to participate in the definition of the national R&D priority and associated scientific strategies. This is all the more legitimate that these strategies will have profound impact on the future of our societies and therefore cannot be decided only by scientists. Hence, it is crucial to identify innovative tools promoting debate on sciences and their technological spin-off. Here, we contend that science fiction has major assets that could face this challenge and facilitate the dialogue between sciences and society.
Dierkesmann, R.; Huzly, A.
Side effects that have occurred in over 250 endobronchial laser treatments are reported. The laser has been used in severe tracheal and in bronchial obstructions. In two cases significant bleeding had to be treated with tamponade. In one patient an emphysema of the mediastinum developed, in 2 further patients a small pneumothorax. Perforation of the airway was not detected and no special treatment was necessary. Three patients with life-threatening tracheal stenoses and one patient with severe stenosis of both the mainstem bronchi due to metastasis in the bifurcation lymph node had a large defect in the tracheal or bronchial wall with a deep necrosis five to twelve weeks after laser treatment; all these patients had extensive radiotherapy in addition. One patient died due to severe respiratory insufficiency, probably caused by smoke intoxication. After the laser treatment, rubber-like fibrin-rich plaques may develop, which can lead to life-threatening obstructions of the airway. It is recommended that laser bronchoscopy should be performed with the rigid bronchoscope. After treatment of tracheal lesion an endoscopic check must be performed within 24 hours. The combination of laser treatment and radiotherapy seems to involve a certain risk of large defects in the bronchial wall due to necrosis of the tumor.
Vorup Petersen, Jacob
function, and 3) the feasibility, motivation and injury rate of regular small-sided ball games in untrained elderly. Purpose. The overall aims of the present thesis were to examine physiological adaptations important for health after a period of small-sided ball game training and protein ingestion...... adults, 16 weeks of small-sided soccer was shown to improve physical function and exercise capacity, whereas muscle mass was unaffected by the training despite a high intake of daily protein. However, a number of questions still need to be answered regarding small-sided ball game training in untrained...... elderly: 1) The effect of other small-sided ball games, e.g. floorball training and cone ball, on physiological adaptations important for health as well as the effect of combined protein intake, 2) the effect of regular small-sided ball games in older adults with a more advanced age and low physical...
After more than 20 years of operation, the secondary side of the four steam generators at Gentilly-2 were chemically cleaned during the 2005 annual outage. The FRAMATOME ANP high temperature cleaning process used to remove magnetite loading involved stepwise injection of solvent with PHT temperature in the range 160 o C to 175 o C. The heat required to maintain the PHT temperature was provided by the operation of the main PHT pumps and the reactor core residual heat. The temperature control was accomplished by the shutdown cooling system heat exchangers. A total of 1280 kg of magnetite was removed from the four steam generators. A copper-cleaning step was applied after the iron step. The PHT has been cooled down and the steam generators drained to temporary tanks and dried in preparation of the copper step. The process has been applied at room temperature, two boilers at a time. The solvent removed a total of 116 kg of copper. During the iron step, steam flow to the feedwater tank chemically contaminate the Balance Of Plant (BOP) systems. The isolation of this path should have been part of the G2 procedures. Around 700 m3 of water had to be drained to interim storage tanks for subsequent resin treatment before disposal. Visual inspection of BO1 tubesheet and first support plate showed clean surfaces without measurable sludge pile. Upper support plates visual inspection of BO4 revealed that broach holes blockage reported in 2000 is still present in peripheral area. Following the plant restart, the medium range level measurement instability observed since several years for BO3 was no more present. As anticipated, it also has been observed that the medium and wide range level measurements have shifted down as a result of downcomer flow increase after the cleaning. The cleaning objectives were achieved regarding the fouling reduction on the steam generators secondary side but broach holes blockage of the upper support plate is still present in periphery. (author)
Novack, H.; Machac, J.; Horowitz, S.F.
Estimation of left-sided valvular insufficiency has been obtained using the ratio of left- to right-ventricular stroke counts, i.e., the regurgitant index. The present study was designed to evaluate the usefulness of the regurgitant index in identifying patients with isolated right-sided valvular insufficiency. We identified 12 patients with tricuspid or pulmonic regurgitation by at least two of the following criteria: (1) pulsatile liver, (2) positive Carvallo's sign, and (3) pulsatile jugular-venous distension. In 9 of the 12 patients, the right-sided insufficiency was confirmed by catheterization or contrast echocardiography and flow-directed pulsed-echo Doppler. The regurgitant index in patients with right-sided insufficiency was 0.59 +- 0.23. This was significantly different from patients with left-sided insufficiency (3.09 +- 0.8) and from control subjects (1.49 +- 0.32). In 11 of the 12 patients with right-sided regurgitant lesions, the regurgitant index was less than 1.0. The hepatic expansion fraction, a possible correlate of an expansile liver, has previously been found to be both sensitive and specific for the detection of patients with right-sided regurgitation. We calculated the hepatic expansion fraction in 6 patients with tricuspid regurgitation (including 3 with pulsatile livers) and 5 controls using the method of Handler et al.. In the present study, the hepatic expansion fraction in tricuspid-insufficiency patients was 4.3% as compared to 4.1% in normals (P=NS). In summary, this study suggests that the regurgitant index may be a sensitive tool for the diagnosis of right-sided regurgitant lesions, while the hepatic expansion fraction does not appear to be useful for identifying tricuspid insufficiency.
Novack, H.; Machac, J.; Horowitz, S.F.; Mount Sinai Medical Center, New York
Estimation of left-sided valvular insufficiency has been obtained using the ratio of left- to right-ventricular stroke counts, i.e., the regurgitant index. The present study was designed to evaluate the usefulness of the regurgitant index in identifying patients with isolated right-sided valvular insufficiency. We identified 12 patients with tricuspid or pulmonic regurgitation by at least two of the following criteria: (1) pulsatile liver, (2) positive Carvallo's sign, and (3) pulsatile jugular-venous distension. In 9 of the 12 patients, the right-sided insufficiency was confirmed by catheterization or contrast echocardiography and flow-directed pulsed-echo Doppler. The regurgitant index in patients with right-sided insufficiency was 0.59+-0.23. This was significantly different from patients with left-sided insufficiency (3.09+-0.8; P<0.001) and from control subjects (1.49+-0.32; P<0.001). In 11 of the 12 patients with right-sided regurgitant lesions, the regurgitant index was less than 1.0. The hepatic expansion fraction, a possible correlate of an expansile liver, has previously been found to be both sensitive and specific for the detection of patients with right-sided regurgitation. We calculated the hepatic expansion fraction in 6 patients with tricuspid regurgitation (including 3 with pulsatile livers) and 5 controls using the method of Handler et al.. In the present study, the hepatic expansion fraction in tricuspid-insufficiency patients was 4.3% as compared to 4.1% in normals (P=NS). In summary, this study suggests that the regurgitant index may be a sensitive tool for the diagnosis of right-sided regurgitant lesions, while the hepatic expansion fraction does not appear to be useful for identifying tricuspid insufficiency. (orig.)
Choi, Eun Young; Gao, Chunji; Lee, Suck Hyun; Kwon, O Pil
We rationally designed and synthesized metallopolymers with organic 1,4-benzenedicarboxylic acid (BDC) linkers with different lengths of oxyethylene side chains in order to examine the influence of side chains on the coordination characteristics. While in a previous report the BDC linkers with alkyl side chains were found to form three-dimensional (3D) isoreticular metal-organic framework (IRMOF) structures or one-dimensional (1D) coordination polymeric structures with short -O(CH 2 ) 6 CH 3 or long -O(CH 2 ) 9 CH 3 side chains, respectively, new BDC linkers with oxyethylene side chains of the same lengths, -(OCH 2 CH 2 ) 2 CH 3 and -(OCH 2 CH 2 ) 3 CH 3 , form only 3D IRMOF structures. This result is attributed to the higher flexibility and smaller volume of oxyethylene side chains compared to alkyl side chains
Lee, Yong; Kang, Heung Sik; Chang, Kee Hyun; Han, Seoul Heui; Kwon, Oh Sung; Myung, Ho Gin
The study was conducted to compare the side effects in myelography of the two non-ionic water-soluble contrast medias, lopamidol (Niopam) and Metrizamide (Amipaque). A total of 111 patients were examined, 64 with lopamidol and 47 with Metrizamide. Side effects consisted of headache, nausea, vomiting, dizziness, urinary difficulty, muscular pain, seizure, neurobehavioral disturbance, neurological sign change, vital sign change and etc. The common side effects were headache, nausea, vomiting and dizziness in order of frequency. Most of the side effects were subsided within 24 hours following myelography. lopamidol myelography caused fewer and milder side effects than Metrizamide study. The side effects were more commonly observed in cervical, thoracic or total myelography than in lumbar myelography with either lopamidol or Metrizamide. There was no significant correlation between incidence of the side effects and premedication with phenobarbital or valium injection before myelography and CSF sampling during the procedure.
Lee, Yong; Kang, Heung Sik; Chang, Kee Hyun; Han, Seoul Heui; Kwon, Oh Sung; Myung, Ho Gin [Seoul National University College of Medicine, Seoul (Korea, Republic of)
The study was conducted to compare the side effects in myelography of the two non-ionic water-soluble contrast medias, lopamidol (Niopam) and Metrizamide (Amipaque). A total of 111 patients were examined, 64 with lopamidol and 47 with Metrizamide. Side effects consisted of headache, nausea, vomiting, dizziness, urinary difficulty, muscular pain, seizure, neurobehavioral disturbance, neurological sign change, vital sign change and etc. The common side effects were headache, nausea, vomiting and dizziness in order of frequency. Most of the side effects were subsided within 24 hours following myelography. lopamidol myelography caused fewer and milder side effects than Metrizamide study. The side effects were more commonly observed in cervical, thoracic or total myelography than in lumbar myelography with either lopamidol or Metrizamide. There was no significant correlation between incidence of the side effects and premedication with phenobarbital or valium injection before myelography and CSF sampling during the procedure.
Full Text Available In order to detect hearing loss more efficiently and accurately, this study proposed a new method based on fractional Fourier transform (FRFT. Three-dimensional volumetric magnetic resonance images were obtained from 15 patients with left-sided hearing loss (LHL, 20 healthy controls (HC, and 14 patients with right-sided hearing loss (RHL. Twenty-five FRFT spectrums were reduced by principal component analysis with thresholds of 90%, 95%, and 98%, respectively. The classifier is the single-hidden-layer feed-forward neural network (SFN trained by the Levenberg–Marquardt algorithm. The results showed that the accuracies of all three classes are higher than 95%. In all, our method is promising and may raise interest from other researchers.
Olders, S. [RWTH Aachen (Germany). Inst. fuer Kraftfahrwesen
High level requirements are made to the control units and sensors of side airbag systems with regard to the reaction time until activation, because there is only a short deformation zone within the lateral zone of a vehicle. For further development of these systems and in order to minimise the possibility of erroneous activation, these airbag systems are tested in many impact configurations relevant to airbag activation and in so-called misuse tests. One of these non-deployment requirements is the kerbstone impact. Since the load on the occupants is only minimal in this impact configuration, activation of the side airbags is not necessary. Kerbstone impacts can be simulated realistically at the Institute for Automotive Engineering Aachen (Institut fuer Kraftfahrwesen Aachen (ika)) - by means of sled tests. By varying the boundary test conditions, additional information can be gathered regarding the positioning of sensors and the signal curves for adjustment of airbag electronics. (orig.)
Full Text Available In order to study the fluctuation of kinetic parameter of cylinder matrix in incompressible stationary flow, the flow fluid around three side-by-side circular cylinders are simulated using Immersed Boundary–Lattice Boltzmann method (IB-LBM. Drag and lift force of the three cylinders are investigated as the interval between each cylinder varied from zero to five times of the cylinder diameter. Five flow patterns are defined according to the vortices structure in the downstream of the cylinders. Power spectrum analysis of lift force is developed to explain the vortex patterns. Through the research, we find the strength and phase of the gap flow play an important role in the vortex formatting process. The vortices shedding from different cylinders neutralize and combine in the near wake, contributing a lot to the variation of forces.
Jabbari, Masoud; Bulatova, Regina; Hattel, Jesper Henri
temperature of the magnetic regenerator varies along the paths. The main goal of this research is to study the multiple material flow in SBS tape casting and analyze its influence on the interface between the stripes. The materials used for the experimental part are La0.85Sr0.15MnO3 and Ce0.9Gd0.1O2ceramic...... is a common process in producing multilayer ceramics, which now is used for producing side-by-side (SBS) functionally graded ceramics (FGCs). These FGCs are mostly used in the magnetic refrigeration sectors due to the varying composition of the magnetocaloric materials so that the magnetic transition...... slurries. The rheological behavior of the slurries are extracted from experiments and used in the ANSYS FLUENT commercial code to develop a fluid flow model for the non-Newtonian ceramic slurries and evaluate the interface oscillation between the stripes in SBS tape casting. The Numerical results show...
Raulin, Christian; Gündogan, Cüneyt; Greve, Bärbel; Gebert, Susanne
We report for the first time on hair regrowth in alopecia areata of the scalp achieved with the 308-nm xenon-chloride excimer laser in a prospective side-by-side trial. The alopecia areata had shown progression over a period of three years, and various treatments had not been effective. Out of a number of affected areas, one representative lesion was chosen; one half of it was treated, the other half remained untreated. After 27 sessions (200 - 4000 mJ/cm2, cumulative dose 52.6 J/cm2) over 3 months, only the treated area showed hair growth; which suggests that this was most probably not a spontaneous remission.
Full Text Available The purpose of this study was to examine, first, the movement actions performed during two different small-sided games and, second, their effects on a series of field endurance and technical tests. Thirty-four young soccer players (age: 13 ± 0.9 yrs; body mass: 62.3 ± 15.1 kg; height: 1.65 ± 0.06 m participated in the study. Small-sided games included three-a-side (3 versus 3 players and six-a-side (6 versus 6 players games consisting of 10 bouts of 4 min duration with 3 min active recovery between bouts. Soccer player performance was evaluated using five field tests: a 30m sprint, b throw-in for distance, c Illinois Agility Test, d dribbling the ball and e horizontal jump before, in the middle and after the implementation of both game situations. Heart rate was monitored during the entire testing session. Each game was also filmed to measure soccer movements within the game. The ANOVA analysis indicated that the three-a- side games displayed significantly higher heart rate values compared with the six-a-side games (p < 0.05. The number of short passes, kicks, tackles, dribbles and scoring goals were significantly higher during the three-a-side compared with the six-a-side game condition (p < 0. 05 while players performed more long passes and headed the ball more often during the six-a-side (p < 0.05. After the three-a-side games, there was a significant decline in sprint and agility performance (p < 0.05, while after both game conditions significant alterations in the throw-in and the horizontal jump performance were observed (p < 0.05. The results of the present study indicated that three-a-side games provide higher stimulus for physical conditioning and technical improvement than six-a-side games and their use for training young soccer players is recommended
Full text of publication follows: starting from the assumptions of support theory, this project analyzed the extent to which the specification of potential side effects influences the perceived risk associated, with a particular medication. Respondents were presented with an instruction leaflet for a medication which indicated (a) the overall probability that a side effect will occur or (b) the probability of occurrence of several specific side effects. Support theory predicts that the cognitive availability of potential side effects and therefore the perceived risk increases as a function of the specificity with which the side effects are presented. In contrast the evaluation-mediation hypothesis predicts that a more detailed presentation of potential side effects enhances the perceived quality of the information leaflet and thereby leads to a reduction of perceived risk. Support for the evaluation-mediation hypothesis was found in a series of studies which included the editing hypothesis and the elaboration likelihood model as additional explanations: the more detailed the information about potential side effects, the lower the estimated risk of suffering a side effect on taking the medication. As predicted, the influence of presentation specificity on perceived risk was mediated almost exclusively by the perceived quality of the information leaflet. A current series of studies seeks to support the evaluation-mediation hypothesis in a completely different domain, the perceived risk of environmental pollution by motor vehicles. (author)
Lu, Li Ping; Finlayson, Chris E.; Kabra, Dinesh; Albert-Seifried, Sebastian; Song, Myoung Hoon; Havenith, Remco W. A.; Tu, Guoli; Huck, Wilhelm T. S.; Friend, Richard H.
A study of the organic semiconductor F8TBT is presented, directly comparing a conventional form (F8TBT-out) with a form with varied alkyl side-chain position (F8TBT-in), in terms of optical properties and device performance in light-emitting-diodes (LEDs). Computational simulations of the side-chain
Giles, S.H.; Mitchell, E.D.
San Diego Gas and Electric Company (SDGE) recommends the evaluation of demand-side management as a supply-side resource. The advantages of concurrent economic analysis of DSM options with other traditional sources represents a significant improvement over analysis either before or after the development of a resource plan. The evaluation of utility-sponsored DSM programs that provide system benefits that include deferment of capacity additions and improvements in more efficient system operation should be evaluated side-by-side with traditional resources that provide similar benefits. The utility decision to either provide capital costs to construct a power plant or make demand payments for a power purchase is directly analogous to the decision to provide funding for a DSM program that would defer these same investments. Both types of decision represent utility control over investment decisions that allow the utility to provide reliable, low-cost power to its customers. SDGE has also had experience with using generation expansion scenarios to test different levels of pre-selected packages of DSM programs, attempting to evaluate the total costs of system expansion for each of the different packages. This method was fraught with problems, and the best information that could be gained was if the selection of DSM packages happened to bracket a lower cost scenario, when it could reasonably be assumed that both smaller and larger levels of DSM were not as cost effective as the intermediate level. However, in many cases the selection of DSM programs did not produce this result and the important question of whether individual DSM programs were worthwhile when evaluated individually, or whether the lowest cost scenario would be improved with more or less DSM, could not be answered
Faucheron, J-L; Paquette, B; Trilling, B; Heyd, B; Koch, S; Mantion, G
Few studies compare management and outcomes of obstructive colonic cancer, depending on the tumor site. We aim to evaluate the differences in patient characteristics, tumor characteristics, and outcomes of emergency surgery for obstructive right-sided versus left-sided colonic cancers. Between 2000 and 2009, 71 consecutive patients had an emergency colectomy following strict and clear definition of obstruction in a single institution. We retrospectively analyzed pre, per, and postoperative data that were prospectively collected. There were 31 and 40 patients in the right and left group, respectively. Patients aged over 80 were more frequent in the right group (p = 0.03). At operation, ileocecal valve was less often competent in the right group (p = 0.03). The one-stage strategy was more frequent in the right group (p = 0.008). Patients in the right group had a higher rate of nodes invasion (p = 0.04). One- and two-year mortality rate in the right group had a tendency to be higher. Patients presenting with a right obstructive colonic cancer are older, have a more advanced locoregional disease, and are more often treated in a one-stage strategy than patients with a left obstructive tumor.
Dou, Huashu; Zhang, Shuo; Yang, Hui; Setoguchi, Toshiaki; Kinoue, Yoichi
Flow around two rotating side-by-side circular cylinders of equal diameter D is numerically studied at the Reynolds number 40≤ Re ≤200 and various rotation rate θ i . The incoming flow is assumed to be two-dimensional laminar flow. The governing equations are the incompressible Navier-Stokes equations and solved by the finite volume method (FVM). The ratio of the center-to-center spacing to the cylinder diameter is T/D=2. The objective of the present work is to investigate the effect of rotational speed and Reynolds number on the stability of the flow. The simulation results are compared with the experimental data and a good agreement is achieved. The stability of the flow is analyzed by using the energy gradient theory, which produces the energy gradient function K to identify the region where the flow is the most prone to be destabilized and the degree of the destabilization. Numerical results reveal that K is the most significant at the separated shear layers of the cylinder pair. With Re increases, the length of the wake is shorter and the vortex shedding generally exhibits a symmetrical distribution for θ i < θ crit . It is also shown that the unsteady vortex shedding can be suppressed by rotating the cylinders in the counter-rotating mode.
Kato, Takayoshi; Tsunekawa, Tomohiro; Motoji, Yusuke; Hirakawa, Akihiro; Okawa, Yasuhide; Tomita, Shinji
Regarding to coronary artery bypass grafting (CABG), the end-to-side anastomosis (ESA) has been performed as a gold standard. Recently, the effectiveness of the distal side-to-side anastomosis (SSA) in CABG using internal mammary artery has been reported. The benefit of SSA comparing to ESA also has been disclosed by computing simulation. However, use of SSA by venous conduit for individual CABG has not been reported. In this study, we investigated feasibility of SSA. From January 2013 to October 2014, we conducted 114 CABGs. There were 92 venous distal anastomoses without sequential anastomotic site (61 SSA and 31 ESA). The anastomosis was evaluated before discharge and at 1 year after the procedure by angiography or multi-detector row computed tomographic coronary angiography. The median values for time to anastomosis were 13 min in the two group (p = 0.89). There was no revision of anastomosis in both groups. Additional stitches for hemostasis were required significantly less in SSA than ESA (18.0 vs 45.2 %, respectively, p fashion is easy to perform and maybe beneficial in blood flow pattern.
Impact of chosen behavioural factors on imprecision of present value is discussed here. The formal model of behavioural present value is offered as a result of this discussion. Behavioural present value is described here by fuzzy set. These considerations were illustrated by means of extensive numerical case study. Finally there are shown that in proposed model the return rate is given, as a fuzzy probabilistic set.
Kumar, K V S Hari; Modi, K D; Jha, Sangeeta; Jha, Ratan
Primary hyperaldosteronism (Conns' syndrome) commonly presents with a combination of clinical features of hypokalemia and hypertension. Atypical presentations like normotension, normokalemia and neurological ailments are described in few cases. We encountered two such cases, the first presenting with acute neurological complaint and second case having insignificant hypertension. Both the patients had a characteristic biochemical and imaging profile consistent with primary hyperaldosteronism and responded to surgical resection of adrenal adenoma. (author)
The CERN Electronics Pool has organised a series of presentations in collaboration with oscilloscope manufacturers. The last one will take place according to the schedule below. Time will be available at the end of the presentation to discuss your personal needs. The Agilent presentation had to be postponed and will be organised later. - Lecroy: Thursday, 24 November 2011, in 530-R-030, 14:00 to 16:30.
This article emphasises the importance of effective presentation skills. Such skills allow nurses to share knowledge and expertise and to communicate clearly in a range of workplace scenarios. Nurses are increasingly being asked to present in formal and informal situations, such as conferences, poster presentations, job interviews, case reports and ward-based teaching. This article explores the principles underpinning the development of these skills, discusses the situations in which they could be applied and demonstrates how nurses might improve and develop as presenters.
Full Text Available Memristor as a novel and emerging electronic device having vast range of applications suffer from poor frequency response and saturation length. In this paper, the authors present a novel and an innovative device structure for the memristor with two active layers and its non-linear ionic drift model for an improved frequency response and saturation length. The authors investigated and compared the I–V characteristics for the proposed model with the conventional memristors and found better results in each case (different window functions for the proposed dual sided doped memristor. For circuit level simulation, they developed a SPICE model of the proposed memristor and designed some logic gates based on hybrid complementary metal oxide semiconductor memristive logic (memristor ratioed logic. The proposed memristor yields improved results in terms of noise margin, delay time and dynamic hazards than that of the conventional memristors (single active layer memristors.
Mohan, Brij; Kumar, Ashok; Ahluwalia, P. K.
We performed first-principle study of the structural and electronic properties of two-dimensional hydrogenated silicene for two configurations; one is hydrogenation along one side of silicene sheet and second is hydrogenation in both sides of silicene sheet. The one-side hydrogenated silicene is found stable at planar geometry while increased buckling of 0.725 Å is found for both-side hydrogenated silicene. The result shows that the hydrogenation occupy the extended π-bonding network of silicene, and thus it exhibits semi-conducting behaviour with a band gap of 1.77 eV and 2.19 eV for one-side hydrogenated silicene and both-side hydrogenated silicene respectively. However, both-side hydrogenated silicene of binding energy 4.56 eV is more stable than one-side hydrogenated silicene of binding energy 4.30 eV, but experimentally silicene is synthesized on substrates which interacts one side of silicene layer and only other side is available for H-atoms. Therefore, practically one-side hydrogenation is also important
Hardman, H.L.; Ossenbruggen, van J.R.
Finding relevant information is one step in the chain of understanding information. Presenting material to a user in a suitable way is a further step. Our research focuses on using semantic annotations of multimedia elements to increase the "presentability" of retrieved information. We investigate
Verma, Gopalkrishna G; Dave, Dhaval; Byrne, Eileen
We present three cases of sunburn to the head, presenting with oedema of the face in children aged 6, 9 and 13 years. Oedema was predominantly on the forehead and temporal region; a direct effect of gravity was associated with erythema of the scalp. Sunburn healed without any complications.
A novel theory, the Second Event theory, advanced by Chris Busby, suggested that certain man-made radioisotopes could bypass cellular genetic repair mechanisms and cause cancer at very low dose. The present paper, after some introductory comments on the effects of particle tracks on cells, goes on to present the author's own perception of this Second Event theory. (UK)
Héctor Rojas Herazo
Full Text Available La añoranza suele ser, casi siempre, la línea critica de menor resistencia. El lema de que "todo tiempo pasado fue mejor" tiene un poco la culpa. En cualquier orden del conocimiento el pasado sigue el verdadero presente. Ese presente en que nos gusta respirar y vivir. Nada de compromiso circundante. Nada de inmediatez.
Sinha, Maruti N.
Advent of modern sensing technologies, data processing capabilities and rising cost of energy are driving the implementation of intelligent systems in buildings and houses which constitute 41% of total energy consumption. The primary motivation has been to provide a framework for demand-side management and to improve overall reliability. The entire formulation is to be implemented on NILM (Non-Intrusive Load Monitoring System), a smart meter. This is going to play a vital role in the future of demand side management. Utilities have started deploying smart meters throughout the world which will essentially help to establish communication between utility and consumers. This research is focused on investigation of a suitable thermal model of residential house, building up control system and developing diagnostic and energy usage forecast tool. The present work has considered measurement based approach to pursue. Identification of building thermal parameters is the very first step towards developing performance measurement and controls. The proposed identification technique is PEM (Prediction Error Method) based, discrete state-space model. The two different models have been devised. First model is focused toward energy usage forecast and diagnostics. Here one of the novel idea has been investigated which takes integral of thermal capacity to identify thermal model of house. The purpose of second identification is to build up a model for control strategy. The controller should be able to take into account the weather forecast information, deal with the operating point constraints and at the same time minimize the energy consumption. To design an optimal controller, MPC (Model Predictive Control) scheme has been implemented instead of present thermostatic/hysteretic control. This is a receding horizon approach. Capability of the proposed schemes has also been investigated.
Hardy, P.G.; Richter, H.J.
A LOCA can be caused, e.g. by a small break in the primary cooling system. The rate of fluid escaping through such a break will define the time until the core will be uncovered. Therefore the prediction of fluid loss and pressure transient is of major importance to plan for timely action in response to such an event. Stratification of the two phases might be present upstream of the break, thus, the location of the break relative to the vapor-liquid interface and the overall upstream fluid conditions are relevant for the calculation of fluid loss. Experimental results and analyses are presented here for small breaks at the bottom or at the side of a small pressure vessel. It was found that in such a case the onset of the so-called ''vapor pull through'' is important but swelling at sufficient depressurization rates of the liquid due to flashing is also of significance. It was also discovered that in the bottom break the flow rate is strongly dependent on the break entrance quality of the vapour-liquid mixture. The side break can be treated similarly to the bottom break if the interface level is above the break. The analyses developed on the basis of experimental observations showed reasonable agreement of predicted and measured pressure transients. It was possible to calculate the changing interface level and mixture void fraction history in a way compatible with the behavior observed during the experiments. Even though the experiments were performed at low pressures, this work should help to get a better understanding of physical phenomena occurring in a full scale small break LOCA. (orig./HP)