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Sample records for term breech presentation

  1. [External cephalic version of breech presentation at term].

    Science.gov (United States)

    Albrechtsen, Susanne; Berge, Lillian N; Børdahl, Per E; Egeland, Thore; Henriksen, Tore; Håheim, Lise Lund; Øian, Pål

    2005-03-03

    External cephalic version could be an alternative to either vaginal delivery or caesarean section in breech presentation at term. A systematic literature review about external cephalic version in breech presentation. The numbers of breech presentation delivered by caesarean section could probably be reduced in Norway by offering version, but this would not affect perinatal mortality.

  2. Term pregnancy in breech presentation in a unicornuate uterus: a ...

    African Journals Online (AJOL)

    This is a case report of an eighteen-year-old woman who presented at 38 weeks gestation in labour with the fetus in breech presentation. A caesarean section was performed, intraoperatively she was found to have a unicornuate uterus with a rudimentary horn. Term pregnancies are possible in patients with mullerian ...

  3. The relation of breech presentation at term to epilepsy in childhood

    DEFF Research Database (Denmark)

    Krebs, Lone; Langhoff-Roos, Jens

    2006-01-01

    with epilepsy until year 1996. For each case delivered in breech presentation (n = 290), the two subsequent deliveries of non-malformed, singleton infants delivered in breech presentation at term at the same hospital were selected as controls (n = 580). RESULTS: Breech presentation was a risk factor...

  4. Contribution of changing risk factors to the trend in breech presentation at term.

    Science.gov (United States)

    Bin, Yu Sun; Roberts, Christine L; Nicholl, Michael C; Nassar, Natasha; Ford, Jane B

    2016-12-01

    Recent population-wide changes in perinatal risk factors may affect rates of breech presentation at birth, and have implications for the provision of breech services and training in breech management. To investigate whether changes in maternal and pregnancy characteristics explain the observed trend in breech presentation at term. All singleton term (≥37 week) births in New South Wales during 2002-2012 were identified through birth and associated hospital records. Annual rates of breech presentation were determined. Logistic regression modelling was used to predict expected rates of breech presentation and these were compared with observed rates over time. A priori predictors included maternal age, country of birth, parity, smoking during pregnancy, diabetes, pregnancy hypertension, placenta praevia, previous singleton term breech, previous caesarean section, infant sex, gestational age, birthweight and congenital anomalies. Hospital and Medicare data were used to assess concomitant trends in external cephalic version. Among 914 147 singleton term births, 3.1% were breech at delivery. Rates of breech presentation declined from 3.6% in 2002 to 2.7% in 2012 (test for trend P breech presentation and previous caesarean section. However, use of external cephalic version appears to have increased over time. Breech presentation at delivery has decreased in New South Wales. Increased use of external cephalic version likely accounts for this decline, as changes in risk factors do not. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  5. External cephalic version for breech presentation before term.

    Science.gov (United States)

    Hutton, Eileen K; Hofmeyr, G Justus; Dowswell, Therese

    2015-07-29

    External cephalic version (ECV) of the breech fetus at term (after 37 weeks) has been shown to be effective in reducing the number of breech presentations and caesarean sections, but the rates of success are relatively low. This review examines studies initiating ECV prior to term (before 37 weeks' gestation). To assess the effectiveness of a policy of beginning ECV before term (before 37 weeks' gestation) for breech presentation on fetal presentation at birth, method of delivery, and the rate of preterm birth, perinatal morbidity, stillbirth or neonatal mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies. Randomised controlled trials (RCTs) of ECV attempted before term (37 weeks' gestation) or commenced before term, compared with a control group of women (in breech presentation) in which either no ECV attempted or ECV was attempted at term. Cluster-randomised trials were eligible for inclusion but none were identified. Quasi-RCTs or studies using a cross-over design were not eligible for inclusion. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. Studies were assessed for risk of bias and for important outcomes the overall quality of the evidence was assessed using the GRADE approach. Five studies are included (2187 women). It was not possible for the intervention to be blinded, and it is not clear what impact lack of blinding would have on the outcomes reported. For other 'Risk of bias' domains studies were either at low or unclear risk of bias.One study reported on ECV that was undertaken and completed before 37 weeks' gestation compared with no ECV. No difference was found in the rate of non-cephalic presentation at birth (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.64 to 1.69; participants = 102). One study reported on a policy of ECV that was initiated before term (33 weeks) and up until 40

  6. External cephalic version for breech presentation at term

    International Nuclear Information System (INIS)

    Rauf, B.; Hassan, L.

    2007-01-01

    To assess the success rate of External Cephalic Version (ECV) at term and its effects on measures of pregnancy outcome. A total of 40 patients were offered ECV over a period of fourteen months. All singleton breech presentations with an otherwise normal antenatal course between 36-41 weeks of gestation were included in the study. Exclusion criteria included contraindications to ECV i.e. multiple pregnancy, oligohydramnios, growth retardation, antepartum hemorrhage, rupture of membranes toxemias of pregnancy, non-reassuring fetal monitoring pattern, previous uterine scar, bad obstetric history, any contraindication to vaginal delivery, labour and patient wishes after thorough counseling. Overall success rate of the procedure and its effect on maternal and fetal outcome was determined. Significance of results was determined using Chi-square test. A total of 40 patients were recruited for the trial. Overall success rate was 67.5% with only 30% being primi-gravida (p<0.05). Multi-gravida showed higher success rate of 80%. Following successful ECV, spontaneous vaginal delivery was attained in 77.7% (n=21), while caesarean section was performed due to various indications in about 6 cases (p<0.05). Following failed version, 61.5% (n=8) had elective C/S and only 5 delivered vaginally. Route of delivery did not affect the perinatal outcome except for congenital abnormalities. Following successful ECV, there was only one stillbirth. Overall live births associated with successful version was 96.2% (p<0.05), while in failed version, there were no fetal deaths. ECV at term appears to be a useful procedure to reduce the number and associated complications of term breech presentation. It is safe for the mother and the fetus and helps to avoid a significant number of caesarean sections. (author)

  7. The relation of breech presentation at term to cerebral palsy

    DEFF Research Database (Denmark)

    Krebs, L; Topp, M; Langhoff-Roos, J

    1999-01-01

    OBJECTIVE: To examine the relation between breech delivery and cerebral palsy, considering the influence of intrauterine growth, low Apgar score at birth, and mode of delivery. DESIGN: Register-based, case-control study. POPULATION: A cohort of infants with cerebral palsy born between 1979 and 1986...... in East Denmark, identified by linkage of the cerebral palsy register with the national birth register. Discharge letters from births of breech infants with cerebral palsy were reviewed. MAIN OUTCOME MEASURES: Presentation, mode of delivery, gestational age, birthweight, Apgar score, type of cerebral...

  8. Management of breech presentation at term: a retrospective cohort study of 10 years of experience.

    Science.gov (United States)

    Burgos, J; Rodríguez, L; Cobos, P; Osuna, C; Del Mar Centeno, M; Larrieta, R; Martínez-Astorquiza, T; Fernández-Llebrez, L

    2015-10-01

    To evaluate the impact of management of childbirth (external cephalic version (ECV) plus planned vaginal delivery (PVD)) of breech presentation at term (⩾37 weeks of gestation). This retrospective cohort study was based on data collected of singleton breech presentations at term in the Obstetrics and Gynaecology Service, Cruces University Hospital (Biscay, Spain), from January 2003 to December 2012. We attended 2377 singleton breech pregnancies at term. We attended 1684 singleton breech term deliveries, attempting vaginal delivery after selection in 52.9% of cases and were successful in 57.5% of attempts. A total of 1360 ECV were attempted, with a success rate of 50.3% of those attempted. The use of ECV has decreased the rate of breech presentation at delivery by 39.0%, the rate of breech presentation as a caesarean section (CS) indication by 47.1% (CS due to breech presentation/total of CS) and the rate of CS for breech presentation out of the total of deliveries by 39.1% (CS due to breech presentation/total of deliveries). Early postnatal parameters (5-min Apgar score, umbilical cord arterial pH and acid-base analysis) were significantly lower following PVD compared with planned CS for breech presentation. However, we did not find any differences in the rates of admissions to the neonatal unit or neonatal mortality. Management of breech presentation with a protocol that includes ECV, careful selection criteria and active management of vaginal delivery achieve a great decrease in the rate of CS for breech presentation.

  9. External cephalic version for breech presentation at term.

    Science.gov (United States)

    Hofmeyr, G Justus; Kulier, Regina; West, Helen M

    2015-04-01

    Management of breech presentation is controversial, particularly in regard to manipulation of the position of the fetus by external cephalic version (ECV). ECV may reduce the number of breech presentations and caesarean sections, but there also have been reports of complications with the procedure. The objective of this review was to assess the effects of ECV at or near term on measures of pregnancy outcome. Methods of facilitating ECV, and ECV before term are reviewed separately. We searched the Cochrane Pregnancy and Childbirth Trials Register (28 February 2015) and reference lists of retrieved studies. Randomised trials of ECV at or near term (with or without tocolysis) compared with no attempt at ECV in women with breech presentation. Two review authors assessed eligibility and trial quality, and extracted the data. We included eight studies, with a total of 1308 women randomised. The pooled data from these studies show a statistically significant and clinically meaningful reduction in non-cephalic presentation at birth (average risk ratio (RR) 0.42, 95% confidence interval (CI) 0.29 to 0.61, eight trials, 1305 women); vaginal cephalic birth not achieved (average RR 0.46, 95% CI 0.33 to 0.62, seven trials, 1253 women, evidence graded very low); and caesarean section (average RR 0.57, 95% CI 0.40 to 0.82, eight trials, 1305 women, evidence graded very low) when ECV was attempted in comparison to no ECV attempted. There were no significant differences in the incidence of Apgar score ratings below seven at one minute (average RR 0.67, 95% CI 0.32 to 1.37, three trials, 168 infants) or five minutes (RR 0.63, 95% CI 0.29 to 1.36, five trials, 428 infants, evidence graded very low), low umbilical vein pH levels (RR 0.65, 95% CI 0.17 to 2.44, one trial, 52 infants, evidence graded very low), neonatal admission (RR 0.80, 95% CI 0.48 to 1.34, four trials, 368 infants, evidence graded very low), perinatal death (RR 0.39, 95% CI 0.09 to 1.64, eight trials, 1305 infants

  10. Long-term follow-up of cognitive outcome after breech presentation at birth

    DEFF Research Database (Denmark)

    Sørensen, Henrik Toft; Steffensen, Flemming Hald; Olsen, Jørn

    1999-01-01

    Studies of long-term consequences of birth in breech presentation are sparse. Therefore, we conducted a cohort study linking birth registry data with data collected during evaluation for military service in 4,298 conscripts born between 1973 and 1976. The cognitive functions were measured...... with the Boerge Prien IQ test. A total of 164 conscripts were born in breech presentation and 70 (42.7%) of these were delivered after Caesarean section. The mean Boerge Prien test score was 43.2 among men born in cephalic presentation and 39.9 among those born in breech presentation for a difference of 3.3 (95......% confidence interval = 1.8-4.7). The negative association between breech presentation and cognitive outcome persisted after stratifying by Caesarean section and after adjustment for confounders. It also persisted when we restricted the analyses to term singleton pregnancies....

  11. External cephalic version for breech presentation at term. A prospective interventional study.

    Science.gov (United States)

    Al-Jwadi, Saja A; Al-Ibrahim, Baraa L Humo

    2014-08-01

    To evaluate the external cephalic version (ECV) procedure for the management of at term breech presenting fetuses. In this prospective, interventional study, 90 patients with uncomplicated breech presentations at or after 37 weeks' gestation were considered for ECV. This was performed in Al-Batool Teaching Hospital, Mosul, Iraq, between January 2011 and March 2012. The main outcome measure was assessed as the success rate of ECV attempt and the rate of cesarean section following a successful procedure. Parity, type of breech, placental location, and birth weight were evaluated as predictors of success. Also, any fetal or maternal complications during the procedure were evaluated. Data were analyzed by x2 test. Statistical significance was determined at a level of pbreech. There were no serious fetal or maternal complications associated with the attempt. With appropriate selection of patients, ECV is highly successful and is a safer alternative to vaginal breech delivery or cesarean delivery.

  12. Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term.

    Science.gov (United States)

    Nassar, Natasha; Roberts, Christine L; Barratt, Alexandra; Bell, Jane C; Olive, Emily C; Peat, Brian

    2006-03-01

    The aim of this study was to determine the frequency of adverse maternal and fetal outcomes of both external cephalic version (ECV) and persisting breech presentation at term. We conducted a systematic review of the literature using Medline, Embase and All Evidence Based Medicine (EBM) Reviews databases. Data were extracted from studies that compared women who had an ECV from 36 weeks' gestation with a similar control group of women enrolled at the same gestational age, eligible for, but who did not have an ECV. Eleven studies with a total of 2503 women were included. Adverse outcomes related to ECV were rarely reported and in most studies there was no evidence that relevant outcomes were ascertained among similar women who did not have an ECV. There was no increased risk of antepartum fetal death associated with ECV, but numbers were small. There were no reported cases of uterine rupture, placental abruption, prelabour rupture of membranes or cord prolapse, but these outcomes were not examined among controls. Onset of labour within 24 h and nuchal cord was non-significantly higher among women who had an ECV compared with those with a persisting breech. Despite limited reporting and small numbers, the results of our review suggest that adverse maternal and fetal outcomes of both ECV and persisting breech presentation are rare. Only with improved reporting and collection of safety data on ECV and persisting breech presentation can we provide high-quality information to assist informed decision making by pregnant women with a breech presentation at term.

  13. Factors associated with the success of external cephalic version (ECV) of breech presentation at term.

    Science.gov (United States)

    Obeidat, N; Lataifeh, I; Al-Khateeb, M; Zayed, F; Khriesat, W; Amarin, Z

    2011-01-01

    To evaluate the predictors of success of ECV for breech presentation at term. A retrospective study was conducted over a 3-year period from 2005-2007, where 101 patients who had singleton breech presentation at term were undergoing external cephalic version (ECV) after 37 weeks of gestation at two major teaching hospitals in the North of Jordan. Comparative analysis was made between the successful ECV and unsuccessful ECV groups. The collected data were analysed by using statistical analysis Sudent's t-test and Mann-Whitney test as appropriate and on discrete results chi square or Fisher's exact test when appropriate. The differences were considered significant at a p value of breeches (74% vs 26%, p = 0.002), posterior placenta (38.6% vs 16.4%, p = 0.0001) and anterior fetal back (53.4% vs 34.8%, p = 0.03). Once turned the babies remained cephalic until delivery. All the 28 cases who had failed ECV had caesarean section. Among those who had a successful external cephalic version, the incidence of intrapartum caesarean section was only 8.2% which was lower than that of the average of both units caesarean rate (28%). There were no complications related to the ECV procedure in the study. Multiparity, flexed breech, posterior placenta, and anterior foetal back were the most favourable factors for successful ECV in our study. Moreover, with careful evaluation of individual predictors patient selection and success rates can be optimised.

  14. Uptake of external cephalic version for term breech presentation: an Australian population study, 2002-2012.

    Science.gov (United States)

    Bin, Yu Sun; Roberts, Christine L; Nicholl, Michael C; Ford, Jane B

    2017-07-26

    The safety, efficacy, and cost-effectiveness of external cephalic version (ECV) for term breech presentation has been demonstrated. Clinical guidelines recommend ECV for all eligible women, but the uptake of this procedure in the Australian healthcare setting is unknown. This study aimed to describe ECV uptake in New South Wales, the most populous state of Australia, during 2002 to 2012. Data from routine hospital and birth records were used to identify ECVs conducted at ≥36 weeks' gestation. Women with ECV were compared to women who were potentially eligible for but did not have ECV. Eligibility for ECV was based on clinical guidelines. For those with ECV, birth outcomes following successful and unsuccessful procedures were examined. In N = 32,321 singleton breech pregnancies, 10.5% had ECV, 22.3% were ineligible, and 67.2% were potentially eligible but did not undergo ECV. Compared to women who were eligible but who did not attempt ECV, those who had ECV were more likely to be older, multiparous, overseas-born, public patients at delivery, and to deliver in tertiary hospitals in urban areas (p < 0.01). Fewer women who underwent ECV smoked during pregnancy, fewer were morbidly obese, and fewer had a hypertensive disorder of pregnancy, compared to those who were eligible. Caesarean section occurred in 25.9% of successful compared to 95.6% of unsuccessful ECVs. Infant outcomes did not differ by ECV success. The majority of women with a breech presentation did not receive ECV. It is unclear whether this is attributable to issues with service provision or low acceptability among women. Policies to improve access to and information about ECV appear necessary to improve uptake among women with term breech presentation. Improved data collection around the diagnosis of breech presentation, ECV attempts, and outcomes may help to identify specific barriers to ECV uptake.

  15. External cephalic version facilitation for breech presentation at term.

    Science.gov (United States)

    Hofmeyr, G J

    2001-01-01

    Tocolytic drugs to relax the uterus as well as other methods have been also used in an attempt to facilitate external cephalic version at term. The objective of this review is to assess the effects of routine tocolysis, fetal acoustic stimulation, epidural or spinal analgesia and transabdominal amnioinfusion for external cephalic version at term on successful version and measures of pregnancy outcome. The Cochrane Pregnancy and Childbirth Group Trials Register and the Cochrane Controlled Trials Register were searched. Date of last search: April 2001. Randomised and quasi-randomised trials comparing routine versus selective tocolysis; fetal acoustic stimulation in midline fetal spine positions versus dummy or no stimulation; epidural or spinal analgesia versus no regional analgesia; or transabdominal amnioinfusion versus no amnioinfusion for external cephalic version at term. Eligibility and trial quality were assessed by the reviewer. In seven trials, routine tocolysis was associated with fewer failures of external cephalic version (relative risk 0.74, 95% confidence interval 0.64 to 0.87). There were no significant differences between non-cephalic presentations at birth. Caesarean sections were reduced (relative risk 0.85, confidence interval 0.72-0.99). Fetal acoustic stimulation in midline fetal spine positions was associated with fewer failures of external cephalic version at term (relative risk 0.17, 95% confidence interval 0.05 to 0.60). With epidural or spinal analgesia, external cephalic version failure, non-cephalic births and caesarean sections were reduced in one trial but not the other. The overall differences were not statistically significant. No randomised trials of transabdominal amnioinfusion for external cephalic version at term were located. Routine tocolysis appears to reduce the failure rate of external cephalic version at term. Although promising, there is not enough evidence to evaluate the use of fetal acoustic stimulation in midline fetal

  16. Cost-effectiveness of external cephalic version for term breech presentation.

    Science.gov (United States)

    Tan, Jonathan M; Macario, Alex; Carvalho, Brendan; Druzin, Maurice L; El-Sayed, Yasser Y

    2010-01-21

    External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation. A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness. The incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse

  17. Cost-effectiveness of external cephalic version for term breech presentation

    Directory of Open Access Journals (Sweden)

    Carvalho Brendan

    2010-01-01

    Full Text Available Abstract Background External cephalic version (ECV is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation. Methods A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc. was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery, utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY was used to determine cost-effectiveness. Results The incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion

  18. A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term.

    Science.gov (United States)

    Burgos, Jorge; Melchor, Juan Carlos; Pijoán, José Ignacio; Cobos, Patricia; Fernández-Llebrez, Luis; Martínez-Astorquiza, Txantón

    2011-01-01

    To determine the factors associated with the success rate of external cephalic version (ECV) for breech presentation at term. A prospective analysis of 500 ECV maneuvers. The variables maternal age, maternal weight, body mass index, previous cesarean delivery, gestational age, parity, amount of amniotic fluid, placental location, and type of breech were studied using logistic regression analysis. The success rate of ECV was 52.2% (n=261). The variables significantly associated with success were parity, placental location, amount of amniotic fluid, and type of breech (Pbreech presentation had a 2.77-times higher success rate compared with a frank breech presentation (95% CI, 1.16-6.62). The area under the ROC curve showed a predictive ability of 73.6% (95% CI, 69.2%-77.9%) for these 3 variables. Parity, placental location, amount of amniotic fluid, and type of breech presentation were associated with the success rate of ECV. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  19. Remifentanil analgesia during external cephalic version for breech presentation in nulliparous women at term

    Science.gov (United States)

    Wang, Zhi-Hong; Yang, Yi; Xu, Gui-Ping

    2017-01-01

    Abstract Background: The aim of the study was to assess the efficacy and safety of remifentanil for pain relief during external cephalic version (ECV) for breech presentation in nulliparous women at term. Methods: A total of 144 nulliparous women with singleton breech presentation were randomly divided into the intervention group and the placebo group, with 72 subjects in each group. The subjects in the intervention group received remifentanil (infused at 0.1 μg kg–1 min–1 with demand boluses of 0.1 μg/kg), whereas those in the placebo group were given saline placebo. This study was conducted from May 2013 to April 2016. The outcomes measures include pain (measured with the visual analog scale, VAS), success rate of ECV, maternal satisfaction for ECV, and adverse events. Results: A total of 137 participants completed the study. The intervention with remifentanil showed greater efficacy than did placebo in decreasing the VAS score immediately after ECV (intervention group 4.3 ± 2.2 vs placebo group 6.4 ± 2.5, P < 0.01). A significant difference in the ECV success rate was also found between the 2 groups (intervention group 56.9% vs placebo group 38.9%, P = 0.03). In addition, a significant difference in the satisfaction score was also detected (intervention group 9.3 ± 0.9 vs placebo group 6.7 ± 1.2, P < 0.01). The observed adverse events were similar between the 2 groups. Conclusion: This study shows that remifentanil could decrease pain, improve the ECV success rate, and improve satisfaction in nulliparous women at term during the period of ECV. Furthermore, it is also well tolerated with few adverse events. PMID:28296735

  20. [External cephalic version for breech presentation at term: an effective procedure to reduce the caesarean section rate].

    Science.gov (United States)

    Lojacono, A; Donarini, G; Valcamonico, A; Soregaroli, M; Frusca, T

    2003-12-01

    Although term breech presentation is a relatively rare condition (3-5% of all births), it continues to be an important indication for caesarean section and has contributed to its increased use. Risk of complications may be increased for both mother and foetus in such a situation. Vaginal delivery of a breech presenting foetus is complex and may involve many difficulties, so today there is a general consensus that planned caesarean section is better than planned vaginal birth for the foetus in breech presentation at term. External cephalic version is one of the most effective procedures in modern obstetrics. It involves the external manipulation of the foetus from the breech into the cephalic presentation. A successful manoeuvre can decrease costs by avoiding operative deliveries and decreasing maternal morbidity. The aim of the present study is to evaluate the effectiveness of this obstetric manoeuvre to increase the proportion of vertex presentation among foetuses that were formerly in the breech position near term, so as to reduce the caesarean section rate. The safety of the version is also showed. From 1999 to 2002, 89 women with foetal breech presentation underwent external cephalic version at the Department of Obstetrics and Gynaecology of the Brescia University. The gestational age was 36.8+/-0.8 weeks. The following variables have been taken into consideration: breech variety, placental location, foetal back position, parity, amount of amniotic fluid and gestational age. Every attempt was performed with a prior use of an intravenous drip of Ritodrine, and foetal heart rate was monitored continuously with cardiotocogram. The success rate of the procedure was 42.7% (n=38). No maternal or foetal complication or side effects occurred, both during and after the manoeuvre, except a transient foetal bradycardia that resolved spontaneously. Only one spontaneous reversion of the foetus occurred before delivery. Of all the women that underwent a successful version

  1. Fear for external cephalic version and depression : Predictors of successful external cephalic version for breech presentation at term?

    NARCIS (Netherlands)

    Ciliacus, Emily; van der Zalm, Marieke; Truijens, Sophie E.; Hasaart, Tom H.; Pop, Victor J.; Kuppens, Simone M.

    2014-01-01

    Background Objective was to determine whether fear for external cephalic version (ECV) and depression are associated with the success rate of ECV in women with a breech presentation at term. Methods Prospective study conducted in the Catharina Hospital Eindhoven between October 2007 and May 2012.

  2. Interventions to help external cephalic version for breech presentation at term.

    Science.gov (United States)

    Hofmeyr, G J

    2004-01-01

    Breech presentation places a fetus at increased risk. The outcome for the baby is improved by planned caesarean section compared with planned vaginal delivery. External cephalic version attempts to reduce the chances of breech presentation at birth, but is not always successful. Tocolytic drugs to relax the uterus as well as other methods have been used in an attempt to facilitate external cephalic version at term. To assess the effects of routine tocolysis, fetal acoustic stimulation, epidural or spinal analgesia and transabdominal amnioinfusion for external cephalic version at term on successful version and measures of pregnancy outcome. The Cochrane Pregnancy and Childbirth Group trials register (September 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2003) were searched. Randomised and quasi-randomised trials comparing routine versus selective or no tocolysis; fetal acoustic stimulation in midline fetal spine positions versus dummy or no stimulation; epidural or spinal analgesia versus no regional analgesia; or transabdominal amnioinfusion versus no amnioinfusion for external cephalic version at term. The reviewer assessed eligibility and trial quality. In six trials, routine tocolysis with beta-stimulants was associated with fewer failures of external cephalic version (relative risk (RR) 0.74, 95% confidence interval (CI) 0.64 to 0.87). The reduction in non-cephalic presentations at birth was not statistically significant. Caesarean sections were reduced (RR 0.85, 95% CI 0.72 to 0.99). In four small trials, sublingual nitroglycerine used as a tocolytic was associated with significant side-effects, and was not found to be effective. Fetal acoustic stimulation in midline fetal spine positions was associated with fewer failures of external cephalic version at term (RR 0.17, 95% CI 0.05 to 0.60). With epidural or spinal analgesia, external cephalic version failure, non-cephalic births and caesarean sections were

  3. Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands

    NARCIS (Netherlands)

    Rosman, A. N.; Vlemmix, F.; Fleuren, M. A H; Rijnders, M. E.; Beuckens, A.; Opmeer, Brent C; Mol, B.W.J.; van Zwieten, M.C.B.; Kok, M.

    Objective: external cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. There is professional consensus that ECV should be offered to all women with a fetus in breech presentation, but only up to 70% of

  4. Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands

    NARCIS (Netherlands)

    Rosman, A. N.; Vlemmix, F.; Fleuren, M. A. H.; Rijnders, M. E.; Beuckens, A.; Opmeer, B. C.; Mol, B. W. J.; van Zwieten, M. C. B.; Kok, M. [=Marjolein

    2014-01-01

    external cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. There is professional consensus that ECV should be offered to all women with a fetus in breech presentation, but only up to 70% of women eligible

  5. Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands

    NARCIS (Netherlands)

    Rosman, A.N.; Vlemmix, F.; Fleuren, M.A.H.; Rijnders, M.E.; Beuckens, A.; Opmeer, B.C.; Mol, B.W.J.; Zwieten, M.C.B. van; Kok, M.

    2014-01-01

    Objective: external cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. There is professional consensus that ECV should be offered to all women with a fetus in breech presentation, but only up to 70% of

  6. External cephalic version for breech presentation at term: predictors of success, and impact on the rate of caesarean section.

    Science.gov (United States)

    Hussin, O A; Mahmoud, M A; Abdel-Fattah, M M

    2013-02-01

    The incidence of caesarean section for breech presentation has increased markedly in the last 20 years. A prospective, interventional cohort study was carried out of the success rate of external cephalic version (ECV) and its predictors of as well as its impact on the rate of caesarean section for vaginal breech delivery. All 128 women admitted during the study period to the obstetrics department of a tertiary care military hospital in Taif, Saudi Arabia with breech presentation at term, regardless of age and parity, who accepted ECV were recruited. ECV was successful in 53.9% of the women. Most of the women with successful ECV delivered normally (84.1%) and only 14.5% of them delivered by caesarean section. Conversely, normal vaginal delivery was reported among 8.5% of those who had spontaneous version with failed ECV and approximately two-thirds of them delivered by caesarean section (62.7%). Successful ECV reduced the breech and caesarean section rate.

  7. Fear for external cephalic version and depression: predictors of successful external cephalic version for breech presentation at term?

    Science.gov (United States)

    Ciliacus, Emily; van der Zalm, Marieke; Truijens, Sophie E; Hasaart, Tom H; Pop, Victor J; Kuppens, Simone M

    2014-03-12

    Objective was to determine whether fear for external cephalic version (ECV) and depression are associated with the success rate of ECV in women with a breech presentation at term. Prospective study conducted in the Catharina Hospital Eindhoven between October 2007 and May 2012. Participants fulfilled The Edinburgh Depression Scale (EDS) questionnaire and expressed their degree of fear on a visual analogue scale from one to ten before ECV. Obstetric factors were evaluated as well. Primary outcome was the relation between psychological factors (fear for ECV and depression EDS scores) and ECV success rate. Secondary outcome was a possible relation between fear for ECV and increased abdominal muscle tension. The overall success rate was 55% and was significantly lower (p < 0.001) in nulliparous women (44.3%) compared with parous women (78.0%). Fear for ECV and depression EDS-scores were not related with ECV success rate. Parity, placental location, BMI and engagement of the fetal breech were obstetric factors associated with ECV outcome. There was no relation between fear for ECV and abdominal muscle tone. Fear for ECV and depression were not related with ECV success rate in this study. Engagement of the fetal breech was the most important factor associated with a successful ECV. The Eindhoven Breech Intervention Study, NCT00516555.

  8. Vaginal breech birth: can we move beyond the Term Breech Trial?

    Science.gov (United States)

    Hunter, Linda A

    2014-01-01

    Since the publication of the Term Breech Trial in 2000, planned cesarean has become the preferred mode of birth for women whose fetus is in a breech presentation. Over the past 20 years, however, subsequent evidence has not shown conclusively that cesarean birth is safer than vaginal birth for a fetus in a breech presentation when certain criteria are met. Many obstetric organizations support the option of planned vaginal birth for women with a breech presentation under strict prelabor selection criteria and intrapartum management guidelines. The growing trend toward cesarean unfortunately has left midwives and other intrapartum care providers in training with dwindling opportunities to competently master skills for vaginal breech birth. Although simulation training offers opportunities to practice infrequently encountered skills such as vaginal breech birth, it is unknown if this alternative will provide sufficient experience for future generations of clinicians. As a result, women with a breech presentation at term who desire a trial of labor often have limited choices. This article reviews the controversies surrounding the ideal mode of birth created by the Term Breech Trial. Criteria for vaginal breech birth are summarized and the role of simulation explored. Implications for midwifery practice when a breech presentation is diagnosed are also included. © 2014 by the American College of Nurse-Midwives.

  9. Evaluation of a decision aid for women with breech presentation at term: a randomised controlled trial [ISRCTN14570598

    Science.gov (United States)

    Nassar, N; Roberts, CL; Raynes-Greenow, CH; Barratt, A; Peat, B

    2007-01-01

    Objectives To evaluate the effectiveness of a decision aid for women with a breech presentation compared with usual care. Design Randomised controlled trial. Setting Tertiary obstetric hospitals offering external cephalic version (ECV). Population Women with a singleton pregnancy were diagnosed antenatally with a breech presentation at term, and were clinically eligible for ECV. Methods Women were randomised to either receive a decision aid about the management options for breech presentation in addition to usual care or to receive usual care only with standard counselling from their usual pregnancy care provider. The decision aid comprised a 24-page booklet supplemented by a 30-minute audio-CD and worksheet that was designed for women to take home and review with a partner. Main outcome measures Decisional conflict (uncertainty), knowledge, anxiety and satisfaction with decision making, and were assessed using self-administered questionnaires. Results Compared with usual care, women reviewing the decision aid experienced significantly lower decisional conflict (mean difference −8.92; 95% CI −13.18, −4.66) and increased knowledge (mean difference 8.40; 95% CI 3.10, 13.71), were more likely to feel that they had enough information to make a decision (RR 1.30; 95% CI 1.14, 1.47), had no increase in anxiety and reported greater satisfaction with decision making and overall experience of pregnancy and childbirth. In contrast, 19% of women in the usual care group reported they would have made a different decision about their care. Conclusions A decision aid is an effective and acceptable tool for pregnant women that provides an important adjunct to standard counselling for the management of breech presentation. Please cite this paper as: Nassar N, Roberts C, Raynes-Greenow C, Barratt A, Peat B, on behalf of the Decision Aid for Breech Presentation Trial Collaborators. Evaluation of a decision aid for women with breech presentation at term: a randomised controlled

  10. Tocolysis in term breech external cephalic version.

    Science.gov (United States)

    Nor Azlin, M I; Haliza, H; Mahdy, Z A; Anson, I; Fahya, M N; Jamil, M A

    2005-01-01

    To study the effect of ritodrine tocolysis on the success of external cephalic version (ECV) and to assess the role of ECV in breech presentation at our centre. A prospective randomized double-blind-controlled trial comparing ritodrine and placebo in ECV of singleton term breech pregnancy at a tertiary hospital. Among the 60 patients who were recruited, there was a success rate of 36.7%. Ritodrine tocolysis significantly improved the success rate of ECV (50% vs. 23%; P=0.032). There was a marked effect of ritodrine tocolysis on the ECV success in nulliparae (36.4% vs. 13.0%) and multiparae (87.5% vs. 57.1%). External cephalic version has shown to reduce the rate of cesarean section for breech presentation by 33.5% in our unit. External cephalic version significantly reduced the rate of cesarean section in breech presentation, and ritodrine tocolysis improved the success of ECV and should be offered to both nulliparous and parous women in the case of term breech presentation.

  11. Term breech delivery in The Netherlands

    NARCIS (Netherlands)

    Rietberg, C.C.

    2006-01-01

    The management of the term breech delivery has been a subject of discussion for many years. Only a few randomized trials had been performed on outcome in relation to the mode of delivery in case of breech position. In october 2000 the results of the Term Breech Trial (TBT) were published, in which

  12. Persistent Breech Presentation in a Bicornuate Uterus: A Case Report

    African Journals Online (AJOL)

    We report a case of persistent breech presentation in a primigravida with bicornuate uterus that was initially diagnosed by early ultrasound scan. Persistent breech presentation later in the pregnancy necessitated an elective caesarean section at term. The diagnosis was confirmed intraoperatively by exteriorizing the uterus.

  13. A novel and dedicated multidisciplinary service to manage breech presentation at term; 3 years of experience in a tertiary care maternity unit.

    Science.gov (United States)

    Hickland, Patrick; Gargan, Phyl; Simpson, Jacquie; McCabe, Niamh; Costa, Janitha

    2017-08-09

    In order to provide uniform and unbiased multidisciplinary counselling on the options available, including vaginal breech delivery (VBD) and external cephalic version (ECV), the latter of which could then be performed, a weekly Breech Clinic was introduced to a tertiary care maternity unit in Northern Ireland in June 2013, replacing the traditional ECV Clinic introduced in June 2012. Retrospective data collection was undertaken using clinic proformas, Northern Ireland Maternity System data and case notes of women who attended the clinics (ECV and Breech) from June 2012 to May 2015. There were 434 referrals to the clinic over the 3-year period; 356 women attended. The proportion of women attending increased from 69% to 85% since the introduction of the Breech Clinic. Two hundred and thirty-two were deemed eligible and 179 of these underwent ECV after counselling. Although the proportion of women undergoing ECV decreased from 69% to 46%, 11 women opted for and achieved VBD during the 2 years of the Breech Clinic, compared with one woman in the year of the ECV Clinic. Seventy-one of the attempted ECVs were successful, with 61 women having a normal vaginal delivery. Notably, the success rate of ECV increased from 33% to 42%. The number of caesarean sections performed solely for breech at term decreased from 199 in the 12 months before the introduction of ECV clinic, to 188 during the ECV clinic, and 154 in the final 12 months of Breech Clinic. A dedicated service to counsel women on the management of breech presentation can decrease caesarean sections for breech presentation through increased uptake and success of ECV, and encouraging suitable women to opt for VBD when ECV is unsuccessful, contraindicated or declined.

  14. Breech at term--mode of delivery?

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Weber, T

    1995-01-01

    BACKGROUND: The present study was designed to determine neonatal mortality and morbidity in non-malformed singleton term infants delivered in breech presentation and identify a possible correlation between outcome on the one hand and mode of delivery, parity and birth weight on the other. METHODS...

  15. Outcomes of external cephalic version and breech presentation at term, an audit of deliveries at a Sydney tertiary obstetric hospital, 1997-2004.

    Science.gov (United States)

    Nassar, Natasha; Roberts, Christine L; Cameron, Carolyn A; Peat, Brian

    2006-01-01

    Probabilistic information on outcomes of breech presentation is important for clinical decision-making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997-2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy-one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), nuchal cord (9.3%), cord prolapse (0.4%), and fetal death (0.3%); and did not differ by clinical classification. Women who had an external cephalic version had a reduced risk of onset-of-labor within 24 h (RR 0.25; 95%CI 0.08, 0.82) compared with women eligible for but who did not have an external cephalic version. Women diagnosed with breech in labor had the highest rates of emergency cesarean section (64%), cord prolapse (1.4%) and poorest infant outcomes. Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation.

  16. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version

    Science.gov (United States)

    Cluver, Catherine; Hofmeyr, G Justus; Gyte, Gillian ML; Sinclair, Marlene

    2014-01-01

    Background Breech presentation is associated with increased complications. Turning a breech baby to head first presentation using external cephalic version (ECV) attempts to reduce the chances of breech presentation at birth, and reduce the adverse effects of breech vaginal birth or caesarean section. Tocolytic drugs and other methods have been used in an attempt to facilitate ECV. Objectives To assess interventions such as tocolysis, fetal acoustic stimulation, regional analgesia, transabdominal amnioinfusion or systemic opioids on ECV for a breech baby at term. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 September 2011) and the reference lists of identified studies. Selection criteria Randomised and quasi-randomised trials comparing the above interventions with no intervention or other methods to facilitate ECV at term. Data collection and analysis We assessed eligibility and trial quality. Two review authors independently assessed for inclusion all potential studies identified as a result of the search strategy and independently extracted the data using a designed data extraction form. Main results We included 25 studies, providing data on 2548 women. We used the random-effects model for pooling data due to clinical heterogeneity in the included studies in the various comparisons. The overall quality of the evidence was reasonable, but a number of assessments had insufficient data to provide an answer with any degree of assurance. Tocolytic drugs, in particular betastimulants, were effective in increasing cephalic presentations in labour (average risk ratio (RR) 1.38, 95% confidence interval (CI) 1.03 to 1.85, eight studies, 993 women) and in reducing the number of caesarean sections (average RR 0.82, 95% CI 0.71 to 0.94, eight studies, 1177 women). No differences were identified in fetal bradycardias (average RR 0.95, 95% CI 0.48 to 1.89, three studies, 467 women) although the review is underpowered for

  17. Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double-blinded, placebo-controlled trial.

    Science.gov (United States)

    Impey, Lawrence; Pandit, Meghana

    2005-05-01

    External cephalic version (ECV) reduces the incidence of breech presentation at term and caesarean section for non-cephalic births. Tocolytics may improve success rates, but are time consuming, may cause side effects and have not been proven to alter caesarean section rates. The aim of this trial was to determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. To determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. Randomised, double-blinded, placebo-controlled trial. UK teaching hospital. One hundred and twenty-four women with a breech presentation at term who had undergone an unsuccessful attempt at ECV. Relative risks with 95% confidence intervals for categorical variables and a t test for continuous variables. Analysis was by intention to treat. Incidence of cephalic presentation at delivery. Secondary outcomes were caesarean section and measures of neonatal and maternal morbidity. The use of tocolysis for a repeat attempt at ECV significantly increases the incidence of cephalic presentation at delivery (RR 3.21; 95% CI 1.23-8.39) and reduces the incidence of caesarean section (RR 0.33; 95% CI 0.14-0.80). The effects were most marked in multiparous women (RR for cephalic presentation at delivery 9.38; 95% CI 1.64-53.62). Maternal and neonatal morbidity remain unchanged. The use of tocolysis increases the success rate of repeat ECV and reduces the incidence of caesarean section. A policy of only using tocolysis where an initial attempt has failed leads to a relatively high success rate with minimum usage of tocolysis.

  18. External cephalic version for breech presentation with or without spinal analgesia in nulliparous women at term: a randomized controlled trial.

    Science.gov (United States)

    Weiniger, Carolyn F; Ginosar, Yehuda; Elchalal, Uriel; Sharon, Einav; Nokrian, Malka; Ezra, Yossef

    2007-12-01

    To compare the success of external cephalic version using spinal analgesia with no analgesia among nulliparas. A prospective randomized controlled trial was performed in a tertiary referral center delivery suite. Nulliparous women at term requesting external cephalic version for breech presentation were randomized to receive spinal analgesia (7.5 mg bupivacaine) or no analgesia before the external cephalic version. An experienced obstetrician performed the external cephalic version. Primary outcome was successful conversion to vertex presentation. Seventy-four women were enrolled, and 70 analyzed (36 spinal, 34 no analgesia). Successful external cephalic version occurred among 24 of 36 (66.7%) women randomized to receive spinal analgesia compared with 11 of 34 (32.4%) without, P=.004 (95% confidence interval [CI] of the difference: 0.0954-0.5513). External cephalic version with spinal analgesia resulted in a lower visual analog pain score, 1.76+/-2.74 compared with 6.84+/-3.08 without, Pexternal cephalic version success was 4.0-fold higher when performed with spinal analgesia P=.02 (95% CI, odds ratio [OR] 1.2-12.9). Complete breech presentation before attempting external cephalic version increased the odds of success 8.2-fold, P=.001 (95% CI, OR 2.2-30.3). Placental position, estimated fetal weight, and maternal weight did not contribute to the success rate when spinal analgesia was used. There were no cases of placental abruption or fetal distress. Administration of spinal analgesia significantly increases the success rate of external cephalic version among nulliparous women at term, which allows possible normal vaginal delivery. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00119184 I.

  19. [Umbilical blood-gas status at cesarean section for breech presentation: a comparison with vertex presentation].

    Science.gov (United States)

    Haruta, M; Saeki, N; Naka, Y; Funato, T; Ohtsuki, Y

    1989-10-01

    Umbilical blood-gas status at elective cesarean section with oxygen inhalation for breech presentation (25 cases) was compared with that for vertex presentation (25 cases), so as to confirm the security of full-term breech fetuses delivered by cesarean section under spinal anesthesia. Umbilical arterial oxygen levels were significantly lower in the breech group (Mean PO2:18.9 mmHg; SO2:37.3%; Oxygen content:7.6 ml/dl). The number of hypoxemic fetuses was significantly higher in the breech group (the breech: 7; the vertex; 0). The other umbilical blood-gas values revealed no significant differences between the breech and vertex groups, and were within normal limits in both groups. Oxygen extraction in the breech (Mean: 49.0%) was higher than that in the vertex (32.9%). Therefore decreased umbilical blood flow in the breech was suggested. The incidence of depression at 1 minute after delivery in the breech infants (24%) was significantly higher than that in the vertex infants (0%). It became obvious in the breech that as the interval between the uterine incision and delivery increased, umbilical arterial blood tended to acidosis and the 1 minute Apgar score decreased. Cesarean section for breech presentation requires sufficient and optimal incisions of the abdominal wall and uterus as well as a skillful manual delivery technique, because the fetus or neonate should be protected against asphyxia resulting from umbilical compression and prolonged delivery interval.

  20. Remifentanil analgesia during external cephalic version for breech presentation in nulliparous women at term: A randomized controlled trial.

    Science.gov (United States)

    Wang, Zhi-Hong; Yang, Yi; Xu, Gui-Ping

    2017-03-01

    The aim of the study was to assess the efficacy and safety of remifentanil for pain relief during external cephalic version (ECV) for breech presentation in nulliparous women at term. A total of 144 nulliparous women with singleton breech presentation were randomly divided into the intervention group and the placebo group, with 72 subjects in each group. The subjects in the intervention group received remifentanil (infused at 0.1 μg kg min with demand boluses of 0.1 μg/kg), whereas those in the placebo group were given saline placebo. This study was conducted from May 2013 to April 2016. The outcomes measures include pain (measured with the visual analog scale, VAS), success rate of ECV, maternal satisfaction for ECV, and adverse events. A total of 137 participants completed the study. The intervention with remifentanil showed greater efficacy than did placebo in decreasing the VAS score immediately after ECV (intervention group 4.3 ± 2.2 vs placebo group 6.4 ± 2.5, P < 0.01). A significant difference in the ECV success rate was also found between the 2 groups (intervention group 56.9% vs placebo group 38.9%, P = 0.03). In addition, a significant difference in the satisfaction score was also detected (intervention group 9.3 ± 0.9 vs placebo group 6.7 ± 1.2, P < 0.01). The observed adverse events were similar between the 2 groups. This study shows that remifentanil could decrease pain, improve the ECV success rate, and improve satisfaction in nulliparous women at term during the period of ECV. Furthermore, it is also well tolerated with few adverse events.

  1. Moxibustion for Cephalic Version of Breech Presentation.

    Science.gov (United States)

    Schlaeger, Judith M; Stoffel, Cynthia L; Bussell, Jeanie L; Cai, Hui Yan; Takayama, Miho; Yajima, Hiroyoshi; Takakura, Nobuari

    2018-05-01

    Moxibustion, a form of traditional Chinese medicine (TCM), is the burning of the herb moxa (Folium Artemisiae argyi or mugwort) over acupuncture points. It is often used in China to facilitate cephalic version of breech presentation. This article reviews the history, philosophy, therapeutic use, possible mechanisms of action, and literature pertaining to its use for this indication. For moxibustion, moxa can be rolled into stick form, placed directly on the skin, or placed on an acupuncture needle and ignited to warm acupuncture points. Studies have demonstrated that moxibustion may promote cephalic version of breech presentation and may facilitate external cephalic version. However, there is currently a paucity of research on the effects of moxibustion on cephalic version of breech presentation, and thus there is a need for further studies. Areas needing more investigation include efficacy, safety, optimal technique, and best protocol for cephalic version of breech presentation. © 2018 by the American College of Nurse-Midwives.

  2. Patients' and professionals' barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands.

    Science.gov (United States)

    Rosman, A N; Vlemmix, F; Fleuren, M A H; Rijnders, M E; Beuckens, A; Opmeer, B C; Mol, B W J; van Zwieten, M C B; Kok, M

    2014-03-01

    external cephalic version (ECV) is a relatively simple and safe manoeuvre and a proven effective approach in the reduction of breech presentation at term. There is professional consensus that ECV should be offered to all women with a fetus in breech presentation, but only up to 70% of women eligible for ECV undergo an ECV attempt. The aim of the study was to identify barriers and facilitators for ECV among professionals and women with a breech presentation at term. qualitative study with semi-structured interviews. Dutch hospitals. pregnant women with a breech presentation who had decided on ECV, and midwives and gynaecologists treating women with a breech presentation. on the basis of national guidelines and expert opinions, we developed topic lists to guide the interviews and discuss barriers and facilitators in order to decide on ECV (pregnant women) or advice on ECV (midwives and gynaecologists). among pregnant women the main barriers were fear, the preference to have a planned caesarean section (CS), incomplete information and having witnessed birth complications within the family or among friends. The main facilitators were the wish for a home birth, the wish for a vaginal delivery and confidence of the safety of ECV. Among professionals the main barriers were a lack of knowledge to fully inform and counsel patients on ECV, and the inability to counsel women who preferred a primary CS. The main facilitator was an unambiguous policy on (counselling for) ECV within the region. we identified several barriers and facilitators possibly explaining the suboptimal implementation of ECV for breech presentation in the Netherlands. This knowledge should be taken into account in designing implementation strategies for ECV to improve the uptake of ECV by professionals and patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Facilitators and barriers to external cephalic version for breech presentation at term among health care providers in the Netherlands: a quantitative analysis

    NARCIS (Netherlands)

    Rosman, Ageeth N.; Vlemmix, Floortje; Beuckens, Antje; Rijnders, Marlies E.; Opmeer, Brent C.; Mol, Ben Willem J.; Kok, Marjolein; Fleuren, Margot A. H.

    2014-01-01

    guidelines recommend that external cephalic version (ECV) should be offered to all women with a fetus in breech presentation at term. However, only 50-60% of the women receive an ECV attempt. We explored the determinants (barriers and facilitators) affecting the uptake of the guidelines among

  4. Facilitators and barriers to external cephalic version for breech presentation at term among health care providers in the Netherlands: A quantitative analysis

    NARCIS (Netherlands)

    Rosman, A.N.; Vlemmix, F.; Beuckens, A.; Rijnders, M.E.; Opmeer, B.C.; Mol, B.W.J.; Kok, M.; Fleuren, M.A.H.

    2014-01-01

    OBJECTIVE: guidelines recommend that external cephalic version (ECV) should be offered to all women with a fetus in breech presentation at term. However, only 50-60% of the women receive an ECV attempt. We explored the determinants (barriers and facilitators) affecting the uptake of the guidelines

  5. Maternal outcomes of term breech presentation delivery: impact of successful external cephalic version in a nationwide sample of delivery admissions in the United States.

    Science.gov (United States)

    Weiniger, Carolyn F; Lyell, Deirdre J; Tsen, Lawrence C; Butwick, Alexander J; Shachar, BatZion; Callaghan, William M; Creanga, Andreea A; Bateman, Brian T

    2016-07-08

    We aimed to define the frequency and predictors of successful external cephalic version in a nationally-representative cohort of women with breech presentations and to compare maternal outcomes associated with successful external cephalic version versus persistent breech presentation. Using the Nationwide Inpatient Sample, a United States healthcare utilization database, we identified delivery admissions between 1998 and 2011 for women who had successful external cephalic version or persistent breech presentation (including unsuccessful or no external cephalic version attempt) at term. Multivariable logistic regression identified patient and hospital-level factors associated with successful external cephalic version. Maternal outcomes were compared between women who had successful external cephalic version versus persistent breech. Our study cohort comprised 1,079,576 delivery admissions with breech presentation; 56,409 (5.2 %) women underwent successful external cephalic version and 1,023,167 (94.8 %) women had persistent breech presentation at the time of delivery. The rate of cesarean delivery was lower among women who had successful external cephalic version compared to those with persistent breech (20.2 % vs. 94.9 %; p external cephalic version were also less likely to experience several measures of significant maternal morbidity including endometritis (adjusted Odds Ratio (aOR) = 0.36, 95 % Confidence Interval (CI) 0.24-0.52), sepsis (aOR = 0.35, 95 % CI 0.24-0.51) and length of stay > 7 days (aOR = 0.53, 95 % CI 0.40-0.70), but had a higher risk of chorioamnionitis (aOR = 1.83, 95 % CI 1.54-2.17). Overall a low proportion of women with breech presentation undergo successful external cephalic version, and it is associated with significant reduction in the frequency of cesarean delivery and a number of measures of maternal morbidity. Increased external cephalic version use may be an important approach to mitigate the high rate of

  6. Interventions for helping to turn term breech babies to head first presentation when using external cephalic version.

    Science.gov (United States)

    Cluver, Catherine; Gyte, Gillian M L; Sinclair, Marlene; Dowswell, Therese; Hofmeyr, G Justus

    2015-02-09

    Breech presentation is associated with increased complications. Turning a breech baby to head first presentation using external cephalic version (ECV) attempts to reduce the chances of breech presentation at birth so as to avoid the adverse effects of breech vaginal birth or caesarean section. Interventions such as tocolytic drugs and other methods have been used in an attempt to facilitate ECV. To assess, from the best evidence available, the effects of interventions such as tocolysis, acoustic stimulation for midline spine position, regional analgesia (epidural or spinal), transabdominal amnioinfusion, systemic opioids and hypnosis, or the use of abdominal lubricants, on ECV at term for successful version, presentation at birth, method of birth and perinatal and maternal morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and the reference lists of identified studies. Randomised and quasi-randomised trials comparing the above interventions with no intervention or other methods to facilitate ECV at term. We assessed eligibility and trial quality. Two review authors independently assessed for inclusion all potential studies identified as a result of the search strategy and independently extracted the data using a specially designed data extraction form. We included 28 studies, providing data on 2786 women. We used the random-effects model for pooling data because of clinical heterogeneity between studies. A number of trial reports gave insufficient information to allow clear assessment of risk of bias. We used GradePro software to carry out formal assessments of quality of the evidence for beta stimulants versus placebo and regional analgesia with tocolysis versus tocolysis alone.Tocolytic parenteral beta stimulants were effective in increasing cephalic presentations in labour (average risk ratio (RR) 1.68, 95% confidence interval (CI) 1.14 to 2.48, five studies, 459 women, low-quality evidence) and

  7. [External cephalic version in case of persisting breech presentation at term: motivations and women's experience of the intervention].

    Science.gov (United States)

    Pichon, M; Guittier, M-J; Irion, O; Boulvain, M

    2013-01-01

    To evaluate the efficacy and acceptability of external cephalic version (ECV). From 2004 to 2008, 212 pregnant women between 34-37 weeks of gestation with fetus in breech presentation were included in a randomized clinical trial and 125 externals cephalic versions were studied. A success rate of 37.6%t was recorded. At 34 weeks of gestation, 80.6% of women were considering an ECV in the event of persistent breech position at 37 weeks. These women expressed the desire to give birth vaginally (52% versus 24.4%, P<0.001). In contrast, others women preferred an elective cesarean section to avoid the risk of a breech vaginal delivery. Women felt pain during the ECV and scored 60 on average using the analogical visual scale. Women rated on a verbal rating scale the ECV as severely painful to unbearable (68%), and as stressful (70%). Despite this, the majority of women would recommend ECV to their friends or would be willing to repeat it for themselves. ECV remains a scary and painful medical procedure. More research is needed to reduce the impact. The use of analgesic medication for this indication is controversial. Hypnosis could be an alternative to evaluate. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  8. Consequences of the term breech trial in Denmark

    DEFF Research Database (Denmark)

    Hartnack Tharin, J.E.; Krebs, L.; Rasmussen, S.

    2011-01-01

    Objective. To analyze the consequences of the handling of breech presentation in Denmark after publication of the Term Breech Trial (TBT). Design. Population-based retrospective cohort study. Settings. Data from the National Birth Registry and discharge letters from cases with perinatal death....... Population. Singleton breech fetuses at termand alive at onset of labor delivered between 1997 and 2008 (n=23 789). Methods. Outcomes before and after publication of TBT were compared and analyzed by planned mode of delivery. Main outcome measures. Cesarean section, intrapartum or early neonatal mortality...

  9. Improving external cephalic version for foetal breech presentation.

    Science.gov (United States)

    Zandstra, H; Mertens, H J M M

    2013-01-01

    If success rate of external cephalic version (ECV) increases, the rate of primary caesarean sections -declines. The aims of this retrospective cohort study were to evaluate the ECV and to identify factors associated with the success rate of ECV for breech presentation at term. The second aim of this study was to analyse the outcome of labour of all patients with a foetus in breech near term. All women with a foetus in breech near or at term were included. Logistic regression analyses were -performed to identify the association between patient characteristics and success rate of ECV. The overall rate of successful ECV's was 19%. Foetal and maternal complications after ECV were negligible. BMI, type of breech and amount of amniotic fluid were significantly correlated with a successful ECV. The rate of primary caesarean sections for the group of patients who underwent an ECV was lower than the rate in the group who did not (52.9% vs. 79.6%). The rate of spontaneous deliveries was increased after ECV (36% versus 12%). After successful ECV the rate of spontaneous deliveries was 75%; after unsuccessful ECV 26.8%. The overall rate of successful ECV was low (19%). BMI, type of breech and amount of amniotic fluid were significantly correlated with a successful ECV. The rate of primary caesarean sections was significantly lower in patients with ECV (52.9% versus 79.6%). The rate of spontaneous deliveries was significantly higher (36% -versus 12%).

  10. Cephalic version by moxibustion for breech presentation.

    Science.gov (United States)

    Coyle, Meaghan E; Smith, Caroline A; Peat, Brian

    2012-05-16

    Moxibustion (a type of Chinese medicine which involves burning a herb close to the skin) to the acupuncture point Bladder 67 (BL67) (Chinese name Zhiyin), located at the tip of the fifth toe, has been proposed as a way of correcting breech presentation. To examine the effectiveness and safety of moxibustion on changing the presentation of an unborn baby in the breech position, the need for external cephalic version (ECV), mode of birth, and perinatal morbidity and mortality for breech presentation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (26 March 2012), MEDLINE (1966 to 1 August 2011), EMBASE (1980 to August 2011), CINAHL (1982 to 1 August 2011), MIDIRS (1982 to 1 August 2011) and AMED (1985 to 1 August 2011) and searched bibliographies of relevant papers. The inclusion criteria were published and unpublished randomised controlled trials comparing moxibustion (either alone or in combination with acupuncture or postural techniques) with a control group (no moxibustion), or other methods (e.g. external cephalic version, acupuncture, postural techniques) in women with a singleton breech presentation. Two review authors independently assessed eligibility and trial quality and extracted data. The outcome measures were baby's presentation at birth, need for external cephalic version, mode of birth, perinatal morbidity and mortality, maternal complications and maternal satisfaction, and adverse events. Six new trials have been added to this updated review. One trial has been moved to studies awaiting classification while further data are being requested. This updated review now includes a total of eight trials (involving 1346 women). Meta-analyses were undertaken (where possible) for the main and secondary outcomes. Moxibustion was not found to reduce the number of non-cephalic presentations at birth compared with no treatment (P = 0.45). Moxibustion resulted in decreased use of oxytocin before or during labour for women who had vaginal

  11. Maternal and neonatal complications in term breech delivered vaginally

    International Nuclear Information System (INIS)

    Jadoon, S.; Jadoon, S.M.K.; Shah, R.

    2008-01-01

    To evaluate the maternal and neonatal complications in terms of genital tract trauma to mother, perinatal mortality. Apgar score at 5 minutes and neonatal trauma in all singleton term breech cases delivered vaginally. A 100 consecutive patients with singleton breech presentation, whether booked or unbooked, were admitted and delivered vaginally in hospital during the study period. They were studied for maternal and neonatal complications. Maternal complication included any genital tract trauma during delivery while neonatal complications were perinatal mortality, low Apgar score (less than eight at 5 minutes) and birth trauma. There were a total 3977 deliveries during this study period, 145 breech presentation (incidence 3.6%). Out of those, 100 were included in the study. All were unbooked cases, 87% were multigravida while 13% were primigravida. An Apgar score of eight was recorded in 87% babies while 10% had an Apgar score of less than eight after 5 minutes. There were 3 still births and one neonatal death. Aggregated perinatal mortality rate was 40/1000 live births. Only one baby had birth trauma (Erbs paralysis) during vaginal breech delivery. Ninety seven (97%) mothers had no complications while only 3 (3%) had complications. Out of these, one had cervical tear and 2 had vaginal tears. Offering a trial of vaginal breech delivery to strictly selected and well-counselled patients remains an appropriate option without compromising perinatal and maternal outcome. It also decreases the rate of operative delivery for this malpresentation. (author)

  12. Breech presentation at a district level hospital in South Africa

    African Journals Online (AJOL)

    2009-03-05

    Mar 5, 2009 ... The results of the Term Breech Trial led the researchers to conclude that the combined ... and methodology of the Term Breech Trial6 and suggestions made that .... gestation), giving an incidence of 2.4%. Three hundred and ...

  13. Pregnancy outcome in singleton term breeches from a referral ...

    African Journals Online (AJOL)

    It is recommended that attention should be given to trainee obstetrician in selective external cephalic version at term and also the procedure of AVBD so as to reduce the caesarean section rate and also neonatal morbidity in term breeches in our community. Keywords: Pregnancy outcome, Singleton breech, Vaginal ...

  14. Elective cesarean delivery for term breech

    DEFF Research Database (Denmark)

    Krebs, Lone; Langhoff-Roos, Jens

    2003-01-01

    and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women......OBJECTIVE: To compare the maternal complications of elective cesarean delivery for breech at term with those after vaginal or emergency cesarean delivery. METHODS: We conducted a population-based, retrospective cohort study of 15441 primiparas who delivered singleton breech at term. Information...... was obtained from the Danish Medical Birth Register, the Register of Death Causes, and the Denmark Patient Register. RESULTS: Elective cesarean delivery was associated with lower rates of puerperal fever and pelvic infection (relative risk [RR] 0.81; 95% confidence interval [CI] 0.70, 0.92), hemorrhage...

  15. Facilitators and barriers to external cephalic version for breech presentation at term among health care providers in the Netherlands: a quantitative analysis.

    Science.gov (United States)

    Rosman, Ageeth N; Vlemmix, Floortje; Beuckens, Antje; Rijnders, Marlies E; Opmeer, Brent C; Mol, Ben Willem J; Kok, Marjolein; Fleuren, Margot A H

    2014-03-01

    guidelines recommend that external cephalic version (ECV) should be offered to all women with a fetus in breech presentation at term. However, only 50-60% of the women receive an ECV attempt. We explored the determinants (barriers and facilitators) affecting the uptake of the guidelines among gynaecologists and midwives in the Netherlands. national online survey. the Netherlands. gynaecologists and midwives. in the online survey, we identified the determinants that positively or negatively influenced the professionals׳ adherence to three key recommendations in the guidelines: (a) counselling, (b) advising for ECV, (c) arranging an ECV. Determinants were identified in a previously performed qualitative study and were categorised into five underlying constructs; attitude towards ECV, professional obligation, outcome expectations, self-efficacy and preconditions for successful ECV. We performed a multivariate analysis to assess the importance of the different constructs for adherence to the guideline. 364 professionals responded to the survey. Adherence varied: 84% counselled, 73% advised, and 82% arranged an ECV for (almost) all their clients. Although 90% of respondents considered ECV to be an effective treatment for preventing caesarean childbirths, only 30% agreed that 'every client should undergo ECV'. Self-efficacy (perceived skills) was the most important determinant influencing adherence. self-efficacy appears to be the most significant determinant for counselling, advising and arranging an ECV. to improve adherence to the guidelines on ECV we must improve self-efficacy. Copyright © 2014. Published by Elsevier Ltd.

  16. Finding the breech: Influence of breech presentation on mode of delivery based on timing of diagnosis, attempt at external cephalic version, and provider success with version.

    Science.gov (United States)

    Andrews, Suzanne; Leeman, Lawrence; Yonke, Nicole

    2017-09-01

    Breech presentation affects 3-4% of pregnancies at term and malpresentation is the primary indication for 10-15% of cesarean deliveries. External cephalic version is an effective intervention that can decrease the need for cesarean delivery; however, timely identification of breech presentation is required. We hypothesized that women with a fetus in a breech presentation that is diagnosed after 38 weeks' estimated gestational age have a decreased likelihood of external cephalic version attempted and an increased likelihood of cesarean delivery. This was a retrospective cohort study. A chart review was performed for 251 women with breech presentation at term presenting to our tertiary referral university hospital for external cephalic version, cesarean for breech presentation, or vaginal breech delivery. Vaginal delivery was significantly more likely (31.1% vs 12.5%; Pexternal cephalic version was offered, and subsequently attempted in a greater proportion of women diagnosed before 38 weeks. External cephalic version was more successful when performed by physicians with greater procedural volume during the 3.5 year period of the study (59.1% for providers performing at least 10 procedures vs 31.3% if performing fewer than 10 procedures, Pexternal cephalic version. © 2017 Wiley Periodicals, Inc.

  17. Risk of developmental dysplasia of the hip in breech presentation: the effect of successful external cephalic version

    NARCIS (Netherlands)

    Lambeek, A. F.; de Hundt, M.; Vlemmix, F.; Akerboom, B. M. C.; Bais, J. M. J.; Papatsonis, D. N. M.; Mol, B. W. J.; Kok, M. [=Marjolein

    2013-01-01

    To evaluate the effect of successful external cephalic version on the incidence of developmental dysplasia of the hip (DDH) requiring treatment in singleton breech presentation at term. Observational cohort study. Three large teaching hospitals in the Netherlands. Women with a singleton breech

  18. Maternal deaths after elective cesarean section for breech presentation in the Netherlands

    NARCIS (Netherlands)

    Schutte, Joke M.; Steegers, Eric A. P.; Santema, Job G.; Schuitemaker, Nico W. E.; Van Roosmalen, Jos

    2007-01-01

    Background and methods. The cesarean section rate for term singleton breech babies in the Netherlands rose from 57 to 81% after the Term Breech Trial in 2000. The Dutch Maternal Mortality Committee registered and evaluated maternal mortality due to elective cesarean section for breech. Results. Four

  19. External cephalic version before elective caesarean section for breech presentation

    International Nuclear Information System (INIS)

    Zafar, F.; Sanusi, A.

    2008-01-01

    The Royal College of Obstetrics and Gynaecology guidelines state that all uncomplicated breech Presentation should be offered external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version before undertaking the procedure. To ascertain the acceptability of external cephalic version before elective caesarean section for breech Presentation by pregnant ladies and see whether they were adequately informed about the risks and benefits. The clinical audit was registered with the audit department at Watford general hospital and written Consent for the access of medical records was obtained. A retrospective view of 86 accessible medical records out of Total 110 elective breech caesarean sections was done over a period of one year. This retrospective study was conducted at the gynaecology and obstetrics department at Watford general hospital, Watford United Kingdom. Written consent for the access of medical records was obtained. All women who under went elective caesarean section due to breech presentation were included in the study. Out of a total of 110 elective breech caesarean sections performed, the data on 86 cases was selected for the final analysis. The information gathered included patient's profile, whether patient was informed of risks and benefits of external cephalic version, recognition of obstetric risk factors, external cephalic version performed and its success. Out of total 86 caesarean sections 46 were suitable for external cephalic version of whom 37 cases were offered external cephalic version. Among 37 patients who were offered external cephalic version only 15 patients accepted (22 declined) the procedure. Moreover, it was found that the documentation of risk/benefit explanation of the procedure was inadequate. External cephalic version was not successful in any of the patient. Causes for

  20. Cephalic version by postural management for breech presentation.

    Science.gov (United States)

    Hofmeyr, G Justus; Kulier, Regina

    2012-10-17

    Babies with breech presentation (bottom first) are at increased risk of complications during birth, and are often delivered by caesarean section. The chance of breech presentation persisting at the time of delivery, and the risk of caesarean section, can be reduced by external cephalic version (ECV - turning the baby by manual manipulation through the mother's abdomen). It is also possible that maternal posture may influence fetal position. Many postural techniques have been used to promote cephalic version. The objective of this review was to assess the effects of postural management of breech presentation on measures of pregnancy outcome. We evaluated procedures in which the mother rests with her pelvis elevated. These include the knee-chest position, and a supine position with the pelvis elevated with a wedge-shaped cushion. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (22 August 2012). Randomised and quasi-randomised trials comparing postural management with pelvic elevation for breech presentation, with a control group. One or both review authors assessed eligibility and trial quality. We have included six studies involving a total of 417 women. The rates for non-cephalic births, Cesarean section and Apgar scores below 7 at one minute, regardless of whether ECV was attempted or not, were similar between the intervention and control groups (risk ratio (RR) 0.98; 95% confidence interval (CI) 0.84 to 1.15; RR 1.10; 95% CI 0.89 to 1.37; RR 0.88; 95% CI 0.50 to 1.55). There is insufficient evidence from well-controlled trials to support the use of postural management for breech presentation. The numbers of women studied to date remain relatively small. Further research is needed.

  1. Breech at term--mode of delivery? A register-based study

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Weber, Tom

    1995-01-01

    ) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores. CONCLUSIONS. Register data on singleton term breech deliveries imply......BACKGROUND. The present study was designed to determine neonatal mortality and morbidity in non-malformed singleton term infants delivered in breech presentation and identify a possible correlation between outcome on the one hand and mode of delivery, parity and birth weight on the other. METHODS....... Register-based cohort study of all (n = 15718) singleton term breech deliveries of non-malformed infants in Denmark 1982-1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. RESULTS. A total...

  2. Detecting Breech Presentation Before Labour: Lessons From a Low-Risk Maternity Clinic.

    Science.gov (United States)

    Ressl, Bill; O'Beirne, Maeve

    2015-08-01

    Evaluation of fetal position is an important part of prenatal care. A woman with a breech presentation may need referral for external cephalic version, for assisted breech delivery, or to schedule a Caesarean section. In many centres, a breech presentation undetected until labour will result in an emergency Caesarean section, a less desirable alternative for both the mother and the health care system. The anecdotal reports of undiagnosed breech presentations at a busy maternity clinic prompted a study to quantify the missed breech presentations and to evaluate the effectiveness of the current detection process, with the aim of allowing no more than 1% of breech presentations to remain undetected until labour. We performed a retrospective analysis of 102 breech deliveries over a 14 month period to quantify missed breech presentations, and used a prospective physician survey documenting how fetal presentation was determined at 186 prenatal visits over four months to analyze the current detection process. We found that approximately 8% of breech presentations were undetected until labour. We concluded that within the limitations of the small sample size evaluated, the current practice of using a vaginal examination to verify fetal presentation determined by abdominal palpation (Leopold's manoeuvres) may not be more accurate than abdominal palpation alone. The current detection process resulted in an unacceptably high rate of missed breech presentations. The results of this study prompted the clinic's acquisition of bedside ultrasound capability to assess fetal position.

  3. Vaginal delivery versus cesarean section for term breech delivery

    Directory of Open Access Journals (Sweden)

    Babović Ivana

    2010-01-01

    Full Text Available Background/Aim. The optimal method of delivery for breech presentation at term still remains a matter of controversy. This is probably due to the fact that the skills of vaginal breech delivery are being lost. The aim of this study was to examine risk factors: mother's age, parity, labor's duration, estimated neonatal birth weight for the mode of breech presentation delivery at term as well as the influence of the delivery mode on neonatal outcome. Methods. A retrospective study of 401 terms (more than 37 week's gestation breech deliveries at the Institute of Gynecology and Obstetrics, Belgrade, from 2007 to 2008 was made. The following groups with respect to mode of delivery were included: the group I - vaginal delivery (VD in 139 patients; the group II - urgent cesarean section (UCS in 128 patients; and the group III - elective cesarean section (ECS in 134 patients. Mother's age, parity, duration of VD, neonatal birth weight (BW, the Apgar score at 5th minute, and duration of stay in a neonatal intensive care unit (NICU vere determined. Neonatal mortality and major neonatal morbidity were compared according to the route of delivery. Fetuses and neonates with hemolytic disease and fetal and neonatal anomalies were excluded from the study. For statistical analyses we performed Student's t test, χ2 likelihood ratio, Kruskall-Wallis test, Mann Whitney test, and ANOVA. Results. The mean age of patients in the group I was 28.29 ± 4.97 years, in the group II 29.68 ± 5.92 years and in the group III 30.06 ± 5.41 years. Difference in mother's age between the group I and III was significant (p = 0.022. In the group III there were 73.9% nuliparous similarly to the gropu II (73.4%. We performed ECS in 54.6% of the nuliparous older than 35 years, and 54.4% multiparous younger than 35 years were delivered by VD. The use of oxytocin for stimulation of vaginal labor was not associated with its duration (p = 0.706. Lowset maneuver was performed in 88.5% of

  4. [External cephalic version in cases of breech presentation: renaissance of a well-known procedure?].

    Science.gov (United States)

    Schmidt, M; Callies, R; Kuhn, U; Willruth, A; Kimmig, R

    2009-01-01

    About 3-4% of all pregnant women will have a fetus presenting by the breech at term. External cephalic version offers the opportunity to reduce the rate of caesarean sections caused by breech presentation. We analysed retrospectively 51 cases of external cephalic version at our clinic. External cephalic version was performed 51 times between 37 and 41 weeks of pregnancy. External cephalic version was successful in 32/51 cases (62,7%) with a consecutive rate of vaginal delivery of 71,9%. The best results were seen at 37 weeks of pregnancy with 81,25% of successful versions followed by 76,9% of vaginal deliveries. Complications were rare. There was just 1 case of emergency caesarean section due to persisting fetal bradycardia. External cephalic version is an effective and safe treatment to enable vaginal delivery of cephalic presentation. For this operation, 37 weeks of pregnancy can be considered the best time. 2009 S. Karger AG, Basel.

  5. How singleton breech babies at term are born in France: a survey of data from the AUDIPOG network.

    Science.gov (United States)

    Lansac, J; Crenn-Hebert, C; Rivière, O; Vendittelli, F

    2015-05-01

    Based on data from the AUDIPOG sentinel network between 1994 and 2010, we can say that the rate of singleton breech presentation at term is 3% and remains unchanged despite an external cephalic version rate of 35%. The total cesarean section rate is currently 75%. This rate increased by nearly 20% after the Hannah publication in 2000, regardless of the type of breech and type of maternity unit. The rate of planned cesarean sections increased in particular, going from 40% to 60%, and even reaching 67% for footling breech presentations. The rate is higher in type I maternity units than in type II or III. This cesarean section rate has been stable since 2005 and has even decreased for the Frank breech. The average rate of external cephalic version remains stable at around 23%. The episiotomy rate is 28%. The rate of babies transferred to neonatology units is higher for breech babies at term than for babies presenting cephalically (3.9% compared to 2.9%), but the newborns most often transferred are those born by cesarean section (4.1% compared to 3.4%). Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Risk of developmental dysplasia of the hip in breech presentation: the effect of successful external cephalic version.

    Science.gov (United States)

    Lambeek, A F; De Hundt, M; Vlemmix, F; Akerboom, B M C; Bais, J M J; Papatsonis, D N M; Mol, B W J; Kok, M

    2013-04-01

    To evaluate the effect of successful external cephalic version on the incidence of developmental dysplasia of the hip (DDH) requiring treatment in singleton breech presentation at term. Observational cohort study. Three large teaching hospitals in the Netherlands. Women with a singleton breech presentation of 34 weeks of gestation or more, who underwent an external cephalic version attempt. We made a comparison of the incidence of DDH between children born in breech presentation and children born in cephalic presentation after a successful external cephalic version. The incidence of DDH requiring either conservative treatment, with a harness, or surgical treatment. A total of 498 newborns were included in the study, of which 40 (8%) were diagnosed with DDH and 35 required treatment. Multivariate analysis showed that female gender (OR 2.79, 95% CI 1.23-6.35) and successful external cephalic version (OR 0.29, 95% CI 0.09-0.95) were independently associated with DDH. A successful external cephalic version is associated with a lower incidence of DDH, although a high percentage of children born after a successful external cephalic version still appear to have DDH. A larger cohort study is needed to establish the definite nature of this relationship. Until then, we recommend the same screening policy for infants born in cephalic position after a successful external cephalic version as for infants born in breech position. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  7. Changes in vaginal breech delivery rates in a single large metropolitan area.

    LENUS (Irish Health Repository)

    Hehir, Mark P

    2012-06-01

    Vaginal breech delivery rates have been accepted widely to be in decline and the Term Breech Trial (TBT) has recommended delivery of a breech-presenting infant by elective cesarean section delivery. Our aim was to examine the rate of vaginal delivery of term breech pregnancies in the 8 years before and after the publication of the TBT.

  8. The breech presentation and the vertex presentation following an external version represent risk factors for neonatal hip instability.

    Science.gov (United States)

    Andersson, J E; Odén, A

    2001-08-01

    The aim of this study was to evaluate the frequency and type of hip-joint instability and the frequency of hip dislocation requiring treatment in neonates who had been lying in the breech presentation and were delivered vaginally after an external version or by caesarean section, and to compare them with neonates who were naturally in the vertex presentation. Breech presentations without ongoing labour were subjected to an attempted external version and, in cases where this proved unsuccessful or where labour had started, to deliver by caesarean section. None of the breech presentations was vaginally delivered. The anterior-dynamic ultrasound method was used to assess the hip-joint status of the neonates. Out of 6,571 foetuses, 257 were in breech presentation after 36 wk of pregnancy. Sixty-two were vaginally delivered following an external version to vertex presentation and 195 were delivered by caesarean section, 75 of these following unsuccessful attempts to perform a version. Treatment for congenital hip-joint dislocation was performed on 0.2%. Out of the breech presentations, 1.0% of those delivered by caesarean section were treated, while in those with vaginal delivery following an external version the treatment frequency was 3.2%. No case of late diagnosed hip dislocation was recorded. Significant differences in frequency of hip-joint instability and treatment were found between (i) neonates delivered in breech presentation and those delivered with vertex presentation, (ii) infants delivered in vertex presentation, naturally or after successful version, and (iii) those delivered by caesarean section with or without attempted external version and those delivered with vortex presentation. Breech presentation predisposes to increased hip instability. The instability is present prior to delivery and is certainly not a primary result of delivery forces. Both breech and vertex presentations following an external or spontaneous version should be considered as risk

  9. Elective Caesarean Section for Breech Presentation in First Pregnancy and Subsequent Mode of Labour

    International Nuclear Information System (INIS)

    Khaskheli, M.; Baloch, S.; Sheeba, A.

    2014-01-01

    Objective: To determine the effect on subsequent mode of labour in case of previous elective caesarean for breech presentation in primiparous women. Study Design: A cohort study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, Unit-1 and 1V, from January 2005 to December 2009. Methodology: All women with previous one elective caesarean section for breech or cephalic presentation visited OPD for antenatal checkup or admitted in emergency in maternity or labour ward were recruited for the study, while the women with previous 2 and 3 caesarean section were excluded from the study. The case records of these women were reviewed thoroughly, and entered in predesigned proforma. The main outcome measure was mode of labour in current pregnancy decided electively or adopted in emergency. Results: Out of the total, 131 (16.92%) women had previous elective caesarean section due to breech presentation while 643 (83.07%) women had previous elective caesarean section with cephalic presentation. Overall repeat caesarean section rate was 92 (70.22%) in women with previous breech presentation (n=131) in comparison with 475 (73.87%) women with previous cephalic presentation n=643 (RR=1.04, p=0.32). The vaginal birth rate after elective caesarean section due to breech presentation was 39 (29.77%) in comparison with 168 (26.12%) cases with previous cephalic presentation (RR=0.98, p=0.83). Conclusion: Women having elective caesarean section for breech presentation in their previous pregnancy had about 1 in 6 chance of having repeat elective caesarean section. (author)

  10. External cephalic version of the term breech baboon (Papio sp.) fetus.

    Science.gov (United States)

    Barrier, Breton F; Joiner, Laura Lee Rihl; Jimenez, Joe B; Leland, M Michelle

    2007-06-01

    Breech presentation in baboons may be associated with head entrapment and stillbirth during vaginal delivery. For this reason, pregnant dams at our institution typically undergo cesarean delivery for known breech presentation, leading to problems with maternal-infant bonding and increased nursery utilization. This paper describes a simple, non-invasive technique called external cephalic version (ECV) that effectively converts the baboon breech fetus into a cephalic presentation. ECV was successful in each of seven attempted cases, with the consistent development of contractions and vaginal bleeding leading to the delivery of a healthy liveborn infant within 72 hours. ECV may offer a safe and effective alternative to cesarean section for delivery of the breech baboon fetus.

  11. Protocol for the evaluation of a decision aid for women with a breech-presenting baby [ISRCTN14570598

    Directory of Open Access Journals (Sweden)

    Peat Brian

    2004-12-01

    Full Text Available Abstract Background There is now good evidence about the management options for pregnant women with a breech presentation (buttocks or feet rather than head-first at term; external cephalic version (ECV – the turning of a breech baby to a head-down position and/or planned caesarean section (CS. Each of these options has benefits and risks and the relative importance of these vary for each woman, subject to her personal values and preferences, a situation where a decision aid may be helpful. Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. The ECV decision aid was developed using the Ottawa Decision Support Framework, including a systematic review of the evidence about the benefits and risks of the options for breech pregnancy. It comprises an audiotape with a supplementary booklet and worksheet, a format that can be taken home and discussed with a partner. This project aims to evaluate the ECV decision aid for women with a breech presenting baby in late pregnancy. Study design We aim to evaluate the effectiveness of the decision aid compared with usual care in a randomised controlled trial in maternity hospitals that offer ECV. The study group will receive the decision aid in addition to usual care and the control group will receive standard information on management options for breech presentation from their usual pregnancy care provider. Approximately 184 women with a single breech-presenting baby at greater than 34 weeks gestation and who are clinically eligible for ECV will be recruited for the trial. The primary outcomes of the study are knowledge, decisional conflict, anxiety and satisfaction with decision-making that

  12. Protocol for the evaluation of a decision aid for women with a breech-presenting baby [ISRCTN14570598

    Science.gov (United States)

    Roberts, Christine L; Nassar, Natasha; Barratt, Alexandra; Raynes-Greenow, Camille H; Peat, Brian; Henderson-Smart, David

    2004-01-01

    Background There is now good evidence about the management options for pregnant women with a breech presentation (buttocks or feet rather than head-first) at term; external cephalic version (ECV) – the turning of a breech baby to a head-down position and/or planned caesarean section (CS). Each of these options has benefits and risks and the relative importance of these vary for each woman, subject to her personal values and preferences, a situation where a decision aid may be helpful. Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. The ECV decision aid was developed using the Ottawa Decision Support Framework, including a systematic review of the evidence about the benefits and risks of the options for breech pregnancy. It comprises an audiotape with a supplementary booklet and worksheet, a format that can be taken home and discussed with a partner. This project aims to evaluate the ECV decision aid for women with a breech presenting baby in late pregnancy. Study design We aim to evaluate the effectiveness of the decision aid compared with usual care in a randomised controlled trial in maternity hospitals that offer ECV. The study group will receive the decision aid in addition to usual care and the control group will receive standard information on management options for breech presentation from their usual pregnancy care provider. Approximately 184 women with a single breech-presenting baby at greater than 34 weeks gestation and who are clinically eligible for ECV will be recruited for the trial. The primary outcomes of the study are knowledge, decisional conflict, anxiety and satisfaction with decision-making that will be assessed using

  13. [Fewer caesarean sections for breech presentation following external cephalic version according to a protocol in a special office visit].

    Science.gov (United States)

    Kuppens, S M I; Hasaart, T H M; van der Donk, M W P; Huibers, M; Franssen, M J; de Becker, B M J; Wijnen, H A A; Pop, V J M

    2008-06-07

    Identification of determinants affecting the outcome of external cephalic version (ECV) in breech presentation, and investigation of the impact of ECV--performed according to a standardized protocol in an outpatient clinic--on the mode of delivery. Retrospective analysis. In 2003 a standardized protocol of ECV was developed in the outpatient clinic for obstetrics of the Catharina Hospital in Eindhoven, the Netherlands; it was tested in 'version office visits'. Obstetric characteristics of all pregnant women who underwent attempts of ECV in the clinic from January 2004 until June 2006 during these sessions, and the subsequent births, were analysed. 85% of all ECVs were performed by the same hospital midwife and gynaecologist, in accordance with the protocol. ECV was successful in 96 of 209 pregnant women (46%). In 1 pregnant woman an emergency caesarean section was performed after ECV because of partial abruptio placentae. Nulliparity, incomplete breech presentation and low birth weight of the baby were associated with a lower success rate of ECV in this study. In the group with a successful ECV the percentage of caesarean deliveries was substantially lower (9 versus 83%; odds ratio: 0.21; 95% CI: 0.09-0.51). A regular team consisting of a hospital midwife and a gynaecologist working according to a standardized protocol for ECV in a case of breech presentation proved successful: the number of term breech presentations substantially diminished and therefore the percentage of caesarean sections was lower in the group in which ECV had been successful. This could have considerable impact on health care in the Netherlands in terms of reduced maternal morbidity and cost savings.

  14. Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports.

    Science.gov (United States)

    Petrovska, Karolina; Sheehan, Athena; Homer, Caroline S E

    2017-07-01

    Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth. © 2017 by the American College of Nurse-Midwives.

  15. [Impact of the external cephalic version on the obstetrical prognosis in a team with a high success rate of vaginal delivery in breech presentation].

    Science.gov (United States)

    Coppola, C; Mottet, N; Mariet, A S; Baeza, C; Poitrey, E; Bourtembourg, A; Ramanah, R; Riethmuller, D

    2016-10-01

    To analyse the impact of external cephalic version (ECV) on caesarean section rate in a team with a high success rate of vaginal delivery in breech presentation. Retrospective monocentric study including 298 patients with a breech presentations between 33 and 35weeks of amenorrhea followed at our university hospital and delivered after 35weeks, between 1st January 2011 and 31st December 2013. Patients were divided into 2 groups: planned ECV (n=216 patients) versus no planned ECV (n=57 patients). Our rate of successful vaginal breech delivery over the period of the study was 61.1%. We performed 165 ECV, with a 21.8% success rate. The average term of the attempt of ECV was 36.7weeks of amenorrhea. The caesarean section rate was not significantly different in the planned ECV group, even after adjustment on age, parity and previous caesarean delivery (adjusted OR=1.67 [0.77-3.61]). Attempt of ECV did not reduce the number of breech presentation at delivery (61.1% versus 61.4% [P=0.55]). Planned ECV in our center with a high level of breech vaginal delivery did not significantly impact our cesarean section rate. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. External cephalic version for singleton breech presentation: proposal of a practical check-list for obstetricians.

    Science.gov (United States)

    Indraccolo, U; Graziani, C; Di Iorio, R; Corona, G; Bonito, M; Indraccolo, S R

    2015-07-01

    External cephalic version (ECV) for breech presentation is not routinely performed by obstetricians in many clinical settings. The aim of this work is to assess to what extent the factors involved in performing ECV are relevant for the success and safety of ECV, in order to propose a practical check-list for assessing the feasibility of ECV. Review of 214 references. Factors involved in the success and risks of ECV (feasibility of ECV) were extracted and were scored in a semi-quantitative way according to textual information, type of publication, year of publication, number of cases. Simple conjoint analysis was used to describe the relevance found for each factor. Parity has the pivotal role in ECV feasibility (relevance 16.6%), followed by tocolysis (10.8%), gestational age (10.6%), amniotic fluid volume (4.7%), breech variety (1.9%), and placenta location (1.7%). Other factors with estimated relevance around 0 (regional anesthesia, station, estimated fetal weight, fetal position, obesity/BMI, fetal birth weight, duration of manoeuvre/number of attempts) have some role in the feasibility of ECV. Yet other factors, with negative values of estimated relevance, have even less importance. From a logical interpretation of the relevance of each factor assessed, ECV should be proposed with utmost prudence if a stringent check-list is followed. Such a check-list should take into account: parity, tocolytic therapy, gestational age, amniotic fluid volume, breech variety, placenta location, regional anesthesia, breech engagement, fetal well-being, uterine relaxation, fetal size, fetal position, fetal head grasping capability and fetal turning capability.

  17. Breech at term--mode of delivery? A register-based study

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Weber, Tom

    1995-01-01

    . Register-based cohort study of all (n = 15718) singleton term breech deliveries of non-malformed infants in Denmark 1982-1990. Process and outcome measures: mode of delivery, gestational age, birth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. RESULTS. A total...... of 3247 (20.7%) term infants were delivered vaginally, 7106 (45.3%) by elective and 5356 (34.1%) by emergency cesarean section. Infants delivered vaginally and by emergency cesarean section had significantly higher rates of mortality (intrapartum and early neonatal death) and morbidity (low Apgar scores......) when compared to those delivered by elective cesarean section. In vaginal deliveries, parity was not correlated with outcome, but infants with a birth weight above 4000 grams had significantly higher rates of low Apgar scores. CONCLUSIONS. Register data on singleton term breech deliveries imply...

  18. Is routine caesarean section necessary for breech-breech and ...

    African Journals Online (AJOL)

    Subjects: Twin gestations with breech-breech and breech-transverse presentations. Main outcome measures: Birth weights, 5-minute Apgar scores and neonatal mortality rates among 41 women who underwent vaginal delivery were compared with those of 27 who underwent transverse lower-segment caesarean sections.

  19. Brief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation.

    Science.gov (United States)

    Carvalho, Brendan; Tan, Jonathan M; Macario, Alex; El-Sayed, Yasser Y; Sultan, Pervez

    2013-07-01

    In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. Using a computer cost model, which considers possible outcomes and probability uncertainties at the same time, we estimated total expected delivery costs for breech presentation managed by a trial of ECV with and without neuraxial anesthesia. From published studies, the average probability of successful ECV with neuraxial anesthesia was 60% (with individual studies ranging from 44% to 87%) compared with 38% (with individual studies ranging from 31% to 58%) without neuraxial anesthesia. The mean expected total delivery costs, including the cost of attempting/performing ECV with anesthesia, equaled $8931 (2.5th-97.5th percentile prediction interval $8541-$9252). The cost was $9207 (2.5th-97.5th percentile prediction interval $8896-$9419) if ECV was attempted/performed without anesthesia. The expected mean incremental difference between the total cost of delivery that includes ECV with anesthesia and ECV without anesthesia was $-276 (2.5th-97.5th percentile prediction interval $-720 to $112). The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.

  20. Contraindications for external cephalic version in breech position at term: a systematic review.

    Science.gov (United States)

    Rosman, Ageeth N; Guijt, Aline; Vlemmix, Floortje; Rijnders, Marlies; Mol, Ben W J; Kok, Marjolein

    2013-02-01

    External cephalic version (ECV) is a safe and effective intervention that can prevent breech delivery, thus reducing the need for cesarean delivery. It is recommended in national guidelines. These guidelines also mention contraindications for ECV, and thereby restrict the application of ECV. We assessed whether the formulation of these contraindications in guidelines are based on empiric data. Systematic review. Pregnant women with a singleton breech presentation from 34 weeks. We searched the National Guideline Clearinghouse, the Cochrane Central Register of Controlled Trials, MEDLINE (1953-2009), EMBASE (1980-2009), TRIP database (until 2011), NHS (National Health Services, until 2011), Diseases database (until 2011) and NICE guidelines (until 2011) for existing guidelines on ECV and studied the reproducibility of the contraindications stated in the guidelines. Furthermore, we systematically reviewed the literature for contraindications and evidence on these contraindications. Contraindications of ECV. We found five guidelines mentioning 18 contraindications, varying from five to 13 per guideline. The contraindications were not reproducible between the guidelines with oligohydramnios as the only contraindication mentioned in all guidelines. The literature search yielded 60 studies reporting on 39 different contraindications, of which we could only assess evidence of six of them. The present study shows that there is no general consensus on the eligibility of patients for ECV. Therefore we propose to limit contraindications for ECV to clear empirical evidence or to those with a clear pathophysiological relevance. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. Risks of vaginal breech delivery at term compared with elective cesarean section - reply to comments by Walker and Powell, and Sholapurkar

    NARCIS (Netherlands)

    Vlemmix, Floortje; Mol, Ben Willem; Kok, Marjolein

    2015-01-01

    We thank both Walker and Powell (1), as well as Sholapurkar (2) for their interest in our work. Walker and Powell note that the risk of neonatal mortality for planned vaginal breech delivery (VBD) in our study is lower than the mortality reported in the term breech trial and comparable to the risk

  2. Predictors of successful outcomes after external cephalic version in singleton term breech pregnancies: a nine-year historical cohort study.

    Science.gov (United States)

    Cho, L Y; Lau, W L; Lo, T K; Tang, Helen H T; Leung, W C

    2012-02-01

    To study the success rate, predictors for success, and pregnancy outcomes after external cephalic version. Historical cohort study. Regional hospital, Hong Kong. All women who had singleton term breech pregnancies at term and opted for external cephalic version during 2001 and 2009. Their demographic data, clinical and ultrasound findings, procedure details, complications, and delivery outcomes were analysed. Predictive factors for successful external cephalic version. A total of 209 external cephalic versions were performed during the 9-year period. The success rate was 63% (75% for multiparous and 53% for nulliparous women). There was no significant complication. On univariate analysis, predictors of successful external cephalic version were: multiparity, unengaged presenting part, higher amniotic fluid index (≥ 10 cm), thin abdominal wall, low uterine tone, and easily palpable fetal head (subjective assessment by practitioners before external cephalic version). On multivariate analysis, only multiparity, non-engagement of the fetal buttock and thin maternal abdomen were associated with successful external cephalic version. In all, 69% of those who had successful external cephalic version succeeded in the first roll (Pexternal cephalic versions had vaginal deliveries (93% in multiparous and 69% in nulliparous women). Uptake rate of external cephalic version was studied in the latter part of the study period (2006-2009). Whilst 735 women were eligible for external cephalic version, 131 women chose to have the procedure resulting in an uptake rate of 18%. External cephalic version was effective in reducing breech presentations at term and corresponding caesarean section rates, but the uptake rate was low. Further work should address the barriers to the low acceptance of external cephalic version. The results of this study could encourage women to opt for external cephalic version.

  3. Amnioinfusion for women with a singleton breech presentation and a previous failed external cephalic version: a randomized controlled trial.

    Science.gov (United States)

    Diguisto, Caroline; Winer, Norbert; Descriaud, Celine; Tavernier, Elsa; Weymuller, Victoire; Giraudeau, Bruno; Perrotin, Franck

    2018-04-01

    Our trial aimed to assess the effectiveness of amnioinfusion for a second attempt at external cephalic version (ECV). This open randomized controlled trial was planned with a sequential design. Women at a term ≥36 weeks of gestation with a singleton fetus in breech presentation and a first unsuccessful ECV were recruited in two level-3 maternity units. They were randomly allocated to transabdominal amnioinfusion with a 500-mL saline solution under ultrasound surveillance or no amnioinfusion before the second ECV attempt. Trained senior obstetricians performed all procedures. The primary outcome was the cephalic presentation rate at delivery. Analyses were conducted according to intention to treat (NCT00465712). Recruitment difficulties led to stopping the trial after a 57-month period, 119 women were randomized: 59 allocated to amnioinfusion + ECV and 60 to ECV only. Data were analyzed without applying the sequential feature of the design. The rate of cephalic presentation at delivery did not differ significantly according to whether the second version attempt was or was not preceded by amnioinfusion (20 versus 12%, p = .20). Premature rupture of the membranes occurred for 15% of the women in the amnioinfusion group. Amnioinfusion before a second attempt to external version does not significantly increase the rate of cephalic presentation at delivery.

  4. A randomized trial of remifentanil for analgesia in external cephalic version for breech presentation.

    Science.gov (United States)

    Liu, Xiaohua; Xue, Aiqin

    2016-12-01

    Although external cephalic version (ECV) can be effective for correcting the fetus in a cephalic presentation, it may be painful for the mother. This study aimed to evaluate the efficacy and safety of remifentanil for pain relief during ECV in China. In all, 152 Chinese parturients with singleton breech presentation were randomly divided into 2 groups, each with 76 patients. All 152 patients were assigned to receive either remifentanil (infused at 0.1 μg/kg/min and demand boluses of 0.1 μg/kg) or saline placebo. The study was performed between January 2012 and December 2015. Outcome measurements included the Numerical Rating Pain Scale score (0-10) after ECV, success rate for ECV, and maternal satisfaction after ECV. Adverse events were also evaluated. The study was completed by 146 patients. Remifentanil showed greater efficacy than placebo in decreasing the pain score immediately after ECV (remifentanil 4.6 ± 2.6 vs placebo 6.5 ± 2.7; P < 0.001). The success rate for ECV showed a significant difference between the 2 groups (remifentanil 56.5% vs placebo 39.5%; P = 0.04). Maternal satisfaction also showed a significant difference between the 2 groups (remifentanil 9.6 ± 1.4 vs placebo 6.4 ± 3.7; P < 0.001). However, the adverse events profiles were similar between both groups. The results of this study demonstrate that remifentanil is an effective intervention for reducing pain, achieving successful ECV, and increasing maternal satisfaction during ECV, and is generally well-tolerated without additional adverse effects.

  5. Breech birth

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000623.htm Breech birth To use the sharing features on this page, ... safer for your baby to pass through the birth canal. In the last weeks of pregnancy, your ...

  6. Randomized trial of anaesthetic interventions in external cephalic version for breech presentation.

    Science.gov (United States)

    Khaw, K S; Lee, S W Y; Ngan Kee, W D; Law, L W; Lau, T K; Ng, F F; Leung, T Y

    2015-06-01

    Successful external cephalic version (ECV) for breech presenting fetus reduces the need for Caesarean section (CS). We aimed to compare the success rate of ECV with either spinal anaesthesia (SA) or i.v. analgesia using remifentanil. In a double-phased, stratified randomized blinded controlled study we compared the success rates of ECV, performed under spinal anaesthesia (SA), i.v. analgesia (IVA) using remifentanil or no anaesthetic interventions. In phase I, 189 patients were stratified by parity before randomization to ECV, performed by blinded operators, under SA using either hyperbaric bupivacaine 9 mg with fentanyl 15 µg, i.v. remifentanil infusion 0.1 µg kg min(-1), or Control (no anaesthetic intervention). Operators performing ECV were blinded to the treatment allocation. In phase 2, patients in the Control group in whom the initial ECV failed were further randomized to receive either SA (n=9) or IVA (n=9) for a re-attempt. The primary outcome was the incidence of successful ECV. The success rate in Phase 1 was greatest using SA [52/63 (83%)], compared with IVA [40/63 (64%)] and Control [40/63 (64%)], (P=0.027). Median [IQR] pain scores on a visual analogue scale (range 0-100), were 0 [0-0] with SA, 35 [0-60] with IVA and 50 [30-75] in the Control group (P<0.001). Median [IQR] VAS sedation scores were highest with IVA [75 (50-80)], followed by SA, [0 (0-50)] and Control [0 (0-0)]. In phase 2, 7/9 (78%) of ECV re-attempts were successful with SA, whereas all re-attempts using IVA failed (P=0.0007). The incidence of fetal bradycardia necessitating emergency CS within 30 min, was similar among groups; 1.6% (1/63) in the SA and IVA groups and 3.2% (2/63) in the Control group. SA increased the success rate and reduced pain for both primary and re-attempts of ECV, whereas IVA using remifentanil infusion only reduced the pain. There was no significant increase in the incidence of fetal bradycardia or emergency CS, with ECV performed under anaesthetic

  7. Fracture of the Femur of A Newborn after Cesarean Section for Breech Presentation and Fibroid Uterus :A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ibrahima Farikou

    2014-01-01

    Full Text Available Introduction: The practice of cesarean section is known to decrease the occurrence of long bone fractures. We present here an unusual diaphyseal fracture of the femur of a newborn after cesarean section, the only case observed in our 14 years of practice. Case Report: The patient was a 3.4-kg female child born at 38 weeks of gestation. The mother was a primipara and aged 39 years. Ultrasound examination at 20th week revealed intrauterine fibroids with a breech presentation. Therefore, elective cesarean section was indicated. There was no apparent bone disorder that could predispose to sustain femur fracture. The fracture was treated successfully with a bilateral spica cast. The cesarean section was indicated in an aged primipara, bearer of uterine fibroids, and breech presentation. She had a good general health status, but her bone density was unknown since this examination is not routinely performed in our clinical settings in Africa. Conclusion: Elderly age, primipara status, presence of uterine fibroids, and breech presentation are usual indications for cesarean section. However, there are not many reports on femur fracture after cesarean section. Our present case suggests that despite the latest advances in delivery techniques, cesarean section for breech presentation predisposes the neonate to femoral fractures. Keywords: Femur fracture; Cesarean section; Fibroid; Breech presentation; Africa.

  8. [Breech presentation: mode of delivery and maternal and fetal outcomes at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital].

    Science.gov (United States)

    Sy, T; Diallo, Y; Diallo, A; Soumah, A; Diallo, F B; Hyjazi, Y; Diallo, M S

    2011-01-01

    The authors in a prospective, analytical study of 8 months from January 1st to August 31st performed at the Ignace Deen Clinic of Gynecology and Obstetrics, Conakry University Hospital; assessed the impact of the mode of delivery in breech presentation on maternal and fetal outcome in the African context of Guinea. Breech presentation in mono fetal pregnancy of at least 28 weeks of amenorrhea was the inclusion criterion in this study. Among 1490 deliveries, 144 breech presentations were reviewed, representing a frequency of 9.66%. Half of breech deliveries (49.99%) were premature against only 11.85% in cephalic presentations. The breech was incomplete in 57.64% cases and complete in 42.35%. Caesarean section was performed in 40.97% of cases against 39.54% in cephalic presentation. The indications were often primiparity (30.50%), acute fetal distress (28.81%) and macrosomia (23.72%). Deliveries through the lower route frequently used the maneuver of Bracht (52.50%). 54.16% of the new-born babies had a fetal weight lower than 2500 g at born. Morbid Apgar score at the 1st minute after delivery through the lower route was found in 69.40% of the breech presentation born babies; however, this rate was 32.70% in cephalic presentation (p=0.000). The maternal morbidity concerned essentially perineal lesions (26.53%). The outcome is largely better in case of delivery through the upper route. The caesarean section is an alternative for the improvement of fetal outcome in countries with low resources.

  9. Contraindications for external cephalic version in breech position at term: a systematic review

    NARCIS (Netherlands)

    Rosman, Ageeth N.; Guijt, Aline; Vlemmix, Floortje; Rijnders, Marlies; Mol, Ben W. J.; Kok, Marjolein

    2013-01-01

    External cephalic version (ECV) is a safe and effective intervention that can prevent breech delivery, thus reducing the need for cesarean delivery. It is recommended in national guidelines. These guidelines also mention contraindications for ECV, and thereby restrict the application of ECV. We

  10. Contraindications for external cephalic version in breech position at term: A systematic review

    NARCIS (Netherlands)

    Rosman, A.N.; Guijt, A.; Vlemmix, F.; Rijnders, M.; Mol, B.W.J.; Kok, M.

    2013-01-01

    Objective. External cephalic version (ECV) is a safe and effective intervention that can prevent breech delivery, thus reducing the need for cesarean delivery. It is recommended in national guidelines. These guidelines also mention contraindications for ECV, and thereby restrict the application of

  11. Factors affecting the success of moxibustion in the management of a breech presentation as a preliminary treatment to external cephalic version.

    Science.gov (United States)

    Manyande, Anne; Grabowska, Christine

    2009-12-01

    to explore the effects of moxibustion treatment, to examine the predictors of its use in causing a breech presentation to spontaneously turn to a cephalic presentation which will result in a vaginal birth (the paper will refer to this as 'successful') and offer external cephalic version (ECV) subsequently after moxibustion treatment when the fetus remains in a breech presentation. a prospective study over a two-year time period from February 2004 until January 2006. 76 pregnant women from various acupuncture practices in the UK, with a third trimester breech presentation. the acupuncturist taught the women how to apply moxibustion (sticks of compressed dried herbs-Artemisia vulgaris) treatment at home by stimulating the acupoint on the outer edge at the base of the little toe nail for seven days twice a day (morning and afternoon). If the breech presentation persisted after treatment, ECV was carried out towards the end of the pregnancy. The obstetricians offered this during the routine antenatal hospital visits. the results show that following treatment with moxibustion, 31 (40.8%) of the breech presentations spontaneously turned to cephalic presentations, and a further 33 (43.4%) breech presentations were turned by ECV. Women who involved other people in the administration of moxibustion were twice as likely to be successful. Multiparous women were also 16% more likely than primiparous women to succeed in achieving a spontaneous version with the use of moxibustion. Fewer side effects reported when using moxibustion were the strongest predictor of successful spontaneous cephalic version with an odds ratio of 12% (p = 0.02). moxibustion creates a better chance of vaginal birth for expectant mothers. Of the women who were successful in turning their babies using moxibustion, 88% went on to have a normal birth and 12% had a caesarean section. Moxibustion treatment also significantly increases version from a breech presentation to a cephalic presentation where there

  12. Congenital high airway obstruction syndrome in the breech presentation managed by ex utero intrapartum treatment procedure after intraoperative external cephalic version.

    Science.gov (United States)

    Miwa, Ichiro; Sase, Masakatsu; Nakamura, Yasuhiko; Hasegawa, Keiko; Kawasaki, Masahiro; Ueda, Kazuyuki

    2012-05-01

    Congenital high airway obstruction syndrome (CHAOS) caused by laryngeal atresia was diagnosed by prenatal ultrasound in a male fetus at 26 weeks of gestation. Findings included massive ascites, subcutaneous edema, enlarged hyperechogenic lungs with diaphragmatic inversion, dilated trachea, polyhydramnios, and breech presentation. Those findings of CHAOS spontaneously returned to normal by 33 weeks of gestation. However, the placenta was localized to the anterior uterine wall. In addition, the fetal position had been breech until delivery. At 36 weeks of gestation, a planned ex utero intrapartum treatment (EXIT) procedure was performed following intraoperative external cephalic version (ECV) in which the fetus was approached from the posterior wall of the uterus. Laryngoscopy revealed the predicted laryngeal obstruction, and tracheostomy was placed. Intraoperative ECV may be a useful technique in breech presentation before EXIT procedure. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  13. Conduta Obstétrica na Apresentação Pélvica Obstetric Management in Breech Presentation

    Directory of Open Access Journals (Sweden)

    Márcia Maria Auxiliadora de Aquino

    2000-09-01

    Full Text Available Objetivo: avaliar os resultados da assistência ao parto de gestantes com apresentação pélvica. Pacientes e Métodos: estudo descritivo em que foram analisadas 160 gestantes com feto em apresentação pélvica, com recém-nascidos vivos, divididas em 2 grupos conforme o tipo de parto. Foram estudados dados clínicos referentes ao trabalho de parto, parto e recém-nascido (RN. Para os procedimentos estatísticos comparararam-se os partos vaginais às cesarianas, utilizando cálculo de médias, desvio-padrão, chi² e os testes de Mann-Whitney e t de Student. Resultados: o índice geral de cesárea foi de 81,2%. A idade gestacional e o peso do RN foram significativamente menores no grupo de parto vaginal. A prematuridade e o baixo peso do RN estiveram significativamente associados ao parto vaginal. Somente 14 recém-nascidos tiveram índice de Apgar Purpose: to evaluate the results of assistance to breech deliveries. Methods: this was a descriptive study where 160 pregnant women with breech presentation and live newborns were analyzed. They were divided into two groups according to the route of delivery. Clinical data concerning labor, delivery and newborns were studied. For statistical analysis vaginal deliveries were compared with cesarean sections using mean and standard deviation estimates, Student's t, Mann-Whitney and chi² tests. Results: the global cesarean section rate was 81.2%. The gestational age and the weight of the newborns were significantly lower in the vaginal delivery group. Prematurity and low birth weight were significantly associated with vaginal delivery. Only 14 newborns had an Apgar score below 7 at the fifth minute, almost 60% of them in the vaginal delivery group. Conclusions: this population presented a high cesarean section rate and also high perinatal morbidity, prematurity and low birth weight in the vaginal delivery group. These findings do not allow conclusions regarding the real relationships among breech

  14. Women's experiences of planning a vaginal breech birth in Australia.

    Science.gov (United States)

    Homer, Caroline Se; Watts, Nicole P; Petrovska, Karolina; Sjostedt, Chauncey M; Bisits, Andrew

    2015-04-11

    In many countries, planned vaginal breech birth (VBB) is a rare event. After the Term Breech Trial in 2000, VBB reduced and caesarean section for breech presentation increased. Despite this, women still request VBB. The objective of this study was to explore the experiences and decision-making processes of women who had sought a VBB. A qualitative study using descriptive exploratory design was undertaken. Twenty-two (n = 22) women who planned a VBB, regardless of eventual mode of birth were recruited. The women had given birth at one of two maternity hospitals in Australia that supported VBB. In-depth, semi-structured interviews using an interview guide were conducted. Interviews were analysed thematically. Twenty two women were interviewed; three quarters were primiparous (n = 16; 73%). Nine (41%) were already attending a hospital that supported VBB with the remaining women moving hospitals. All women actively sought a vaginal breech birth because the baby remained breech after an external cephalic version - 12 had a vaginal birth (55%) and 10 (45%) a caesarean section after labour commenced. There were four main themes: Reacting to a loss of choice and control, Wanting information that was trustworthy, Fighting the system and seeking support for VBB and The importance of 'having a go' at VBB. Women seeking a VBB value clear, consistent and relevant information in deciding about mode of birth. Women desire autonomy to choose vaginal breech birth and to be supported in their choice with high quality care.

  15. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

    Science.gov (United States)

    2014-01-01

    Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

  16. Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

    NARCIS (Netherlands)

    Vlemmix, F.; Rosman, A N; Fleuren, M A H; Rijnders, M E B; Beuckens, A.; Haak, M.C.; Akerboom, B.M.C.; Bais, J.M.J.; Kuppens, S M I; Papatsonis, D.N.M.; Opmeer, Brent C; van der Post, J.A.M.; Mol, B.W.J.; Kok, M

    2010-01-01

    Background: Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for

  17. Implementation of the external cephalic version in breech delivery Dutch national implementation study of external cephalic version

    NARCIS (Netherlands)

    Vlemmix, Floortje; Rosman, Ageeth N.; Fleuren, Margot A. H.; Rijnders, Marlies E. B.; Beuckens, Antje; Haak, Monique C.; Akerboom, Bettina M. C.; Bais, Joke M. J.; Kuppens, Simone M. I.; Papatsonis, Dimitri N.; Opmeer, Brent C.; van der Post, Joris A. M.; Mol, Ben Willem J.; Kok, Marjolein

    2010-01-01

    ABSTRACT: BACKGROUND: Breech presentation occurs in 3 to 4 % of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch

  18. Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences.

    Science.gov (United States)

    Catling, C; Petrovska, K; Watts, N; Bisits, A; Homer, C S E

    2016-04-01

    Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech presentation have been given one birth option, that is, caesarean section. The aim of this study was to explore clinician's experiences of caring for women when facilitating a vaginal breech birth. A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives) from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed. The interviews were analysed thematically. Participants were five obstetricians and four midwives. There were two overarching themes that arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are described in the paper. In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully counsel and select suitable women, and approach the option in a calm, collaborative way. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  19. Survey of external cephalic version for breech presentation and neuraxial blockade use.

    Science.gov (United States)

    Weiniger, Carolyn F; Sultan, Pervez; Dunn, Ashley; Carvalho, Brendan

    2016-11-01

    Neuraxial blockade may increase external cephalic version (ECV) success rates. This survey aimed to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV. We surveyed Society for Obstetric Anesthesia and Perinatology members regarding ECV practice using a 15-item survey developed by 3 obstetric anesthesiologists and tested for face validity. The survey was e-mailed in January 2015 and again in February 2015 to the 1056 Society of Obstetric Anesthesiology and Perinatology members. We present descriptive statistics of responses. Our survey response rate was 322 of 1056 (30.5%). Neuraxial blockade was used for ECV always by 18 (5.6%), often by 52 (16.1%), sometimes by 98 (30.4%), rarely by 78 (24.2%), and never by 46 (14.3%) of respondents. An anesthetic sensory block target was selected by 141 (43.8%) respondents, and analgesic by 102 (31.7%) respondents. Epidural drug doses ranged widely, including sufentanil 5-25 μg; lidocaine 1% or 2% 10-20 mL, bupivacaine 0.0625% to 0.5% 6-15 mL, and ropivacaine 0.2% 20 mL. Intrathecal bupivacaine was used by 182 (56.5%) respondents; the most frequent doses were 2.5 mg used by 24 (7.5%), 7.5 mg used by 35 (10.9%), and 12 mg used by 30 (9.3%). Neuraxial blockade is not universally offered to facilitate ECV, and there is wide variability in neuraxial blockade techniques, in drugs and doses administered, and in the sensory blockade (anesthetic or analgesic) targeted. Future studies need to evaluate and remove barriers to allow for more widespread use of neuraxial blockade for pain relief and to optimize ECV success rates. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Comparison of Fetomaternal Outcome between 47 Deliveries Following Successful External Cephalic Version for Breech Presentation and 7456 Deliveries Following Spontaneous Cephalic Presentation.

    Science.gov (United States)

    de Gregorio, Nikolaus; Friedl, Thomas; Schramm, Amelie; Reister, Frank; Janni, Wolfgang; Ebner, Florian

    2017-08-25

    Achieving a cephalic position after a successful external cephalic version (ECV) is desired to result in delivery and fetal outcomes that are similar to those of deliveries following spontaneous cephalic presentation. We performed a retrospective cohort study including patients with successful ECV following fetal breech position (ECV cohort, n = 47) or with a singleton spontaneous cephalic pregnancy at ≥37 weeks of gestational age (control group, n = 7,456) attempting a vaginal delivery between 2010 and 2013 at the University Hospital Ulm. The mode of delivery and fetal outcome parameters were compared between these 2 groups using nonparametric statistics. ECV cohort and control group did not differ with respect to maternal age, parity, gestational age at birth, and fetal gender. There were no significant differences between the 2 groups with regard to all parameters indicating fetal outcome. However, the rate of cesarean sections was higher after successful ECV compared to spontaneous cephalic presentation (27.7 vs. 12.8%, OR 2.615). While vaginal delivery is less likely to happen after a successful ECV compared to spontaneous cephalic singleton pregnancies, fetal outcome parameters showed no difference between the 2 groups. Physicians should be counseling and encouraging women to attempt ECV, as it is a safe and effective procedure. © 2017 S. Karger AG, Basel.

  1. The Impact of an ECV Service is Limited by Antenatal Breech Detection: A Retrospective Cohort Study.

    Science.gov (United States)

    Hemelaar, Joris; Lim, Lee N; Impey, Lawrence W

    2015-06-01

    External cephalic version (ECV) reduces the chance of breech presentation at term birth and lowers the chance of a cesarean delivery. ECV services are now in place in many units in the United Kingdom but their effectiveness is unknown. The aim of this study was to investigate the reasons for breech presentation at term birth. We performed a retrospective cohort study of 394 consecutive babies who were in breech presentation at term birth in a large United Kingdom maternity unit that offers ECV. The cohort was analyzed over two time periods 10 years apart: 1998-1999 and 2008-2009. Only 33.8 percent of women had undergone a (failed) ECV attempt. This low proportion was mainly because breech presentation was not diagnosed antenatally (27.9%). Other contributing factors were: ECV not offered by clinicians (12.2%), ECV declined by women (14%), and contraindications to ECV (10.7%). Over the 10-year period, the proportion of breech presentations that were not diagnosed antenatally increased from 23.2 to 32.5 percent (p = 0.04), which constituted 52.8 percent of women who had not undergone an ECV attempt in 2008-2009. Failure of clinicians to offer ECV reduced from 21.6 to 3.0 percent (p = 0.0001) and the proportion of women declining ECV decreased from 19.1 to 9.0 percent (p = 0.005). Overall, ECV attempts increased from 28.9 to 38.5 percent (p = 0.05). Although ECV counseling, referral, and attempt rates have increased, failure to detect breech presentation antenatally is the principal barrier to successful ECV. Improved breech detection would have a greater impact than methods to increase ECV success rates. © 2015 Wiley Periodicals, Inc.

  2. Breech delivery at a University Hospital in Tanzania

    DEFF Research Database (Denmark)

    Högberg, Ulf; Claeson, Catrin; Krebs, Lone

    2016-01-01

    delivery (VD) (adjusted odds ratio (aOR) 6.2; 95 % confidence interval (CI) 3.0-12.6) and referral (aOR 2.1; 95 % CI 1.1-3.9), but not with parity, birth weight, or delivery year. Overall perinatal mortality was 5.8 % and this did not decline, due to an increase in stillbirths among vaginal breech......Background: There is a global increase in rates of Cesarean delivery (CD). A minor factor in this increase is a shift towards CD for breech presentation. The aim of this study was to analyze breech births by mode of delivery and investigate short-term fetal and maternal outcomes in a low...... death (stillbirths + in-hospital neonatal deaths) and moderate asphyxia. Maternal outcomes, such as death, hemorrhage, and length of hospital stay, were also described. Results: The CD rate for breech presentation increased from 28 % in 1999 to 78 % in 2010. Perinatal deaths were associated with vaginal...

  3. Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial.

    Science.gov (United States)

    Chalifoux, Laurie A; Bauchat, Jeanette R; Higgins, Nicole; Toledo, Paloma; Peralta, Feyce M; Farrer, Jason; Gerber, Susan E; McCarthy, Robert J; Sullivan, John T

    2017-10-01

    Breech presentation is a leading cause of cesarean delivery. The use of neuraxial anesthesia increases the success rate of external cephalic version procedures for breech presentation and reduces cesarean delivery rates for fetal malpresentation. Meta-analysis suggests that higher-dose neuraxial techniques increase external cephalic version success to a greater extent than lower-dose techniques, but no randomized study has evaluated the dose-response effect. We hypothesized that increasing the intrathecal bupivacaine dose would be associated with increased external cephalic version success. We conducted a randomized, double-blind trial to assess the effect of four intrathecal bupivacaine doses (2.5, 5.0, 7.5, 10.0 mg) combined with fentanyl 15 μg on the success rate of external cephalic version for breech presentation. Secondary outcomes included mode of delivery, indication for cesarean delivery, and length of stay. A total of 240 subjects were enrolled, and 239 received the intervention. External cephalic version was successful in 123 (51.5%) of 239 patients. Compared with bupivacaine 2.5 mg, the odds (99% CI) for a successful version were 1.0 (0.4 to 2.6), 1.0 (0.4 to 2.7), and 0.9 (0.4 to 2.4) for bupivacaine 5.0, 7.5, and 10.0 mg, respectively (P = 0.99). There were no differences in the cesarean delivery rate (P = 0.76) or indication for cesarean delivery (P = 0.82). Time to discharge was increased 60 min (16 to 116 min) with bupivacaine 7.5 mg or higher as compared with 2.5 mg (P = 0.004). A dose of intrathecal bupivacaine greater than 2.5 mg does not lead to an additional increase in external cephalic procedural success or a reduction in cesarean delivery.

  4. A study of labour outcome in breech delivery

    Directory of Open Access Journals (Sweden)

    Suman Budania

    2017-01-01

    Full Text Available Aim: Breech is the most common form of malpresentation. It is defined as when foetus occupies a longitudinal lie with the pelvic extremity at the pelvic brim and head at the fundus of the uterus. The present study was conducted on 100 cases of breech presentation to find out the labour outcome in breech deliveries and various factors affecting it. Materials and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur. A total of 100 cases of breech presentation including single as well as plural pregnancies in which one or more foetuses were presenting as breech were taken. Both booked and unbooked cases in primigravidae and multigravidae were studied. The cases were selected at random among those who got admitted in labour room. Results: In the present series, incidence of breech deliveries came to be 4.1094%. Incidence of breech presentation was maximum (45% in the age group of 21–25 years. In this study, out of 100 cases, 62 were multigravidae and 38 were primigravidae, and 43 cases (43% were associated with factors which endanger of life of the foetus, among which twin pregnancy and pre-eclamptic toxaemia were the most commonly associated factors. In the present series, among 100 cases studied, 14 were breech babies and congenital malformation, of which hydrocephalus was the most common malformation found. Conclusion: The study concludes that prematurity is associated with high incidence of breech presentation. The most common variety of breech presentation is flexed breech, which is found more in multigravidae. Caesarean section is the mode of delivery of choice as it carries minimal foetal loss. Extended variety of breech is safest for the baby and carries minimal foetal loss.

  5. A randomized controlled trial of the effect of combined spinal-epidural analgesia on the success of external cephalic version for breech presentation.

    Science.gov (United States)

    Sullivan, J T; Grobman, W A; Bauchat, J R; Scavone, B M; Grouper, S; McCarthy, R J; Wong, C A

    2009-10-01

    Improving the success of external cephalic version (ECV) for breech presentation may help avoid some cesarean deliveries. The results of randomized trials comparing the success of ECV with neuraxial analgesia compared to control are inconsistent. We hypothesized that combined spinal-epidural (CSE) analgesia would increase the success of ECV when compared with systemic opioid analgesia. Parturients with singleton breech presentation (n=96) were randomized to receive CSE analgesia with bupivacaine 2.5mg and fentanyl 15 microg (CSE group) or intravenous fentanyl 50 microg (SYS group) before ECV attempt. The primary outcome was ECV success. The success rate of ECV was 47% with CSE and 31% in the SYS group (P=0.14). Subsequent vaginal delivery was 36% for CSE and 25% for SYS (P=0.27). Median [IQR] visual analog pain scores (0-100mm scale) were lower with CSE (3 [0-12]) compared to SYS analgesia (36 [16 to 54]) (P<0.005) and patient satisfaction (0-10 scale) was higher (CSE 10 [9 to 10] versus SYS 7 [4 to 9]) (P<0.005). There were no differences in fetal heart rate patterns, but median time to return to fetal heart rate reactivity after analgesia was shorter with CSE (13 [IQR 9-21] min) compared to the SYS group (39 [IQR 23-51] min) (P=0.02). There was no difference in the rate of successful ECV or vaginal delivery with CSE compared to intravenous fentanyl analgesia. Pain scores were lower and satisfaction higher with CSE analgesia, and median time to fetal heart rate reactivity was shorter in the CSE group.

  6. Revisiting the mode of delivery and outcome of singleton breech ...

    African Journals Online (AJOL)

    There was an increased rate of special care baby unit admission in the group that had assisted vaginal breech delivery than in those that had elective caesarean section. There was no difference in terms of birth injury, neonatal death and maternal morbidities between those that had assisted vaginal breech delivery and ...

  7. Turning breech babies after 34 weeks: the if, how, & when of turning breech babies.

    Science.gov (United States)

    Cohain, Judy Slome

    2007-01-01

    Techniques for turning a term breech baby are 1). External cephalic version (ECV) using hands and ultrasound only; 2). Acupuncture point stimulation, by needle or moxibustion; 3). Chiropractic "Webster" technique; 4). Hypnotherapy; and 5). Special exercises. Fifty % of breech fetuses at 34 weeks will turn by themselves to head down by 38 weeks. Therefore, to be considered effective, a technique for turning breech must turn the baby and keep it turned more than 50% of the time. Only ECV with an experienced practitioner has been documented to have a greater than 50% success rate at 37 weeks; in 95% of cases the head stays down. Most women experience the fetus turning by hand as quick but very painful. "Unstable lie" is sometimes used as a baseless excuse for inducing labor after the baby turns from breech to head down. (judyslome@hotmail.com).

  8. [Fewer breech deliveries after implementation of a modified cephalic version protocol].

    Science.gov (United States)

    Kuppens, Simone M I; Francois, Anne M H; Hasaart, Tom H M; van der Donk, Maria W P; Pop, Victor J M

    2010-01-01

    To investigate the effect of implementation of a number of process policy guidelines (protocol), on the success rate of external cephalic version (ECV) for breech presentation. Prospective study. During a 3-year period (2004-2006) a standardized protocol for an ECV consultation was developed, evaluated and adapted. After implementing this modified protocol as 'process policy guidelines', the effect on the rate of successful ECV was prospectively evaluated during the period 1 January 2007-31 July 2008. Success was defined as cephalic presentation (ultrasound) immediately after ECV. A secondary outcome measure was the elective caesarean section rate for breech presentation. The rate of successful ECV increased significantly from 47% (110/236 pregnant women) in the period January 2004-December 2006 to 61% (85/139, p = 0.006) in the period January 2007-July 2008. Patient characteristics were similar in both groups, with the exception of 2 subgroups of term of version. The increase was preferentially found in nulliparous and multiparous women with frank breech. Nulliparity, frank breech, anterior placenta and low birth weight were associated with a lower success rate of ECV. The term of pregnancy at which ECV was performed did not seem to affect the success rate. Implementing the process policy guidelines increased the number of cephalic presentations at delivery and decreased the rate of elective caesarean sections for breech presentation from 39% to 27% (p = 0.03). The number needed to treat to prevent 1 elective caesarean section by ECV according to the process policy guidelines was 8. After implementation of the process policy guidelines, the success rate of ECV increased considerably. The rate of elective caesarean section for breech presentation declined. These findings are in favour of establishing specialized ECV centres in the Netherlands.

  9. Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including moxibustion, for women with a breech foetus at 33 weeks gestation: a modelling approach.

    Science.gov (United States)

    van den Berg, Ineke; Kaandorp, Guido C; Bosch, Johanna L; Duvekot, Johannes J; Arends, Lidia R; Hunink, M G Myriam

    2010-04-01

    To assess, using a modelling approach, the effectiveness and costs of breech version with acupuncture-type interventions on BL67 (BVA-T), including moxibustion, compared to expectant management for women with a foetal breech presentation at 33 weeks gestation. A decision tree was developed to predict the number of caesarean sections prevented by BVA-T compared to expectant management to rectify breech presentation. The model accounted for external cephalic versions (ECV), treatment compliance, and costs for 10,000 simulated breech presentations at 33 weeks gestational age. Event rates were taken from Dutch population data and the international literature, and the relative effectiveness of BVA-T was based on a specific meta-analysis. Sensitivity analyses were conducted to evaluate the robustness of the results. We calculated percentages of breech presentations at term, caesarean sections, and costs from the third-party payer perspective. Odds ratios (OR) and cost differences of BVA-T versus expectant management were calculated. (Probabilistic) sensitivity analysis and expected value of perfect information analysis were performed. The simulated outcomes demonstrated 32% breech presentations after BVA-T versus 53% with expectant management (OR 0.61, 95% CI 0.43, 0.83). The percentage caesarean section was 37% after BVA-T versus 50% with expectant management (OR 0.73, 95% CI 0.59, 0.88). The mean cost-savings per woman was euro 451 (95% CI euro 109, euro 775; p=0.005) using moxibustion. Sensitivity analysis showed that if 16% or more of women offered moxibustion complied, it was more effective and less costly than expectant management. To prevent one caesarean section, 7 women had to use BVA-T. The expected value of perfect information from further research was euro0.32 per woman. The results suggest that offering BVA-T to women with a breech foetus at 33 weeks gestation reduces the number of breech presentations at term, thus reducing the number of caesarean sections

  10. [External cephalic version of breech fetus after 36 weeks of gestation - evaluation of efectiveness and complications].

    Science.gov (United States)

    Hruban, L; Janků, P; Jordánová, K; Gerychová, R; Huser, M; Ventruba, P; Roztočil, A

    2017-01-01

    Evaluation of success rate and the safety of external cephalic version after 36 weeks of gestation. Retrospective analysis. Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. A retrospective analysis of external cephalic version attempts performed on a group of 638 singleton breech pregnancies after 36 weeks gestation in the years 2003-2016 at the Department of Gynecology and Obstetrics, Masaryk University, Brno. The effectiveness, number and type of complications, mode of delivery and perinatal result were observed. The effectiveness of external cephalic version from breech to head presentation was 47.8% (305 cases). After a successful external cephalic version 238 patients (78.0%) gave birth vaginally. After unsuccessful cephalic version 130 patients (39.0%) gave birth vaginally. The number of serious complications did not exceed 0,9% and did not affect perinatal outcomes. External cephalic version-related emergency cesarean deliveries occurred in 6 cases (2 placental abruption, 4 abnormal cardiotocography). The fetal outcome was good in all these cases. The death of the fetus in connection with the external version has not occurred in our file. Spontaneous discharge of amniotic fluid within 24 hours after procedure occurred in 5 cases (0.8%). The spontaneous onset of labor within 24 hours of procedure occurred in 5 cases (0.8%). The pH value of a. umbilicalis external version and in the group with unsuccessful external version in 9 cases. The Apgar score in the 5th minute external cephalic version of the fetus in the case of breech presentation after the 36th week of pregnancy is an effective and safe alternative for women who have a fear of the vaginal breech delivery. Performing the external cephalic version can reduce the rate of elective caesarean sections due to breech presentation at term.

  11. Are intrapartum and neonatal deaths in breech delivery at term potentially avoidable?--a blinded controlled audit

    DEFF Research Database (Denmark)

    Krebs, Lone; Langhoff-Roos, Jens; Bødker, Birgit

    2002-01-01

    -92 were studied. For each of the 12 deaths two controls matched by presentation and planned mode of delivery were selected. Eleven obstetricians assessed the care through narratives that ended when the infant was delivered to umbilicus and stated if the infant died, and whether the "possible death...

  12. Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version.

    Science.gov (United States)

    Vlemmix, Floortje; Rosman, Ageeth N; Fleuren, Margot A H; Rijnders, Marlies E B; Beuckens, Antje; Haak, Monique C; Akerboom, Bettina M C; Bais, Joke M J; Kuppens, Simone M I; Papatsonis, Dimitri N; Opmeer, Brent C; van der Post, Joris A M; Mol, Ben Willem J; Kok, Marjolein

    2010-05-10

    Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less.We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV.The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Dutch Trial Register (NTR): 1878.

  13. Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

    Directory of Open Access Journals (Sweden)

    Papatsonis Dimitri N

    2010-05-01

    Full Text Available Abstract Background Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV and the Dutch Society for Obstetrics and Gynaecology (NVOG. Implementation of ECV does not exceed 50 to 60% and probably less. We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. Method/design The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV. The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. Discussion This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Trial

  14. The fact and the fiction: A prospective study of internet forum discussions on vaginal breech birth.

    Science.gov (United States)

    Petrovska, Karolina; Sheehan, Athena; Homer, Caroline S E

    2017-04-01

    Women with a breech baby late in pregnancy may use the internet to gather information to assist in decision-making for birth. The aim of this study was to examine how women use English language internet discussion forums to find out information about vaginal breech birth and to increase understanding of how vaginal breech birth is perceived among women. A descriptive qualitative study of internet discussion forums was undertaken. Google alerts were created with the search terms "breech birth" and "breech". Alerts were collected for a one-year period (January 2013-December 2013). The content of forum discussions was analysed using thematic analysis. A total of 50 forum discussions containing 382 comments were collected. Themes that arose from the data were: Testing the waters-which way should I go?; Losing hope for the chance of a normal birth; Seeking support for options-who will listen to me?; Considering vaginal breech birth-a risky choice?; Staying on the 'safe side'-caesarean section as a guarantee; Exploring the positive potential for vaginal breech birth. Women search online for information about vaginal breech birth in an attempt to come to a place in their decision-making where they feel comfortable with their birth plan. This study highlights the need for clinicians to provide comprehensive, unbiased information on the risks and benefits of all options for breech birth to facilitate informed decision-making for the woman. This will contribute to improving the woman's confidence in distinguishing between "the fact and the fiction" of breech birth discussions online. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  15. Case of pituitary stalk transection syndrome ascertained after breech delivery.

    Science.gov (United States)

    Fukuta, Kaori; Hidaka, Takao; Ono, Yosuke; Kochi, Keiko; Yasoshima, Kuniaki; Arai, Takashi

    2016-02-01

    Pituitary stalk transection syndrome (PSTS) is a rare complication that can accompany breech delivery. Early diagnosis of this syndrome is difficult, and it may cause a serious delay in the diagnosis. We present a case of PSTS ascertained after breech delivery. A 20-year-old woman presented with primary amenorrhea. The patient was born by breech delivery and had a history of treatment for pituitary dwarfism. Her laboratory findings showed pituitary hypothyroidism, and hormone replacement therapy was initiated. At 28 years old, she became pregnant and had a normal delivery at 38 weeks' gestation. One year after delivery, her thyroid hormone level changed. Laboratory test showed adrenocortical insufficiency, and magnetic resonance imaging of the pituitary gland showed transection of the pituitary stalk and development of an ectopic posterior lobe. These findings were compatible with PSTS. When a patient who has been born by breech delivery presents with symptoms of pituitary deficiency, PSTS should be considered in the differential diagnosis. © 2015 Japan Society of Obstetrics and Gynecology.

  16. A Rare Complication of a Vaginal Breech Delivery

    Directory of Open Access Journals (Sweden)

    H. C. Vergers-Spooren

    2011-01-01

    Full Text Available Rectal lesions without anal sphincter trauma in childbirth are only sporadically described in literature. We describe the case of a 29-year-old primigravida who delivered a child in frank breech presentation. During the second stage of labour a foot presented transanally through a rectal laceration with intact anal sphincters. The laceration was repaired immediately after delivery in theatre. Follow-up visits showed a properly cured laceration and no complaints of incontinence or foul discharge.

  17. Moxibustion for breech version: a randomized controlled trial.

    Science.gov (United States)

    Guittier, Marie-Julia; Pichon, Michelle; Dong, Hongguang; Irion, Olivier; Boulvain, Michel

    2009-11-01

    To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the cephalic version of fetuses in breech presentation and the acceptability of this method by women. We conducted a randomized controlled trial in a Swiss university hospital maternity unit. We proposed to stimulate the acupoint BL 67 by moxibustion daily for 2 weeks for 212 consenting women between 34 and 36 weeks of gestation with a single fetus in breech presentation. We did the intervention three times weekly in the hospital and a teaching session and information leaflet on the technique for additional daily therapy at home. The control group received expectant management care. The availability of external cephalic version was maintained for both groups. The main outcome measure was the comparison of the proportion of women with cephalic presentation at delivery. Baseline characteristics were similar between groups, except more nulliparous women were randomized to moxibustion. The percentage of versions was similar between groups: 18% in the moxibustion group compared with 16% in the control group (relative risk 1.12, 95% confidence interval 0.62 to 2.03). Adjustment for the imbalance in parity did not change these results. The frequency of cesarean delivery was similar (64% compared with 58% in the moxibustion group and the control group, respectively). Acceptability of the intervention and women's perceptions of moxibustion were favorable. We observed no beneficial effect of moxibustion to facilitate the cephalic version of fetuses in breech presentation. Despite this lack of proven effectiveness, women had positive opinions on the intervention. ClinicalTrials.gov, www.clinicaltrials.gov,NCT00890474. I.

  18. Care during the decision-making phase for women who want a vaginal breech birth: Experiences from the field.

    Science.gov (United States)

    Catling, C; Petrovska, K; Watts, N P; Bisits, A; Homer, C S E

    2016-03-01

    few women are given the option of a vaginal breech birth in Australia, unless the clinicians feel confident and have the skills to facilitate this mode of birth. Few studies describe how clinicians provide care during the decision-making phase for women who choose a vaginal breech birth. The aim of this study was to explore how experienced clinicians facilitated decisions about external cephalic version and mode of birth for women who have a breech presentation. a descriptive exploratory design was undertaken with nine experienced clinicians (obstetricians and midwives) from two tertiary hospitals in Australia. Data were collected through face to face interviews and analysed thematically. five obstetricians and four midwives participated in this study. All were experienced in caring for women having a vaginal breech birth and were currently involved in providing such a service. The themes that arose from the data were: Pitching the discussion, Discussing safety and risk, Being calm and Providing continuity of care. caring for women who seek a vaginal breech birth includes careful selection of appropriate women, full discussions outlining the risks involved, and undertaking care with a calm manner, ensuring continuity of care. Health services considering establishing a vaginal breech service should consider that these elements are included in the establishment and implementation processes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Expertise in physiological breech birth: A mixed-methods study.

    Science.gov (United States)

    Walker, Shawn; Parker, Pam; Scamell, Mandie

    2018-06-01

    The safety of vaginal breech birth depends on the expertise of birth attendants, yet the meaning of "expertise" remains unclear and subjectively defined. The objective of this study was to define expertise and the roles experts may play in expanding access to this service. We performed an integrative analysis of two strands of data concerning expertise in physiological breech birth, including the following: survey data from a Delphi study involving 26 very experienced clinicians (mean experience = 135 breech births) and 2 service user representatives, and interviews from a grounded theory study of 14 clinicians more moderately experienced with physiological methods (5-30 upright breech births). Data were pooled and analyzed using constant comparative methods. Expertise is defined by its ongoing function, the generation of comparatively good outcomes, and confidence and competence among colleagues. Although clinical experience is important, expertise is developed and expressed in social clinical roles, which expand as experience grows: clinician, mentor, specialist, and expert. To develop expertise within a service, clinicians who have an interest in breech birth should be supported to perform these roles within specialist teams. Specialist breech teams may facilitate the development of expertise within maternity care settings. Evaluation of expertise based on enablement of women and colleagues, as well as outcomes, will potentially avoid the pitfalls of alienation produced by some forms of specialist authority. © 2017 Wiley Periodicals, Inc.

  20. Congenital Uterovaginal Prolapse Present at Birth

    African Journals Online (AJOL)

    of the buttocks down to the legs with crepe bandage for 72 h. Key words: Breech, congenital, Nigeria, prolapse, spina bifida, utero- ... pressure during breech delivery stretches the pelvic floor muscle and the ligaments thus increasing the risk of ... and mucosal ulceration sets in. In conclusion, UVP presenting at birth is a rare ...

  1. The effects of the term breech trial on vaginal breech delivery 8 years on

    LENUS (Irish Health Repository)

    Hehir, MP

    2011-02-01

    Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2011

  2. Volvulus in term and preterm infants - clinical presentation and outcome.

    Science.gov (United States)

    Horsch, Sandra; Albayrak, Bilge; Tröbs, Ralf-Bodo; Roll, Claudia

    2016-06-01

    Our aim was to assess if term and preterm infants with volvulus showed different patterns with regard to pathogenesis, clinical presentation and outcome. We reviewed the medical records and imaging data of infants aged less than six months with volvulus treated in a single surgical referral centre from 2006-2013. Volvulus was diagnosed in 19 infants, with no anatomical anomaly in three of the 12 preterm infants and one of the seven term infants. Most cases (74%) presented during the first eight days of life. Later presentations occurred exclusively in preterm infants, with only one of the five having no anatomic anomalies. Bilious vomiting was the leading symptom in six of the seven term infants, while the symptoms in preterm infants were rather nonspecific. Intestinal necrosis, with the need for bowel resection, occurred in one term (14%) infant and nine (75%) preterm infants. The clinical presentation and outcome of volvulus differed between preterm and term infants, but the rate and distribution of underlying anomalies did not differ. Symptoms in preterm infants were often nonspecific and led to a delay in diagnosis. This might have contributed to the higher rate of intestinal necrosis in preterm infants. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  3. Delivery mode and neonatal outcome after a trial of external cephalic version (ECV): a prospective trial of vaginal breech versus cephalic delivery.

    Science.gov (United States)

    Reinhard, Joscha; Sänger, Nicole; Hanker, Lars; Reichenbach, Lena; Yuan, Juping; Herrmann, Eva; Louwen, Frank

    2013-04-01

    To examine the delivery mode and neonatal outcome after a trial of external cephalic version (ECV) procedures. This is an interim analysis of an ongoing larger prospective off-centre randomised trial, which compares a clinical hypnosis intervention against neuro-linguistic programming (NLP) of women with a singleton breech foetus at or after 37(0/7) (259 days) weeks of gestation and normal amniotic fluid index. Main outcome measures were delivery mode and neonatal outcome. On the same day after the ECV procedure two patients (2 %), who had unsuccessful ECVs, had Caesarean sections (one due to vaginal bleeding and one due to pathological CTG). After the ECV procedure 40.4 % of women had cephalic presentation (n = 38) and 58.5 % (n = 55) remained breech presentation. One patient remained transverse presentation (n = 1; 1.1 %). Vaginal delivery was observed by 73.7 % of cephalic presentation (n = 28), whereas 26.3 % (n = 10) had in-labour Caesarean sections. Of those, who selected a trial of vaginal breech delivery, 42.4 % (n = 14) delivered vaginally and 57.6 % (n = 19) delivered via Caesarean section. There is a statistically significant difference between the rate of vaginal birth between cephalic presentation and trial of vaginal breech delivery (p = 0.009), however, no difference in neonatal outcome was observed. ECV is a safe procedure and can reduce not only the rate of elective Caesarean sections due to breech presentation but also the rate of in-labour Caesarean sections even if a trial of vaginal breech delivery is attempted.

  4. Management of preterm delivery in women with abnormal fetal presentation

    NARCIS (Netherlands)

    Bergenhenegouwen, L.A.

    2015-01-01

    The aim of the thesis was to answer the following questions. 1. What is the optimal mode of delivery in preterm breech presentation? 2. Does an intended caesarean section reduce the risk of perinatal mortality and morbidity as compared to intended vaginal delivery in preterm breech presentation? 3.

  5. On Intelligent Design and Planning Method of Process Route Based on Gun Breech Machining Process

    Science.gov (United States)

    Hongzhi, Zhao; Jian, Zhang

    2018-03-01

    The paper states an approach of intelligent design and planning of process route based on gun breech machining process, against several problems, such as complex machining process of gun breech, tedious route design and long period of its traditional unmanageable process route. Based on gun breech machining process, intelligent design and planning system of process route are developed by virtue of DEST and VC++. The system includes two functional modules--process route intelligent design and its planning. The process route intelligent design module, through the analysis of gun breech machining process, summarizes breech process knowledge so as to complete the design of knowledge base and inference engine. And then gun breech process route intelligently output. On the basis of intelligent route design module, the final process route is made, edited and managed in the process route planning module.

  6. Subacute Thyroiditis: Clinical Presentation and Long Term Outcome

    Science.gov (United States)

    Alfadda, Assim A.; Sallam, Reem M.; Elawad, Ghadi E.; AlDhukair, Hisham; Alyahya, Mossaed M.

    2014-01-01

    Few studies have been reported from the Kingdom of Saudi Arabia (SA) to describe the clinical presentation and long term outcomes of subacute thyroiditis (SAT). Our aim was to review the demographic, anthropometric, clinical presentation, laboratory results, treatment, and disease outcome in Riyadh region and to compare those with results from different regions of the Kingdom and different parts of the world. We reviewed the medical files of patients who underwent thyroid uptake scan during an 8-year period in King Khalid University Hospital. Only 25 patients had confirmed diagnosis of thyroiditis. Age and gender distribution were similar to other studies. Most patients presented with palpitation, goiter, and weight change. Elevated thyroid hormones, suppressed thyroid-stimulating hormone, and elevated ESR were reported. Among those, 7 cases of SAT were recorded. β-Blockers were prescribed to 57% and nonsteroidal anti-inflammatory drugs to 29% of SAT. Long follow-up demonstrated that 85.7% of SAT cases recovered, while 14.3% developed permanent hypothyroidism. In conclusion, SAT is uncommon in the central region of SA. Compared to the western region, corticosteroid is not commonly prescribed, and permanent hypothyroidism is not uncommon. A nation-wide epidemiological study to explain these interprovincial differences is warranted. PMID:24803929

  7. Retention of Vaginal Breech Delivery Skills Taught in Simulation.

    Science.gov (United States)

    Stone, Heather; Crane, Joan; Johnston, Kathy; Craig, Catherine

    2018-02-01

    The optimal frequency of conducting simulation training for high-acuity, low-frequency events in obstetrics and gynaecology residency programs is unknown. This study evaluated retention over time of vaginal breech delivery skills taught in simulation, by comparing junior and senior residents. In addition, the residents' subjective comfort level to perform this skill clinically was assessed. This prospective cohort study included 22 obstetrics and gynaecology residents in a Canadian residency training program. Digital recordings were completed for pre-training, immediate post-training, and delayed (10-26 weeks later) post-training intervals of a vaginal breech delivery simulation, with skill assessment by a blinded observer using a binary checklist. Residents also completed questionnaires to assess their subjective comfort level at each interval. Junior and senior residents had significant improvements in vaginal breech delivery skills from the pre-training assessment to both the immediate post-training assessment (junior, P simulation 10-26 weeks later, although a decline in skills occurred over this time period. Comfort level was positively affected and retained. These results will aid in determining the frequency of simulation teaching for high-acuity, low-frequency events in a residency simulation curriculum. Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  8. Breech delivery at term in Denmark, 1982-92

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J

    1999-01-01

    ,476) in Denmark, 1982-92, a review of medical records of all (n = 218) cases with Apgar score controls, was performed. Planned vaginal delivery was associated with a 15 times greater risk of low Apgar score than elective Caesarean section...

  9. Breech deliveries in Usmanu Danfodiyo University Teaching Hospital Sokoto, Northwestern Nigeria: A 10-year review

    Directory of Open Access Journals (Sweden)

    Karima Tunau

    2013-01-01

    Full Text Available Background: Breech delivery is a major issue in obstetric practice mainly because of the high perinatal morbidity and mortality associated with it. The aims of the study are to determine the prevalence management and perinatal outcome of singleton breech deliveries in our center. Materials and Methods: A retrospective study involving 395 singleton breech deliveries out of 24,160 deliveries conducted at the Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, over a 10-year (2001-2010 period. Results: The prevalence rate of singleton breech delivery was 1.7%. Breech deliveries occurred more in the primigravidae. Most babies (69.1% had vaginal delivery. There was a high caesarean section (CS rate of 30.9%. Babies delivered by CS had better Apgar scores than those delivered through the vagina (P < 0.05. The perinatal mortality rate in breech deliveries (410/1000 was significantly higher than that (101.5/10000 in their cephalic counterparts (P < 0.05. Similarly, perinatal deaths were more common in unbooked than in booked patients (P < 0.05. Conclusion: Breech delivery was frequent in the study population. Singleton breech delivered by CS had better outcome than those who were delivered through the vagina.

  10. [Face presentation: retrospective study of 32 cases at term].

    Science.gov (United States)

    Ducarme, G; Ceccaldi, P-F; Chesnoy, V; Robinet, G; Gabriel, R

    2006-05-01

    To determine the etiologic factors, circumstances of diagnosis, obstetrical management and complications of face presentation and to value the maternal and foetal prognosis of this presentation. Thirty-two cases of face presentation have been observed in the maternity wards of Reims and Troyes over the last 12 years. The incidence of face presentation was 0.7 per 1000 deliveries. Spontaneous vaginal delivery occurred with mento-anterior presentation 73% of the time and caesarean section was performed in 100% of mento-posterior presentation. There was no increasing rate of foetal or maternal mortality and morbidity with vaginal delivery. Face presentation is an unusual complication of pregnancy with obstetric factors that predispose the foetus to face presentation. The low foetal and maternal mortality and morbidity substantiate the effectiveness of conservative management in face presentation.

  11. Acute mastoiditis in children: presentation and long term consequences.

    LENUS (Irish Health Repository)

    Glynn, F

    2008-03-01

    Acute mastoiditis, a destructive bacterial infection of the mastoid bone and air cell system, is relatively uncommon today but remains a potentially serious condition. There is a lack of information in the literature regarding the long term otological problems that children may face following an episode of this condition.

  12. Deliberate acquisition of competence in physiological breech birth: A grounded theory study.

    Science.gov (United States)

    Walker, Shawn; Scamell, Mandie; Parker, Pam

    2018-06-01

    Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems. Due to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear. How do professionals develop competence and expertise in physiological breech birth? Nine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition. Among the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners. The results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices. Deliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  13. Presentation Modality and Proactive Interference in Children's Short-Term Memory.

    Science.gov (United States)

    Douglas, Joan Delahanty

    This study examined the role of visual and auditory presentation in memory encoding processes of 80 second-grade children, using the release-from-proactive-interference short-term memory (STM) paradigm. Words were presented over three trials within one of the presentation modes and one taxonomic category, followed by a fourth trial in which the…

  14. Presentations

    International Nuclear Information System (INIS)

    2007-01-01

    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

  15. Impact of the mode of delivery on maternal and neonatal outcome in spontaneous-onset breech labor at 32+0-36+6 weeks of gestation: A retrospective cohort study.

    Science.gov (United States)

    Toivonen, Elli; Palomäki, Outi; Korhonen, Päivi; Huhtala, Heini; Uotila, Jukka

    2018-03-30

    To compare neonatal and maternal outcomes in spontaneously onset preterm breech deliveries after trial of labor (BTOL) and intended cesarean section (BCS), and between BTOL and vertex control deliveries, in singleton fetuses at 32 +0 -36 +6  weeks of gestation. Retrospective single center cohort study in a Finnish University Hospital including all spontaneous-onset preterm breech deliveries with 32 completed gestational weeks in 2003-2015. The study population comprised a total of 176 preterm breech and 103 vertex control deliveries, matched by gestational age and whether the mother had given birth vaginally before or not. Infants with severe malformations and antepartum fetal distress were excluded. Subgroup analyses were made in two cohorts according to gestational age. Main outcome measures were maternal and neonatal mortality and morbidity, low cord pH and Apgar score. No mortality was observed, and severe morbidity was rare. No difference in incidence of low cord pH or five-minute Apgar score was observed between the groups. Apgar scores at the age of one minute were comparable in the breech groups but more often low in the BTOL group compared to the vertex control group. 16.5% of neonates in the BTOL group, 23.3% in the BCS group and 7.8% in the vertex group needed intensive care. In logistic regression analysis, lower gestational age and being small for gestational age were associated with the need for neonatal intensive care. Being allowed a trial of labor was not associated with the need for neonatal intensive care. Maternal morbidity was similar across the groups, but median blood loss was more pronounced in the BCS group compared to the BTOL group. In breech deliveries at 32 +0 -36 +6 gestational weeks, trial of labor did not increase neonatal morbidity compared to intended cesarean delivery. Infants born after a trial of labor in breech presentation display low one-minute Apgar score and need intensive care more often compared to vertex controls

  16. Presentations

    International Nuclear Information System (INIS)

    2007-01-01

    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

  17. When past is present: Substitutions of long-term memory for sensory evidence in perceptual judgments

    OpenAIRE

    Fan, Judith E.; Hutchinson, J. Benjamin; Turk-Browne, Nicholas B.

    2016-01-01

    When perception is underdetermined by current sensory inputs, memories for related experiences in the past might fill in missing detail. To evaluate this possibility, we measured the likelihood of relying on long-term memory versus sensory evidence when judging the appearance of an object near the threshold of awareness. Specifically, we associated colors with shapes in long-term memory and then presented the shapes again later in unrelated colors and had observers judge the appearance of the...

  18. Effects of age, gender, and stimulus presentation period on visual short-term memory.

    Science.gov (United States)

    Kunimi, Mitsunobu

    2016-01-01

    This study focused on age-related changes in visual short-term memory using visual stimuli that did not allow verbal encoding. Experiment 1 examined the effects of age and the length of the stimulus presentation period on visual short-term memory function. Experiment 2 examined the effects of age, gender, and the length of the stimulus presentation period on visual short-term memory function. The worst memory performance and the largest performance difference between the age groups were observed in the shortest stimulus presentation period conditions. The performance difference between the age groups became smaller as the stimulus presentation period became longer; however, it did not completely disappear. Although gender did not have a significant effect on d' regardless of the presentation period in the young group, a significant gender-based difference was observed for stimulus presentation periods of 500 ms and 1,000 ms in the older group. This study indicates that the decline in visual short-term memory observed in the older group is due to the interaction of several factors.

  19. Presentation

    Directory of Open Access Journals (Sweden)

    Eduardo Vicente

    2013-06-01

    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

  20. Short term memory bowing effect is consistent with presentation rate dependent decay.

    Science.gov (United States)

    Tarnow, Eugen

    2010-12-01

    I reanalyze the free recall data of Murdock, J Exp Psychol 64(5):482-488 (1962) and Murdock and Okada, J Verbal Learn and Verbal Behav 86:263-267 (1970) which show the famous bowing effect in which initial and recent items are recalled better than intermediate items (primacy and recency effects). Recent item recall probabilities follow a logarithmic decay with time of recall consistent with the tagging/retagging theory. The slope of the decay increases with increasing presentation rate. The initial items, with an effectively low presentation rate, decay with the slowest logarithmic slope, explaining the primacy effect. The finding that presentation rate limits the duration of short term memory suggests a basis for memory loss in busy adults, for the importance of slow music practice, for long term memory deficiencies for people with attention deficits who may be artificially increasing the presentation rates of their surroundings. A well-defined, quantitative measure of the primacy effect is introduced.

  1. Political Youth Education in Germany. Presenting a Qualitative Study on Its Biographically Long-Term Effects

    Science.gov (United States)

    Balzter, Nadine; Ristau, Yan; Schröder, Achim

    2017-01-01

    Purpose: There is an impact analysis presented, which explores the long-term effect of extra-curricular political youth education from the perspective of participants. Methods: The former participants retell their own education and life stories about five years later. Life stories were then interpreted in the course of research workshops and…

  2. Developmental dysplasia of hip screening using ortolani and barlow testing on breech delivered neonates.

    Science.gov (United States)

    Sulaiman, Ar; Yusof, Zakaria; Munajat, I; Lee, Naa; Zaki, Nik

    2011-11-01

    We conducted this study to compare the specificity and sensitivity of the Ortolani and Barlow tests performed by dedicated examiners, and to ascertain the incidence of developmental dysplasia of the hip (DDH) in breech babies. A dedicated examiner underwent specific training and testing by a paediatric orthopaedic surgeon. Routine examiners were medical officers who had basic training in medical school and were briefly trained by their superiors. The dedicated examiner examined 170 babies. Thirty babies including 5 babies with positive tests (according to the dedicated examiner) were examined by a blinded routine examiner. RESULTS of Ortolani and Barlow tests on 30 babies were compared with ultrasound examination by blinded radiologist. Five babies had positive Ortolani and Barlow tests. The routine examiner did not detect positive Ortolani and Barlow tests. The incidence of positive Ortolani and Barlow tests among breech babies was 2.8%. Result of Ortolani and Barlow tests by dedicated hip screener were better than results performed by routine examiner. Ortolani and Barlow, Dedicated Examiner, Routine Examiner, Breech, Ultrasound.

  3. Short and long-term mortality of patients presenting with bleeding events to the Emergency Department.

    Science.gov (United States)

    Conti, Alberto; Renzi, Noemi; Molesti, Daniele; Bianchi, Simone; Bogazzi, Irene; Bongini, Giada; Pepe, Giuseppe; Frosini, Fabiana; Bertini, Alessio; Santini, Massimo

    2017-12-01

    Death of patients presenting with bleeding events to the Emergency Department still represent a major problem. We sought to analyze clinical characteristics associated with worse outcomes including short- and long-term death, beyond antithombotic treatment strategy. Patients presenting with any bleeding events during 2016-2017years were enrolled. Clinical parameters, site of bleeding, major bleeding, ongoing anti-thrombotic treatment strategy and death were collected. Hard 5:1 propensity score matching was performed to adjust dead patients in baseline characteristics. Endpoints were one-month and one-year death. Out of 166,000 visits to the Emergency Department, 3.050 patients (1.8%) were enrolled and eventually 429 were analyzed after propensity. Overall, anticoagulants or antiplatelets were given to 234(54%). Major bleeding account for 111(26%) patients, without differences between those taking anticoagulants or antiplatelets versus others. Death at one-month and one-year was 26(6%) and 72(17%), respectively. Independent predictors of one-month death were major bleeding (Odds Ratio, OR 26, pbleeding (OR 7, pbleeding where higher than others (pbleeding and age (0.75 and 0.72, respectively) over others; pbleeding events, death rate was driven by major bleeding on short-term and older age on long-term. Among dead patients mortality was approximately 40% on one-month; 60% in older patients, and 80% in female gender. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Long-term European temperature variations between 1525 and the present

    International Nuclear Information System (INIS)

    Weber, G.R.

    1994-01-01

    Long-term European temperature records are analyzed between 1525 and the present. It is found that the warmest periods occurred around the middle of this century, whereas the coldest periods generally occurred around the middle and the end of the last century. Urban warming may have occurred in the 19th century, causing urban areas to warm relative to rural areas and smaller towns between 1800 and 1900. The magnitude of natural climatic variability was determined. Trends were calculated for various time intervals. There was general warming between late 19th century and the present, but general cooling between the late 18th century and late 19th century. In some longer-term records, there was cooling between the 16th and the late 19th century. The largest warming occurred in the 1900s and in the 1930s. There has been a pronounced seasonal variation in trends of the last 200 years, with warming being centered in late fall to early spring, whereas the summer half of the year either did not warm or even cooled. European temperatures in the last decades are significantly above longer-term averages. However, they are much below estimates of modeled greenhouse warming which might have occurred in the last decades. Those differences cannot plausibly be explained by natural climatic variability. 43 refs., 5 figs., 10 tabs

  5. Short-Term fo F2 Forecast: Present Day State of Art

    Science.gov (United States)

    Mikhailov, A. V.; Depuev, V. H.; Depueva, A. H.

    An analysis of the F2-layer short-term forecast problem has been done. Both objective and methodological problems prevent us from a deliberate F2-layer forecast issuing at present. An empirical approach based on statistical methods may be recommended for practical use. A forecast method based on a new aeronomic index (a proxy) AI has been proposed and tested over selected 64 severe storm events. The method provides an acceptable prediction accuracy both for strongly disturbed and quiet conditions. The problems with the prediction of the F2-layer quiet-time disturbances as well as some other unsolved problems are discussed

  6. Compound presentation in labour: highlighting the importance of ...

    African Journals Online (AJOL)

    Objective: To describe the occurrence of compound presentation in labour, as an obstetric emergency. Background: Compound presentation is a rare obstetric event, defined as the presentation of the hand or foot alongside the head or breech. It places both mother and baby at severe risk. The presence of skilled attendants ...

  7. Long term needs for nuclear data development. Texts of papers presented at the advisory group meeting

    International Nuclear Information System (INIS)

    Herman, M.

    2001-08-01

    This report contains the texts of the invited presentations delivered at the Advisory Group Meeting on Long Term Needs for Nuclear Data Development. The meeting was organized by the International Atomic Energy Agency (IAEA) and held at IAEA Headquarters, Vienna, Austria, 28 November - 1 December 2000. The texts are reproduced here, directly from the author's manuscripts with little or no editing, in the order in which the presentations were made at the meeting. For the main conclusions refer to the Summary Report, published as INDC(NDS)-423. The contributed papers deal with cross section data needed for production of radionuclides; for internal radiation dosimetry; for ion beam analysis; neutron data needs in astrophysics; nuclear data for advanced fast reactors; lead cooled reactors; accelerator driven subcritical assemblies

  8. Surface ozone in China: present-day distribution and long-term changes

    Science.gov (United States)

    Xu, X.; Lin, W.; Xu, W.

    2017-12-01

    Reliable knowledge of spatio-temporal variations of surface ozone is highly needed to assess the impacts of ozone on human health, ecosystem and climate. Although regional distributions and trends of surface ozone in European and North American countries have been well characterized, little is known about the variability of surface ozone in many other countries, including China, where emissions of ozone precursors have been changing rapidly in recent decades. Here we present the first comprehensive description of present-day (2013-2017) distribution and long-term changes of surface ozone in mainland China. Recent ozone measurements from China's air quality monitoring network (AQMN) are analyzed to show present-day distributions of a few ozone exposure metrics for urban environment. Long-term measurements of ozone at six background sites, a rural site and an urban are used to study the trends of ozone in background, rural and urban air, respectively. The average levels of ozone at the AQMN sites (mainly urban) are close to those found at many European and North American sites. However, ozone at most of the sites shows very large diurnal and seasonal variations so that ozone nonattainment can occur in many cities, particularly those in the North China Plain (NCP), the south of Northeast China (NEC), the Yangtze River Delta (YRD), the Pearl River Delta (PRD), and the Sichuan Basin-Chongqing region (SCB). In all these regions, particularly in the NCP, the maximum daily 8-h average (MDA8) ozone concentration can significantly exceed the national limit (75 ppb). High annual sum of ozone means over 35 ppb (SOMO35) exist mainly in the NCP, NEC and YRD, with regional averages over 4000 ppb·d. Surface ozone has significantly increased at Waliguan (a baseline site in western China) and Shangdianzi (a background site in the NCP), and decreased in winter and spring at Longfengshan (a background site in Northeast China). No clear trend can be derived from long-term measurements

  9. When past is present: Substitutions of long-term memory for sensory evidence in perceptual judgments.

    Science.gov (United States)

    Fan, Judith E; Hutchinson, J Benjamin; Turk-Browne, Nicholas B

    2016-06-01

    When perception is underdetermined by current sensory inputs, memories for related experiences in the past might fill in missing detail. To evaluate this possibility, we measured the likelihood of relying on long-term memory versus sensory evidence when judging the appearance of an object near the threshold of awareness. Specifically, we associated colors with shapes in long-term memory and then presented the shapes again later in unrelated colors and had observers judge the appearance of the new colors. We found that responses were well characterized as a bimodal mixture of original and current-color representations (vs. an integrated unimodal representation). That is, although irrelevant to judgments of the current color, observers occasionally anchored their responses on the original colors in memory. Moreover, the likelihood of such memory substitutions increased when sensory input was degraded. In fact, they occurred even in the absence of sensory input when observers falsely reported having seen something. Thus, although perceptual judgments intuitively seem to reflect the current state of the environment, they can also unknowingly be dictated by past experiences.

  10. The effects of presenting oncologic information in terms of opposites in a medical context

    Directory of Open Access Journals (Sweden)

    Burro R

    2018-03-01

    Full Text Available Roberto Burro,1 Ugo Savardi,1 Maria Antonietta Annunziata,2 Paolo De Paoli,2 Ivana Bianchi3 1Department of Human Sciences, University of Verona, Verona, Italy; 2National Cancer Institute IRCCS ‘Centro di Riferimento Oncologico’ (CRO, Aviano, Italy; 3Department of Humanities (Section Philosophy and Human Sciences, University of Macerata, Macerata, Italy Background: An extensive body of literature has demonstrated that many patients who have been asked to participate in clinical trials do not fully understand the informed consent forms. A parallel independent study has demonstrated that opposites have a special status in human cognitive organization: they are common to all-natural languages and are intuitively and naturally understood and learnt.Purpose: The study investigates whether, and how, the use of opposites impacts on doctor–patient communication: does using the terms “small–large” to describe a nodule (ie, bipolar communication rather than speaking in terms of centimeters (ie, unipolar communication affect a patient’s understanding of the situation? And is it better to speak of “common–rare” side effects (ie, bipolar communication instead of the number of people who have suffered from particular side effects (ie, unipolar communication?Methods: Two questionnaires were created and used, one presenting the information in terms of opposites (ie, bipolar communication and another using unipolar communication.Results: The participants’ perception of their situation (in terms of feeling healthy–ill, being at high–low risk, and their treatment requiring high–low commitment varied in the two conditions. Moreover, self-reported levels of understanding and satisfaction with how the information was communicated were higher when opposites were used.Limitations: Since this is the first study that addresses the merits of using bipolar structures versus unipolar structures in doctor–patient communication, further work is

  11. Short term outcome of varus derotation osteotomy in late presenting perthes disease

    Directory of Open Access Journals (Sweden)

    Narendra Joshi

    2018-01-01

    Full Text Available Background: Untreated Perthes disease can lead to osteoarthritis by the fourth decade. The treatment is conservative for children 10 years of age at presentation. All patients had limitation of abduction and internal rotation. Eight patients (53.33% had pain at the hip and 12 patients (80% had limp. Mean time between diagnosis and corrective surgery was 3 weeks. Results: The evaluation was done using caput index (CI and epiphyseal quotient (EQ and articulotrochanteric distance radiologically, range of motion and Harris Hip Score for clinical outcome. All the measurements were carried out on pre- and postoperative X-rays after 3 years followup and compared with the contralateral normal hip. After a mean followup period of 3.4 years, we noted the statistically significant difference between pre- and postoperative values. We noted that all (100% children in Stage IB, IIA and 50% children in Stage IIB achieved satisfactory results. There was a significant change (P = 0.000 in CI among all the patients after surgery. The final EQ after 3 years of VDRO was 0.606 and was significant (P = 0.0000. Conclusion: In our opinion, based on the encouraging short term radiological and clinical outcomes, VDRO may be regarded as a treatment procedure for late presenting Perthes disease in stage IB, IIA, IIB.

  12. Characteristics and Long-Term Prognosis of Holocaust Survivors Presenting with Acute Myocardial Infarction.

    Science.gov (United States)

    Shiyovich, Arthur; Plakht, Ygal; Belinski, Katya; Gilutz, Harel

    2016-05-01

    Catastrophic life events are associated with the occurrence of cardiovascular incidents and worsening of the clinical course followirg-such events. To evaluate the characteristics and long-term prognosis of Holocaust survivors presenting with acute myocardial infarction (AMI) compared to non-Holocaust survivors. Israeli Jews who were born before 1941 and had been admitted to a tertiary medical center due to AMI during the period 2002-2012 were studied. Holocaust survivors were compared with non-Holocaust survivor controls using individual age matching. Overall 305 age-matched pairs were followed for up to 10 years after AMI. We found a higher prevalence of depression (5.9% vs. 3.3%, P = 0.045) yet a similar rate of cardiovascular risk factors, non-cardiovascular co-morbidity, severity of coronary artery disease, and in-hospital complications in survivors compared to controls. Throughout the follow-up period, similar mortality rates (62.95% vs. 63.9%, P = 0.801) and reduced cumulative mortality (0.9 vs. 0.96, HR = 0.780, 95% CI 0.636-0.956, P = 0.016) were found among survivors compared to age-matched controls, respectively. However, in a multivariate analysis survival was not found to be an independent predictor of mortality, although some tendency towards reduced mortality was seen (AdjHR = 0.84, 95% CI 0.68-1.03, P = 0.094). Depression disorder was associated with a 77.9% increase in the risk for mortality. Holocaust survivors presenting with AMI were older and had a higher prevalence of depression than controls. No. excessive, and possibly even mildly improved, risk of mortality.was observed in survivors compared with controls presenting with AMI. Possibly, specific traits that are associated with surviving catastrophic events counter the excess risk of such events following AMI.

  13. Persistent muscle fiber regeneration in long term denervation. Past, present, future

    Directory of Open Access Journals (Sweden)

    Ugo Carraro

    2015-03-01

    Full Text Available Despite the ravages of long term denervation there is structural and ultrastructural evidence for survival of muscle fibers in mammals, with some fibers surviving at least ten months in rodents and 3-6 years in humans. Further, in rodents there is evidence that muscle fibers may regenerate even after repeated damage in the absence of the nerve, and that this potential is maintained for several months after denervation. While in animal models permanently denervated muscle sooner or later loses the ability to contract, the muscles may maintain their size and ability to function if electrically stimulated soon after denervation. Whether in mammals, humans included, this is a result of persistent de novo formation of muscle fibers is an open issue we would like to explore in this review. During the past decade, we have studied muscle biopsies from the quadriceps muscle of Spinal Cord Injury (SCI patients suffering with Conus and Cauda Equina syndrome, a condition that fully and irreversibly disconnects skeletal muscle fibers from their damaged innervating motor neurons. We have demonstrated that human denervated muscle fibers survive years of denervation and can be rescued from severe atrophy by home-based Functional Electrical Stimulation (h-bFES. Using immunohistochemistry with both non-stimulated and the h-bFES stimulated human muscle biopsies, we have observed the persistent presence of muscle fibers which are positive to labeling by an antibody which specifically recognizes the embryonic myosin heavy chain (MHCemb. Relative to the total number of fibers present, only a small percentage of these MHCemb positive fibers are detected, suggesting that they are regenerating muscle fibers and not pre-existing myofibers re-expressing embryonic isoforms. Although embryonic isoforms of acetylcholine receptors are known to be re-expressed and to spread from the end-plate to the sarcolemma of muscle fibers in early phases of muscle denervation, we suggest

  14. Predictors of success of external cephalic version and cephalic presentation at birth among 1253 women with non-cephalic presentation using logistic regression and classification tree analyses.

    Science.gov (United States)

    Hutton, Eileen K; Simioni, Julia C; Thabane, Lehana

    2017-08-01

    Among women with a fetus with a non-cephalic presentation, external cephalic version (ECV) has been shown to reduce the rate of breech presentation at birth and cesarean birth. Compared with ECV at term, beginning ECV prior to 37 weeks' gestation decreases the number of infants in a non-cephalic presentation at birth. The purpose of this secondary analysis was to investigate factors associated with a successful ECV procedure and to present this in a clinically useful format. Data were collected as part of the Early ECV Pilot and Early ECV2 Trials, which randomized 1776 women with a fetus in breech presentation to either early ECV (34-36 weeks' gestation) or delayed ECV (at or after 37 weeks). The outcome of interest was successful ECV, defined as the fetus being in a cephalic presentation immediately following the procedure, as well as at the time of birth. The importance of several factors in predicting successful ECV was investigated using two statistical methods: logistic regression and classification and regression tree (CART) analyses. Among nulliparas, non-engagement of the presenting part and an easily palpable fetal head were independently associated with success. Among multiparas, non-engagement of the presenting part, gestation less than 37 weeks and an easily palpable fetal head were found to be independent predictors of success. These findings were consistent with results of the CART analyses. Regardless of parity, descent of the presenting part was the most discriminating factor in predicting successful ECV and cephalic presentation at birth. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  15. Idiopathic membranous nephropathy in pediatric patients: presentation, response to therapy, and long-term outcome

    Directory of Open Access Journals (Sweden)

    Valderrama Elsa

    2007-08-01

    Full Text Available Abstract Background Idiopathic membranous nephropathy (IMN is one of the most common causes of primary nephrotic syndrome in adults. However, it is a relatively rare entity in the pediatric population and there is a paucity of data about the incidence, prognosis, and optimal treatment of IMN in children and adolescents. We conducted this study to evaluate pediatric patients with IMN in order to clarify the presentation, response to therapy, and clinical outcome. Methods A retrospective chart review was performed on patients identified with biopsy-proven IMN between 1988–2005. Patients with systemic lupus erythematosus or hepatitis-related lesions were excluded. The following data were tabulated: age, gender, ethnicity, presenting clinical and laboratory findings, proteinuria in a first morning urine specimen, estimated glomerular filtration rate (GFRe, histopathology, type and duration of treatment, and clinical status at final evaluation. Results 13 cases of IMN were identified out of 460 renal biopsies performed for evaluation of primary kidney disease during the study interval. Mean age was 9.6 ± 4.6, gender 6 M:7 F, ethnicity 8 W:2 B:3 H. At the initial visit hematuria was present in 9 patients, edema in 5, nephrotic-range proteinuria in 5, and hypertension in 3. Mean urinary protein:creatinine ratio 3.3 ± 2.5 and all patients had a normal GFRe. Classic glomerular findings of IMN were seen in all renal specimens, with concomitant interstitial changes in 2 cases. Treatment included an angiotensin converting enzyme inhibitor or angiotensin receptor blocker in 11 cases. Most patients were also given immunosuppressive medications – prednisone in 10, a calcineurin inhibitor in 5, and mycophenolate mofetil or azathioprine in 3 patients. At the last follow-up, 42 ± 35 months after the diagnostic biopsy, 7 children were hypertensive and the urine protein:creatinine ratio was 2.3 ± 3.1. The mean GFRe was 127 ± 57 mL/min/m2. Three patients

  16. Present state and long term planning on nuclear power plants in principal countries in the world

    International Nuclear Information System (INIS)

    Nomura, Junichi

    1978-01-01

    The situation of nuclear power stations and the long term planning in each major country in the world were summarized, but the situation is changing from time to time, therefore it is difficult to make the long term prediction. The advanced countries in terms of nuclear power established the long term plans to adopt nuclear power generation largely owing to the oil crisis, but thereafter the revision was carried out again and again in respective countries. The developing countries already started the operation of nuclear power generation occupy only 2 to 3% of the total installed capacity in the world, but the countries constructing or planning nuclear power generation are many, and if the operation will be started as scheduled, their capacity will reach 30 million kW by 1985, and occupy about 10% of the total installed capacity of nuclear power generation in the world. As for the range of investigation of this report, the countries where the long term plans are unknown or the number of construction is small, Japan, Great Britain, USA and communist countries are excluded. As a rule, the light water reactors with power output of more than 200,000 kW are listed. The number of nuclear power plants in operation, under construction and in planning stage, national situation, long term plan, and others in each country are described. (Kako, I.)

  17. Labor induction just after external cephalic version with epidural analgesia at term.

    Science.gov (United States)

    Cuerva, Marcos J; Piñel, Carlos S; Caceres, Javier; Espinosa, Jose A

    2017-06-01

    To analyze the benefits of external cephalic version (ECV) with epidural analgesia at term and labor induction just after the procedure. This is a retrospective observational study with patients who did not want trying a breech vaginal delivery and decided trying an ECV with epidural analgesia at term and wanted labor induction or cesarean section after the procedure. We present the results of 40 ECV with epidural analgesia at term and labor induction or cesarean section just after the ECV. ECV succeeded in 26 out of 40 (65%) patients. Among the 26 successful ECV, 6 delivered by cesarean (23.1%). 20 patients delivered vaginally (76.9%; 50% of all patients). Considering that a high number of cesarean deliveries can be avoided, induction of labor after ECV with epidural analgesia at term can be considered after being discussed in selected patient. Copyright © 2017. Published by Elsevier B.V.

  18. Context effects in short-term memory : Confirmatory evidence from recall of visually presented lists

    NARCIS (Netherlands)

    Bunt, A.A.

    1976-01-01

    Thirty-two subjects had tests of serial recall of visually presented nine-digit lists which were either presented in a single block of trials (constant context) or in between lists of much longer length (variable context). Other variables were vocalization-during-presentation versus silent

  19. Present and long-term composition of MSW landfill leachate: A review

    DEFF Research Database (Denmark)

    Kjeldsen, Peter; Barlaz, M.A.; Rooker, A.P.

    2002-01-01

    The major potential environmental impacts related to landfill leachate are pollution of groundwater and surface waters. Landfill leachate contains pollutants that can be categorized into four groups (dissolved organic matter, inorganic macrocomponents, heavy metals, and xenobiotic organic compounds...... are observed. In contrast, the concentration of ammonia does not decrease, and often constitutes a major long-term pollutant in leachate. A broad range of xenobiotic organic compounds is observed in landfill leachate. The long-term behavior of landfills with respect to changes in oxidation-reduction status...... is discussed based on theory and model simulations. It seems that the somewhere postulated enhanced release of accumulated heavy metals would not take place within the time frames of thousands of years. This is supported by a few laboratory investigations. The existing data and model evaluations indicate...

  20. Breech - slideshow

    Science.gov (United States)

    ... Duplication for commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow us Disclaimers Copyright ...

  1. Reverse breech extraction versus the standard approach of pushing the impacted fetal head up through the vagina in caesarean section for obstructed labour: A randomised controlled trial.

    Science.gov (United States)

    Nooh, Ahmed Mohamed; Abdeldayem, Hussein Mohammed; Ben-Affan, Othman

    2017-05-01

    The objective of this study was to assess effectiveness and safety of the reverse breech extraction approach in Caesarean section for obstructed labour, and compare it with the standard approach of pushing the fetal head up through the vagina. This randomised controlled trial included 192 women. In 96, the baby was delivered by the 'reverse breech extraction approach', and in the remaining 96, by the 'standard approach'. Extension of uterine incision occurred in 18 participants (18.8%) in the reverse breech extraction approach group, and 46 (47.9%) in the standard approach group (p = .0003). Two women (2.1%) in the reverse breech extraction approach group needed blood transfusion and 11 (11.5%) in the standard approach group (p = .012). Pyrexia developed in 3 participants (3.1%) in the reverse breech extraction approach group, and 19 (19.8%) in the standard approach group (p = .0006). Wound infection occurred in 2 women (2.1%) in the reverse breech extraction approach group, and 12 (12.5%) in the standard approach group (p = .007). Apgar score pushing the fetal head up through the vagina.

  2. Impact of Substance Use Disorder on Presentation and Short-Term Course of Schizophrenia

    Directory of Open Access Journals (Sweden)

    Rudraprosad Chakraborty

    2014-01-01

    Full Text Available The aim of the present study was to compare a cohort of schizophrenia patients with substance use disorder (SUD with a similar cohort of schizophrenia patients without SUD with regard to sociodemographic variables, clinical variables, psychopathology, anxiety symptoms, depressive symptoms, treatment outcome, and side effect profile of drugs. A total of 143 consecutive inpatients with ICD-10 DCR diagnosis of schizophrenia were included after obtaining informed consent. Patients were evaluated by a semistructured data sheet and Maudsley Addiction Profile. They were then rated by Positive and Negative Symptoms Scale, Calgary Depression Scale, Hamilton Anxiety Rating Scale, and Brief Psychiatric Rating Scale at presentation, three weeks, and six weeks. At three weeks and six weeks, they were also evaluated by UKU Side Effect Rating Scale. Substance abuse was detected in 63.6% schizophrenia patients. Nicotine was the commonest substance followed by cannabis and alcohol. Substance users had longer untreated illness and more depressive symptoms at presentation and six-week follow-up. Dual diagnosis patients had difficulty in abstraction at three and six weeks but not at presentation. Schizophrenia patients with SUD had more depressive symptoms. SUD appeared to mask abstraction difficulties at presentation. Schizophrenia patients with SUD should be carefully assessed for presence of depression.

  3. Direct current induced short-term modulation of the left dorsolateral prefrontal cortex while learning auditory presented nouns

    Directory of Open Access Journals (Sweden)

    Meyer Martin

    2009-07-01

    Full Text Available Abstract Background Little is known about the contribution of transcranial direct current stimulation (tDCS to the exploration of memory functions. The aim of the present study was to examine the behavioural effects of right or left-hemisphere frontal direct current delivery while committing to memory auditory presented nouns on short-term learning and subsequent long-term retrieval. Methods Twenty subjects, divided into two groups, performed an episodic verbal memory task during anodal, cathodal and sham current application on the right or left dorsolateral prefrontal cortex (DLPFC. Results Our results imply that only cathodal tDCS elicits behavioural effects on verbal memory performance. In particular, left-sided application of cathodal tDCS impaired short-term verbal learning when compared to the baseline. We did not observe tDCS effects on long-term retrieval. Conclusion Our results imply that the left DLPFC is a crucial area involved in short-term verbal learning mechanisms. However, we found further support that direct current delivery with an intensity of 1.5 mA to the DLPFC during short-term learning does not disrupt longer lasting consolidation processes that are mainly known to be related to mesial temporal lobe areas. In the present study, we have shown that the tDCS technique has the potential to modulate short-term verbal learning mechanism.

  4. Prediction of neonatal metaboic acidos in women with a singleton term pregnancy in cephalic presentation

    NARCIS (Netherlands)

    Westerhuis, M.E.M.H.; Schuit, E.; Kwee, A.; Zuithoff, N.P.A.; Groenwold, R.H.H.; Akker, van den E.S.A.; Beek, van E.; Dessel, van H.J.H.M.; Drogtrop, A.P.; Geijn, van H.P.; Graziosi, G.C.M.; Lith, van J.M.M.; Nijhuis, J.G.; Oei, S.G.; Oosterbaan, H.P.; Porath, M.M.; Rijnders, R.J.P.; Schuitemaker, N.W.E.; Wijnberger, L.D.E.; Willekes, C.; Wouters, M.G.A.J.; Visser, G.H.A.; Mol, B.W.J.; Moons, K.G.M.

    2012-01-01

    We sought to predict neonatal metabolic acidosis at birth using antepartum obstetric characteristics (model 1) and additional characteristics available during labor (model 2). In 5667 laboring women from a multicenter randomized trial that had a high-risk singleton pregnancy in cephalic presentation

  5. How to reduce long-term drift in present-day and deep-time simulations?

    Science.gov (United States)

    Brunetti, Maura; Vérard, Christian

    2018-06-01

    Climate models are often affected by long-term drift that is revealed by the evolution of global variables such as the ocean temperature or the surface air temperature. This spurious trend reduces the fidelity to initial conditions and has a great influence on the equilibrium climate after long simulation times. Useful insight on the nature of the climate drift can be obtained using two global metrics, i.e. the energy imbalance at the top of the atmosphere and at the ocean surface. The former is an indicator of the limitations within a given climate model, at the level of both numerical implementation and physical parameterisations, while the latter is an indicator of the goodness of the tuning procedure. Using the MIT general circulation model, we construct different configurations with various degree of complexity (i.e. different parameterisations for the bulk cloud albedo, inclusion or not of friction heating, different bathymetry configurations) to which we apply the same tuning procedure in order to obtain control runs for fixed external forcing where the climate drift is minimised. We find that the interplay between tuning procedure and different configurations of the same climate model provides crucial information on the stability of the control runs and on the goodness of a given parameterisation. This approach is particularly relevant for constructing good-quality control runs of the geological past where huge uncertainties are found in both initial and boundary conditions. We will focus on robust results that can be generally applied to other climate models.

  6. Long-term survival of patients with multiple myeloma and acute renal failure at presentation.

    Science.gov (United States)

    Lazarus, H M; Adelstein, D J; Herzig, R H; Smith, M C

    1983-03-01

    Eight patients presented with simultaneous multiple myeloma and acute renal failure requiring hemodialysis. Patients had no known pre-existing renal disease nor exposure to nephrotoxic agents or x-ray contrast dye. Renal failure was attributed to light chain nephropathy in all cases. In 4 of these patients the diagnosis of myeloma was initially unsuspected. Renal biopsies in 3 of these patients, and post-mortem material in a fourth revealed the changes of "myeloma kidney." No patient regained renal function and all required chronic hemodialysis. Among these eight patients, three survived for periods greater than 21 months.

  7. Principles of general relativity theory in terms of the present day physics

    International Nuclear Information System (INIS)

    Pervushin, V.N.

    1986-01-01

    A hystory of gradual unification of general relativity theory and quantum field theory on the basis of unified geometrical principles is detected. The gauge invariance principles became universal for construction of all physical theories. Quantum mechanics, electrodynamics and Einstein gravitation theory were used to form geometrical principles. Identity of inertial and gravitational masses is an experimental basis of the general relativity theory (GRT). It is shown that correct understanding of GRT bases is a developing process related to the development of the present physics and stimulating this development

  8. Tenon’s Cyst Presenting as a Long-Term Complication following Incision Cataract Surgery

    Directory of Open Access Journals (Sweden)

    Prabhakar Srinivasapuram Krishnacharya

    2013-01-01

    Full Text Available Context. Tenon’s cyst or conjunctival cyst formation is not uncommon late complication of traditional extracapsular cataract surgery; however, few reports are available in the literature. Aims. Large cystic swellings were clinically diagnosed as filtering blebs at the cataract incision site in two patients. The purpose of the case presentation is to discuss the factors leading to cyst formation, visual loss and cyst recurrence after its excision. Patients and Methods. Case 1. Sixty-one-year-old male patient presented with a bleb at superior limbal region in the right eye, two years after cataract surgery. Case 2. A giant bleb was found at the same region in the right eye of a 65-year-old male patient, eight years after cataract surgery. Results. Complete excision of the cyst was performed with conjunctival autograft in the first patient and followed up for two years. No recurrence of the cyst was observed. Internal wound gaping was seen on gonioscopy in the second patient. Conclusions. Unstable scleral tunnel could explain bleb formation in both the patients. Complete bleb excision with conjunctival auto-graft resulted in closure of the defect with no bleb recurrence during two-year follow-up. Over-filtration causing hypotonic maculopathy was the reason for decreased vision in the second case.

  9. Nuclear electric energy in Romania - present status and long term prospects

    International Nuclear Information System (INIS)

    Fulga, V.

    1996-01-01

    The paper presents an analysis of the option for nuclear power in view of the decreasing energy demand in Romania, following industrial restructuring and abandonment of highly consuming industrial capacities. The costs of Cernavoda NPP based on CANDU type reactors amounted up to USD 2.2 billions, 160 % higher than the real price. Even though this reactor type is positioned among the highest as the safety is concerned, it could be assumed that even small incidents (predictable as well as repairable) would result in a decay of the tourism on Romanian sea shore or Danube delta. The paper raises also five questions and asks for updating the data necessary for a renewal of governmental decision concerning the Romanian nuclear power program

  10. Isolated acute non-cystic white matter injury in term infants presenting with neonatal encephalopathy.

    LENUS (Irish Health Repository)

    Barrett, Michael Joseph

    2013-03-01

    We discuss possible aetiological factors, MRI evolution of injury and neuro-developmental outcomes of neonatal encephalopathy (NE). Thirty-six consecutive infants diagnosed with NE were included. In this cohort, four infants (11%) were identified with injury predominantly in the deep white matter on MRI who were significantly of younger gestation, lower birthweight with higher Apgars at one and five minutes compared to controls. Placental high grade villitis of unknown aetiology (VUA) was identified in all four of these infants. Our hypothesis states VUA may induce white matter injury by causing a local inflammatory response and\\/or oxidative stress during the perinatal period. We underline the importance of continued close and systematic evaluation of all cases of NE, including examination of the placenta, in order to come to a better understanding of the clinical presentation, the patterns of brain injury and the underlying pathophysiological processes.

  11. Short-term minoxidil use associated with pericardial effusion and cardiac tamponade: an uncommon presentation.

    Science.gov (United States)

    Pasala, Krishna K; Gujja, Karthik; Prabhu, Hejmadi; Vasavada, Balendu; Konka, Sudarsanam

    2012-11-01

    A 48-year-old man presented with complaints of shortness of breath and lower extremity swelling. His medical history was significant for hypertension on minoxidil and recent intracerebellar hemorrhage. Electrocardiography showed sinus tachycardia with left ventricular hypertrophy, and cardiomegaly was noted in the chest x-ray. The patient was hypertensive and tachypneic on admission. An echocardiogram taken immediately showed a large pericardial effusion with evidence of cardiac tamponade. He underwent immediate pericardiocentesis with drainage of 900 mL of pericardial fluid with significant improvement in the symptoms. Analysis of the pericardial fluid proved to be nondiagnostic. Infectious and rheumatologic causes were ruled out. After an extensive battery of tests, not yielding any diagnostic results, the pericardial effusion was attributed to minoxidil therapy. Closer monitoring is needed to prevent potentially fatal complications such as cardiac tamponade as in our patient.

  12. Wolff-Parkinson-White Syndrome in a Term Infant Presenting With Cardiopulmonary Arrest.

    Science.gov (United States)

    Hoeffler, Christina D; Krenek, Michele E; Brand, M Colleen

    2016-02-01

    Wolff-Parkinson-White syndrome is a congenital abnormality of the cardiac conduction system caused by the presence of an abnormal accessory electrical pathway between the atria and the ventricles. This can result in intermittent tachyarrhythmias such as supraventricular tachycardia. In rare occasions, sudden death may occur from atrial fibrillation with rapid ventricular conduction. Supraventricular tachycardia typically has a sudden onset and offset, classified as a paroxysmal arrhythmia. Because of the variable occurrence, Wolff-Parkinson-White syndrome may go undiagnosed in the immediate newborn period. To highlight arrhythmia as a possible cause of sudden decompensation in infants. The clinical presentation of this infant is complex and a number of potential diagnoses were considered. Preexcitation on electrocardiogram resulted in the diagnosis of Wolff-Parkinson-White syndrome. Nurses caring for infants should be alert to tachycardia and irregularities of the heart rate, including those in the prenatal history, and should report them for evaluation. While all parents should be taught to watch for signs of illness, parents of infants with Wolff-Parkinson-White have additional learning needs, including recognizing early signs and symptoms of heart failure.

  13. Objective Structured Assessment of Technical Skills (OSATS) evaluation of theoretical versus hands-on training of vaginal breech delivery management: a randomized trial.

    Science.gov (United States)

    Buerkle, Bernd; Rueter, Katharina; Hefler, Lukas A; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B

    2013-12-01

    To compare the skills of performing a vaginal breech (VB) delivery after hands-on training versus demonstration. We randomized medical students to a 30-min demonstration (group 1) or a 30-min hands-on (group 2) training session using a standardized VB management algorithm on a pelvic training model. Subjects were tested with a 25 item Objective Structured Assessment of Technical Skills (OSATS) scoring system immediately after training and 72 h thereafter. OSATS scores were the primary outcome. Performance time (PT), self assessment (SA), confidence (CON), and global rating scale (GRS) were the secondary outcomes. Statistics were performed using the Mann-Whitney U-test, chi-square test, and multiple linear regression analysis. 172 subjects were randomized. OSATS scores (primary outcome) were significantly higher in group 2 (n=88) compared to group 1 (n=84) (21.18±2.29 vs. 20.19±2.37, respectively; p=0.006). The secondary outcomes GRS (10.31±2.28 vs. 9.17±2.21; p=0.001), PT (214.60±57.97 s vs. 246.98±59.34 s; ptraining leads to a significant improvement of VB management in a pelvic training model, but this effect was only seen in the short term. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. Long-term outcome in term breech infants with low Apgar score--a population-based follow-up

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Thorngren-Jerneck, K

    2001-01-01

    and 218 controls. RESULTS: Four cases (4.6%) and one control (0.5%) had cerebral palsy. In infants without cerebral palsy, speech/language problems were more frequent than controls (10.6 versus 3.2%) (P=0.02). There were no differences in rates of deficits in attention, motor control and perception (DAMP...

  15. Cardiovascular dynamics in relation to presentation and postural changes in normal fetuses.

    Science.gov (United States)

    Luterkort, M; Gennser, G

    1987-01-01

    The role of fetal cardiovascular function in the reduced intrauterine growth rate of breech pregnancy was studied in fetuses with different presentations. Hemodynamic responses to postural changes were also investigated in fetuses in horizontal and vertical positions. Thirty-one normal pregnancies, with 15 fetuses presenting by the breech and 16 fetuses by the vertex, were included in the study. Diameter pulse waves from the fetal descending aorta were measured using equipment combining real-time ultrasound imaging with phase-locked echo-tracking. No differences in basal pulse wave parameters were demonstrated between breech and vertex fetuses nor did any differences appear when maternal posture was changed from horizontal to upright or vice versa. The present observations suggest that fetal circulatory factors are less likely to be a primary cause of the reduced intrauterine growth in breech presentation. Tilting of the fetus in late gestation seems to produce neither a redistribution of its blood volume nor secondary adaptations to an orthostatic challenge. The hydrostatic effect of amniotic fluid presumably precludes the requirement of fetal circulatory adaptation to postural changes.

  16. An investigation of the effects of interference speech on short-term memory for verbally presented prose

    Science.gov (United States)

    Lodico, Dana M.; Torres, Rendell R.; Shimizu, Yasushi; Hunter, Claudia

    2004-05-01

    This study investigates the effects of interference speech and the built acoustical environment on human performance, and the possibility of designing spaces to architecturally meet the acoustical goals of office and classroom environments. The effects of room size, geometry, and acoustical parameters on human performance are studied through human subject testing. Three experiments are used to investigate the effects of distracting background speech on short-term memory for verbally presented prose under constrained laboratory conditions. Short-term memory performance is rated within four different acoustical spaces and five background noise levels, as well as a quiet condition. The presentation will cover research methods, results, and possibilities for furthering this research. [Work supported by the Program in Architectural Acoustics, School of Architecture, Rensselaer Polytechnic Institute.

  17. Long-term treatment outcomes of acromegaly patients presenting biochemically-uncontrolled at a tertiary pituitary center.

    Science.gov (United States)

    Carmichael, John D; Broder, Michael S; Cherepanov, Dasha; Chang, Eunice; Mamelak, Adam; Said, Qayyim; Neary, Maureen P; Bonert, Vivien

    2017-08-04

    Acromegaly is a rare, slowly progressive disorder resulting from excessive growth hormone (GH) production by a pituitary somatotroph tumor. The objective of this study was to examine acromegaly treatment outcomes during long-term care at a specialized pituitary center in patients presenting with lack of biochemical control. Data came from an acromegaly registry at the Cedars-Sinai Medical Center Pituitary Center (center). Acromegaly patients included in this study were those who presented biochemically-uncontrolled for care at the center. Biochemical control status, based on serum insulin-like growth factor-1 values, was determined at presentation and at study end. Patient characteristics and acromegaly treatments were reported before and after presentation by presenting treatment status and final biochemical control status. Data on long-term follow-up were recorded from 1985 through June 2013. Seventy-four patients presented uncontrolled: 40 untreated (54.1%) and 34 (45.9%) previously-treated. Mean (SD) age at diagnosis was 43.2 (14.7); 32 (43.2%) were female patients. Of 65 patients with tumor size information, 59 (90.8%) had macroadenomas. Prior treatments among the 34 previously-treated patients were pituitary surgery alone (47.1%), surgery and medication (41.2%), and medication alone (11.8%). Of the 40 patients without prior treatment, 82.5% achieved control by study end. Of the 34 with prior treatment, 50% achieved control by study end. This observational study shows that treatment outcomes of biochemically-uncontrolled acromegaly patients improve with directed care, particularly for those that initially present untreated. Patients often require multiple modalities of treatment, many of which are offered with the highest quality at specialized pituitary centers. Despite specialized care, some patients were not able to achieve biochemical control with methods of treatment that were available at the time of their treatment, showing the need for additional

  18. The effects of short-term and long-term learning on the responses of lateral intraparietal neurons to visually presented objects.

    Science.gov (United States)

    Sigurdardottir, Heida M; Sheinberg, David L

    2015-07-01

    The lateral intraparietal area (LIP) is thought to play an important role in the guidance of where to look and pay attention. LIP can also respond selectively to differently shaped objects. We sought to understand to what extent short-term and long-term experience with visual orienting determines the responses of LIP to objects of different shapes. We taught monkeys to arbitrarily associate centrally presented objects of various shapes with orienting either toward or away from a preferred spatial location of a neuron. The training could last for less than a single day or for several months. We found that neural responses to objects are affected by such experience, but that the length of the learning period determines how this neural plasticity manifests. Short-term learning affects neural responses to objects, but these effects are only seen relatively late after visual onset; at this time, the responses to newly learned objects resemble those of familiar objects that share their meaning or arbitrary association. Long-term learning affects the earliest bottom-up responses to visual objects. These responses tend to be greater for objects that have been associated with looking toward, rather than away from, LIP neurons' preferred spatial locations. Responses to objects can nonetheless be distinct, although they have been similarly acted on in the past and will lead to the same orienting behavior in the future. Our results therefore indicate that a complete experience-driven override of LIP object responses may be difficult or impossible. We relate these results to behavioral work on visual attention.

  19. Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain.

    Science.gov (United States)

    Horn, Maggie E; Brennan, Gerard P; George, Steven Z; Harman, Jeffrey S; Bishop, Mark D

    2015-10-01

    To determine the effect of clinical presentations of neck pain on short-term physical therapy outcomes. Retrospective analysis of pair-matched groups from a clinical cohort. Thirteen outpatient physical therapy clinics in 1 health care system. Patients (N=1069) grouped by common clinical presentations of neck pain: nonspecific neck pain (NSNP) with duration 4 weeks; neck pain with arm pain; neck pain with headache; and neck pain from whiplash. Conservative interventions provided by physical therapists. Neck Disability Index (NDI) and numerical pain rating scale (NPRS) recorded at the initial and last visits. The main outcome of interest was achieving recovery status on the NDI. Changes in NDI and NPRS were compared between clinical presentation groups. Compared with patients presenting with NSNP >4 weeks, patients with NSNP neck pain and arm pain demonstrated an increased odds of achieving recovery status on the NDI (P=.04) compared with patients presenting with NSNP >4 weeks. Treating patients with NSNP within <4 weeks of onset of symptoms may lead to improved clinical outcomes from physical therapy compared with other common clinical presentations. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Determinants and Long-Term Outcomes of Percutaneous Coronary Interventions vs. Surgery for Multivessel Disease According to Clinical Presentation.

    Science.gov (United States)

    Hong, Sung-Jin; Kim, Byeong-Keuk; Shin, Sanghoon; Suh, Yongsung; Kim, Seunghwan; Ahn, Chul-Min; Kim, Jung-Sun; Ko, Young-Guk; Choi, Donghoon; Hong, Myeong-Ki; Jang, Yangsoo

    2018-03-23

    The long-term outcome of percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG), particularly for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), remains controversial.Methods and Results:We retrospectively analyzed 2,827 patients (stable coronary artery disease [SCAD], n=1,601; NSTE-ACS, n=1,226) who underwent either PCI (n=1,732) or CABG (n=1,095). The 8-year composite of cardiac death and myocardial infarction (MI) was compared between PCI and CABG before and after propensity matching. For patients with NSTE-ACS, PCI was performed more frequently for those with higher Thrombolysis in Myocardial Infarction risk score and 3-vessel disease, and PCI led to significantly higher 8-year composite of cardiac death and MI than CABG (14.1% vs. 5.9%, hazard ratio [HR]=2.22, 95% confidence interval [CI]=1.37-3.58, P=0.001). There was a significant interaction between clinical presentation and revascularization strategy (P-interaction=0.001). However, after matching, the benefit of CABG vs. PCI was attenuated in patients with NSTE-ACS, whereas it was pronounced in those with SCAD. Interactions between clinical presentation and revascularization strategy were not observed (P-interaction=0.574). Although the determinants of PCI vs. CABG in real-world clinical practice differ according to the clinical presentation, a significant interaction between clinical presentation and revascularization strategy was not noted for long-term outcomes. The revascularization strategy for patients with NSTE-ACS can be based on the criteria applied to patients with SCAD.

  1. Effects of varying presentation time on long-term recognition memory for scenes: Verbatim and gist representations.

    Science.gov (United States)

    Ahmad, Fahad N; Moscovitch, Morris; Hockley, William E

    2017-04-01

    Konkle, Brady, Alvarez and Oliva (Psychological Science, 21, 1551-1556, 2010) showed that participants have an exceptional long-term memory (LTM) for photographs of scenes. We examined to what extent participants' exceptional LTM for scenes is determined by presentation time during encoding. In addition, at retrieval, we varied the nature of the lures in a forced-choice recognition task so that they resembled the target in gist (i.e., global or categorical) information, but were distinct in verbatim information (e.g., an "old" beach scene and a similar "new" beach scene; exemplar condition) or vice versa (e.g., a beach scene and a new scene from a novel category; novel condition). In Experiment 1, half of the list of scenes was presented for 1 s, whereas the other half was presented for 4 s. We found lower performance for shorter study presentation time in the exemplar test condition and similar performance for both study presentation times in the novel test condition. In Experiment 2, participants showed similar performance in an exemplar test for which the lure was of a different category but a category that was used at study. In Experiment 3, when presentation time was lowered to 500 ms, recognition accuracy was reduced in both novel and exemplar test conditions. A less detailed memorial representation of the studied scene containing more gist (i.e., meaning) than verbatim (i.e., surface or perceptual details) information is retrieved from LTM after a short compared to a long study presentation time. We conclude that our findings support fuzzy-trace theory.

  2. Long-term entrenchment and consequences in present flood hazard in Garona River (Val d'Aran, central Pyrenees)

    Science.gov (United States)

    Victoriano-Lamariano, Ane; Garcia-Silvestre, Marta; Furdada-Bellavista, Gloria

    2015-04-01

    Flood risk is one of the most dangerous natural disasters in mountainous areas. Risk management and mitigation have to be based on exhaustive risk evaluation. Moreover, hazard analysis requires a multidisciplinary approach to achieve a complete understanding of the dynamics of the phenomena. The Val d'Aran valley is located in the axial part of the Pyrenees and is drained by the Garona River. Flooding events are relatively frequent there. The last extraordinary episode occurred in June 2013. Considering both the main effects of this flooding and the geomorphology, the long-term dynamics of the Garona River was studied in two different areas (Arties-Vielha and Era Bordeta-Les), which are representative of the whole length along the Val d'Aran. In fact, present short-term processes can be partly explained as a result of the long-term fluvial tendency. During the analysis of the 2013 flood effects, several entrenchment and incision indicators were found. Under the hypothesis that the fluvial network tends to incise, an entrenchment indicator analysis was carried out. Firstly, we considered the geomorphologic features, such as two generations of alluvial fans, two generations of alluvial terraces and, incisions on geomorphologic features and in Paleozoic bedrock. Secondly, we found out that erosion dominated over overflow and deposition during the 2013 flooding. Finally, great erosion was identified in engineering structures, for instance, in bridges, channelization dikes, gauging stations and dams. The geomorphologic analysis and the entrenchment indicators are essential to perform a post-glacial evolution interpretation. During the last Pleistocene glacial retreat, a fluvio-torrential network was developed at the bottom of the ancient glacial valley. An early post-glacial phase with a high sediment transport lead to the formation of first generation alluvial fans and alluvial terraces (nowadays located ≈15m above the channel). As sediment transport decreased

  3. Termómetros de mercurio, aún tóxicos aún presentes Mercury thermometers, still toxic, still present

    OpenAIRE

    A. Souto; L. Gómez Gómez; S. García Mata

    2012-01-01

    Los termómetros de mercurio han sido y son, a pesar de la prohibición de su fabricación, una de las principales fuentes de exposición en la edad pediátrica al mercurio (Hg) elemental en nuestro medio. La toxicidad producida por el Hg elemental depende de la vía de exposición y de la duración de la misma. La exposición a través del tracto digestivo no produce prácticamente toxicidad, pero la inoculación subcutánea o endovenosa y la inhalación puede producir lesiones a nivel local o sistémico. ...

  4. [The long-term results of the application of the combined rehabilitative treatment in the patients presenting with knee osteoarthrosis].

    Science.gov (United States)

    Razumov, A N; Purigа, A O; Yurova, O V

    2015-01-01

    The rehabilitative treatment of the patients suffering from knee osteoarthrosis (OA) up-to-date remains one of the most important medical and social problems of modern medicine due to the high prevalence of this disease, heavy morbidity, and the significant deterioration of the quality of the patients' life. The objective of the present study was to evaluate the long-term results of the combined application of radon and extracorporeal shock-wave therapy for the rehabilitation of the patients presenting with knee OA. The study involved 75 patients at the age from 35 to 62 years with the confirmed diagnosis of stage II and III knee osteoarthrosis. They were divided into 3 groups. Those comprising the main group received extracorporeal shock-wave therapy in combination with the treatment based on the use of radon baths. The patients included in the group of comparison were given a course of radon therapy alone while the patients of the control group received the standard treatment including physiotherapy, magnetic therapy, and the use of non-steroidal anti-inflammatory drugs (NSAIDs). The study has demonstrated the high effectiveness of the combined application of the radon baths and extracorporeal shock-wave therapy that was manifested as the substantial decrease of pain intensity, the increased range of motion in the knee joints, and the improvement of the general quality of life. These beneficial effects persisted during a period of up to 12 months. The stable remission was documented in 82% of the patients comprising the main group. The data obtained give reason to recommend the method employed in the present study for the extensive practical application at different stages of medical rehabilitation of the patients presenting with knee osteoarthrosis.

  5. A Patient on Long-Term Proton Pump Inhibitors Develops Sudden Seizures and Encephalopathy: An Unusual Presentation of Hypomagnesaemia

    Directory of Open Access Journals (Sweden)

    Nirav Y. Gandhi

    2012-01-01

    Full Text Available Objective. To present an unusual but known cause of hypomagnesaemia induced-hypocalcaemia in a chronic GORD patient with severe symptoms with a review of the current literature. Methods. Analysis of the clinical and laboratory findings of the patient and discussion of the multi-factorial nature of his disease and the underlying mechanisms. Results. Our patient described features of magnesium deficiency such as weakness, muscle twitches, and fits with clinical signs of hypocalcaemia: a carpal pedal spasm and paraesthesia. Preadmission blood results revealed low calcium and magnesium levels. He was admitted to ITU, when he presented with seizures and developed encephalopathy. The total vitamin D level was 52.4 nmol/L (>49.9. His U&Es and LFTs were within the normal range with the exception of potassium. He was on Omeprazole for his GORD. With omission of the PPI 1 day after admission and replacement therapy, his ion levels normalised. Conclusion. Hypomagnesaemia is often undiagnosed and is associated with multiple biochemical abnormalities. Treatment focus should be aimed at stopping the PPI and replacing the magnesium. Over use of PPIs is a problem in practice, with the FDA issuing a warning over long-term use. Continued monitoring and decision making on dose reduction/withdrawal is essential to avoid complications.

  6. Full-term extrauterine abdominal pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    Babgi Reem

    2011-10-01

    Full Text Available Abstract Introduction Extrauterine abdominal pregnancy is extremely rare and is frequently missed during antenatal care. This is a report of a full-term extrauterine abdominal pregnancy in a primigravida who likely had a ruptured ectopic pregnancy with secondary implantation and subsequently delivered a healthy baby. Case presentation A 23-year-old, Middle Eastern, primigravida presented at 14 weeks gestation with intermittent suprapubic pain and dysuria. An abdominal ultrasound examination showed a single viable fetus with free fluid in her abdomen. A follow-up examination at term showed a breech presentation and the possibility of a bicornute uterus with the fetus present in the left horn of her uterus. Our patient underwent Cesarean delivery under general anesthesia and was found to have a small intact uterus with the fetus lying in her abdomen and surrounded by an amniotic fluid-filled sac. The baby was extracted uneventfully, but the placenta was implanted in the left broad ligament and its removal resulted in massive intraoperative bleeding that necessitated blood and blood products transfusion and the administration of Factor VII to control the bleeding. Both the mother and newborn were discharged home in good condition. Conclusions An extrauterine abdominal pregnancy secondary to a ruptured ectopic pregnancy with secondary implantation could be missed during antenatal care and continue to term with good maternal and fetal outcome. An advanced extrauterine pregnancy should not result in the automatic termination of the pregnancy.

  7. Atypical clinical presentation and long-term survival in a patient with optic nerve medulloepithelioma: a case report

    Directory of Open Access Journals (Sweden)

    Pastora-Salvador Natalia

    2012-05-01

    Full Text Available Abstract Introduction Medulloepithelioma is a rare congenital tumor of the primitive medullary neuroepithelium. A significant proportion of patients with medulloepithelioma arising from the optic nerve die from intracranial spread or cerebral metastasis. Because it has no known distinct clinical features and because of its low frequency, this tumor presents within the first two to six years of life and is usually misdiagnosed clinically as a different type of optic nerve tumor. Here, we describe a new and atypical case of medulloepithelioma of the optic nerve in a 12-year-old boy. To the best of our knowledge, he is the oldest reported patient to present with this disease and, now as an adult, has the longest documented period of disease-free survival. Case presentation A 12-year-old Caucasian boy with headache and unilateral amaurosis was referred for a presumed optic nerve glioma to our hospital. A computed tomography scan showed optic nerve enlargement, and fundoscopy showed a whitish mass at the optic disc. Our patient had been followed at his local hospital for four years for an 'optic disc cyst' with no change or progression. He experienced mild progressive visual impairment during that period. He was admitted for resection, and a histopathological analysis revealed a medulloepithelioma of the optic nerve. Supplemental orbital radiotherapy was performed. He remained disease-free for 25 years. Conclusions Medulloepithelioma of the optic nerve can clinically mimic more common pediatric tumors, such as optic glioma, meningioma, or retinoblastoma. Thus, medulloepithelioma should be included in the differential diagnoses of pediatric optic nerve lesions. Fundoscopy in these patients may provide relevant information for diagnosis. Anterior optic nerve medulloepitheliomas may behave differently from and have a better prognosis than medulloepitheliomas that have a more posterior location. Our case report illustrates that long-term survival can be

  8. Long-term prognosis of patients presenting first-ever vestibular symptoms in a community-based study.

    Science.gov (United States)

    Felgueiras, Rui; Magalhães, Rui; Correia, Manuel; Silva, Maria Carolina

    2014-09-01

    Vestibular symptoms (VSs) are frequent complaints in patients attending ambulatory care and the emergency room. They may represent a peripheral vestibular disorder or a stroke/transient ischemic attack (TIA), yet many patients have VSs that cannot be clearly classified at presentation. This study aims to characterize and determine the long-term prognosis of these patients. In a prospective community-based study involving 104,700 individuals registered at 4 health centers of Northern Portugal, patients with a first-ever-in-lifetime focal neurologic symptom (FNS) were ascertained using comprehensive methods, including referrals from physicians working in the study area and data retrieved from emergency/discharge records. Physicians were encouraged to report/notify any patient who might have experienced an FNS, including those with vertigo or vertigo-like symptoms, imbalance, presyncope, or nonspecific dizziness. After neurologic assessment patients were classified as having a peripheral vestibular symptom (pVS), a stroke/TIA, or an unclassified vestibular symptom (uVS). They were followed up 7 years after the index event at the outpatient clinic; predictors of survival free from stroke or vascular events were determined using Cox proportional hazards models. Of the 1163 patients with an FNS, 360 (31.0%) were included, 16.7% had a stroke/TIA, 57.8% had pVS, and 25.6% had uVS. Most patients presented only isolated VSs (62.8%); 63% were women and mean age was 60.1 years (standard deviation = 16); hypertension (47.8%), hypercholesterolemia (41.9%), and diabetes (19.2%) were the most prevalent vascular risk factors (VRFs). Cranial computed tomography (CT) scan was performed in 63.3%. Adjusting for age, sex, VRFs, and diagnosis (TIA, pVS and uVS), the long-term risk of stroke was higher when CT showed silent infarctions (hazard rate [HR] = 3.96; 95% confidence interval [CI], 1.63-9.60) and the risk of vascular events (stroke, myocardial infarction, or vascular death) was

  9. Hypersensitivity pneumonia-nonspecific interstitial pneumonia/fibrosis histopathologic presentation: a study in diagnosis and long-term management.

    Science.gov (United States)

    Jacobs, Robert L; Andrews, Charles P

    2003-02-01

    improvement, but may convert a patient from an acute to an insidious presenter. The environmental challenge obviates a need for specific challenges to determine specific causation. Remediation of or moving from an environmental contamination to achieve reversibility or prevent progression was the treatment of choice to avoid use of long-term immunosuppressive agents.

  10. The Present, Mid-Term, and Long-Term Supply Curves for Tellurium; and Updates in the Results from NREL's CdTe PV Module Manufacturing Cost Model (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Woodhouse, M.; Goodrich, A.; Redlinger, M.; Lokanc, M.; Eggert, R.

    2013-09-01

    For those PV technologies that rely upon Te, In, and Ga, first-order observations and calculations hint that there may be resource constraints that could inhibit their successful deployment at a SunShot level. These are only first-order approximations, however, and the possibility for an expansion in global Te, In, and Ga supplies needs to be considered in the event that there are upward revisions in their demand and prices.In this study, we examine the current, mid-term, and long-term prospects of Tellurium (Te) for use in PV. We find that the current global supply base of Te would support <10 GW of annual traditional CdTe PV manufacturing production. But as for the possibility that the supply base for Te might be expanded, after compiling several preliminary cumulative availability curves we find that there may be significant upside potential in the supply base for this element - principally vis a vis increasing demand and higher prices. Primarily by reducing the Tellurium intensity in manufacturing and by increasing the recovery efficiency of Te in Cu refining processes, we calculate that it may prove affordable to PV manufacturers to expand the supply base for Te such that 100 GW, or greater, of annual CdTe PV production is possible in the 2030 - 2050 timeframe.

  11. An assessment of the long term suitability of present and proposed methods for the management of uranium mill tailings

    International Nuclear Information System (INIS)

    1979-07-01

    Proposals for safe, long-term containment of conventional tailings include 1) storage under water, 2) storage in active, abandoned or specially created underground mines and, 3) storage in open pits, with subsequent flooding or covering with overburden. The underwater proposal can meet most of the requirements of long term containment; however, extensive study of existing tailings deposits in deep water locations will be needed. Underground mines cannot provide sufficient storage capacity, since the tailings bulk during mill operation can occupy twice the volume of the original ore. It is possible to reduce the hazard by reducing the radium and thorium content of the tailings. Proposals for such an undertaking include ore beneficiation with rejection of the relatively innocuous fraction, radium-thorium removal in the mill, and significant changes in both ore processing and treatment of tailings. It is concluded that surface-stored tailings are vulnerable over the long term to dispersion by leaching and water erosion, and that access to a tailings site cannot be prevented, while only a major climatic or seismic event could disturb tailings stored in suitable underwater or underground mine sites. The criteria for determining suitability for each method, however, will need to be identified, tested, and accepted through the normal process of modeling, pilot plant evaluation, monitoring and evaluation. (author)

  12. The Early External Cephalic Version (ECV) 2 Trial: an international multicentre randomised controlled trial of timing of ECV for breech pregnancies.

    Science.gov (United States)

    Hutton, E K; Hannah, M E; Ross, S J; Delisle, M-F; Carson, G D; Windrim, R; Ohlsson, A; Willan, A R; Gafni, A; Sylvestre, G; Natale, R; Barrett, Y; Pollard, J K; Dunn, M S; Turtle, P

    2011-04-01

    To investigate whether initiating external cephalic version (ECV) earlier in pregnancy might increase the rate of successful ECV procedures, and be more effective in decreasing the rate of non-cephalic presentation at birth and of caesarean section. An unblinded multicentred randomised controlled trial. A total of 1543 women were randomised from 68 centres in 21 countries. Women with a singleton breech fetus at a gestational age of 33(0/7) weeks (231 days) to 35(6/7) weeks (251 days) of gestation were included. Participants were randomly assigned to having a first ECV procedure between the gestational ages of 34(0/7) (238 days) and 35(6/7) weeks of gestation (early ECV group) or at or after 37(0/7) (259 days) weeks of gestation (delayed ECV group). The primary outcome was the rate of caesarean section; the secondary outcome was the rate of preterm birth. Fewer fetuses were in a non-cephalic presentation at birth in the early ECV group (314/765 [41.1%] versus 377/768 [49.1%] in the delayed ECV group; relative risk [RR] 0.84, 95% CI 0.75, 0.94, P=0.002). There were no differences in rates of caesarean section (398/765 [52.0%] versus 430/768 [56.0%]; RR 0.93, 95% CI 0.85, 1.02, P=0.12) or in risk of preterm birth (50/765 [6.5%] versus 34/768 [4.4%]; RR 1.48, 95% CI 0.97, 2.26, P=0.07) between groups. External cephalic version at 34-35 weeks versus 37 or more weeks of gestation increases the likelihood of cephalic presentation at birth but does not reduce the rate of caesarean section and may increase the rate of preterm birth. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

  13. Malnutrition: a highly predictive risk factor of short-term mortality in elderly presenting to the emergency department.

    Science.gov (United States)

    Gentile, S; Lacroix, O; Durand, A C; Cretel, E; Alazia, M; Sambuc, R; Bonin-Guillaume, S

    2013-04-01

    To identify independent risk factors of mortality among elderly patients in the 3 months after their visit (T3) to an emergency department (ED). Prospective cohort study. University hospital ED in an urban setting in France. One hundred seventy-three patients aged 75 and older were admitted to the ED over two weeks (18.7% of the 924 ED visits). Of these, 164 patients (94.8%) were included in our study, and 157 (95.7%) of them were followed three months after their ED visit. During the inclusion period (T0), a standardized questionnaire was used to collect data on socio-demographic and environmental characteristics, ED visit circumstances, medical conditions and geriatric assessment including functional and nutritional status. Three months after the ED visits (T3), patients or their caregivers were interviewed to collect data on vital status, and ED return or hospitalization. Among the 157 patients followed at T3, 14.6% had died, 19.9% had repeated ED visits, and 63.1% had been hospitalized. The two independent predictive factors for mortality within the 3 months after ED visit were: malnutrition screened by the Mini Nutritional Assessment short-form (MNA-SF) (OR=20.2; 95% CI: 5.74-71.35; pMalnutrition is the strongest independent risk factor predicting short-term mortality in elderly patients visiting the ED, and it was easily detected by MNA-SF and supported from the ED visit.

  14. The effect of post-learning presentation of music on long-term word-list retention.

    Science.gov (United States)

    Judde, Sarah; Rickard, Nikki

    2010-07-01

    Memory consolidation processes occur slowly over time, allowing recently formed memories to be altered soon after acquisition. Although post-learning arousal treatments have been found to modulate memory consolidation, examination of the temporal parameters of these effects in humans has been limited. In the current study, 127 participants learned a neutral word list and were exposed to either a positively or negatively arousing musical piece following delays of 0, 20 or 45min. One-week later, participants completed a long-term memory recognition test, followed by Carver and White's (1994) approach/avoidance personality scales. Retention was significantly enhanced, regardless of valence, when the emotion manipulation occurred at 20min, but not immediately or 45min, post-learning. Further, the 20min interval effect was found to be moderated by high 'drive' approach sensitivity. The selective facilitatory conditions of music identified in the current study (timing and personality) offer valuable insights for future development of more specified memory intervention strategies.

  15. Sphincter Preservation After Short-term Preoperative Radiotherapy for Low Rectal Cancer - Presentation of Own Data and a Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Bujko, Krzysztof; Nowacki, Marek P.; Oldzki, Janusz; Sopyo, Rafa; Skoczylas, Jerzy; Chwaliski, Maciej [The Maria Sklodowska-Curie Memorial Cancer Centre and Inst. of Oncology, Warsaw (Poland)

    2001-07-01

    This report is based on a series of 108 patients with clinically staged T2 (9), T3 (94) and T4 (5) rectal cancer treated with preoperative irradiation with 25 Gy, 5 Gy per fraction given for one week. In 77% of patients, the tumour was located within 7 cm of the anal verge and in 15% the anal canal was involved. Surgery was usually undertaken during the week after irradiation. For low tumours, total mesorectal excision was performed, and for middle and upper cancers, the whole circumference of the mesorectum was excised at least 2 cm below the lower pole of a tumour. Tumour was resected in 103 patients, and sphincter-preserving surgery was performed in 73% of them. In the subgroup where the tumour was located higher than 4 cm from the anal verge, sphincter-preserving surgery was performed in 95%. The follow-up period ranged from 10 to 49 months, with a median of 25 months. Local recurrences were observed in 4% of patients. Anorectal dysfunction caused impairment of social life in 40% of patients and 18% admitted that their quality of life was seriously affected - however, none of them stated that they would have preferred a colostomy. These preliminary data suggest that following high dose per fraction short-term preoperative radiotherapy a high rate of sphincter-preserving surgery can be reached, with acceptable anorectal function and an acceptable rate of local failure and late complications. The results of our own data and literature review indicate the need for a randomized clinical trial comparing high dose per fraction preoperative radiotherapy with immediate surgery with conventional preoperative radiochemotherapy with delayed surgery.

  16. Sex differences in the characteristics and short-term prognosis of patients presenting with acute symptomatic pulmonary embolism.

    Directory of Open Access Journals (Sweden)

    Deisy Barrios

    Full Text Available We sought to examine sex-related differences in the characteristics and outcome in patients presenting with acute symptomatic pulmonary embolism (PE.We conducted a retrospective cohort study of 2,096 patients diagnosed with acute PE. The characteristics were recorded at presentation. Treatment was at the discretion of patients' physicians. The primary study outcome, all-cause mortality, and the secondary outcomes of PE-specific mortality, recurrent venous thromboembolism, and major bleeding were assessed during the first month of follow-up after PE diagnosis.Overall, the women were older than the men and had significantly higher rates of immobilization. They had significantly lower rates of chronic obstructive pulmonary disease and cancer. Women had a higher prevalence of syncope and elevated brain natriuretic peptide levels. Thirty-day all-cause mortality was similar between women and men (7.1% versus 6.2%; P = 0.38. Male gender was not independently significantly associated with PE-related death (adjusted odds ratio [OR] 1.02; 95% CI, 0.50 to 2.07; P = 0.96. Restricting the analyses to haemodynamically stable patients (n = 2,021, female gender was an independent predictor of all-cause (adjusted OR 1.56; 95% CI, 1.07 to 2.28; P = 0.02 and PE-specific mortality (adjusted OR 1.85; 95% CI, 1.02 to 3.33; P = 0.04. Compared with men, women were 2.05 times more likely to experience a major bleed.Women and men with PE had different clinical characteristics, presentation, and outcomes. Women receiving anticoagulation have a significantly higher risk of major bleeding, suggesting the need for careful monitoring of anticoagulant intensity in women.

  17. Long-term degradation of resin-based cements in substances present in the oral environment: influence of activation mode

    Directory of Open Access Journals (Sweden)

    Eduardo Moreira da SILVA

    2013-06-01

    Full Text Available Indirect restorations in contact with free gingival margins or principally within the gingival sulcus, where the presence of organic acids produced by oral biofilm is higher, may present faster degradation of the resin-based cement pellicle. Objectives To investigate the degradation of four resin-based cements: Rely X ARC (R, Variolink II (V, Enforce (E and All Cem (A, after immersion in distilled water (DW, lactic acid (LA and artificial saliva (AS and to analyze the influence of the activation mode on this response. Material and Methods Two activation modes were evaluated: chemical (Ch and dual (D. In the dual activation, a two-millimeter thick ceramic disk (IPS Empress System was interposed between the specimen and light-curing unit tip. Specimens were desiccated, immersed in distilled water, artificial saliva and lactic acid 0.1 M at 37°C for 180 days, weighed daily for the first 7 days, and after 14, 21, 28, 90 and 180 days and were desiccated again. Sorption and solubility (µg/mm 3 were calculated based on ISO 4049. The data were submitted to multifactor analysis of variance (MANOVA and Tukey's HSD test for media comparisons (α=0.05. Results Sorption was higher after immersion in LA (pD (p<0.05. The lowest solubility was presented by R (p<0.05. Conclusions Lactic acid increased the degradation of resin-based cements. Moreover, the physical component of activation, i.e., light-activation, contributed to a low degradation of resin-based cements.

  18. Longitudinal changes in seizure outcomes after resection of cerebral cavernous malformations in patients presenting with seizures: a long-term follow-up of 46 patients.

    Science.gov (United States)

    Kim, Jiha; Kim, Chi Heon; Chung, Chun Kee

    2014-08-01

    Seizure is the most common presentation in patients with cerebral cavernous malformations (CCMs). Although many articles have documented seizure outcomes after resection of CCM, few have conducted long-term follow-ups; thus, the fluctuating seizure outcomes have been neglected. The purpose of this study is to describe long-term postoperative seizure outcomes in patients with CCM and to compare seizure outcomes between patients with sporadic seizures and those with chronic seizures. Forty-six patients with CCM presenting with seizures underwent surgery. The male-to-female ratio was 1:1, and the average age at initial seizure onset was 27.6 years. The mean preoperative seizure duration was 42.7 months. Patients were divided into two groups: a chronic group (N = 20) and a sporadic group (N = 26) according to seizure frequency and duration. The mean postoperative follow-up duration was 96.3 months, and the postoperative seizure outcomes were checked annually based upon Engel's classification. After the first year of follow-up, 80.8 % of the sporadic group and 75.0 % of the chronic group were evaluated as Engel class I. These rates increased to 100.0 % and 90.0 %, respectively, at the eighth year of follow-up. Overall, 29 (63.0 %) of the 46 patients experienced changes in seizure outcomes over the follow-up period. Despite their delayed improvements, the chronic group showed less favorable outcomes throughout follow-up (p = 0.025). Long-term follow-up is indispensable for accurately assessing postoperative seizure outcomes because these outcomes change continuously. We recommend earlier surgery to achieve seizure-free status in patients with CCM. However, even in the chronic group, surgery is recommended, considering the overall delayed improvement.

  19. Management and Long-Term Outcome of Acute Coronary Syndrome Patients Presenting with Heart Failure in a Contemporary New Zealand Cohort (ANZACS-QI 4).

    Science.gov (United States)

    Kueh, Shaw Hua Anthony; Devlin, Gerry; Lee, Mildred; Doughty, Rob N; Kerr, Andrew J

    2016-08-01

    Acute heart failure (HF) associated with an acute coronary syndrome (ACS) predicts adverse outcome. There have been important recent improvements in ACS management. Our aim was to describe the management and outcomes in those with and without HF in a contemporary ACS cohort. Consecutive patients presenting with ACS between 2007 and 2011 were enrolled in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Outcomes and medication dispensing were obtained using anonymised linkage to national data sets. A summary pharmacotherapy measure of "quadruple therapy" was defined as dispensing of at least one agent from each of the four evidence-based classes - anti-platelet, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker and beta blocker. Of 3743 ACS patients 14% had acute HF. Acute heart failure patients were older (69.2±12.6 vs 62.3±12.8 years, pcoronary angiography (66% vs 86%, pAcute heart failure complicating ACS is associated with heightened risk of short-term and long-term mortality. One in three ACS patients with HF did not have coronary angiography and less than half received quadruple therapy a year after presentation. Copyright © 2016. Published by Elsevier B.V.

  20. Short-term memory digit-span performance under auditory and visual contexts as a function of rate of digit presentation.

    Science.gov (United States)

    Vitulli, W F; McNeil, M J

    1990-12-01

    This exploratory investigation concerned the effects of both auditory and visual context variations on the immediate recall of a series of digits presented on a computer screen (CRT). 5 intensities of background noise and 5 background hues were presented randomly to 110 undergraduate volunteers as they studied 25 numerals ranging from 1 to 5 at rates of change of either 1 or 3 sec. per numeral timed from the onset of the previous numeral. A 2 x 2 x 5 mixed split-plot factorial analysis of variance gave a significant difference in mean immediate-recall scores between rates of digit presentation with better recall associated with the 3-sec. rate. There was no significant main effect in recall scores for auditory vs color contexts, yet a post hoc analysis of variance for successive stages followed by Scheffé comparisons showed that across auditory intensities, Stages 3 and 4 and 5 (combined) had significantly higher immediate recall scores than Stages 1 and 2 (combined). This improvement across stages was not found under the visual (color) series. There was a three-way interaction for modality-contexts x rates x levels explained by the partitioning of stages which differed for auditory and for visual contexts. Results are discussed in terms of effects of modality.

  1. Diagnosis of district potential in terms of renewable energies. Report 1 - Present situation: Assessment of renewable energy production, Identification and quantification of territory's potentialities in terms of renewable energies

    International Nuclear Information System (INIS)

    2010-10-01

    After a presentation of the Gers district context (geography, administrative organisation, demography, housing, economy, expertise), the report presents the energy situation, an overview of the solar thermal sector (installations and installers), of the solar photovoltaic sector (existing and projected installations, installers), of hydroelectricity, of wood-energy (individual heating, industrial heating plants, planned installations), of wind energy, of biogas, and of geothermal energy (existing and planned installations). It proposes an assessment of these energies as a whole. Then, after an overview of the district situation with respect to national objectives and to other districts of the region, the study reports an identification and quantification of potentialities in terms of theoretical resources for different energy sources (solar, wind, hydraulic, wood, methanization, valorizable biomass, geothermal, and agri-fuels). Avoided CO 2 emissions are assessed

  2. Association of external cephalic version before term with late preterm birth.

    Science.gov (United States)

    Poole, Kristie L; McDonald, Sarah D; Griffith, Lauren E; Hutton, Eileen K

    2017-08-01

    While evidence suggests that beginning an external cephalic version (ECV) before term (34 0/7 to 36 6/7 weeks) compared with after term may be associated with an increase in late preterm birth (34 0/7 to 36 6/7 weeks), it remains unknown what might account for this risk. The objective of the present study is to further investigate the association between ECV before term and late preterm birth. Secondary analysis of data collected from the international, multicenter Early ECV trials. We evaluated the relation between ECV exposure and late preterm birth (34 0/7 to 36 6/7 weeks), as well as whether additional risk factors for preterm birth (such as maternal age, height, body mass index, parity, placental location, and perinatal mortality rate) moderated this relation. Generalized linear mixed methods were used to account for center effect and adjust for covariates. Among 1765 women with breech pregnancies and without a prior preterm birth, 749 (42.4%) received at least one ECV before term. Exposure to an ECV before term was not associated significantly independently with odds of preterm birth. However, placenta location moderated the association between early ECV exposure and late preterm birth. The odds of preterm birth in women who were exposed to an ECV before term and who also had an anterior placenta were doubled (OR 2.05; 95% CI 1.12-3.71; p = 0.02). In a large cohort of women without known risks for preterm birth, those with an anterior placenta who undergo an ECV before term constitute a subgroup at particular risk for late preterm birth. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. Repairing the breech

    Directory of Open Access Journals (Sweden)

    Harry C. Boyte

    2012-04-01

    Full Text Available The main obstacle to genuine and productive partnerships between institutions of higher education and the professionals they prepare, on the one side, and communities, on the other, is a “knowledge war,” full of invisible hierarchies and exclusions, producing a hypercompetitive achievement culture. This knowledge war dramatically limits communities’ and citizens’ ability to act on the problems they face today. It also sharply erodes the power of higher education, professionals, and civic leaders to help shape the culture in democratic ways.We have to get beyond arrogant experts and aggrieved communities if we want to develop communities’ capacities to solve problems and also to generate a larger vision of a good society. Community is the living context for evaluating expert knowledge. But without engagement with other ways of knowing appeal to community knowledge can easily produce a Know-Nothing reaction to the larger world.If we are to build communities’ civic agency – capacities to work across differences to meet our common challenges – we need to democratize the politics of knowledge and end the knowledge war. This requires learning from effective community organizing the idea of “schools for public life,” where ordinary people develop skills, habits, and confidence of citizenship. It also means creating what might be called middle spaces, not owned by academics or professionals, but open to academic and scientific knowledge, where different ways of knowing and acting intermingle in creative ways. Middle spaces put science and academic knowledge in the mix, “on tap, not on top.” They also recognize the power and the limits of communal knowledge.Keywordscivic agency, cultural organizing, knowledge war

  4. Long-term follow-up in primary Sjögren's syndrome reveals differences in clinical presentation between female and male patients

    DEFF Research Database (Denmark)

    Ramírez Sepúlveda, Jorge I; Kvarnström, Marika; Eriksson, Per

    2017-01-01

    BACKGROUND: Despite men being less prone to develop autoimmune diseases, male sex has been associated with a more severe disease course in several systemic autoimmune diseases. In the present study, we aimed to investigate differences in the clinical presentation of primary Sjögren's syndrome (p......SS) between the sexes and establish whether male sex is associated with a more severe form of long-term pSS. METHODS: Our study population included 967 patients with pSS (899 females and 68 males) from Scandinavian clinical centers. The mean follow-up time (years) was 8.8 ± 7.6 for women and 8.5 ± 6.2 for men...... (ns). Clinical data including serological and hematological parameters and glandular and extraglandular manifestations were compared between men and women. RESULTS: Male patient serology was characterized by more frequent positivity for anti-Ro/SSA and anti-La/SSB (p = 0.02), and ANA (p = 0...

  5. Use of ABCD2 risk scoring system to determine the short-term stroke risk in patients presenting to emergency department with transient ischaemic attack

    International Nuclear Information System (INIS)

    Ozpolat, C.; Denizbasi, A.; Onur, O.; Eroglu, S.E.

    2013-01-01

    Objective: To determine the 3-day stroke risk of patients presenting to emergency department with transient ischaemic attack, and to evaluate the predictive value of ABCD2 (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) score for these patients. Methods: The prospective study was conducted on patients with diagnosis of transient ischaemic attack who were divided into low (0-3 points), medium (4-5 points) and high (6-7 points) risk groups according to their ABCD2 scores. The sensitivity of the scoring system on estimation of the risk of stroke in 3 days was evaluated through receiver operating characteristic curve. SPSS 15 was used for data analysis. Results: Of the 64 patients in the study, none of the low-risk group had stroke. Stroke was present in 4 of 33 (12.12%) medium-risk patients, while there were 4 in 18 (22.22%) in the high-risk group. Sensitivity and specificity of each ABCD2 score for 3rd day stroke risk was calculated. In the receiver operating curve generated by these calculations, the c statistics was determined as 0.76 (95% CI: 0.64, 0.86; p<0.01) and the most appropriate cut-off score to dichotomise the study group was determined as 4. Conclusions: In transient ischaemic attack patients with an ABCD2 score of four or higher had a markedly increased short-term stroke risk, while those with a lower score were quite safe. It is appropriate to hospitalise patients with a score of four or more and investigate for underlying cause and initiate treatment. (author)

  6. "I Always Vet Things": Navigating Privacy and the Presentation of Self on Health Discussion Boards Among Individuals with Long-Term Conditions.

    Science.gov (United States)

    Brady, Ellen; Segar, Julia; Sanders, Caroline

    2016-10-13

    The ethics of research into online communities is a long-debated issue, with many researchers arguing that open-access discussion groups are publically accessible data and do not require informed consent from participants for their use for research purposes. However, it has been suggested that there is a discrepancy between the perceived and actual privacy of user-generated online content by community members. There has been very little research regarding how privacy is experienced and enacted online. The objective of this study is to address this gap by qualitatively exploring the expectations of privacy on Internet forums among individuals with long-term conditions. Semistructured interviews were conducted with 20 participants with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and 21 participants with type 1 and 2 diabetes mellitus, and were analyzed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups. The findings indicate that privacy online is a nebulous concept. Rather than individuals drawing a clear-cut distinction between what they would and would not be comfortable sharing online, it was evident that these situations were contextually dependent and related to a number of unique and individual factors. Interviewees were seen to carefully manage how they presented themselves on forums, filtering and selecting the information that they shared about themselves in order to develop and maintain a particular online persona, while maintaining and preserving an acceptable level of privacy.

  7. “I Always Vet Things”: Navigating Privacy and the Presentation of Self on Health Discussion Boards Among Individuals with Long-Term Conditions

    Science.gov (United States)

    Segar, Julia; Sanders, Caroline

    2016-01-01

    Background The ethics of research into online communities is a long-debated issue, with many researchers arguing that open-access discussion groups are publically accessible data and do not require informed consent from participants for their use for research purposes. However, it has been suggested that there is a discrepancy between the perceived and actual privacy of user-generated online content by community members. Objective There has been very little research regarding how privacy is experienced and enacted online. The objective of this study is to address this gap by qualitatively exploring the expectations of privacy on Internet forums among individuals with long-term conditions. Methods Semistructured interviews were conducted with 20 participants with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and 21 participants with type 1 and 2 diabetes mellitus, and were analyzed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups. Results The findings indicate that privacy online is a nebulous concept. Rather than individuals drawing a clear-cut distinction between what they would and would not be comfortable sharing online, it was evident that these situations were contextually dependent and related to a number of unique and individual factors. Conclusions Interviewees were seen to carefully manage how they presented themselves on forums, filtering and selecting the information that they shared about themselves in order to develop and maintain a particular online persona, while maintaining and preserving an acceptable level of privacy. PMID:27737819

  8. The Role of Long-Term Tectonic Deformation on the Distribution of Present-Day Seismic Activity in the Caribbean and Central America

    Science.gov (United States)

    Schobelock, J.; Stamps, D. S.; Pagani, M.; Garcia, J.; Styron, R. H.

    2017-12-01

    The Caribbean and Central America region (CCAR) undergoes the entire spectrum of earthquake types due to its complex tectonic setting comprised of transform zones, young oceanic spreading ridges, and subductions along its eastern and western boundaries. CCAR is, therefore, an ideal setting in which to study the impacts of long-term tectonic deformation on the distribution of present-day seismic activity. In this work, we develop a continuous tectonic strain rate model based on inter-seismic geodetic data and compare it with known active faults and earthquake focal mechanism data. We first create a 0.25o x 0.25o finite element mesh that is comprised of block geometries defined in previously studies. Second, we isolate and remove transient signals from the latest open access community velocity solution from UNAVCO, which includes 339 velocities from COCONet and TLALOCNet GNSS data for the Caribbean and Central America, respectively. In a third step we define zones of deformation and rigidity by creating a buffer around the boundary of each block that varies depending on the size of the block and the expected deformation zone based on locations of GNSS data that are consistent with rigid block motion. We then assign each node within the buffer a 0 for the deforming areas and a plate index outside the buffer for the rigid. Finally, we calculate a tectonic strain rate model for CCAR using the Haines and Holt finite element approach to fit bi-cubic Bessel splines to the the GNSS/GPS data assuming block rotation for zones of rigidity. Our model of the CCAR is consistent with compression along subduction zones, extension across the mid-Pacific Rise, and a combination of compression and extension across the North America - Caribbean plate boundary. The majority of CCAR strain rate magnitudes range from -60 to 60 nanostrains/yr. Modeling results are then used to calculate expected faulting behaviors that we compare with mapped geologic faults and seismic activity.

  9. Short term memory decays and high presentation rates hurry this decay: The Murdock free recall experiments interpreted in the Tagging/Retagging model

    OpenAIRE

    Tarnow, Dr. Eugen

    2009-01-01

    I show that the curious free recall data of Murdock (1962) can be explained by the Tagging/Retagging model of short term memory (Tarnow, 2009 and 2008) in which a short term memory item is a tagged long term memory item. The tagging (linear in time) corresponds to the synaptic process of exocytosis and the loss of tagging (logarithmic in time) corresponds to synaptic endocytosis. The Murdock recent item recall probabilities follow a logarithmic decay with time of recall. The slope of the d...

  10. Effect of stage development of mining operations on maximization the net present value in long-term planning of open pits

    OpenAIRE

    Kržanović, Daniel; Rajković, Radmilo; Mikić, Miomir; Ljubojev, Milenko

    2014-01-01

    Long-term planning in the mining industry has one main goal: maximizing the value that is realized by excavation and processing of mineral resources. When designing the open pits, determining the stages of development the mining operations, (eng. Pushback) is one of the important factors in the process of long-term production planning. Using the different scientific methods and mathematical algorithms underlying the operation of modern software for strategic planning of production, it is poss...

  11. The Long-term deformation of the Longmen Shan (Sichuan, China), a key to understand the present structure of the eastern Tibet

    Science.gov (United States)

    Airaghi, Laura; de Sigoyer, Julia; Guillot, Stéphane; Lanari, Pierre; Warren, Clare J.; Robert, Alexandra

    2017-04-01

    The Longmen Shan thrust belt, at the eastern border of Tibetan plateau, is a tectonically active region as demonstrated by the Mw 7.9 Wenchuan (2008) and Mw 6.6 Lushan (2013) earthquakes. The Moho discontinuity deepens across the Longmen Shan (below the along-strike Wenchuan fault) from ˜40 km beneath the Sichuan basin to more than 60 km beneath the Songpan-Ganze block. Such a thickness is not compatible with the only ˜35 km of shortening estimated at the front of the belt during the Cenozoic-Quaternary compressive reactivation. The geological inheritance may thus play a key role in the present structure of the Longmen Shan. However the long-term history of the belt is still poorly documented. The major Wenchuan fault separates medium-grade metamorphic rocks to the West (internal domain of the Longmen Shan) to the greenschist metamorphic rocks to the East (external domain). In the hanging and footwall of the fault the South China basement also crops out. Metamorphic rocks, exhumed from depth, offer the opportunity to investigate the deep processes occurred in the Longmen Shan. We have characterized and dated the metamorphism in the central part of the belt by combining structural and microstructural observations with high-resolution X-ray mapping and chemical analyses of metamorphic minerals related to the different stages of deformation. In situ 40Ar/39Ar dating on mica and in situ U-Pb/Th dating on allanite (REE-rich epidote) allowed the different phases of metamorphism and deformation to be dated. Our results show that the Longmen Shan underwent a complex Mesozoic tectono-metamorphic history, articulated in a succession of pulses of deformation (burial or uplifting) and periods of quiescence. A first phase of rapid thin-skinned deformation occurred about 200 Ma ago. Internal sedimentary units were strongly deformed and buried down to 11±1 kbar, 550±30˚ C. This phase was followed by a period of slow exhumation between 200 and 170 Ma. A second pulse of

  12. Estimation of excess mortality due to long-term exposure to PM2.5 in Japan using a high-resolution model for present and future scenarios

    Science.gov (United States)

    Goto, Daisuke; Ueda, Kayo; Ng, Chris Fook Sheng; Takami, Akinori; Ariga, Toshinori; Matsuhashi, Keisuke; Nakajima, Teruyuki

    2016-09-01

    Particulate matter with a diameter of less than 2.5 μm, known as PM2.5, can affect human health, especially in elderly people. Because of the imminent aging of society in the near future in most developed countries, the human health impacts of PM2.5 must be evaluated. In this study, we used a global-to-regional atmospheric transport model to simulate PM2.5 in Japan with a high-resolution stretched grid system (∼10 km for the high-resolution model, HRM) for the present (the 2000) and the future (the 2030, as proposed by the Representative Concentrations Pathway 4.5, RCP4.5). We also used the same model with a low-resolution uniform grid system (∼100 km for the low-resolution model, LRM). These calculations were conducted by nudging meteorological fields obtained from an atmosphere-ocean coupled model and providing emission inventories used in the coupled model. After correcting for bias, we calculated the excess mortality due to long-term exposure to PM2.5 among the elderly (over 65 years old) based on different minimum PM2.5 concentration (MINPM) levels to account for uncertainty using the simulated PM2.5 distributions to express the health effect as a concentration-response function. As a result, we estimated the excess mortality for all of Japan to be 31,300 (95% confidence intervals: 20,700 to 42,600) people in 2000 and 28,600 (95% confidence intervals: 19,000 to 38,700) people in 2030 using the HRM with a MINPM of 5.8 μg/m3. In contrast, the LRM resulted in underestimates of approximately 30% (for PM2.5 concentrations in the 2000 and 2030), approximately 60% (excess mortality in the 2000) and approximately 90% (excess mortality in 2030) compared to the HRM results. We also found that the uncertainty in the MINPM value, especially for low PM2.5 concentrations in the future (2030) can cause large variability in the estimates, ranging from 0 (MINPM of 15 μg/m3 in both HRM and LRM) to 95,000 (MINPM of 0 μg/m3 in HRM) people.

  13. This baby is not for turning: Women's experiences of attempted external cephalic version.

    Science.gov (United States)

    Watts, N P; Petrovska, K; Bisits, A; Catling, C; Homer, C S E

    2016-08-26

    Existing studies regarding women's experiences surrounding an External Cephalic Version (ECV) report on women who have a persistent breech post ECV and give birth by caesarean section, or on women who had successful ECVs and plan for a vaginal birth. There is a paucity of understanding about the experience of women who attempt an ECV then plan a vaginal breech birth when their baby remains breech. The aim of this study was to examine women's experience of an ECV which resulted in a persistent breech presentation. A qualitative descriptive exploratory design was undertaken. In-depth semi-structured interviews were conducted and analysed thematically. Twenty two (n = 22) women who attempted an ECV and subsequently planned a vaginal breech birth participated. Twelve women had a vaginal breech birth (55 %) and 10 (45 %) gave birth by caesarean section. In relation to the ECV, there were five main themes identified: 'seeking an alternative', 'needing information', 'recounting the ECV experience', 'reacting to the unsuccessful ECV' and, 'reflecting on the value of an ECV'. ECV should form part of a range of options provided to women, rather than a default procedure for management of the term breech. For motivated women who fit the safe criteria for vaginal breech birth, not being subjected to a painful experience (ECV) may be optimal. Women should be supported to access services that support vaginal breech birth if this is their choice, and continuity of care should be standard practice.

  14. A qualitative interview study exploring pregnant women’s and health professionals’ attitudes to external cephalic version

    Science.gov (United States)

    2013-01-01

    Background Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV. Methods We carried out semi-structured interviews with pregnant women with a breech presentation (n=11) and health professionals who manage breech presentation (n=11) recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases. Results Four main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women’s attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals’ attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation. Conclusions Women had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the differences between evidence

  15. A qualitative interview study exploring pregnant women’s and health professionals’ attitudes to external cephalic version

    Directory of Open Access Journals (Sweden)

    Say Rebecca

    2013-01-01

    Full Text Available Abstract Background Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV and how they want to give birth if the baby remains breech, either by planned caesarean section (CS or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV. Methods We carried out semi-structured interviews with pregnant women with a breech presentation (n=11 and health professionals who manage breech presentation (n=11 recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases. Results Four main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women’s attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals’ attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation. Conclusions Women had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the

  16. A qualitative interview study exploring pregnant women's and health professionals' attitudes to external cephalic version.

    Science.gov (United States)

    Say, Rebecca; Thomson, Richard; Robson, Stephen; Exley, Catherine

    2013-01-16

    Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV. We carried out semi-structured interviews with pregnant women with a breech presentation (n=11) and health professionals who manage breech presentation (n=11) recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases. Four main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women's attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals' attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation. Women had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the differences between evidence-based information about ECV and lay beliefs

  17. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care : a review

    NARCIS (Netherlands)

    de Lange, E.; Verhaak, P. F. M.; van der Meer, K.

    Objective The aim of this study is to provide an overview of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalized long-term care. Design The method used in this study is a systematic PubMed search and literature review. Results The prevalence of delirium

  18. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review.

    NARCIS (Netherlands)

    Lange, E. de; Verhaak, P.F.M.; Meer, K. van der

    2013-01-01

    Objective: The aim of this study is to provide an overview of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalized long-term care. Design: The method used in this study is a systematic PubMed search and literature review. Results: The prevalence of

  19. Subcutaneous Fat Necrosis of the Newborn: A Case Report of a Term Infant Presenting with Malaise and Fever at Age of 9 Weeks

    Directory of Open Access Journals (Sweden)

    Ayuk Adaeze Chikaodinaka

    2015-01-01

    Full Text Available Background. Subcutaneous fat necrosis (SFN is a rare, temporary, self-limited pathology affecting adipose tissue of full-term or postmature neonates. It is a rare entity especially in Nigeria and usually occurs in the first weeks following a complicated delivery. Because it is not very common, diagnosis is easily missed. It may resolve spontaneously without sequelae but patients need to be followed up because of development of late complications especially hypercalcemia. We report a case of SFN of the newborn noted within one week of birth and highlight the need for proper prompt diagnosis and the need for follow-up to assess possible complications.

  20. Carnitine deficiency presenting with a decreased mental state in a patient with amyotrophic lateral sclerosis receiving long-term tube feeding: a case report.

    Science.gov (United States)

    Isse, Naohi; Miura, Yoh; Obata, Toshiyuki; Takahara, Noriko

    2013-12-30

    L-carnitine is an important metabolic mediator involved in fatty acid transport. It is obtained from the diet, particularly from animal products, such as red meat. Previous reports have revealed that long-term tube feeding with a commercial product containing no or low levels of carnitine can lead to an altered mental state caused by hyperammonemia. A 72-year-old Japanese man had a 12-year history of amyotrophic lateral sclerosis. He was bedridden and had required mechanical ventilation and enteral tube feeding for 10 years at home. His main enteral solution was a commercial product that contained low carnitine levels, and he sometimes received coffee and homemade products such as miso soup. Our patient's ability to communicate gradually deteriorated over a period of one year. His serum total carnitine level was abnormally low, at 26.7μmol/L (normal range, 45 to 91μmol/L), but his ammonium level was normal. His mental state improved dramatically after starting L-carnitine supplementation (600mg twice daily). This case highlights the importance of avoiding carnitine deficiency in patients with amyotrophic lateral sclerosis undergoing long-term tube feeding. These patients experience progressive muscle atrophy that might cause impaired carnitine storage and might manifest as communication difficulties. Carnitine deficiency can be misdiagnosed as a progression of systemic muscle atrophy. Clinicians should be aware of this disorder and should consider periodically measuring carnitine levels, regardless of the patient's serum ammonium levels.

  1. Effect of maternal intravenous fluid therapy on external cephalic version at term: a prospective cohort study.

    Science.gov (United States)

    Burgos, Jorge; Quintana, Eider; Cobos, Patricia; Osuna, Carmen; Centeno, María del Mar; Melchor, Juan Carlos

    2014-12-01

    We sought to analyze whether maternal intravenous fluid therapy prior to external cephalic version (ECV) increases the amount of amniotic fluid and the success rate of the procedure. This was a prospective single-center cohort study of 200 women with a consecutive cohort of 100 pregnant women with a breech presentation at term who were administered intravenous fluid therapy with 2 L of hypotonic saline before the version attempt, compared to a control cohort of 100 pregnant women not given hydration treatment. The mean increase in the amniotic fluid index (AFI) after intravenous maternal hydration was 3.75 ± 2.71 cm. The amount of fluid before hydration was the only variable found to be associated with increases in amniotic fluid levels, both in absolute and relative terms (odds ratio, -0.21; 95% confidence interval, -0.37 to -0.05 and odds ratio, -4.62; 95% confidence interval, -6.17 to -3.06; P < .01, respectively). We did not observe any severe complications secondary to the intravenous fluid therapy. The ECV success rate was 43% in the study group compared to 47% in the control group (P = .67). The success rate was significantly lower the larger the relative increase in the AFI, although no correlation was found in absolute terms (χ(2) for linear trend = 0.03 and 0.34, respectively). Maternal intravenous fluid therapy with 2 L of hypotonic saline prior to ECV is an effective and safe technique for increasing the AFI. However, its use in ECV does not increase the success rate of the procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. 3. International Conference on Nuclear Power Plant Life Management (PLiM) for Long Term Operations (LTO). Keynotes, papers, presentations, posters

    International Nuclear Information System (INIS)

    2012-01-01

    The world's fleet of nuclear power plants is, on average, more than 20 years old. Even though the design life of a nuclear power plant is typically 30-40 years, many plants will operate in excess of their design lives, provided that nuclear power plant engineers demonstrate by analysis, equipment and system upgrades, increased vigilance, testing and ageing management that the plant will operate safely. In the operation of nuclear power plants, safety should always be the prime consideration. Plant operators and regulators must always ensure that plant safety is maintained and, where possible, enhanced during its operating lifetime. Nuclear power plant life management (PLiM) has gained increased attention over the past decade, and effective ageing management of systems, structures and components (SSCs) is a key element in PLiM for the safe and reliable long term operation of nuclear power plants. A PLiM programme is an effective tool that allows an operator to safely and cost effectively manage ageing effects in SSCs for long term operation (LTO). A PLiM programme helps facilitate decisions concerning when and how to repair, replace or modify SSCs in an economically optimized way, while assuring that a high level of safety is maintained. The option for extended nuclear power plant operation has been recognized by operators and regulators alike, as evidenced in the number of licence renewal programmes that are being developed by Member States. After the severe accident at the Fukushima Daiichi nuclear power plant, the safe operation of nuclear power plants has become even more important; not only in terms of technical or ageing issues, but also in terms of management system and qualified workforce related issues. Application of an integrated management system and structured workforce planning are needed throughout the plant life in order to ensure effective plant organization and management. The IAEA organized the first and second International Conference on Nuclear

  3. Effect of an Education Presentation On the Knowledge and Awareness of Urinary Tract Infection among Non-Licensed and Licensed Health Care Workers in Long-Term Care Facilities.

    Science.gov (United States)

    Freeman-Jobson, Jennifer H; Rogers, Jamie L; Ward-Smith, Peggy

    2016-01-01

    This article presents the findings of a pre-test, post-test quality improvement project that describes the change in knowledge from prior to and following an evidence-based education presentation. The presentation addressed the clinical symptoms, diagnostic processes, interventions, and responsibilities of licensed and unlicensed health care workers employed in long-term care facilities related to prevention and detection of non-catheter-related urinary tract infections. Results indicate that the education presentation improved knowledge in specific.

  4. Essure® present controversies and 5 years' learned lessons: a retrospective study with short- and long-term follow-up.

    Science.gov (United States)

    Câmara, Sara; de Castro Coelho, Filipa; Freitas, Cláudia; Remesso, Lilia

    2017-01-01

    The risk-benefit of contraception with Essure® is being readdressed due to an increase of reports of adverse effects with this device. Our aim was to proceed to an internal quality evaluation and to identify opportunities for protocol improvement. We proceeded to a one-center, retrospective consecutive case series of women admitted for Essure® placement, from 1 January 2012 until 31 December 2016 (5 years). In a total of 274 women, technical difficulties were mainly unilateral, with no acute or short-term severe complications. The procedure was brief (median 3.2 min, IQR 2.5-5.2) and moderately painful (median of 4 in a 0-10 scale; IQR 3-5). At 3 months, the failure rate was 2%, with no pregnancies. Second surgery indication (Essure® and avoid the erroneous indication for implant removal. Long follow-up allowed for both internal quality evaluation and clarification of misconception; it could possibly also have contributed to patient satisfaction.

  5. Efficacy of a tool to predict short-term mortality in older people presenting at emergency departments: Protocol for a multi-centre cohort study.

    Science.gov (United States)

    Cardona, Magnolia; Lewis, Ebony T; Turner, Robin M; Alkhouri, Hatem; Asha, Stephen; Mackenzie, John; Perkins, Margaret; Suri, Sam; Holdgate, Anna; Winoto, Luis; Chang, Chan-Wei; Gallego-Luxan, Blanca; McCarthy, Sally; Kristensen, Mette R; O'Sullivan, Michael; Skjøt-Arkil, Helene; Ekmann, Anette A; Nygaard, Hanne H; Jensen, Jonas J; Jensen, Rune O; Pedersen, Jonas L; Breen, Dorothy; Petersen, John A; Jensen, Birgitte N; Mogensen, Christian Backer; Hillman, Ken; Brabrand, Mikkel

    Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death. The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians' prognostic uncertainty on the time to patients' death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices. Copyright © 2018 Elsevier B.V. All rights reserved.

  6. Prefrontal blood flow and oxygenation measured by NIRS during long-term memory tasks are impaired by acute hyperglycemia (Conference Presentation)

    Science.gov (United States)

    Harris, R. Luke; Bell, Lindsay; Reimer, Andrea; Pettersen, Jacqueline A.; Siakaluk, Paul; Duffels, Brian

    2017-02-01

    Our goal was to use 2-channel frequency domain near-infrared spectroscopy (NIRS) to investigate the hemodynamic and metabolic mechanisms underlying hyperglycemia-associated long-term memory impairment. We hypothesized that prefrontal cortex (PFC) oxygen saturation (%Sat) and perfusion (tHb, i.e. total hemoglobin) would decrease due to hyperglycemia during learning, and then increase during recall. During learning, participants' blood glucose was manipulated with beverages containing either 47.4 mg saccharine control (CON, n = 10), or 50 g dextrose + 23.7 mg saccharine (GLC, n = 10). In the Symbol-Digit Modalities Test (SMDT) participants matched nine symbols to corresponding digits (1-9 inclusive), completing 105 learning and 15 testing trials on day 1 and 15 testing trials on day 2. From learning to recall, CON SMDT performance was unchanged, but GLC SMDT performance was decreased 11% (P = 0.0173). There were significant interactions (2-way ANOVA) between the CON-GLC treatment effects and the learning-recall effects for both PFC perfusion and oxygen saturation. Specifically, comparing learning to recall, CON exhibited no tHb differences but for GLC there was a large tHb decrease during learning with a partial recovery toward CON values during recall (P = 0.0012); and, comparing learning to recall, CON exhibited a large %Sat decrease but GLC exhibited a large %Sat increase (P = 0.021). We speculate that, during learning, after overnight fasting (CON) the PFC demands more hemodynamic and metabolic resources and "works" harder, but with readily available sugar (GLC) the PFC exhibits decreased "effort."

  7. Only visual impressions are almost always present in long-term memories, and reported completeness, accuracy, and verbalizability of recollections increase with age.

    Science.gov (United States)

    Westman, A S; Orellana, C

    1996-10-01

    In two studies, students answered questions about their earliest memories from childhood and either elementary school and high school or college and yesterday. Visual sensory impressions were present in all childhood and almost all later memories. Sound aspects were more frequent in memories from high school and college than in those from childhood. Earliest memories from yesterday almost always included internal sensations. Recollections were rated as more accurate, complete, and verbalizable as events occurred later in life. Memories from childhood, elementary, and high school were thought about, found useful, or shared equally frequently. Yesterday's events were less likely shared, but, if shared, enhanced social relationships.

  8. Long-term trajectories of patients with neck pain and low back pain presenting to chiropractic care: A latent class growth analysis.

    Science.gov (United States)

    Ailliet, L; Rubinstein, S M; Hoekstra, T; van Tulder, M W; de Vet, H C W

    2018-01-01

    Information on the course of neck pain (NP) and low back pain (LBP) typically relies on data collected at few time intervals during a period of up to 1 year. In this prospective, multicentre practice-based cohort study, patients consulting a chiropractor responded weekly for 52 weeks to text messages on their cell phones. Data from 448 patients (153 NP, 295 LBP) who had returned at least one set of answers in the first 26 weeks were used. Outcome measures were pain intensity (VAS) and functional outcome, assessed using four different questions: pain intensity, limitation in activities of daily living (ADL), number of days with pain in the previous week and number of days limited in ADL. Distinct patterns of pain were analysed with quadratic latent class growth analysis. The final model was a 4-class model for NP and LBP. The 'recovering from mild baseline pain' is most common (76.3% of NP patients/58.3% of LBP patients) followed by the 'recovering from severe baseline pain' class (16.3% NP/29.8% LBP). They follow similar trajectories when considered over a period of 6 months. Pain at baseline, duration of complaints, functional status, limitations in ADL and the score on psychosocial scales were the variables that most contributed to distinguish between groups. Most patients with NP or LBP presenting in chiropractic care show a trajectory of symptoms characterized by persistent or fluctuating pain of low or medium intensity. Only a minority either experience a rapid complete recovery or develop chronic severe pain. Ninety percentage of patients with neck pain or low back pain presenting to chiropractors have a 30% improvement within 6 weeks and then show a trajectory of symptoms characterized by persistent or fluctuating pain of low or medium intensity. Only a minority either experience a rapid complete recovery or develop chronic severe pain. © 2017 European Pain Federation - EFIC®.

  9. Short-term additional enfuvirtide therapy is associated with a greater immunological recovery in HIV very late presenters: a controlled pilot study.

    Science.gov (United States)

    Bonora, S; Calcagno, A; Cometto, C; Fontana, S; Aguilar, D; D'Avolio, A; Gonzalez de Requena, D; Maiello, A; Dal Conte, I; Lucchini, A; Di Perri, G

    2012-02-01

    To evaluate whether the addition of enfuvirtide to standard highly active antiretroviral therapy (HAART) could confer immunovirological benefits in human immunodeficiency virus (HIV)-infected very late presenters. The current study is an open comparative therapeutic trial of standard protease inhibitor (PI)-based HAART ± additional enfuvirtide in treatment-naïve deeply immunologically impaired HIV-positive patients. Very late presenters (CD4 HIV RNA was intensively monitored in the first month, and, thereafter, monthly, as for CD4+ cell count and percentage, clinical data, and plasma drug concentrations. Of 22 enrolled patients (11 per arm), 19 completed the study (10 in the ENF arm). Baseline CD4+ cell counts and % were comparable, with 20 CD4+/mm(3) (12-37) and a percentage of 3.3 (1.7-7.1) in the ENF arm, and 16 CD4+/mm(3) (9-29) and a percentage of 3.1 (2.3-3.8) in the CO arm, respectively. The baseline viral load was also comparable between the two arms, with 5.77 log10 (5.42-6) and 5.39 log10 (5.06-6) in the ENF and CO arms, respectively. Enfuvirtide recipients had higher CD4+ percentage at week 8 (7.6 vs. 3.6%, p = 0.02) and at week 24 (10.7 vs. 5.9%, p = 0.02), and a greater CD4+ increase at week 24 (207 vs. 134 cells/mm(3), p = 0.04), with 70% of enfuvirtide intakers versus 12.5% of controls who achieved a CD4+ cell count >200/mm(3) (p = 0.01). At 48 weeks, patients in the ENF arm had CD4+ cell counts higher than controls (251 vs. 153cells/mm(3), p = 0.04) and were also found to be faster in reaching a CD4 cell count over 200/mm(3): 18 (8-24) versus 48 (36-108) weeks (p = 0.01). Viral load decay at week 4 was greater in the ENF arm (-3 vs. -2.2 log, p = 0.04), while the proportion of patients with viral load discovered HIV-positive patients with very low CD4+ cell counts. Induction strategies using an enfuvirtide-based approach in such subjects warrant further investigation.

  10. Conservative treatment of idiopathic scoliosis according to FITS concept: presentation of the method and preliminary, short term radiological and clinical results based on SOSORT and SRS criteria

    Science.gov (United States)

    2011-01-01

    Background Conservative scoliosis therapy according to the FITS Concept is applied as a unique treatment or in combination with corrective bracing. The aim of the study was to present author's method of diagnosis and therapy for idiopathic scoliosis FITS-Functional Individual Therapy of Scoliosis and to analyze the early results of FITS therapy in a series of consecutive patients. Methods The analysis comprised separately: (1) single structural thoracic, thoracolumbar or lumbar curves and (2) double structural scoliosis-thoracic and thoracolumbar or lumbar curves. The Cobb angle and Risser sign were analyzed at the initial stage and at the 2.8-year follow-up. The percentage of patients improved (defined as decrease of Cobb angle of more than 5 degrees), stable (+/- 5 degrees), and progressed (increase of Cobb angle of more than 5 degrees) was calculated. The clinical assessment comprised: the Angle of Trunk Rotation (ATR) initial and follow-up value, the plumb line imbalance, the scapulae level and the distance from the apical spinous process of the primary curve to the plumb line. Results In the Group A: (1) in single structural scoliosis 50,0% of patients improved, 46,2% were stable and 3,8% progressed, while (2) in double scoliosis 50,0% of patients improved, 30,8% were stable and 19,2% progressed. In the Group B: (1) in single scoliosis 20,0% of patients improved, 80,0% were stable, no patient progressed, while (2) in double scoliosis 28,1% of patients improved, 46,9% were stable and 25,0% progressed. Conclusion Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish. PMID:22122964

  11. Conservative treatment of idiopathic scoliosis according to FITS concept: presentation of the method and preliminary, short term radiological and clinical results based on SOSORT and SRS criteria

    Directory of Open Access Journals (Sweden)

    Białek Marianna

    2011-11-01

    Full Text Available Abstract Background Conservative scoliosis therapy according to the FITS Concept is applied as a unique treatment or in combination with corrective bracing. The aim of the study was to present author's method of diagnosis and therapy for idiopathic scoliosis FITS-Functional Individual Therapy of Scoliosis and to analyze the early results of FITS therapy in a series of consecutive patients. Methods The analysis comprised separately: (1 single structural thoracic, thoracolumbar or lumbar curves and (2 double structural scoliosis-thoracic and thoracolumbar or lumbar curves. The Cobb angle and Risser sign were analyzed at the initial stage and at the 2.8-year follow-up. The percentage of patients improved (defined as decrease of Cobb angle of more than 5 degrees, stable (+/- 5 degrees, and progressed (increase of Cobb angle of more than 5 degrees was calculated. The clinical assessment comprised: the Angle of Trunk Rotation (ATR initial and follow-up value, the plumb line imbalance, the scapulae level and the distance from the apical spinous process of the primary curve to the plumb line. Results In the Group A: (1 in single structural scoliosis 50,0% of patients improved, 46,2% were stable and 3,8% progressed, while (2 in double scoliosis 50,0% of patients improved, 30,8% were stable and 19,2% progressed. In the Group B: (1 in single scoliosis 20,0% of patients improved, 80,0% were stable, no patient progressed, while (2 in double scoliosis 28,1% of patients improved, 46,9% were stable and 25,0% progressed. Conclusion Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish.

  12. Delivery presentations

    Science.gov (United States)

    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 ...

  13. Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents.

    Science.gov (United States)

    Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe; Aquino, Melissa; Stone, Gregg W; Sartori, Samantha; Steg, Philippe Gabriel; Wijns, William; Smits, Pieter C; Jeger, Raban V; Leon, Martin B; Windecker, Stephan; Serruys, Patrick W; Morice, Marie-Claude; Camenzind, Edoardo; Weisz, Giora; Kandzari, David; Dangas, George D; Mastoris, Ioannis; Von Birgelen, Clemens; Galatius, Soren; Kimura, Takeshi; Mikhail, Ghada; Itchhaporia, Dipti; Mehta, Laxmi; Ortega, Rebecca; Kim, Hyo-Soo; Valgimigli, Marco; Kastrati, Adnan; Chieffo, Alaide; Mehran, Roxana

    2015-09-15

    The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women. Published by Elsevier Inc.

  14. Clinical and social characteristics associated with reduced visual acuity at presentation in Australian patients with neovascular age-related macular degeneration: a prospective study from a long-term observational data set. The Fight Retinal Blindness! Project.

    Science.gov (United States)

    Nguyen, Vuong; Daien, Vincent; Guymer, Robyn H; McAllister, Ian L; Morlet, Nigel; Barthelmes, Daniel; Gillies, Mark C

    2018-04-01

    Identifying variables that influence presenting visual acuity (VA) in patients with neovascular age-related macular degeneration (nAMD) is important because it is a strong predictor of long-term outcomes. To assess the clinical and social characteristics associated with low presenting VA in nAMD patients. The present study is a cross-sectional analysis from a prospective, observational database. We identified 3242 treatment-naïve patients from 54 Australian practices in the Fight Retinal Blindness! registry. Age, gender, ethnicity and VA were recorded at the baseline visit. Socio-economic status was determined using the Australian Bureau of Statistics socio-economic indexes for areas. Association between clinical and socio-economic characteristics with presenting VA was identified. Poor VA (≤35 letters) in the presenting eye was associated with older age (adjusted odds ratio [AOR]: 1.33 for patients aged ≥80 years vs. <80 years [95% confidence interval, CI: 1.04, 1.71]), treatment at a public practice (AOR: 1.91 for public vs. private practices [95% CI: 1.46, 2.50]) and intermediate (36-69 letters) VA in the fellow eye (AOR: 0.67 [95% CI: 0.47, 0.95] and 0.64 [95% CI: 0.48, 0.85] for poor [≤35 letters] and good [≥70 letters] VA vs. intermediate VA in the fellow eye). Gender, ethnicity and socio-economic status were not independently associated with VA at presentation. Poor presenting vision is detrimental to the long-term outcomes of nAMD. Poor presentation of nAMD in Australia may not be related to socio-economic circumstances, but due to systems of care. Further research is warranted to determine why patients at public practices present with worse vision compared with private practices in Australia. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

  15. Lecture Presentations

    International Nuclear Information System (INIS)

    2007-01-01

    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

  16. CATCHY PRESENTATIONS

    DEFF Research Database (Denmark)

    Eriksen, Kaare; Tollestrup, Christian; Ovesen, Nis

    2011-01-01

    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...

  17. Workshop presentations

    International Nuclear Information System (INIS)

    Sanden, Per-Olof; Edland, Anne; Reiersen, Craig; Mullins, Peter; Ingemarsson, Karl-Fredrik; Bouchard, Andre; Watts, Germaine; Johnstone, John; Hollnagel, Erik; Ramberg, Patric; Reiman, Teemu

    2009-01-01

    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

  18. CERN presentations

    CERN Multimedia

    CERN. Geneva

    2011-01-01

    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

  19. Delivery presentations

    Science.gov (United States)

    ... 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 ...

  20. Information Presentation

    Science.gov (United States)

    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.

    2009-01-01

    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.

  1. Voting Present

    Directory of Open Access Journals (Sweden)

    James Lo

    2013-12-01

    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.

  2. Lecture Presentations

    International Nuclear Information System (INIS)

    2008-01-01

    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

  3. Presentation Technique

    International Nuclear Information System (INIS)

    Froejmark, M.

    1992-10-01

    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.)

  4. Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

    DEFF Research Database (Denmark)

    Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe

    2015-01-01

    The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11......,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST......-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p clinical...

  5. Sequential Use of Second-Generation Tyrosine Kinase Inhibitor Treatment and Intensive Chemotherapy Induced Long-Term Complete Molecular Response in Imatinib-Resistant CML Patient Presenting as a Myeloid Blast Crisis

    Directory of Open Access Journals (Sweden)

    Masaaki Tsuji

    2017-01-01

    Full Text Available Myeloid blast crisis of chronic myeloid leukemia (CML-MBC is rarely seen at presentation and has a poor prognosis. There is no standard therapy for CML-MBC. It is often difficult to distinguish CML-MBC from acute myeloid leukemia expressing the Philadelphia chromosome (Ph+ AML. We present a case in which CML-MBC was seen at the initial presentation in a 75-year-old male. He was treated with conventional AML-directed chemotherapy followed by imatinib mesylate monotherapy, which failed to induce response. However, he achieved long-term complete molecular response after combination therapy involving dasatinib, a second-generation tyrosine kinase inhibitor, and conventional chemotherapy.

  6. Technical presentation

    CERN Document Server

    FI Department

    2008-01-01

    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...

  7. Technical presentation

    CERN Document Server

    FP Department

    2009-01-01

    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

  8. Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4.

    Science.gov (United States)

    Fulkerson, Daniel H; White, Ian K; Rees, Jacqueline M; Baumanis, Maraya M; Smith, Jodi L; Ackerman, Laurie L; Boaz, Joel C; Luerssen, Thomas G

    2015-10-01

    Patients with traumatic brain injury (TBI) with low presenting Glasgow Coma Scale (GCS) scores have very high morbidity and mortality rates. Neurosurgeons may be faced with difficult decisions in managing the most severely injured (GCS scores of 3 or 4) patients. The situation may be considered hopeless, with little chance of a functional recovery. Long-term data are limited regarding the clinical outcome of children with severe head injury. The authors evaluate predictor variables and the clinical outcomes at discharge, 1 year, and long term (median 10.5 years) in a cohort of children with TBI presenting with postresuscitation GCS scores of 3 and 4. A review of a prospectively collected trauma database was performed. Patients treated at Riley Hospital for Children (Indianapolis, Indiana) from 1988 to 2004 were reviewed. All children with initial GCS (modified for pediatric patients) scores of 3 or 4 were identified. Patients with a GCS score of 3 were compared with those with a GCS score of 4. The outcomes of all patients at the time of death or discharge and at 1-year and long-term follow-up were measured with a modified Glasgow Outcome Scale (GOS) that included a "normal" outcome. Long-term outcomes were evaluated by contacting surviving patients. Statistical "classification trees" were formed for survival and outcome, based on predictor variables. Sixty-seven patients with a GCS score of 3 or 4 were identified in a database of 1636 patients (4.1%). Three of the presenting factors differed between the GCS 3 patients (n = 44) and the GCS 4 patients (n = 23): presence of hypoxia, single seizure, and open basilar cisterns on CT scan. The clinical outcomes were statistically similar between the 2 groups. In total, 48 (71.6%) of 67 patients died, remained vegetative, or were severely disabled by 1 year. Eight patients (11.9%) were normal at 1 year. Ten of the 22 patients with long-term follow-up were either normal or had a GOS score of 5. Multiple clinical

  9. Editorial Presentation

    Directory of Open Access Journals (Sweden)

    Ilan Avrichir

    2017-01-01

    Ogasavara, take as starting point a bibliometric study of  the theme global cities. After  analyzing the evolution of academic production about the subject, and of the concept itself ,  they maintain that the phenomenon is relevant to the understanding of the contemporary strategies of internationalization of multinational companies, and that the  topic  tends to gain importance in terms of research. Among other indications for researchers who work or think about researching the theme, they suggest that economic geography as an approach with potential for understanding the impact of cities on the strategy and performance of multinationals. Roberto Flores Falcão, Gilmar Masiero, Marcos Campomar review 70 articles published in high impact journals on the transfer of knowledge in multinational companies in the marketing performance of the subsidiaries. From this analysis, they construct a model that incorporates the context of the operation and the dynamics of the markets in the analysis. The authors identify the scales and analysis techniques that should be used to validate the model. In addition to  providing an advanced starting point for empirical research, the theoretical consistency of the model represents a rich possibility for discussion and debate. Last but not least, Eduardo Picanço Cruz, Roberto Pessoa de Queiroz Falcão, in "Bibliometric Review on Immigrant and Ethnic Entrepreneurship" review the academic literature on another highly contemporary phenomenon, the Brazilian immigrant community, and in particular their entrepreneurship. After reviewing the most cited articles on the subject, they demonstrate that the literature on immigrant and ethnic entrepreneurship has grown exponentially, suggesting this is another promising theme. The authors further suggest that there are great research opportunities on the subject in various macro areas of the Administration. In summary, in this issue the reader will find in-depth analyzes of government policies

  10. Invasive micropapillary carcinoma of the breast has a better long-term survival than invasive ductal carcinoma of the breast in spite of its aggressive clinical presentations: a comparison based on large population database and case-control analysis.

    Science.gov (United States)

    Chen, Hongliang; Wu, Kejin; Wang, Maoli; Wang, Fuwen; Zhang, Mingdi; Zhang, Peng

    2017-12-01

    There are controversies in the comparison of overall survival between invasive micropapillary carcinoma of the breast (IMPC) and invasive ductal carcinoma (IDC). The objective of this study was to compare the long-term survival outcome between non-metastatic IMPC and IDC. The Surveillance, Epidemiology, and End Results database was searched to identify women with non-metastatic IMPC and IDC diagnosed between 2001 and 2013. Comparisons of patient and tumor characteristics were performed using Pearson's chi-square. The propensity score matching method was applied with each IMPC matched to one IDC. Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated using the Kaplan-Meier product limit method and compared across groups using the log-rank statistic. Multivariate analysis was performed through Cox models. IMPC was presented with aggressive clinical presentations such as larger tumor, more positive lymph nodes, and more advanced stage compared with IDC. A higher rate of estrogen receptor (ER)/progesterone receptor (PR) positivity was also observed in IMPC. With a median follow-up of 64 months, IMPC had a better BCSS (P = 0.031) and OS (P = 0.012) compared with IDC. In a case-control analysis IMPC was still an independent favorable prognostic factor for BCSS (HR = 0.410, P analysis, IMPC always showed a better survival outcome compared with IDC except in AJCC stage I and histologic grade I disease. IMPC has a better long-term survival outcome compared with IDC in spite of its highly aggressive clinical presentation. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  11. Fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar <7,0 no 5º minuto Perinatal factors associated with pH<7.1 in umbilical artery and Apgar 5 min <7.0 in term newborn

    Directory of Open Access Journals (Sweden)

    Patrícia de Moraes De Zorzi

    2012-08-01

    Full Text Available OBJETIVO: Avaliar os fatores perinatais associados a recém-nascidos de termo com pHPURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR. The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16% had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005, cesarean section (OR=3.5, p<0.01 and modified intrapartum cardiotocography (OR=7.8, p<0.02 presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001, need for resuscitation (OR=12.2, p <0.0001 and base deficit were associated with the event (15.0 versus -4.5, p<0.0001. CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.

  12. Analyzing in the present

    DEFF Research Database (Denmark)

    Revsbæk, Line; Tanggaard, Lene

    2015-01-01

    The article presents a notion of “analyzing in the present” as a source of inspiration in analyzing qualitative research materials. The term emerged from extensive listening to interview recordings during everyday commuting to university campus. Paying attention to the way different parts of vari...

  13. Presentation on ecoenergetic assessment

    International Nuclear Information System (INIS)

    Fournelle, C.

    1998-01-01

    The development of a tool to assess the quality of indoor air for buildings in the residential and commercial sector was presented. The computer software program was designed to allow a building operator to set an optimal target to reflect the greatest economies in energy consumption. Air quality was assessed in terms of carbon dioxide, volatile organic compounds, and other common indoor pollutants

  14. Investigación sobre manejo forestal a largo plazo en Patagonia Sur -Argentina: Lecciones del pasado, desafíos del presente Long-term forest management research in South Patagonia - Argentina: Lessons from the past, challenges from the present

    Directory of Open Access Journals (Sweden)

    GUILLERMO J MARTÍNEZ-PASTUR

    2010-03-01

    ón de tratamientos intermedios, (iii determinar líneas base y definir los impactos de distintos sistemas silvícolas, (iv proponer metodologías de monitoreo de amplio espectro y establecer áreas demostrativas de manejo, y (v proveer áreas y conocimientos para entrenar profesionales en prácticas de manejo forestal y conservación de la biodiversidad. Las parcelas permanentes ya establecidas en los bosques de Nothofagus de Patagonia Sur y las bases de datos obtenidas podrían servir como punto de partida para definir un núcleo regional que pueda participar en el International Long Term Ecological Research para asegurar el uso sustentable de los bosques nativos.Argentina has based its economy in agriculture and cattle production seeing forests as one of the main obstacles for future development. Forest harvesting in South Patagonia has been an activity based on colonization and exploitation of new areas. Harvesting is mainly carried out in old-growth forests without silviculture management after the first cuts. Beyond this mismanagement, scientific research defined the basis to conserve, protect and improve the present forest management for the South Patagonia native forests. The first long-term study permanent plots (1965-1966 monitored only economic and forest structure parameters, and near twenty plots were established in public forested lands of Tierra del Fuego. Most of these plots were destroyed or discontinued due to a lack of land use planning, scarce social interest for long-term researches, absence of commitment of institutions, and few contributions of forest companies. After this, a second group of nine long-term study permanent plots were established in South Patagonia (1993-2004 based in the collaboration between private companies and national research institutions. The objectives included economic as well as ecological parameters. The new plots were established on private lands based on several agreements and joint venture projects between national

  15. Imagined futures, present lives

    DEFF Research Database (Denmark)

    Dalsgaard, Anne Line; Wildermuth, Norbert

    2006-01-01

    The article is focused thematically on the uses and meanings of media for (some) young people in Recife, a million-inhabitant city in the northeast of Brazil. The article brings together the perspective of Anne Line Dalsgaard, a long-term anthropological field researcher who is familiar with the ......The article is focused thematically on the uses and meanings of media for (some) young people in Recife, a million-inhabitant city in the northeast of Brazil. The article brings together the perspective of Anne Line Dalsgaard, a long-term anthropological field researcher who is familiar...... is discussed centrally in this attempt to contribute to an empirically grounded understanding of the role that media play for youth in their striving to ‘find a place in life'. In the empirical context presented in the article, imaginations, expanded and circulated by a globalized media circuit...

  16. Presentation to the symposium

    International Nuclear Information System (INIS)

    Busby, C.

    1997-01-01

    This paper proposes that there is a major error in the present perception of cancer risk from exposure to low level radiation from internal man-made fission products like strontium-90. The author's Second Event theory is discussed which advances the basis that fission products are different in radiation risk terms. Since the scientific community has been so ready to dismiss this idea out of hand, the author also explores scientific culture and scientific revolutions. The evidence that the idea is broadly right is surveyed and finally some studies that could be undertaken to prove or disprove the author's contention are outlined. (UK)

  17. Summary of the presentations

    International Nuclear Information System (INIS)

    2002-01-01

    This part summarizes the content of the six following presentations: 1. IAEA requirements/guidance for the decommissioning safety case (Mike Bell, IAEA); 2. Safety case in an EIA context (Patrick O'SULLIVAN, The Netherlands); 3. Plant configuration and the D and D licensing process (Eugenio GIL LOPEZ and Pedro CARBONERAS, Spain); 4. Accident assessment (Ivo TRIPPUTI, Italy; Ingmar LUND, Sweden); 5. Balancing radiological and industrial risk in the safety case (Pascal DEBOODT, Belgium); 6. The safety case for safe store and dormancy periods (Paul WOOLLAM, UK). Following the six presentations, the WPDD members discussed the safety case in an open discussion led by the Topical Session Chair, Frances Taylor. The discussion was wide-ranging, and topics varied from the standards that apply to releases to the environment during safe store, to decommissioning parallels with other major processing industries and facilities (such as oil rigs). Frances Taylor steered the discussion toward addressing the questions that the WPDD Core Group had proposed for the topical session. The Chair, the Rapporteur, and some members of the group sensed that the presentations had covered such an wide variety of issues, and that the content of the presentations themselves differed so greatly, that it would be difficult to distill a position paper from the information gathered, as had been the mandate from the Core Group. In addition, the meaning of the term 'Safety Case' differed greatly among participants in the topical session. Some took the term to mean the analysis and document that the implementor provides to the regulator, describing how operations will be performed safely. Others considered the term to mean the overall safety and risk conditions inherent in a nuclear facility during operations or decommissioning. With the differences in presentations and with the meaning of the terminology remaining unclear, the WPDD participants did not reach consensus conclusions on December 5, 2001

  18. The Long-Term Benefits of Positive Self-Presentation via Profile Pictures, Number of Friends and the Initiation of Relationships on Facebook for Adolescents' Self-Esteem and the Initiation of Offline Relationships.

    Science.gov (United States)

    Metzler, Anna; Scheithauer, Herbert

    2017-01-01

    Social networking sites are a substantial part of adolescents' daily lives. By using a longitudinal approach the current study examined the impact of (a) positive self-presentation, (b) number of friends, and (c) the initiation of online relationships on Facebook on adolescents' self-esteem and their initiation of offline relationships, as well as the mediating role of positive feedback. Questionnaire data were obtained from 217 adolescents (68% girls, mean age 16.7 years) in two waves. Adolescents' positive self-presentation and number of friends were found to be related to a higher frequency of receiving positive feedback, which in turn was negatively associated with self-esteem. However, the number of Facebook friends had a positive impact on self-esteem, and the initiation of online relationships positively influenced the initiation of offline relationships over time, demonstrating that Facebook may be a training ground for increasing adolescents' social skills. Implications and suggestions for future research are provided.

  19. The Long-Term Benefits of Positive Self-Presentation via Profile Pictures, Number of Friends and the Initiation of Relationships on Facebook for Adolescents’ Self-Esteem and the Initiation of Offline Relationships

    Science.gov (United States)

    Metzler, Anna; Scheithauer, Herbert

    2017-01-01

    Social networking sites are a substantial part of adolescents’ daily lives. By using a longitudinal approach the current study examined the impact of (a) positive self-presentation, (b) number of friends, and (c) the initiation of online relationships on Facebook on adolescents’ self-esteem and their initiation of offline relationships, as well as the mediating role of positive feedback. Questionnaire data were obtained from 217 adolescents (68% girls, mean age 16.7 years) in two waves. Adolescents’ positive self-presentation and number of friends were found to be related to a higher frequency of receiving positive feedback, which in turn was negatively associated with self-esteem. However, the number of Facebook friends had a positive impact on self-esteem, and the initiation of online relationships positively influenced the initiation of offline relationships over time, demonstrating that Facebook may be a training ground for increasing adolescents’ social skills. Implications and suggestions for future research are provided. PMID:29187827

  20. The Long-Term Benefits of Positive Self-Presentation via Profile Pictures, Number of Friends and the Initiation of Relationships on Facebook for Adolescents’ Self-Esteem and the Initiation of Offline Relationships

    OpenAIRE

    Metzler, Anna; Scheithauer, Herbert

    2017-01-01

    Social networking sites are a substantial part of adolescents’ daily lives. By using a longitudinal approach the current study examined the impact of (a) positive self-presentation, (b) number of friends, and (c) the initiation of online relationships on Facebook on adolescents’ self-esteem and their initiation of offline relationships, as well as the mediating role of positive feedback. Questionnaire data were obtained from 217 adolescents (68% girls, mean age 16.7 years) in two waves. Adole...

  1. The Long-Term Cost to the UK NHS and Social Services of Different Durations of IV Thiamine (Vitamin B1) for Chronic Alcohol Misusers with Symptoms of Wernicke's Encephalopathy Presenting at the Emergency Department.

    Science.gov (United States)

    Wilson, Edward C F; Stanley, George; Mirza, Zulfiquar

    2016-04-01

    Wernicke's encephalopathy (WE) is an acute neuropsychiatric condition caused by depleted intracellular thiamine, most commonly arising in chronic alcohol misusers, who may present to emergency departments (EDs) for a variety of reasons. Guidelines recommend a minimum 5-day course of intravenous (IV) thiamine in at-risk patients unless WE can be excluded. To estimate the cost impact on the UK public sector (NHS and social services) of a 5-day course of IV thiamine, vs a 2- and 10-day course, in harmful or dependent drinkers presenting to EDs. A Markov chain model compared expected prognosis of patients under alternative admission strategies over 35 years. Model inputs were derived from a prospective cohort study, expert opinion via structured elicitation and NHS costing databases. Costs (2012/2013 price year) were discounted at 3.5 %. Increasing treatment from 2 to 5 days increased acute care costs but reduced the probability of disease progression and thus reduced the expected net costs by GBP87,000 per patient (95 % confidence interval GBP19,300 to GBP172,300) over 35 years. Increasing length of stay to optimize IV thiamine replacement will place additional strain on acute care but has potential UK public sector cost savings. Social services and the NHS should explore collaborations to realise both the health benefits to patients and savings to the public purse.

  2. The Long-Term Benefits of Positive Self-Presentation via Profile Pictures, Number of Friends and the Initiation of Relationships on Facebook for Adolescents’ Self-Esteem and the Initiation of Offline Relationships

    Directory of Open Access Journals (Sweden)

    Anna Metzler

    2017-11-01

    Full Text Available Social networking sites are a substantial part of adolescents’ daily lives. By using a longitudinal approach the current study examined the impact of (a positive self-presentation, (b number of friends, and (c the initiation of online relationships on Facebook on adolescents’ self-esteem and their initiation of offline relationships, as well as the mediating role of positive feedback. Questionnaire data were obtained from 217 adolescents (68% girls, mean age 16.7 years in two waves. Adolescents’ positive self-presentation and number of friends were found to be related to a higher frequency of receiving positive feedback, which in turn was negatively associated with self-esteem. However, the number of Facebook friends had a positive impact on self-esteem, and the initiation of online relationships positively influenced the initiation of offline relationships over time, demonstrating that Facebook may be a training ground for increasing adolescents’ social skills. Implications and suggestions for future research are provided.

  3. Virtual Presenters: Towards Interactive Virtual Presentations

    NARCIS (Netherlands)

    Nijholt, Antinus; Cappellini, V.; Hemsley, J.

    2005-01-01

    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

  4. Effect of Oral Hydration on External Cephalic Version at Term.

    Science.gov (United States)

    Zobbi, Virna Franca; Nespoli, Antonella; Spreafico, Elisa; Recalcati, Roberta; Loi, Federica; Scian, Antonietta; Galimberti, Stefania

    To evaluate the effect of oral hydration on the success rate of external cephalic version (ECV). Randomized controlled and single-blind trial. Academic tertiary hospital with approximately 3,000 births annually. One hundred sixty-four women at a gestational age of at least 37 weeks with breech-presenting fetuses and normal amniotic fluid indexes (AFIs). Participants were randomly assigned to drink 2000 ml or no more than 100 ml of water in the 2 hours before undergoing ECV. The AFIs were assessed before and after treatment by the same sonographer, who was blinded to the treatment group. Data were collected on relevant maternal and fetal characteristics and ECV success. The mean AFI after hydration was significantly greater than that in the control group (15.5 cm vs. 13.4 cm, p = .003). The ECV success rate was 53.7% in the hydration group and 46.3% in the control group (odds ratio: 1.34, 95% confidence interval [0.69, 2.59]; p = .349). Hydration was well tolerated and there were no serious adverse events. Oral hydration significantly increased the AFIs but did not affect the success rate of ECVs. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  5. Making your presentation fun: creative presentation techniques

    Energy Technology Data Exchange (ETDEWEB)

    KEENEN,MARTHA JANE

    2000-05-18

    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.

  6. Radio-induced breast cancers exhibiting aggressive anatomo-pathological characteristics: retrospective study of the long-term follow-up committee of the French Society of Child Cancers; Cancers du sein radio-induits presentant des caracteristiques anatomopathologiques agressives: etude retrospective du comite de suivi a long terme de la Societe francaise des cancers de l'enfant

    Energy Technology Data Exchange (ETDEWEB)

    Demoor, C.; Mahe, M.A.; Supiot, S. [ICO Rene-Gauducheau, Nantes (France); Vathaire, F. de [Inserm UMRS 1018, institut de cancerologie Gustave-Roussy, Villejuif (France); Oberlin, O. [Institut de cancerologie Gustave-Roussy, Villejuif (France); Noel, G. [Centre Paul-Strauss, Strasbourg (France); Brillaud, V. [Institut Bergonie, Bordeaux (France); Bernier, V. [Centre Alexis-Vautrin, Nancy (France); Laprie, A. [Institut Claudius-Regaud, Toulouse (France); Claude, L. [Centre Leon-Berard, Lyon (France)

    2011-10-15

    The authors report an analysis of clinical-pathological characteristics of radio-induced breast cancers registered in six French centres. 82 breast cancers concerning 75 women have been analyzed in terms of patient age, cancer type, interval between both cancers. It appears that radio-induced cancers exhibited significantly more aggressive characteristics. The screening of young women at risk is therefore recommended for an early diagnosis and treatment. Short communication

  7. ICRP recommendations in the present and in the short term

    International Nuclear Information System (INIS)

    Valentin, Jack

    2003-01-01

    The recommendations of ICRP are either re-stated or revised at intervals of about 15 years, most recently in 1990. The protection philosophy in Publication 60 comprises justification of the practice or intervention considered; optimisation of protection; dose and risk limits and constraints to restrict the options in optimisation. For medical exposures, dose and risk limits and formal constraints are irrelevant, but Diagnostic Reference Levels serve a similar purpose. Building on this foundation, ICRP plans to issue its next recommendations around 2005. The 2005 Recommendations are likely to emphasise protection of the individual more than protection of society; to aim at protection of non-human species as well as man; to summarise and simplify advice given in various reports after Publication 60, and to be formatted as concise recommendations underpinned by separate publications with more detail. The draft will be circulated and comments will be discussed in 2004 with a view approval of the recommendations in 2005 and publication in 2005 or 2006. Thus, integration into legislation may be possible sometime between 2006 and 2010. (author)

  8. Texts of presentation

    Energy Technology Data Exchange (ETDEWEB)

    Magnin, G.; Vidolov, K.; Dufour-Fallot, B.; Dewarrat, Th.; Rose, T.; Favatier, A.; Gazeley, D.; Pujol, T.; Worner, D.; Van de Wel, E.; Revaz, J.M.; Clerfayt, G.; Creedy, A.; Moisan, F.; Geissler, M.; Isbell, P.; Macaluso, M.; Litzka, V.; Gillis, W.; Jarvis, I.; Gorg, M.; Bebie, B.

    2004-07-01

    Implementing a sustainable local energy policy involves a long term reflection on the general interest, energy efficiency, distributed generation and environmental protection. Providing services on a market involves looking for activities that are profitable, if possible in the 'short-term'. The aim of this conference is to analyse the possibility of reconciling these apparently contradictory requirements and how this can be achieved. This conference brings together the best specialists from European municipalities as well as important partners for local authorities (energy agencies, service companies, institutions, etc.) in order to discuss the public-private partnerships concerning the various functions that municipalities may perform in the energy field as consumers and customers, planners and organizers of urban space and rousers as regards inhabitants and economic players of their areas. This document contains the summaries of the following presentations: 1 - Performance contracting: Bulgarian municipalities use private capital for energy efficiency improvement (K. VIDOLOV, Varna (BG)), Contracting experiences in Swiss municipalities: consistent energy policy thanks to the Energy-city label (B. DUFOUR-FALLOT and T. DEWARRAT (CH)), Experience of contracting in the domestic sector (T. ROSE (GB)); 2 - Public procurement: Multicolor electricity (A. FAVATIER (CH)), Tendering for new green electricity capacity (D. GAZELEY (GB)), The Barcelona solar thermal ordinance (T. PUJOL (ES)); 3 - Urban planning and schemes: Influencing energy issues through urban planning (D. WOERNER (DE)), Tendering for the supply of energy infrastructure (E. VAN DE WEL (NL)), Concessions and public utility warranty (J.M. REVAZ (CH)); 4 - Certificate schemes: the market of green certificates in Wallonia region in a liberalized power market (G. CLERFAYT (BE)), The Carbon Neutral{sup R} project: a voluntary certification scheme with opportunity for implementation in other European

  9. Present Day Philosophies of Education

    Science.gov (United States)

    Ediger, Marlow

    2006-01-01

    Presently, there are competing philosophies of education which need comparison. Two philosophies will be compared which are at opposite ends of the continuum. They are distinctly different. And yet, both schools of thought have their disciples. Each of the two will be discussed in terms of its essential features and then there will be selected…

  10. Slide Composition for Electronic Presentations

    Science.gov (United States)

    Larson, Ronald B.

    2004-01-01

    Instructors who use computer-generated graphics in their lectures have many options to consider when developing their presentations. Experts give different advice on which typefaces, background and letter colors, and background imagery improve communications. This study attempted to resolve these controversies by examining how short-term recall of…

  11. BVDV: past, present, and future

    Science.gov (United States)

    The term bovine viral diarrhea (BVD) has come to refer to a collection of diverse clinical presentations that include respiratory, enteric and reproductive diseases accompanied by immunosuppression. BVD may be caused by one of three different species of bovine pestivirus, bovine viral diarrhea viru...

  12. A decision analytical cost analysis of offering ECV in a UK district general hospital

    Directory of Open Access Journals (Sweden)

    Burr Robin

    2001-07-01

    Full Text Available Abstract Objective To determine the care pathways and implications of offering mothers the choice of external cephalic version (ECV at term for singleton babies who present with an uncomplicated breech pregnancy versus assisted breech delivery or elective caesarean. Design A prospective observational audit to construct a decision analysis of uncomplicated full term breech presentations. Setting The North Staffordshire NHS Trust. Subjects All women (n = 176 who presented at full term with a breech baby without complications during July 1995 and June 1997. Main outcome measures The study determined to compare the outcome in terms of the costs and cost consequences for the care pathways that resulted from whether a women chose to accept the offer of ECV or not. All the associated events were then mapped for the two possible pathways. The costs were considered only within the hospital setting, from the perspective of the health care provider up to the point of delivery. Results The additional costs for ECV, assisted breech delivery and elective caesarean over and above a normal birth were £186.70, £425.36 and £1,955.22 respectively. The total expected cost of the respective care pathways for "ECV accepted" and "ECV not accepted" (including the probability of adverse events were £1,452 and £1,828 respectively, that is the cost of delivery through the ECV care pathways is less costly than the non ECV delivery care pathway. Conclusions Implementing an ECV service may yield cost savings in secondary care over and above the traditional delivery methods for breech birth of assisted delivery or caesarean section. The scale of these expected cost savings are in the range of £248 to £376 per patient. This converts to a total expected cost saving of between £43,616 and £44,544 for the patient cohort considered in this study.

  13. Diabetic Myonecrosis: An Atypical Presentation

    Directory of Open Access Journals (Sweden)

    José Hernán Martínez

    2013-01-01

    Full Text Available Diabetic myonecrosis is a frequently unrecognized complication of longstanding and poorly controlled diabetes mellitus. The clinical presentation is swelling, pain, and tenderness of the involved muscle, most commonly the thigh muscles. Management consists of conservative measures including analgesia and rest. Short-term prognosis is good, but long-term prognosis is poor with most patients dying within 5 years. Failure to properly identify this condition will expose the patient to aggressive measures that could result in increased morbidity. To our knowledge this is the first case reported in which there was involvement of multiple muscle groups including upper and lower limbs.

  14. Develop your presentation skills

    CERN Document Server

    Theobald, Theo

    2016-01-01

    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."

  15. Subpart DD Training Presentations

    Science.gov (United States)

    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.

  16. Subpart AA Training Presentations

    Science.gov (United States)

    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.

  17. Subpart W Training Presentations

    Science.gov (United States)

    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.

  18. Rotating Poster Presentations

    Science.gov (United States)

    Lagares, Manuel; Reisenleutner, Sandra

    2017-01-01

    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…

  19. Presenting Food Science Effectively

    Science.gov (United States)

    Winter, Carl K.

    2016-01-01

    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…

  20. Innovative presentations for dummies

    CERN Document Server

    Anthony, Ray

    2014-01-01

    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

  1. Alarm filtering and presentation

    International Nuclear Information System (INIS)

    Bray, M.A.

    1989-01-01

    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.)

  2. Toyotarity. Term, model, range

    Directory of Open Access Journals (Sweden)

    Stanisław Borkowski

    2013-04-01

    Full Text Available The Toyotarity and BOST term was presented in the chapter. The BOST method allows to define relations between material resources and human resources and between human resources and human resources (TOYOTARITY. This term was also invented by the Author (and is legally protected. The idea of methodology is an outcome of 12 years of work.

  3. Dictionary of Marketing Terms.

    Science.gov (United States)

    Everhardt, Richard M.

    A listing of words and definitions compiled from more than 10 college and high school textbooks are presented in this dictionary of marketing terms. Over 1,200 entries of terms used in retailing, wholesaling, economics, and investments are included. This dictionary was designed to aid both instructors and students to better understand the…

  4. Behavioural present value

    OpenAIRE

    Krzysztof Piasecki

    2013-01-01

    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.

  5. Conns' syndrome - atypical presentations

    International Nuclear Information System (INIS)

    Kumar, K V S Hari; Modi, K D; Jha, Sangeeta; Jha, Ratan

    2009-01-01

    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)

  6. CERN Electronics Pool presentations

    CERN Multimedia

    2011-01-01

    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.

  7. Presentation skills for nurses.

    Science.gov (United States)

    Foulkes, Mark

    2015-02-20

    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.

  8. Does the Advice to Assume the Knee-Chest Position at the 36th to ...

    African Journals Online (AJOL)

    Weeks of Gestation Reduce the Incidence of Breech Presentation at ... sentation, found in 2% to 4% of pregnancies at term [3,. 5,12]. ... 15 minutes each day every 2 hours of waking time for 5 .... [2], working on women at the 37th week or more,.

  9. Creating meaningful multimedia presentations

    NARCIS (Netherlands)

    Hardman, H.L.; Ossenbruggen, van J.R.

    2006-01-01

    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

  10. Unusual presentation of sunburn.

    Science.gov (United States)

    Verma, Gopalkrishna G; Dave, Dhaval; Byrne, Eileen

    2008-10-01

    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.

  11. Presentation to the symposium

    International Nuclear Information System (INIS)

    Goodhead, D.

    1997-01-01

    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)

  12. Conjugando el presente

    Directory of Open Access Journals (Sweden)

    Héctor Rojas Herazo

    1968-06-01

    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.

  13. The principal is present

    DEFF Research Database (Denmark)

    Staunæs, Dorthe; Juelskjær, Malou

    2016-01-01

    In the seminal book Discipline and Punish: The Birth of the Prison (1977) French philosopher Michel Foucault described how the psy-disciplines—his collective term for psychiatry, psychology, psycho-analysis and other psycho-therapies—became entangled in new forms of government. 18th and 19th cent...... following simple rules and propositions internal to scientific discovery. As Michel Foucault indicated, and, as has since been elaborated by Nikolas Rose (1998, 1999), among others, educational institutions and actors have been, and continue to be, central to the continuation of the psy...

  14. United States panel presentations

    International Nuclear Information System (INIS)

    Wolfe, B.

    1990-01-01

    According to studies by the Department of Energy, toward the latter part of this decade, we will have to add five or six baseload plants, and in the period from 2000 to 205, we are going to need some sixty additional baseload plants. So in the next fifteen years we will need some sixty-five or seventy baseload plants. One can argue over the accuracy of those numbers, but tens of new baseload plants are going to be needed, and that means we are going to have to start the design of these plants in the next few years to get them online by the end of the century. I think there is going to be a change in attitude towards new plants. My view is that when the American public is faced with the decision of what kind of new energy source they need versus 'do I let the lights dim?', that nuclear power will be one of their choices. We will see as a result the revival of nuclear power - the water reactors in the near term, and I will leave for later discussion the question of whether we will use breeders and gas-cooled reactors for the longer term

  15. The presentation and treatment

    African Journals Online (AJOL)

    user

    tion of single collocations proposals are made for an implicit presentation of complex ... function lexicographers often include items to illustrate the typical use of the ... they have no items explicitly addressed at them to elevate them to treatment.

  16. PRESENT STATUS IN INDIA

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. PRESENT STATUS IN INDIA. FIXED LINES – 36 MILLION. MOBILE CONNECTIONS – 14 MILLION. TELEDENSITY APPROXIMATELY 5. INTERNET CONNECTIONS – 5 MILLION. INTERNET USERS NEARLY – 25 MILLION.

  17. Fostering oral presentation performance

    NARCIS (Netherlands)

    Ginkel, van Stan; Gulikers, Judith; Biemans, Harm; Mulder, Martin

    2017-01-01

    Previous research revealed significant differences in the effectiveness of various feedback sources for encouraging students’ oral presentation performance. While former studies emphasised the superiority of teacher feedback, it remains unclear whether the quality of feedback actually differs

  18. Present status of dibaryons

    International Nuclear Information System (INIS)

    Locher, M.P.

    1981-01-01

    In the present notes the author tries to assess the situation regarding dibaryons in the various channels with baryon number two, emphasizing the problems and discussing in greater detail the most recent developments since the Versailles Conference. One of the motivations for the present search of B=2 states is the possibility of colored subclusters for systems with six quarks which cannot occur for ordinary baryons or mesons. (Auth.)

  19. Presenting New Grammar

    Institute of Scientific and Technical Information of China (English)

    WU Cai-ling; WANG Xi

    2015-01-01

    More and more researchers have now agreed upon the necessity of teaching grammar, but it still remains controversial as how to teach the forms, with the central consideration of not to harm the meaning-focused communicative teaching method. In this essay, one of the issues in grammar teaching will be discussed as how to present new grammar to learners, through evaluating and modifying a particular presentation activity in a grammar-teaching textbook.

  20. The Availability of Indium: The Present, Medium Term, and Long Term

    Energy Technology Data Exchange (ETDEWEB)

    Lokanc, Martin [Colorado School of Mines, Golden, CO (United States); Eggert, Roderick [Colorado School of Mines, Golden, CO (United States); Redlinger, Michael [Colorado School of Mines, Golden, CO (United States)

    2015-10-01

    Demand for indium is likely to increase if the growth in deployment of the copper-indium-gallium-selenide (CIGS) and III-V thin-film photovoltaic technologies accelerates. There are concerns about indium supply constraints since it is relatively rare element in the earth's crust and because it is produced exclusively as a byproduct.

  1. Stellar Presentations (Abstract)

    Science.gov (United States)

    Young, D.

    2015-12-01

    (Abstract only) The AAVSO is in the process of expanding its education, outreach and speakers bureau program. powerpoint presentations prepared for specific target audiences such as AAVSO members, educators, students, the general public, and Science Olympiad teams, coaches, event supervisors, and state directors will be available online for members to use. The presentations range from specific and general content relating to stellar evolution and variable stars to specific activities for a workshop environment. A presentation—even with a general topic—that works for high school students will not work for educators, Science Olympiad teams, or the general public. Each audience is unique and requires a different approach. The current environment necessitates presentations that are captivating for a younger generation that is embedded in a highly visual and sound-bite world of social media, twitter and U-Tube, and mobile devices. For educators, presentations and workshops for themselves and their students must support the Next Generation Science Standards (NGSS), the Common Core Content Standards, and the Science Technology, Engineering and Mathematics (STEM) initiative. Current best practices for developing relevant and engaging powerpoint presentations to deliver information to a variety of targeted audiences will be presented along with several examples.

  2. Milk: Past and Present

    Science.gov (United States)

    Bulajić, S.; Đorđević, J.; Ledina, T.; Šarčević, D.; Baltić, M. Ž.

    2017-09-01

    Although milk/dairy consumption is part of many cultures and is recommended in most dietary guidelines around the world, its contribution to overall diet quality remains a matter of controversy, leading to a highly polarized debate within the scientific community, media and public sector. The present article, at first, describes the evolutionary roots of milk consumption, then reviews the milk-derived bioactive peptides as health-promoting components. The third part of the article, in general, presents the associations between milk nutrients, disease prevention, and health promotion.

  3. Book Presentation | 27 February

    CERN Multimedia

    The CERN Library

    2013-01-01

    "A caccia del bosone di Higgs. Magneti, governi, scienziati e particelle nell'impresa scientifica del secolo" by Luciano Maiani and Romeo Bassoli, published by Mondadori. On Wednesday 27 February Luciano Maiani will present the book "A caccia del bosone di Higgs. Magneti, governi, scienziati e particelle nell'impresa scientifica del secolo". More information here. The presentation will take place in the Council Chamber at 16.00 and will be followed by a debate and book signing. The book will be on sale. You are cordially invited.

  4. Renewable Electricity Futures (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Mai, T.

    2012-08-01

    This presentation library summarizes findings of NREL's Renewable Electricity Futures study, published in June 2012. RE Futures investigated the challenges and impacts of achieving very high renewable electricity generation levels in the contiguous United States by 2050. It was presented at the 2012 RE AMP Annual Meeting. RE-AMP is an active network of 144 nonprofits and foundations across eight Midwestern states working on climate change and energy policy with the goal of reducing global warming pollution economy-wide 80% by 2050.

  5. Breech Babies: What Can I Do If My Baby Is Breech?

    Science.gov (United States)

    ... Control Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids and Teens Pregnancy and Childbirth ... Pregnancy: First TrimesterTaking Care of You and Your Baby While You’re PregnantChanges in Your Body During ...

  6. Hera presentation generator (Poster)

    NARCIS (Netherlands)

    Frasincar, F.; Houben, G.J.P.M.; Barna, P.; Ellis, A.; Hagino, T.

    2005-01-01

    Semantic Web Information Systems (SWIS) are Web Information Systems that use Semantic Web technologies. Hera is a model-driven design methodology for SWIS. In Hera, models are represented in RDFS and model instances in RDF. The Hera Presentation Generator (HPG) is an integrated development

  7. Creating Meaningful Multimedia Presentations

    NARCIS (Netherlands)

    L. Hardman (Lynda); J.R. van Ossenbruggen (Jacco)

    2006-01-01

    textabstractFinding 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

  8. AECL present and future

    International Nuclear Information System (INIS)

    Foster, J.S.

    The history and present activities of the Crown corporation AECL are described. AECL owns limited interests in nuclear power plants and a Manitoba transmission system. AECL is the world's foremost producer of heavy water, and exports CANDU type reactors and radiation processing equipment. AECL backs up the Canadian nuclear power program wherever there is no conflict with private enterprise. (E.C.B.)

  9. Econophysics: Past and present

    Science.gov (United States)

    de Area Leão Pereira, Eder Johnson; da Silva, Marcus Fernandes; Pereira, H. B. B.

    2017-05-01

    This paper provides a brief historical review of the relationship between economics and physics, beginning with Adam Smith being influenced by Isaac Newton's ideas up to the present day including the new econophysics discipline and some of the tools applied to the economy. Thus, this work is expected to motivate new researchers who are interested in this new discipline.

  10. Present State Examination

    DEFF Research Database (Denmark)

    Pedersen, Kamilla; Bertelsen, Aksel

    Present State Examination (PSE) 5. udgave er en revideret version af speciallæge i psykiatri Aksel Bertelsens oprindelige materiale. Aksel Bertelsen er ophavsmand til PSE og til den danske udgave af ICD-10. Revisionen omfatter et forbedret layout, en modernisering af sproget, tilføjelse af...

  11. Presentation of CEA

    International Nuclear Information System (INIS)

    Graf, J.J.

    1976-01-01

    The organization of the CEA, its missions and means are presented. Its activities in the field of light water reactors, fast neutron reactors and PWR reactors of small and medium power for electricity and/or heat generation are emphasized [fr

  12. Going beyond methodological presentism

    DEFF Research Database (Denmark)

    Schmidt, Garbi

    2017-01-01

    Denmark is an example of a country where the idea of historical ethnic homogeneity stands strong. This article challenges this historical presentism: the scholarly and societal tendency to understand social phenomena within a limited contemporary framework, neglecting possible effects and similar...

  13. Keynote presentation : SAR systems

    NARCIS (Netherlands)

    Halsema, D. van; Otten, M.P.G.; Maas, A.P.M.; Bolt, R.J.; Anitori, L.

    2011-01-01

    Synthetic Aperture Radar (SAR) systems are becoming increasingly important sensors in as well the military environment as in the civilian market. In this keynote presentation an overview will be given over more than 2 decades of SAR system∼ and SAR application development at TNO in the Netherlands.

  14. Agriculture Oral Presentations

    International Nuclear Information System (INIS)

    1997-01-01

    This publication contains 23 papers related to the use of nuclear techniques in plant breeding in Turkey, effect of gamma irradiations on growing various plants, mutations and soil chemistry, etc., presented at 4. International Congress of Nuclear Agriculture and Animal Science in Bursa, Turkey, 25-27 Sep 1996. A separate abstract was prepared for each paper

  15. Imagined futures, present lives

    DEFF Research Database (Denmark)

    Dalsgaard, Anne Line; Wildermuth, Norbert

    2006-01-01

    is discussed centrally in this attempt to contribute to an empirically grounded understanding of the role that media play for youth in their striving to ‘find a place in life'. In the empirical context presented in the article, imaginations, expanded and circulated by a globalized media circuit...

  16. Presentation of 2004 earnings

    International Nuclear Information System (INIS)

    2005-03-01

    This presentation offers financial information on the AREVA Group earnings for the year 2004. With manufacturing facilities in over 40 countries and a sales network in over 100, Areva offers customers technological solutions for nuclear power generation and electricity transmission and distribution. The Group also provides interconnect systems to the telecommunications, computer and automotive markets. (A.L.B.)

  17. [Metachromatic Leukodystrophy. Case Presentation].

    Science.gov (United States)

    Espejo, Lina María; de la Espriella, Ricardo; Hernández, José Fernando

    Metachromatic leukodystrophy (MLD) is a rare demyelinating disease (prevalence 1:40 000), also called arylsulfatase A deficiency (ARS-A), which may present with neurological and psychiatric symptoms. Clinical assessment may be difficult, due to unspecific signs and symptoms. A case is presented of a 16 year-old female patient seen in psychiatry due to behavioural changes, psychosis, and with impaired overall performance. She was initially diagnosed with schizophrenia, but the Nuclear Magnetic Resonance (NMR) scan and laboratory tests lead to the diagnosis of MLD. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  18. Sirenomelia: A Rare Presentation

    Science.gov (United States)

    Srinivas, S; Kumar, Shiva; Reddy, Surweshwar; Prasad, Hari; Irfan, G M

    2012-01-01

    We are presenting two cases of Sirenomelia (Mermaid Syndrome), which is an extreme example of the caudal regression syndrome. It invariably presents with lower limb fusion, sacral and pelvic bony anomalies, absent external genitalia, imperforate anus, and renal agenesis or dysgenesis. There are approximately 300 cases reported in the literature, 15% of which are associated with twinning, most often monozygotic. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation. One of our cases survived for 12 days after birth. This new born had an unusually high anorectal anomaly in which the colon was ending at the level of mid transverse colon, fused lower limbs and genital anomalies. Ultrasound of the abdomen revealed horseshoe kidney. Colostomy was performed on day 2 of life. The second case encountered was a stillborn baby on whom an autopsy was performed. PMID:26023366

  19. Sirenomelia: a rare presentation.

    Science.gov (United States)

    Reddy, K Ramesh; Srinivas, S; Kumar, Shiva; Reddy, Surweshwar; Prasad, Hari; Irfan, G M

    2012-01-01

    We are presenting two cases of Sirenomelia (Mermaid Syndrome), which is an extreme example of the caudal regression syndrome. It invariably presents with lower limb fusion, sacral and pelvic bony anomalies, absent external genitalia, imperforate anus, and renal agenesis or dysgenesis. There are approximately 300 cases reported in the literature, 15% of which are associated with twinning, most often monozygotic. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation. One of our cases survived for 12 days after birth. This new born had an unusually high anorectal anomaly in which the colon was ending at the level of mid transverse colon, fused lower limbs and genital anomalies. Ultrasound of the abdomen revealed horseshoe kidney. Colostomy was performed on day 2 of life. The second case encountered was a stillborn baby on whom an autopsy was performed.

  20. Organising and presenting information.

    Science.gov (United States)

    Kankanady, Raghavendra; Wells, Marilyn

    2013-01-01

    Information management can be a daunting process for clinicians, health care providers and policy makers within the health care industry. This chapter discusses the importance of information classification and information architecture in the information economy and specific challenges faced within the health care industry. The healthcare sector has industry specific requirements for information management, standards and specifications for information presentation. Classification of information based on information criticality and the value in the health care industry is discussed in this paper. Presentation of information with reference to eHealth standards and specifications for healthcare information systems and their key requirements are also discussed, as are information architecture for eHealth implementation in Australia. This chapter also touches on information management and clinical governance since the importance of information governance is discussed by various researchers and how this is becoming of value to healthcare information management.

  1. Atypical Presentations of Tularemia.

    Science.gov (United States)

    Odegaard, Karah; Boersma, Beth; Keegan, James

    2017-05-01

    Francisella tularensis is a gram-negative coccobacillus that causes a condition commonly referred to as tularemia. There has been a dramatic increase in tularemia cases reported in South Dakota, many of which were challenging to diagnose due to atypical clinical manifestations. We describe an interesting case of pneumonic tularemia and summarize six similar cases, several of which presented with lung nodules suggestive of malignancy. According to the literature, this is only the third outbreak of pneumonic tularemia reported in the U.S. We believe it is important for clinicians to be aware of the increased incidence of tularemia in the area and to be vigilant in the diagnosis and management of these atypically presenting cases. Copyright© South Dakota State Medical Association.

  2. Presentation = Speech + Slides

    Directory of Open Access Journals (Sweden)

    Derik Badman

    2008-12-01

    Full Text Available Back in October, Aaron Schmidt posted “HOWTO give a good presentation” to his blog walking paper. His second bullet point of “thoughts” on good presentations is: Please don’t fill your slides with words. Find some relevant and pretty pictures to support what you’re saying. You can use the pictures to remind yourself what you’re going [...

  3. EPMA present and future

    International Nuclear Information System (INIS)

    Love, G.

    2002-01-01

    In electron probe microanalysis the objective has always been to gain the maximum information from a sample. To this end efforts have been directed at increasing detection efficiency, reducing the size of the excitation volume, analysing more difficult specimens and improving the accuracy of quantitative measurements whilst, at the same time, attempting to minimize the complexity of the analysis. The present paper comments on the progress that has been made in this areas, focuses on the latest hardware and software developments taking place and looks forward to how these may impact on the technique of EPMA. (author)

  4. Sarcoidosis Presenting Addison's Disease.

    Science.gov (United States)

    Takahashi, Kentaro; Kagami, Shin-Ichiro; Kawashima, Hirotoshi; Kashiwakuma, Daisuke; Suzuki, Yoshio; Iwamoto, Itsuo

    2016-01-01

    We herein describe a second Japanese case of sarcoidosis presenting Addison's disease. A 52-year-old man was diagnosed with sarcoidosis based on clinical and laboratory findings, including bilateral hilar lymphadenopathy and elevated levels of serum angiotensin-converting enzyme and lysozyme, as well as the presence of noncaseating epithelioid granulomas. The patient also exhibited general fatigue, pigmentation, weight loss, hypotension and hyponatremia, suggestive of chronic adrenocortical insufficiency. An endocrine examination confirmed primary adrenocortical insufficiency. This case suggests the direct involvement of sarcoid granuloma in the adrenal glands.

  5. Radwaste - Multimedia presentation

    International Nuclear Information System (INIS)

    2000-01-01

    Radioactivity is a part of the Nature since the creation of the Earth. We have learned how to use radioactivity in medicine, power industry, and in other areas of life. Similarly as in other activities, waste is generated. We offer you basic information about radioactivity and radioactive waste (radwaste) in four films: Radioactivity, Source of radwaste, Management of radwaste. In the glossary are video presentations: Container (Castor) for radioactive waste; Deep underground repository; Transport vehicle; WWER type reactor. Encyclopedic part of the program contains detailed theoretical and practical information about use of radioactivity and radioactive waste. You will find the explanation in the part Glossary. (authors)

  6. Presenting Newtonian gravitation

    International Nuclear Information System (INIS)

    Counihan, Martin

    2007-01-01

    The basic principles of the Newtonian theory of gravitation are presented in a way which students may find more logically coherent, mathematically accessible and physically interesting than other approaches. After giving relatively simple derivations of the circular hodograph and the elliptical orbit from the inverse-square law, the concept of gravitational energy is developed from vector calculus. It is argued that the energy density of a gravitational field may reasonably be regarded as -g 2 /8πG, and that the inverse-square law may be replaced by a Schwarzschild-like force law without the need to invoke non-Euclidean geometry

  7. Radiation myelopathy (case presentation)

    International Nuclear Information System (INIS)

    Sangheli, M.; Lisnic, V.; Plesca, S.; Odainic, O.; Chetrari, L.

    2009-01-01

    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)

  8. DOE financial assurance presentation

    International Nuclear Information System (INIS)

    Huck, R.

    1990-01-01

    The presentation topic is California's approach to license application review in meeting financial assurances for the proposed Ward Valley site. The purpose of the presentation is to provide information on specific financial assurance provisions contained in 10 CFR Part 61 and how California intends to satisfy those requirements. Also, as rate setter, California intends to demonstrate how it will assure allowable costs to the rate base though a financial prudency review. The key provisions of financial assurance are: 10 CFR Section 61.61 - This provision requires an applicant to demonstrate its ability to finance licensed activities; 10 CFR Section 61.62 - This provision requires an applicant to provide assurance that sufficient funds will be available for site closure and stabilization; and 10 CFR Section 61.63 - This provision requires an applicant to provide 'a copy of a binding arrangement, such as a lease, between the applicant and the disposal site owner, so that sufficient funds will be available to cover the costs of the institutional control period.' To assist California in its determination of financial assurance compliance to be demonstrated by the applicant for Part 61 requirements, is NUREG guidance document 1199 'Standard Format and Content of a License Application for a Low-Level Radioactive Waste (LLRW) Disposal Facility.' The detailed financial assurance provisions of NUREG 1199 are then embodied in NUREG 1200, 'Standard Review Plant for the Review of a License Application for a LLRW Disposal Facility.'

  9. Rett syndrome: EEG presentation.

    Science.gov (United States)

    Robertson, R; Langill, L; Wong, P K; Ho, H H

    1988-11-01

    Rett syndrome, a degenerative neurological disorder of girls, has a classical presentation and typical EEG findings. The electroencephalograms (EEGs) of 7 girls whose records have been followed from the onset of symptoms to the age of 5 or more are presented. These findings are tabulated with the Clinical Staging System of Hagberg and Witt-Engerström (1986). The records show a progressive deterioration in background rhythms in waking and sleep. The abnormalities of the background activity may only become evident at 4-5 years of age or during stage 2--the Rapid Destructive Stage. The marked contrast between waking and sleep background may not occur until stage 3--the Pseudostationary Stage. In essence EEG changes appear to lag behind clinical symptomatology by 1-3 years. An unexpected, but frequent, abnormality was central spikes seen in 5 of 7 girls. They appeared to be age related and could be evoked by tactile stimulation in 2 patients. We hypothesize that the prominent 'hand washing' mannerism may be self-stimulating and related to the appearance of central spike discharges.

  10. Bad (Re)Presentations

    CERN Multimedia

    Computer Security Team

    2013-01-01

    This time, we would like to address copyright violations (again) - but with a twist. While previous articles focussed on “Music, videos and the risk for CERN” or on software licences, the focus is now on using photos, music and images “found” on the Web for presentations, publications and web pages…   Just recently, a video produced for CERN and published on YouTube and Facebook used background music from a contemporary popular artist. However, the people responsible failed to obtain the appropriate permission to actually use that music. They thought that having bought it on iTunes was sufficient. But it was not: “buying” means you have the right to listen, but not the right for further distribution or re-publication. As a result, the videos were pulled from YouTube and Facebook. Similarly, how many of us integrate graphics and images “found” on the Web into our presentations?  How many of us...

  11. United States panel presentations

    International Nuclear Information System (INIS)

    Young, H.

    1990-01-01

    monitored retrievable storage site and submitted a license application to the NRC, pointing toward first operation of an MRS facility in 1998. Also on the waste front, we are beginning to study recycling of actinides in spent nuclear fuel to possibly benefit future long-term nuclear waste management. We will encourage and support an effective dialogue with the public on the benefits and risks of nuclear power relative to other alternatives

  12. Film Presentation: Die Urknallmaschine

    CERN Multimedia

    Carolyn Lee

    2010-01-01

    Die Urknallmaschine, an Austrian film by Gerd Baldauf, narrated by Norbert Frischauf (Alpha Österreich - ORF, 2009).  In CERN’s gigantic complex particles are accelerated to almost the speed of light, brought to collision and made to divide into even smaller particles. Public opinion of CERN’s research is also divided. Sceptics fear that black holes may be created. Might the goal to study the origin of the world lead to its destruction? The Austrian researcher Norbert Frischauf worked at CERN for many years. With his guidance it is possible to explore the world’s largest research centre, get a glimpse of the fascinating work the scientists do there and take a crash course in particle physics. Die Urknallmaschine will be presented on Friday, 25 June from 13:00 to 14:00 in the Main Auditorium. Language: German

  13. Abdominal pregnancy - Case presentation.

    Science.gov (United States)

    Bohiltea, R; Radoi, V; Tufan, C; Horhoianu, I A; Bohiltea, C

    2015-01-01

    Abdominal pregnancy, a rare diagnosis, belongs to the ectopic pregnancy group, the leading cause of pregnancy related exitus. The positive diagnosis is very difficult to establish most often in an acute setting, leading to a staggering percent of feto-maternal morbidity and mortality. We present the case of 26-weeks-old abdominal pregnancy with partial feto-placental detachment in a patient, after hysteroscopy and in vitro fertilization, which until the acute symptoms that led to emergency laparotomy went unrecognized. The patient recovered completely and satisfactorily after surgery and, due to the high risk of uterine rupture with regard to a second pregnancy, opted for a surrogate mother. Abdominal pregnancy can be regarded as a difficult to establish diagnosis, with a greater chance in case of increased awareness. It is compulsory to be well informed in order not to be surprised by the diagnosis and to apply the correct treatment immediately as the morbidity and mortality rate is elevated.

  14. Trichinosis - case presentation

    Directory of Open Access Journals (Sweden)

    Rajko Saletinger

    2007-03-01

    Full Text Available Background: Trichinosis is a widespread zoonosis acquired by ingestion of undercooked meat infected with the larvae of Trichinella parasites. The disease has variable clinical manifestations ranging from asymptomatic to fatal. Majority of infections is caused by Trichinella spiralis, although there are some cases caused by other species. The dramatic decline of trichinosis reflects changes in industrial practices and increased public awareness. The majority of human cases are now associated with wild game meat and noncommercial pork. The case of previously healthy, young man with trichinosis is presented. The disease was determined with serologic testing and cured with albendazole. The source of infection has not been determined.Conclusions: In patients with fever, mialgias and eosinophilia infection with tissue nematodes should always be taken in consideration. In those who have recently consumed raw or undercooked pork and wild game meat we should think about trichinosis. The disease is rare in Slovenia.

  15. Presenting practice financial information.

    Science.gov (United States)

    Webster, Lee Ann H

    2007-01-01

    Medical practice leadership teams, often consisting primarily of physicians with limited financial backgrounds, must make important business decisions and continuously monitor practice operations. In order to competently perform this duty, they need financial reports that are relevant and easy to understand. This article explores financial reporting and decision-making in a physician practice. It discusses reports and tools, such as ratios, graphs, and comparisons, that practices typically include in their reports. Because profitability and cash flow are often the most important financial considerations for physician practices, reports should generally focus on the impact of various activities and potential decisions upon these concerns. This article also provides communication tips for both those presenting practice financial information and those making the decisions. By communicating effectively, these leaders can best use financial information to improve decision-making and maximize financial performance.

  16. United States panel presentations

    International Nuclear Information System (INIS)

    Beyea, J.

    1990-01-01

    Before I begin I have to make a disclaimer. That is that I am going to be talking about public perception because I think that is very important. But I do not want to give the impression that I think the public is wrong. I happen to agree with the public's perception of nuclear power, and I want to make that clear. I do not like the current generation of nuclear plants as I have made clear in many statements that I have made. On the other hand, in the long term, I feel that we have only two choices on the supply side, and that is nuclear power and solar electricity. And although I think solar electricity has the best chance, I am realistic enough to know that technologies do not always work the way I want. And so I think it is necessary to have at least some kind of nuclear option available. On the other hand, I do not think just any kind of nuclear technology will do. I want to talk to you about the conditions that I think you have to take into account when you try to design reactors that are publicly acceptable. I look at this as an insurance policy. Again, I do not want to be misquoted: I think nuclear power should be considered as an insurance policy, not as our first line of defense. Having made those disclaimers, what we need to do is set out a problem statement. The problem statement I set out is, 'How could one design and demonstrate a nuclear reactor that would regain public confidence in the United States, if one chose to do that?' By regaining confidence, I mean regaining sufficient confidence to site reactors at a number of locations. It is a pretty heavy task because the public cannot judge the technical issues. They have to judge the players by their characters and their histories, just as the way we calibrate anyone that knows things that we do not. I have three theses that I think are crucial. The first is that people do not believe in the claims of advocates, of any point of view, not just nuclear power, once the advocates have been proved wrong on

  17. Presentation of Canada

    International Nuclear Information System (INIS)

    Hedley, Dianne E.

    1997-01-01

    In contingency of a nuclear emergency event, requiring application of intervention measures on a federal scale, Canada has of a plan ensuring the compatibility of the plans of different provinces and serving as interface between federal and provincial authorities. Exclusive of a nuclear attack against North America, by nuclear emergency it is understood an accident resulting in radionuclide release. This is called the Plan of federal intervention in case of nuclear emergency. 'Sante Canada' is the federal authority responsible for intervention in case of nuclear emergency and it has the task of preparing and coordinating the actions on a federal scale.Should the plan be set in action and if the emergency has repercussions upon the agricultural sector, the sustaining organism will be 'Agriculture and agroalimentaire Canada' which in case of emergency acts through the channels of the National System of intervention in the agro-alimentary sector (SNIUA). The paper presents the objectives, the principles of organization and operation, the responsibilities and the plans which SNIUA has in its charge to implement in case of emergency

  18. STS-69 postflight presentation

    Science.gov (United States)

    1995-10-01

    A postflight conference of the STS-69 mission is presented. The flightcrew ('The Dog Team') consisted of Cmdr. David Walker, Pilot Kenneth Cockrell, Payload Cmdr. James Voss, and Mission Specialists James Newman and Michael Gernhardt. The mission's primary objective was the deployment and retrieval of the SPARTAN-201 satellite, which investigated the interaction between the Sun and it's solar wind. Other secondary experiments and shuttle payloads included the Wake Shield Facility (WSF), which grew several layers of semiconductor films, the International Extreme Ultraviolet Hitchhiker (IEH-1), the Capillary Pumped Loop-2/Gas Bridge Assembly (CAPL-2/GBA), several Get Away Specials (GAS) experiments, the Electrolysis Performance Improvement Concept Study (EPICS), the Thermal Energy Storage (TES-2) experiment, the Commercial Generic Bioprocessing Apparatus-7 (CGBA-7), the National Institutes of Health-Cells 4 (NIH-C4) experiment, and the Biological Research in Canister-6 (BRIC-6) experiment. Earth views consisted of Saudi Arabia water wells, uncommon vortices over Oman, the Amazon River, the Bahamas, Somalia, a sunset over the Earth's horizon, and two hurricanes, Luis and Marilyn.

  19. Present energy status

    Energy Technology Data Exchange (ETDEWEB)

    Desprairies, P

    1988-04-01

    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.

  20. The laryngocele; case presentation

    Directory of Open Access Journals (Sweden)

    Gabriel V. Berteșteanu

    2016-05-01

    Full Text Available Laryngocele is a rare pathology, but because of their clinical evolution and the symptoms they generate, they should always be considered as a differential diagnosis when investigating neck masses. A laryngocele is basically a herniation of the mucosa of the laryngeal ventricle (Morgagni's ventricle arising usually from the saccular region. This herniation may remain confined to the larynx - in which case the laryngocele is internal- or expand through the thyro-hyoid membrane into the structures of the neck - thus being called an external laryngocele. Usually the laryngocele has both an internal and external component thus being a mixed laryngocele. Diagnosis of laryngoceles still relies heavily on clinical signs such as tympanism, easily depressible neck mass, indirect laryngoscopy, but is now simplified by imagistic investigations (ultrasound, CT and MRI. However, the treatment of this condition is exclusively surgical and consists of total excision of the laryngocele, as well as proper identification of the point of origin from the saccule and also the final suture of the breach in order to prevent recurrence. Investigation of possible causes of obstruction of the laryngeal ventricle should always be performed (because of the possibility of an underlying malignancy as well as a follow-up protocol of the patient, given the risk of relapse. We present a recently diagnosed case of a 32 year old man with mixed laryngocele, which we have operated in our clinic.

  1. [Antibiotics: present and future].

    Science.gov (United States)

    Bérdy, János

    2013-04-14

    The author discuss the up to date interpretation of the concept of antibiotics and antibiotic research, as well as the present role of various natural, semisynthetic and synthetic antibiotic compounds in various areas of the human therapy. The origin and the total number of all antibiotics and applied antibiotics in the practice, as well as the bioactive microbial metabolites (antibiotics) in other therapeutical, non-antibiotic fields (including agriculture) are also reviewed. The author discusses main problems, such as increasing (poly)resistance, virulence of pathogens and the non-scientific factors (such as a decline of research efforts and their sociological, economic, financial and regulatory reasons). A short summary of the history of Hungarian antibiotic research is also provided. The author briefly discusses the prospects in the future and the general advantages of the natural products over synthetic compounds. It is concluded that new approaches for the investigation of the unlimited possibilities of the living world are necessary. The discovery of new types or simply neglected (micro)organisms and their biosynthetic capabilities, the introduction of new biotechnological and genetic methods (genomics, metagenom, genome mining) are absolutely required in the future.

  2. IKONOS: future and present

    Science.gov (United States)

    Schaap, Niek

    2003-04-01

    The IKONOS satellite has been operational since January 2000 and was the first commercial satellite collecting imagery with 1 meter resolution. The current life expectancy of the satellite is 10 years. Since the launch, Space Imaging Inc. (the owner of the satellite) supplied IKONOS imagery to users in many vertical markets, such as: agriculture, defense, oil & gas and telecommunications. This oral presentation will give comprehensive information about IKONOS and the future: * Block II, the successor of IKONOS. Space Imaging expects to launch in 2004 a new high-resolution satellite, ensuring both continuity and (for some years) a tandem operation with IKONOS, greatly improving the availability of imagery. * Space Imaging affiliates. IKONOS imagery collected, processed and sold by regional affiliates. These regional affiliates are strategically located around the world, like Japan Space Imaging (Tokyo), Space Imaging Middle East (Dubai) and Space Imaging Eurasia (Ankara, Turkey). * Technical briefing IKONOS. IKONOS (compared to other commercial high-resolution satellites) has superior collection capabilities. Due to, the higher orbit altitude, local reception of the imagery, bi-directional scanning and the high agility of the satellite, is the IKONOS satellite capable to collect the imagery relative quickly.

  3. Presentation of Pydio

    CERN Multimedia

    CERN. Geneva

    2014-01-01

    **Pydio is an open-source platform for file sharing and synchronisation.** It is wildly used by enterprises and organizations worldwide, including major universities. Pydio comes with a rich web-based interface, native clients for both iOS and Android mobile devices, and lately a new sync client for desktop platforms. Pydio v6 is of great useability and introduces many new features that makes it the ultimate sharing machine. Its architecture makes it a perfect fit for either easily deploying an on-premise dropbox solution, or building more complicated solutions where the box feature is integrated as OEM. Storage-agnostic, Pydio is a simple layer that can be deployed on top of any storage backend, thus providing scalability and high-availability out-of-the-box. Charles du Jeu is the lead developer of the solution and will briefly present its feature and how it can fit for research and engineering purpose. See https://pyd.io/ for more information.

  4. THE UPSIDE OF PRESENTISM

    Directory of Open Access Journals (Sweden)

    Lynn Fendler

    2009-01-01

    Full Text Available El presentismo es visto generalmente como un mal necesario en historiografía. Este artículo explora lo positivo de esta inevitabilidad. Aplicando un enfoque filosófico al análisis discursivo en la tradición de la nueva historia cultural, se distingue -de una parte-¿ entre un uso estratégico del presentismo, y -de otra- un enfoque racionalista en historia. El artículo concluye considerando algunas implicaciones políticas en historiografía de las explicaciones racionalistas y de las explicaciones estratégicamente presentistas. Los modos de comprensión racionalistas inscriben las expectativas del pasado en las visiones del futuro; asignando al historiador el papel de profeta; y perpetuando nociones de agentes ahistóricos. En contraste, las historias estratégicamente presentistas incorporan una orientación que deliberadamente emplea las lentes y perspectivas del presente en orden a tener en cuenta supuestos y perspectivas actuales. Cuando las asunciones son examinadas en relación a las perspectivas presentistas, dichos presupuestos sueltan su rienda en el pensamiento. Dado que el presentismo es inevitable, no debe ser desestimado por completo, sino que debe ser una cuestión sondeada y examinada críticamente. Con dicho foco, el presentismo estratégico en la historiografía debe posibilitar una reflexión sobre los límites de lo que es posible pensar.

  5. Director general presentation to personnel

    CERN Multimedia

    2016-01-01

    Dear Colleagues, Many important discussions are scheduled for the upcoming Council Week (13-17 June) on topics including the Medium-Term Plan, the Pension Fund and other matters of great relevance to us.   I would therefore like to share the main outcome of the week with you and I invite you to join me and the Directors in the Main Auditorium at 10 a.m. on Thursday 23 June. The meeting will last about one hour and a webcast will also be available. Best regards, Fabiola Gianotti DG presentation to personnel Thursday 23 June at 10 am Main Auditorium Retransmission in Council Chamber, IT Auditorium, Kjell Jonhsen Auditorium, Prevessin 864-1-C02 Webcast on cern.ch/webcast More information on the event page.

  6. Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney.

    Science.gov (United States)

    Rodgers, R; Beik, N; Nassar, N; Brito, I; de Vries, B

    2017-04-01

    To report the complication rate associated with external cephalic version (ECV) at term. Single-centre retrospective study. A major tertiary hospital in Sydney, Australia. All women who underwent an ECV at Royal Prince Alfred Hospital from 1995-2013 were included. ECV was attempted on all consenting women with a breech presentation at term in the absence of contraindications. Complications were classified as minor (transient cardiotocography abnormalities, ruptured membranes, small antepartum haemorrhage) or serious (fetal death, placental abruption, fetal distress requiring emergency caesarean section, fetal bone injury, cord prolapse). ECV success rates and rate of reversion to breech were recorded. The primary outcome was the incidence of serious complications. Secondary outcome measures were the rate of minor complications and reversion to breech. Of 1121 patients that underwent ECV, five (0.45%) experienced a serious complication. There was one placental abruption, one emergency caesarean section for fetal distress and two cord prolapses. There was one fetal death attributable to a successful ECV. Forty-eight women (4.28%) experienced a minor complication. Reversion to the breech occurred in sixteen patients (3.32%). ECV at term is associated with a low rate of serious complications. Study of 1121 consecutive ECV attempts shows low rate of complications although one fetal death reported. © 2016 Royal College of Obstetricians and Gynaecologists.

  7. Crystallography: past and present

    Science.gov (United States)

    Hodeau, J.-L.; Guinebretiere, R.

    2007-12-01

    structure (chemical order, anisotropy, charge transfer, magnetic order) versus an external parameter like temperature, pressure, magnetic or electric field. Modern crystallography is also extended to the study of very small crystals, powders, ill-ordered or non-crystallized materials. Thus presently, crystallography is concerned with any solid that “scatters” an incident beam. Nevertheless, as quoted by A. Guinier, “the problems facing crystallographers have only changed, ... new ones have appeared which require reflection and imagination, ... and which in turn may still bring much joy to all those who like crystallography” [4]. Such developments open up crystallography to modern materials like artificial ones and nanostructures with low- and/or multi-scaled-periodicities and/or extremely small “crystal size” and to materials of the “real world”, with mixtures of phases and/or amorphous contribution and/or defects, a common characteristic of ancient materials analysed in patrimonial research. In our contribution we will show by selected examples that these improvements were allowed (i) by the use of powerful sources, apparatus and detectors which allow micro-diffraction, in-situ diffraction, spectroscopy, resonant scattering, inelastic scattering, coherent scattering, (ii) by the development of methods like diffraction anomalous fine structure (DAFS), pair distribution function (PDF), simulated annealing, single object reconstruction, (iii) by combination of scattering and spectroscopy and by combination of scattering and microscopy. Such combination of different approaches is very efficient and, as said by H. Curien at the IUCr Bordeaux Congress in 1990, “in crystallography, there is a constant alternation between the crystal space and its associated reciprocal space, ... the alternation between experiment and model building is another feature of crystallography activity ..., the crystallographer relies both on his computer and on his diffractometer

  8. Presentation Extensions of the SOAP

    Science.gov (United States)

    Carnright, Robert; Stodden, David; Coggi, John

    2009-01-01

    A set of extensions of the Satellite Orbit Analysis Program (SOAP) enables simultaneous and/or sequential presentation of information from multiple sources. SOAP is used in the aerospace community as a means of collaborative visualization and analysis of data on planned spacecraft missions. The following definitions of terms also describe the display modalities of SOAP as now extended: In SOAP terminology, View signifies an animated three-dimensional (3D) scene, two-dimensional still image, plot of numerical data, or any other visible display derived from a computational simulation or other data source; a) "Viewport" signifies a rectangular portion of a computer-display window containing a view; b) "Palette" signifies a collection of one or more viewports configured for simultaneous (split-screen) display in the same window; c) "Slide" signifies a palette with a beginning and ending time and an animation time step; and d) "Presentation" signifies a prescribed sequence of slides. For example, multiple 3D views from different locations can be crafted for simultaneous display and combined with numerical plots and other representations of data for both qualitative and quantitative analysis. The resulting sets of views can be temporally sequenced to convey visual impressions of a sequence of events for a planned mission.

  9. Meaningless terms in rewriting

    NARCIS (Netherlands)

    Kennaway, R.; Oostrom, V. van; Vries, F.-J. de

    We present an axiomatic approach to the concept of meaninglessness in finite and transfinite term rewriting and lambda calculus. We justify our axioms in several ways. They can be intuitively justified from the viewpoint of rewriting as computation. They are shown to imply important properties

  10. Audit of long-term and short-term liabilities

    Directory of Open Access Journals (Sweden)

    Korinko M.D.

    2017-03-01

    Full Text Available The article determines the importance of long-term and short-term liabilities for the management of financial and material resources of an enterprise. It reviews the aim, objects and information generators for realization of audit of short-term and long-term obligations. The organizing and methodical providing of audit of long-term and short-term liabilities of an enterprise are generalized. The authors distinguish the stages of realization of audit of long-term and short-term liabilities, the aim of audit on each of the presented stages, and recommend methodical techniques. It is fixed that it is necessary to conduct the estimation of the systems of internal control and record-keeping of an enterprise by implementation of public accountant procedures for determination of volume and maintenance of selection realization. After estimating the indicated systems, a public accountant determines the methodology for realization of public accountant verification of long-term and short-term liabilities. The analytical procedures that public accountants are expedient to use for realization of audit of short-term and long-term obligations are determined. The authors suggest the classification of the educed defects on the results of the conducted public accountant verification of short-term and long-term obligations.

  11. Glossary on peaceful nuclear explosions terms

    International Nuclear Information System (INIS)

    1980-01-01

    The report presents a glossary of terms in the area of peaceful nuclear explosions. The terms are in English, French, Russian and Spanish with cross-references for the corresponding terms of the other languages

  12. present

    African Journals Online (AJOL)

    as medium of instruction enhances concept formation, especially in science subjects as ... The study, on which this paper is based, was conducted to evaluate Malawi's ... corrected in the wake of information flowing from the evaluation phase (Kaplan .... concerning the background information and suggested activities (Thodi,.

  13. PRESENTATION

    OpenAIRE

    Editors, The

    2017-01-01

    To plan and to implement academic projects remain a systematic challenge for the team and the collaborators of the Electronic Journal. Each study published is an opportunity to strengthen the proposed goals and to add more value to the community involved and interested.

  14. Presentations

    International Nuclear Information System (INIS)

    2007-01-01

    The aim of the Exploratory Workshop is to encourage informal discussion and the exchange of expertise between scientists using random matrix theory in various areas of research ranging from fundamental physics: string theory, gravity, quantum chaos, information theory, complexity theory, combinatorics to applied research: biophysics, econophysics, quantitative finance and telecommunication. Such a discussion would be a first step towards creating a common European environment for researchers using this powerful theory

  15. Random walk term weighting for information retrieval

    DEFF Research Database (Denmark)

    Blanco, R.; Lioma, Christina

    2007-01-01

    We present a way of estimating term weights for Information Retrieval (IR), using term co-occurrence as a measure of dependency between terms.We use the random walk graph-based ranking algorithm on a graph that encodes terms and co-occurrence dependencies in text, from which we derive term weights...

  16. Nuclear Fuels: Present and Future

    Directory of Open Access Journals (Sweden)

    Donald R. Olander

    2009-02-01

    Full Text Available The important new developments in nuclear fuels and their problems are reviewed and compared with the status of present light-water reactor fuels. The limitations of these fuels and the reactors they power are reviewed with respect to important recent concerns, namely provision of outlet coolant temperatures high enough for use in H2 production, destruction of plutonium to eliminate proliferation concerns, and burning of the minor actinides to reduce the waste repository heat load and long-term radiation hazard. In addition to current oxide-based fuel-rod designs, the hydride fuel with liquid metal thermal bonding of the fuel-cladding gap is covered. Finally, two of the most promising Generation IV reactor concepts, the Very High Temperature Reactor and the Sodium Fast Reactor, and the accompanying reprocessing technologies, aqueous-based UREX and pyrometallurgical, are summarized. In all of the topics covered, the thermodynamics involved in the material's behavior under irradiation and in the reprocessing schemes are emphasized.

  17. [ISRAEL NEONATOLOGY: PRESENT AND FUTURE].

    Science.gov (United States)

    Dollberg, Shaul

    2016-01-01

    The practice of neonatology in Israel debuted in the 1970s as local enterprises by individual hospitals that needed to provide sick and preterm newly born infants with up-to-date and effective care. Descriptions of research and advances in humane and gentle treatment during neonatal care for preterm infants and their families, as well as prevention of neonatal infections, follow-up of preterm infants and care of full-term infants are presented in this issue. The Israel National Very Low Birth Weight (VLBW) Infant database provides an excellent source of knowledge, which has led to multiple scientific publications. Recent international comparisons of the outcome of preterm VLBW infants, made possible by this unique database in Israel, has provided the neonatal community and the Ministry of Health with insights as to the differences in prognosis between Israel and other countries, especially among extremely low birth weight infants. At the border of viability, mortality in Israelis significantly higher than that reported in other countries and proactive steps undertaken to examine these differences and prompt correctional action should be pursued. The Israel Ministry of Health started positive initiatives and should ensure that their steps are implemented at the preterm infant's bedside.

  18. Waardenburg syndrome presenting with constipation since birth.

    Science.gov (United States)

    Gupta, R; Sharma, S B; Mathur, P; Agrawal, L D

    2014-12-01

    Shah-Waardenburg syndrome is Waardenburg syndrome associated with Hirschsprung's disease. A 10-day-old full-term male neonate of Waardenburg syndrome presented with constipation since birth along with features of small bowel obstruction. Exploratory laparotomy revealed distended proximal jejunal and ileal loops along with microcolon; an ileostomy was performed. Postoperatively patient developed sepsis and died. Histopathology confirmed total colonic aganglionosis. Suspect familial Shah-Waardenburg syndrome in a neonate of Waardenburg syndrome presenting with constipation since birth or intestinal obstruction.

  19. Chapter 2. Borderlands environment, past and present

    Science.gov (United States)

    Guadalupe Sanchez de Carpenter; A.C. MacWilliams

    2006-01-01

    The major mountain ranges in the study area today were produced by Middle Miocene and younger extensional faulting. Faulting continued into the late Pleistocene as evidenced by fault scarps along the margins of the Animas, Hachita, and Playas Valleys. These long-term geologic events resulted in the present basin and range physiography of the Malpai Borderlands, as...

  20. Short-term memory

    Science.gov (United States)

    Toulouse, G.

    This is a rather bold attempt to bridge the gap between neuron structure and psychological data. We try to answer the question: Is there a relation between the neuronal connectivity in the human cortex (around 5,000) and the short-term memory capacity (7±2)? Our starting point is the Hopfield model (Hopfield 1982), presented in this volume by D.J. Amit.

  1. Tips for Good Electronic Presentations.

    Science.gov (United States)

    Strasser, Dennis

    1996-01-01

    Describes library uses of presentation graphics software and offers tips for creating electronic presentations. Tips include: audience retention; visual aid options; software package options; presentation planning; presentation showing; and use of text, colors, and graphics. Sidebars note common presentation errors and popular presentation…

  2. Fission-product source terms

    International Nuclear Information System (INIS)

    Lorenz, R.A.

    1981-01-01

    This presentation consists of a review of fission-product source terms for light water reactor (LWR) fuel. A source term is the quantity of fission products released under specified conditions that can be used to calculate the consequences of the release. The source term usually defines release from breached fuel-rod cladding but could also describe release from the primary coolant system, the reactor containment shell, or the site boundary. The source term would be different for each locality, and the chemical and physical forms of the fission products could also differ

  3. Food Service Technical Terms. English-Spanish Lexicon.

    Science.gov (United States)

    Shin, Masako T.

    This English-Spanish lexicon presents food service technical terms. The terms are divided into seven categories: basic food items, common baking terms, food cutting terms, general cooking terms, non-English culinary terms, and tools and equipment. Each English word or term is followed by its Spanish equivalent(s). (YLB)

  4. Gogny interactions with tensor terms

    Energy Technology Data Exchange (ETDEWEB)

    Anguiano, M.; Lallena, A.M.; Bernard, R.N. [Universidad de Granada, Departamento de Fisica Atomica, Molecular y Nuclear, Granada (Spain); Co' , G. [INFN, Lecce (Italy); De Donno, V. [Universita del Salento, Dipartimento di Matematica e Fisica ' ' E. De Giorgi' ' , Lecce (Italy); Grasso, M. [Universite Paris-Sud, Institut de Physique Nucleaire, IN2P3-CNRS, Orsay (France)

    2016-07-15

    We present a perturbative approach to include tensor terms in the Gogny interaction. We do not change the values of the usual parameterisations, with the only exception of the spin-orbit term, and we add tensor terms whose only free parameters are the strengths of the interactions. We identify observables sensitive to the presence of the tensor force in Hartree-Fock, Hartree-Fock-Bogoliubov and random phase approximation calculations. We show the need of including two tensor contributions, at least: a pure tensor term and a tensor-isospin term. We show results relevant for the inclusion of the tensor term for single-particle energies, charge-conserving magnetic excitations and Gamow-Teller excitations. (orig.)

  5. Punch up your podium presentations.

    Science.gov (United States)

    Wood, Tim J; Hollier, Amelie

    2017-08-01

    The goal of most presentations is to engage audience participants. Effective presenters go beyond content expertise to connect with audiences through various techniques, formats, and presentation styles. Mayer's theory of multimedia learning, neurocognitive factors, and the assertion-evidence approach are essential elements that presenters can use if they have not had formal training in creating presentations. Tips are offered on how to connect with the audience and how to avoid known pitfalls. ©2017 American Association of Nurse Practitioners.

  6. Put Power into Your Presentations: Using Presentation Software Effectively

    Science.gov (United States)

    Safransky, Robert J.; Burmeister, Marsha L.

    2009-01-01

    Microsoft PowerPoint, Apple Keynote, and OpenOffice Impress are relatively common tools in the classroom and in the boardroom these days. What makes presentation software so popular? As the Chinese proverb declares, a picture is worth a thousand words. People like visual presentations. Presentation software can make even a dull subject come to…

  7. Internet interventions: Past, present and future

    Directory of Open Access Journals (Sweden)

    Gerhard Andersson

    2018-06-01

    Full Text Available Internet interventions have been around now for about 20 years. While the field still suffers from a scattered terminology a large number of programs and studies exist. In the present paper I present an overview of my experiences of studying internet-supported cognitive-behaviour therapy (ICBT, but also mention other approaches including the use of smartphones. The paper covers the history of ICBT, short-term effects in controlled trials for a range of conditions, long-term effects, comparisons against face-to-face therapy, effectiveness studies, prediction studies, how the treatment is perceived, critique, and finally future directions. I conclude that we have now reached a stage in which we have numerous evidence-based treatments and procedures, and increasingly internet interventions including ICBT are disseminated. Keywords: Internet treatment, Therapist guidance, Anxiety, Mood disorders, Somatic disorders

  8. Draft Workshop Summary and Presentations

    International Nuclear Information System (INIS)

    Houssin, Didier; ); Tam, Cecilia; ); Cameron, Ron; ); Paillere, Henri; ); Lisann, Beth; Ehlert, Andreas; Kaufer, Barry; Decobert, Veronique; Beutier, Didier; Crepin, Anne; Aurela, Jorma; Baritaud, Manuel; ); Rooke, Oliver; Blundell, Neil; ); Shropshire, David; Noren, Bjarne; Blundell, Neil; ); Dujardin, Thierry; )

    2014-01-01

    In 2010, the International Energy Agency (IEA) and the Nuclear Energy Agency (NEA) released a Nuclear Energy Technology Road-map which outlined the steps needed to accelerate the development of nuclear power and its role in achieve deep greenhouse-gas emissions reduction. Both the global energy sector and the outlook for nuclear have changed significantly since then and an update of this Road-map is currently underway. The Paris meeting from January 23-24, 2014, brought together key stakeholders from industry, government, finance and other relevant organisations to help define and prioritise key items to be discussed in the IEA/NEA's Nuclear Road-map Update. One of the expected outcomes of this intensive brainstorming and Road-map development session was to discuss key targets, milestones, policy measures and other actions needed to support the development and deployment of nuclear power. The workshop was organized in 5 sessions dealing with: Session 1 - Technology development needs for nuclear: Reactor technology (Current state of the market, Gen II and Gen III reactors, Long Term Operation for existing fleet, Enhanced safety features, lessons from the Fukushima Daiichi accident, Small Modular Reactors, Gen IV technologies, Other innovations); Fuel cycle and decommissioning (Front and back end of the fuel cycle: development of new fuels such as accident tolerant fuels, reprocessing options storage and disposal of high level waste, extended storage issues, transport; Decommissioning); Session 2: Overcoming barriers to nuclear build (other than financing): Industrial issues (Supply chain bottlenecks (large heavy forgings), localisation, Codes and standards, Licensing - harmonisation, Building on time and on budget); Human resource issues (Training and capacity development needs, for new build and decommissioning and waste management activities, Identification of skills, mobility). Session 3: Economics and Financing of Nuclear (Industry Perspective; New nuclear and

  9. The Windscale piles - past, present and future

    International Nuclear Information System (INIS)

    Jones, J.M.; Adams, A.L.

    1987-01-01

    The paper concerns the Windscale reactor piles, in which a fire occurred in the core of pile 1 thirty years ago. A description is given of the two Windscale piles, along with the events leading up to the accident, and the state of the piles following shutdown. The surveillance and maintenance to ensure that the pile and associated buildings were in a safe condition is outlined. The present state of the core, water ducts and pile chimneys is described. The present and future programme of work to ensure long term safety is discussed. This includes the initial steps in decommissioning of the piles. (U.K.)

  10. Present market for nuclear energy

    International Nuclear Information System (INIS)

    Marzo, M.A.S.

    1987-01-01

    The present market for nuclear energy is present since nuclear production and electric power generation to the utilization of radioisotopes in medicine and biology. Some data about the main world suppliers to this market are shown. (E.G.) [pt

  11. Integral Presentations of Catalan Numbers

    Science.gov (United States)

    Dana-Picard, Thierry

    2010-01-01

    We compute in three different ways the same definite parametric integral. By-products are the derivation of a combinatorial identity and two integral presentations of Catalan numbers. One of them leads to a presentation using the [gamma] function.

  12. An Atypical Presentation on Insulinoma

    Science.gov (United States)

    2017-06-16

    PUBLICATIONS/ PRESENTATIONS 1. TO: CLINICAL RESEARCH 2. FROM: (Author’s Name, Rank, Grade, Office Symbol) 3. GME/GHSE STUDENT: 4. PROTOCOL NUMBER: Kluesner...PROCESSING OF PROFESSIONAL MEDICAL RESEARCH/TECHNICAL PUBLICATIONS/ PRESENTATIONS 1st ENDORSEMENT (59 MDW/SGVU Use Only) TO: Clinical Research Division 24...CAPT JOSEPH KLUESNER FROM: 59 MDW/SGYU SUBJECT: Professional Presentation Approval 1. Your paper, entitled An Atypical Presentation of Insulinoma

  13. Turning Scientific Presentations into Stories

    Science.gov (United States)

    Aruffo, Christopher

    2015-01-01

    To increase students' confidence in giving scientific presentations, students were shown how to present scientific findings as a narrative story. Students who were preparing to give a scientific talk attended a workshop in which they were encouraged to experience the similarities between telling a personal anecdote and presenting scientific data.…

  14. Long term stability of power systems

    Energy Technology Data Exchange (ETDEWEB)

    Kundur, P; Gao, B [Powertech Labs. Inc., Surrey, BC (Canada)

    1994-12-31

    Power system long term stability is still a developing subject. In this paper we provide our perspectives and experiences related to long term stability. The paper begins with the description of the nature of the long term stability problem, followed by the discussion of issues related to the modeling and solution techniques of tools for long term stability analysis. Cases studies are presented to illustrate the voltage stability aspect and plant dynamics aspect of long term stability. (author) 20 refs., 11 figs.

  15. Dressed to Present: Ratings of Classroom Presentations Vary with Attire

    Science.gov (United States)

    Gurung, Regan A. R.; Kempen, Laura; Klemm, Kayla; Senn, Rebecca; Wysocki, Rosie

    2014-01-01

    This study investigates the effects of formality of dress on ratings of classroom presentations. Participants (N = 65, 66% women) from a Midwestern university in the United States rated three female students giving a presentation designed for a health psychology class in one of four outfits: casual, party, business casual, or business formal.…

  16. Isolated Torticollis May Present as an Atypical Presentation of Meningitis

    Directory of Open Access Journals (Sweden)

    Roger Chirurgi

    2012-01-01

    Full Text Available Background. Bacterial meningitis is a life-threatening medical emergency that requires urgent diagnosis and treatment. Diagnosis is infrequently missed if the patient presents with the classic symptoms of fever, headache, rash, nuchal rigidity, or Kernig or Brudzinski sign. However, it may be less obvious in neonates, elderly, or immunocompromised patients. Meningitis which presents as isolated torticollis, without any other signs or symptoms, is exceedingly rare. Objective. To identify an abnormal presentation of meningitis in an adult immunocompromised patient. Case Report. We present a case of an adult diabetic male who presented multiple times to the ED with complaint of isolated torticollis, who ultimately was diagnosed with bacterial meningitis. Conclusion. We propose that in the absence of sufficient explanation for acute painful torticollis in an immunocompromised adult patient, further evaluation, possibly including a lumbar puncture may be warranted.

  17. Measurement of global and local resonance terms

    CERN Document Server

    Tomás, R; Calaga, R; Fischer, W; Franchi, A; Rumolo, Giovanni

    2005-01-01

    Recently, resonance driving terms were successfully measured in the CERN SPS and the BNL RHIC from the Fourier spectrum of beam position monitor (BPM) data. Based on these measurements a new analysis has been derived to extract truly local observables from BPM data. These local observables are called local resonance terms since they share some similarities with the global resonance terms. In this paper we derive these local terms analytically and present experimental measurements of sextupolar global and local resonance terms in RHIC. Nondestructive measurements of these terms using ac dipoles are also presented.

  18. Evolução das Características Ecográficas da Placenta, da Posição e da Apresentação Fetal em Gestações Normais. Evolution of Ultrasound Characteristics of Placenta and Fetal Position and Presentation in Normal Pregnancies.

    Directory of Open Access Journals (Sweden)

    Maria Regina Machado Perrotti

    1999-10-01

    site. Results: grade 0 placentas were more frequent up to 31 weeks and grade I after 32 weeks. Grade II did not appear until 32 weeks and grade III was more frequent after 36 weeks. The placental thickness significantly increased with gestational age and the most frequent placental locations were anterior and posterior. The cephalic presentation was the most frequent all gestational ages, with only 1% of breech presentation at term. The most frequent fetal position was fetal spine left side, followed by right side. Conclusions: the studied factors showed a similar distribution to that expected for normal populations and could be used as a standard for the Brazilian population.

  19. Discussion paper (presented during meeting)

    International Nuclear Information System (INIS)

    Allemand, R.

    1975-01-01

    A method of particle localization for gas chambers (backgammon game method) is presented. The cathode is geometrically cut in such a way that it is possible to establish a simple relation between the signal amplitude on the different parts of the cathode and the position of the nuclear event. The results obtained in the case of x-ray detectors are presented. The application of this method to the localization of neutrons is presently studied [fr

  20. Unusual presentation of Klinefelter syndrome

    Science.gov (United States)

    Das, Chanchal; Sahana, Pranab Kumar; Sengupta, Nilanjan; Roy, Mukut; Dasgupta, Ranen

    2013-01-01

    Introduction: Klinefelter syndrome usually presents in the puberty and adulthood with its characteristic features. We report a boy who had Klinefelter syndrome with hypospadias and hydrocele. Case Note: Six and half year old boy had complaints of genitourinary problem in the form of hypospadias, small phallus and hydrocele. Karyotyping showed 47,XXY. Conclusion: This case illustrates that Klinefelter syndrome was presented in the infancy with hypospadias and hydrocele which are very uncommon presentation of the disease PMID:24910838

  1. Biography of biophenols: past, present and future

    Directory of Open Access Journals (Sweden)

    Hassan K. Obied

    2013-06-01

    Full Text Available ABSTRACTBackground: The term “biophenols” was first coined by Romeo and Uccella in 1996 to denote bioactive phenols in olives replacing the more common and less chemically accurate term “polyphenols”. “Biophenols” has started gaining popularity beyond olive chemistry and currently used by researchers to refer to plant phenols in general. Biophenols constitute the largest group of secondary plant metabolites with ubiquitous presence in plants and wide spectrum of biological activities. During the last three decades, biophenols have seized scientific attention, lured industry and attracted consumers’ interest due to their antioxidative potential in preservation of food and maintaining human health. For the first time, a definition for “biophenols” has been proposed to present a more precise and comprehensive umbrella term to encompass all phenolic compounds of botanical origin. In this article, the author is tracing the landmarks of the history of biophenol research; profiling contemporary research directions; highlighting research controversies and uncertainties; and presenting an outlook of the biophenols future research.Keywords: polyphenols, chemistry, pharmacology, biological activities, antioxidant

  2. Coming out ahead: the cost effectiveness of external cephalic version using spinal anesthesia

    Science.gov (United States)

    2014-01-01

    Breech presentation is encountered in 3 to 4% of term pregnancies and has been a significant driver of the increased rate of cesarean deliveries over the last 4 decades. External cephalic version (ECV) is recommended at term by most professional organizations in an effort to reduce the prospect of cesarean deliveries. The authors propose the use of regional anesthesia to increase efficacy and reduce cost in the care of patients who undergo ECV in an effort to convert a breech presentation to a vertex counterpart. Despite emerging evidence of the advantages, obstacles to more comprehensive implementation of this approach continue to exist, which include patient acceptance, provider experience, and safety concerns. The addition of tocolytics and use of regional anesthesia for secondary ECV efforts have also been considered as options to increase success and reduce cost. This is a commentary on http://www.ijhpr.org/content/3/1/5. PMID:24565024

  3. Retinoblastoma: a most unusual presentation

    African Journals Online (AJOL)

    Dr. C. Pedro-Egbe

    Although leukocoria and strabismus are the most common presenting signs of retinoblastoma, a retrospective study by Abramson et al. identified 32 distinct presenting signs of retinoblastoma.6-8. A few other studies have also noted some distinct characteristics exhibited by children whose conditions were diagnosed in the ...

  4. Present status of processing method

    Energy Technology Data Exchange (ETDEWEB)

    Kosako, Kazuaki [Sumitomo Atomic Energy Industries Ltd., Tokyo (Japan)

    1998-11-01

    Present status of processing method for a high-energy nuclear data file was examined. The NJOY94 code is the only one available to the processing. In Japan, present processing used NJOY94 is orienting toward the production of traditional cross section library, because a high-energy transport code using a high-energy cross section library is indistinct. (author)

  5. Uncommon presentation of neuro- cysticercosis

    African Journals Online (AJOL)

    Uncommon presentation of neuro- cysticercosis. Neurocysticercosis (NCC) is a common parasitic infection of the central nervous system caused by the pork tapeworm Taenia solium. The clinical presentation of NCC in children includes generalised and partial seizures with or without features of raised intracranial pressure.

  6. Presentation Skills Workshops for Nurses.

    Science.gov (United States)

    Kinn, S.; Kenyon, M.

    2002-01-01

    Workshops were held to prepare nurses (n=87) to present results of professional activities. One year after the course, 20 had made oral and 30 written presentations. The workshops increased their confidence and were considered practical, informal, and nonthreatening. (Contains 31 references.) (SK)

  7. Castleman's disease, an unusual presentation

    Directory of Open Access Journals (Sweden)

    Shital Munde

    2015-01-01

    The present report describes a 30-year-old serving male who presented with pain abdomen and on and off episodes ofmelena, found to have peripancreatic lymphadenopathy on CECT abdomen. Ultrasound guided FN AC was done in private hospital revealed reactive lymphadenopathy. Excision biopsy was done in our institute and a diagnosis of Castleman's disease was made.

  8. Multiphasic presentation of Rasmussen's encephalitis

    NARCIS (Netherlands)

    Avbersek, A.; Miserocchi, A.; McEvoy, A.W.; Patel, A.V.; Aronica, E.; Blumcke, I.; Jacques, T.S.; Acheson, J.; Thom, M.; Sisodiya, S.M.

    2015-01-01

    Rasmussen's encephalitis is a rare, chronic inflammatory disorder of unknown cause, characterised by drug-resistant focal epilepsy that may rarely present in adolescence or adulthood. We present a case of Rasmussen's encephalitis with prominent recurrent fluctuation in symptoms and well-documented

  9. Creating an effective poster presentation.

    Science.gov (United States)

    Taggart, H M; Arslanian, C

    2000-01-01

    One way to build knowledge in nursing is to share research findings or clinical program outcomes. The dissemination of these findings is often a difficult final step in a project that has taken months or years to complete. One method of sharing findings in a relaxed and informal setting is a poster presentation. This method is an effective form for presenting findings using an interactive approach. The milieu of a poster presentation enables the presenters to interact and dialogue with colleagues. Guidelines for size and format require that the poster is clear and informative. Application of design helps to create visually appealing posters. This article summarizes elements of designing and conducting a poster presentation.

  10. Career Exploration Program Exit Presentation

    Science.gov (United States)

    Wotring, Virginia; Hood, Andrew

    2013-01-01

    Mouse liver cells on short-term shuttle flights (STS- 135) have been shown to exhibit changes. By replicating aspects of spaceflight in the laboratory, we can conduct experiments without impacting mission resources. Astronauts are on a high-iron diet during spaceflight. Galactic Cosmic Rays (GCRs) and Solar Particle Events (SPEs) are ionizing radiation sources that can alter physiological functions. Preliminary medication usage data from the International Space Station (ISS) crew shows that the most common reasons for using medications in space are the same for healthy people on earth.

  11. Atypical presentations of Wolframs syndrome

    Directory of Open Access Journals (Sweden)

    S Saran

    2012-01-01

    Full Text Available Background: Wolfram syndrome is a rare hereditary or sporadic neurodegenerative disorder also known as DIDMOAD. The classically described presentation is of insulin-dependent diabetes, followed by optic atrophy, central diabetes insipidus, and sensory neural deafness. Also included are less well-described presentations of Wolframs syndrome. We here present three cases of atypical presentation of this syndrome. Case 1: A 15-year-old boy with insulin-dependent diabetes was presented for evaluation of depressive symptoms associated with suicidal tendency. Neuropsychiatric manifestations are described with Wolframs syndrome, and wolframin gene, in recessive inheritance, is associated with psychiatric illnesses without other manifestations of Wolframs syndrome. Case 2: A 17-year-old diabetic boy on insulin with good control of blood sugar presented for evaluation of delayed puberty. Central hypogonadism and other anterior pituitary hormone dysfunctions are the less publicized hormone dysfunctions in Wolframs syndrome. Case 3: A 23-year-old female who was on insulin for diabetes for the past 14 years, got admitted for evaluation of sudden loss of vision. This patient had developed a vitreous hemorrhage and, on evaluation, was found to have optic atrophy, sensory neural hearing loss, and diabetes insipidus, and presented differently from the gradual loss of vision described in Wolframs syndrome. Conclusion: Wolframs syndrome being a multisystem degenerative disorder can have myriad other manifestations than the classically described features. Neuropsychiatric manifestations, depression with suicidal risk, central hypogonadism, and secondary adrenal insufficiency are among the less well-described manifestations of this syndrome.

  12. An unusual presentation of sporotrichosis

    Directory of Open Access Journals (Sweden)

    S S Vaishampayan

    2013-01-01

    Full Text Available Sporotrichosis can mimic a few diseases. Sporotrichosis presenting as a hypoaesthetic plaque or plaque suggestive of leprosy has not been mentioned in literature. Herein we present a case of a 26 years old man who presented with hypoesthetic plaque on left ankle and was clinically diagnosed to have borderline tuberculoid leprosy who later developed few nodules in linear fashion on left leg, which ruptured to form non healing ulcers. Culture from ulcer grew Sporothrix schenckii. Patient was successfully treated with oral potassium iodide.

  13. Rhabdomyosarcoma presenting as acute leukemia.

    Science.gov (United States)

    Morandi, S; Manna, A; Sabattini, E; Porcellini, A

    1996-08-01

    We describe a case of a very unusual presentation of rhabdomyosarcoma. An 18-year-old woman presented with symptoms and signs compatible with acute leukemia. The bone marrow picture showed diffuse involvement sustained by undifferentiated blasts that turned out to be of striated muscle origin by immunochemistry. While it is well known that rhabdomyosarcoma may metastasize to the bone marrow, extensive marrow involvement with leukemic spread as a unique clinical manifestation is extremely rare. Our observation further confirms the need to consider rhabdomyosarcoma among the possible differential diagnoses in patients who present with a leukemic picture and atypical blasts lacking all hematopoietic markers.

  14. Questioning tool-kit on population involvement in the context of local requests in environmental health. Five public institutes of research and expertise faced to governance trends in terms of activities and situations presenting risks for humans and for the environment

    International Nuclear Information System (INIS)

    Dor, Frederic; Schneider, Thierry; Boucher, Alix; Chiron, Mireille; Coutureau, Fabrice; Hazebrouck, Benoit; Laurier, Dominique; Oudiz, Andre; Petitfrere, Michael

    2010-09-01

    In their daily practice, the five institutes are faced to the uncertainties relative to the quantification of the health-related risks and to the difficulty of communicating with the population. The working group elaborated a questioning tool-kit covering the three steps of a public health assessment: analysis of the situation, progress of the study and feedback and interpretation of the results. This tool concerns more particularly the investigations at a local level identified as potentially harmful. The legitimacy of the institutes intervening, the answer to the expectations of the population, a transparent attitude on what can possibly be done or not, the development of a partnership with the population, the formulation and the follow-up of the recommendations are many important points identified by the working-group. They were consolidated during the auditions with local authorities and associations. Throughout the processes initiated with the population, the investment in terms of time represents an important part of the success or the failure of the management of the situation. (authors)

  15. Clinical presentation of thyroid cancer

    International Nuclear Information System (INIS)

    Samuel, A.M.; Shah, D.H.

    1999-01-01

    The clinical manifestation of thyroid cancer (TC) as seen at the Nuclear Medicine Department, where the patients investigated prior to diagnosis of disease are clinically suspected to harbor malignancy and mostly referred for scintigraphic investigations are presented

  16. Hyperthyroidism: an unusual case presentation.

    Science.gov (United States)

    Scripture, D L

    1998-02-01

    Hyperthyroidism is the most common disorder of the thyroid. Patients typically present with complaints consistent with a hypermetabolic state, including nervousness, weight loss, heat intolerance, palpitations, irritability, and tremor. This case report reviews a 34-year-old woman who presented with unilateral upper extremity weakness, weight gain, and an episode of atrial fibrillation, the latter coinciding with a 36-hour lack of sleep and excess alcohol and caffeine intake. Although an extensive neurologic evaluation failed to identify any abnormality, the patient's laboratory analysis revealed elevations in thyroxine (T4) and triiodothyronine (T3) levels with unsuppressed thyroid-stimulating hormone levels. Subsequent treatment with the antithyroid drug methimazole (Tapazole) provided complete relief of symptoms. This case report illustrates how health care providers can be diverted to pursue a neurologic etiology when muscle weakness presents as a unilateral symptom. Plausible alternative causes for muscle weakness and other symptoms are presented.

  17. Thyrotoxic crisis presenting with jaundice.

    Science.gov (United States)

    Wickramasinghe, R D S S; Luke, W A N V; Sebastiampillai, B S; Gunathilake, M P M L; Premaratna, R

    2016-06-23

    Thyrotoxic crisis is a medical emergency requiring early diagnosis and urgent management, which can be challenging due to its diverse clinical presentations. While common presentations include fever, sweating, palpitations, tremors and confusion, presence of jaundice is rare. We report a 35-year-old male who presented with jaundice due to cholestasis along with other features of thyrotoxic crisis due to Graves' disease. He had a good clinical recovery with resolution of cholestasis following treatment for thyrotoxic crisis. Jaundice can be a rare manifestation of thyrotoxic crisis, and should be considered in the differential diagnosis when other clinical features of thyrotoxic crisis are present. However secondary causes of jaundice should be looked into and excluded.

  18. Presentation at FTP: A review

    International Nuclear Information System (INIS)

    Sheffield, J.

    1987-01-01

    This series of vugraphs presents some information concerning ORNL's involvement in the fusion energy research program. Recent and future experiments are named, and a rough estimate of funding is given

  19. Extradural lipomatosis presenting with paraplegia.

    Directory of Open Access Journals (Sweden)

    Deogaonkar M

    1995-07-01

    Full Text Available An unusual case with spinal extradural lipomatosis in a non-obese and otherwise healthy man is reported. The patient presented with a history of weakness of legs which progressed to paraplegia over a 40 day period.

  20. A centralized audio presentation manager

    Energy Technology Data Exchange (ETDEWEB)

    Papp, A.L. III; Blattner, M.M.

    1994-05-16

    The centralized audio presentation manager addresses the problems which occur when multiple programs running simultaneously attempt to use the audio output of a computer system. Time dependence of sound means that certain auditory messages must be scheduled simultaneously, which can lead to perceptual problems due to psychoacoustic phenomena. Furthermore, the combination of speech and nonspeech audio is examined; each presents its own problems of perceptibility in an acoustic environment composed of multiple auditory streams. The centralized audio presentation manager receives abstract parameterized message requests from the currently running programs, and attempts to create and present a sonic representation in the most perceptible manner through the use of a theoretically and empirically designed rule set.

  1. Hypertension presenting early in pregnancy

    OpenAIRE

    Melvin, Audrey; Kinsley, Brendan

    2015-01-01

    Key Clinical Message Paraganglioma in pregnancy is an exceedingly rare and potentially life?threatening diagnosis. It is important that the clinicians consider secondary causes when women present with hypertension in early pregnancy.

  2. HYDROGEOLOGIC CASE STUDIES (DENVER PRESENTATION)

    Science.gov (United States)

    Hydrogeology is the foundation of subsurface site characterization for evaluations of monitored natural attenuation (MNA). Three case studies are presented. Examples of the potentially detrimental effects of drilling additives on ground-water samples from monitoring wells are d...

  3. QCD machines - present and future

    International Nuclear Information System (INIS)

    Christ, N.H.

    1991-01-01

    The present status of the currently working and nearly working dedicated QCD machines is reviewed and proposals for future machines are discussed with particular emphasis on the QCD Teraflop Project in the US. (orig.)

  4. Anesthetic management of external cephalic version.

    Science.gov (United States)

    Chalifoux, Laurie A; Sullivan, John T

    2013-09-01

    Breech presentation is common at term and its reduction through external cephalic version represents a noninvasive opportunity to avoid cesarean delivery and the associated maternal morbidity. In addition to uterine relaxants, neuraxial anesthesia is associated with increased success of version procedures when surgical anesthetic dosing is used. The intervention is likely cost effective given the effect size and the avoided high costs of cesarean delivery. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Dictionary of machine terms

    International Nuclear Information System (INIS)

    1990-06-01

    This book has introduction of dictionary of machine terms, and a compilation committee and introductory remarks. It gives descriptions of the machine terms in alphabetical order from a to Z and also includes abbreviation of machine terms and symbol table, way to read mathematical symbols and abbreviation and terms of drawings.

  6. Unusual presentation of cutaneous leiomyoma

    Directory of Open Access Journals (Sweden)

    Sapnashree Bhaskar

    2014-01-01

    Full Text Available Herein, we report a case of leiomyoma cutis because of its rarity and unusual presentation. The case presented with a solitary leiomyoma lesion which was painless. However, the adjacent normal appearing area was tender. A biopsy of the lesion as well as of a portion of the adjacent normal appearing area was taken, which confirmed the diagnosis of cutaneous leiomyoma. This may suggest the dormant nature of the disease which has not yet become apparent.

  7. ECRIS 2010 - Proceedings and Presentations

    International Nuclear Information System (INIS)

    2012-01-01

    The workshop focussed on the latest developments in performance, modeling and applications of ECR ion sources along with the associated physics and technologies, including plasma physics, beam optics, beam diagnostics, magnet technology.... The presentations were organized around 8 topics: 1) status of ECRIS operation, 2) new developments, 3) ion beams and low energy beam transport (LEBT), 4) pulsed operation, 5) applications, and 6) plasma and beam investigations. Most papers are accompanied with the slides of their presentation

  8. AN UNUSUAL PRESENTATION OF DIC

    Directory of Open Access Journals (Sweden)

    Manish

    2015-10-01

    Full Text Available Placenta Praevia is a common obstetric problem which presents with antepartum H aemorrhage and is treated by the obstetrician. It is very rare to see a patient with placenta praevia treated in medical ward for post - partum H aemorrhage due to disseminated intravascular coagulation defect with the added complication of acute kidney injury, P ost - partum H ypertension and PRES (posterior reversible encephalopathy syndrome, hence the presentation

  9. Present and future superconducting cyclotrons

    International Nuclear Information System (INIS)

    Nolen, J.A. Jr.

    1987-01-01

    This paper begins with a brief review of the status of present superconducting (SC) cyclotron projects, including the two which are currently operating and the six which are under construction. The next section summarizes the main features shared by five of these machines, while the third section presents recent developments and new concepts introduced in the other three ''second generation'' SC cyclotrons. Projects in early stages of development are discussed in the fourth section

  10. Peripartum Cardiomyopathy Presenting as Bradycardia

    OpenAIRE

    Codsi, Elisabeth; Rose, Carl H.; Tweet, Marysia S.; Hayes, Sharonne N.; Best, Patricia J. M.; Blauwet, Lori A.

    2017-01-01

    Peripartum cardiomyopathy (PPCM) is a disease that typically affects young otherwise healthy women. As PPCM is associated with significant mortality, timely diagnosis is necessary to ensure appropriate care. To our knowledge, this represents the first reported case of PPCM presenting as symptomatic bradycardia. We describe the patient’s clinical presentation and relevant findings and review the potential etiology and ramifications of bradycardia in patients with PPCM.

  11. Optimistically Engaging in the Present

    Directory of Open Access Journals (Sweden)

    Eric A. Fenkl

    2014-07-01

    Full Text Available This study explores the experiences of aging among gay men to further explain the phenomenon of gay male aging in contemporary terms, to put those experiences into a historically relevant context, and to expand upon previous findings on aging within the gay male population. Nineteen self-identifying gay men from a metropolitan area in South Florida were interviewed. The data collected were analyzed using grounded theory method. Findings from the study indicated that a great deal of optimism was revealed by the participants of the study in spite of their past adversarial experiences related to their sexuality and current challenges related to gay male sexuality and aging. Based on these findings, professionals working with an older population should consider the supportive environments that can most benefit this population in the community and even consider partnering with lesbian, gay, bisexual, and transgender (LGBT oriented organizations to better serve the needs of their clients.

  12. Is there an educator present?

    DEFF Research Database (Denmark)

    Christiansen, René Boyer; Nortvig, Anne-Mette; Rosenlund, Lea Tilde

    2015-01-01

    the identity and visual appearance of the teacher plays a crucial role for the interactions between the participants (Kannen 2012) but although the human body in a MOOC is not always as visible the identity and the role of the teacher is as multifaceted and – maybe even more – complex than in the physical......In recent years, MOOCs (Massive Open Online Courses) have become a player within the field of education. MOOC research is a fairly new field but within the last 2-3 years, it has developed rapidly (Liyanagunawardena et al. 2013, Bayne & Ross 2014). Much of this research has had an emphasis...... amount of research occupied with a focus on what happens when academic staff finds themselves in a situation where are asked to re-construct themselves as MOOC educators (MOOC-utvalget 2013). Thus, the focus on MOOC educators (We use this term for teachers working in teacher education designing...

  13. Atypical presentation of an unusual foreign body

    Directory of Open Access Journals (Sweden)

    Arora Vipul

    2010-01-01

    Full Text Available A 14-year-old boy presented with intractable diplopia for 10 days following an assault. A thorough history revealed that he was unaware of any penetrating injury. However, imaging demonstrated a radiolucent foreign body between the globe and the orbital floor. On surgical exploration, it was found to be the proximal part of a ball point pen. Its removal resulted in complete resolution of diplopia. Thorough clinical and radiological examination is recommended when a foreign body is suspected in pediatric patients. Prompt diagnosis will aid in early intervention and prevention of long-term complications.

  14. In Celebration of Past, Present and Future

    DEFF Research Database (Denmark)

    Hasle, Per Frederik Vilhelm; Jakobsen, David; Øhrstrøm, Peter

    2018-01-01

    of determinism led him to a reconstruction of the famous Diodorean Master Argument which had for centuries been regarded as a strong argument in favour of determinism. In his further analysis of the problem, he made extensive use of tense-logic and the idea of branching time suggested to him by Saul Kripke....... However, in Past, Present and Future Prior also stresses that time as such should not simply be understood in terms of branching time diagrams. Such diagrams should be seen not as direct representations of time but rather as figures helpful for understanding a deeper tense-logical structure....

  15. Clinical presentation in patients with systemic sclerosis

    International Nuclear Information System (INIS)

    Silvarino, R.; Rebella, M.; Alonso, J.; Cairoli, E.

    2009-01-01

    Introduction: systemic sclerosis is an autoimmune disease characterized by endothelial damage, and skin, vessel and internal organ fibrosis and inflammation. There are differences in terms of frequency, severity and prognosis for the different ethnic groups, what reinforces the importance of the study in each geographical region with the purpose of enabling early diagnosis of its incipient symptoms.Methods: we conducted a descriptive and retrospective study form March 2006 through March 2008, including patients with a final diagnosis of systemic sclerosis, who are treated at the Systemic Autoimmune Diseases Unit at the Clinicas Hospital. Results: 31 women were included in the study, average follow-up of patients was 39.2 months, and average age at the time of diagnosis was 47.6 years. Eleven patients (35,5) presented diffuse disease and 20 (64.5) of them evidenced limited disease. Thirty patients presented Raynaud's phenomenon. In 92 of cases capilaroscopy showed a sclerodermiform pattern. In terms of the respiratory system, we found interstitial pathology in 25 of cases, pulmonary arterial hypertension in 22.2 and are restrictive pattern in respiratory function studies in 35.5. Also, 67.7 presented digestive manifestations and 9.6 developed sclerodermic renal crisis. We found anti-nuclear antibodies (ANA) in 29 out of 31 patients (93,5) patients; 16 presented anticentromere antibodies and five anti-topoisomerasa-I antibodies. The four patients (12.9)who died during follow-up presented common elements such as diffuse sclerosis, digital ulcers and severe respiratory compromise. Conclusions: the clinical and immune characteristics found in our study were similar to those described in other series. Should there be no specific treatment, it is essential to perform regular assessment of visceral impact in order to control and delay complications which result in high morbimortality rates. (author) [es

  16. Presentation of the ASTRAL software; Presentation du logiciel ASTRAL

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    This report presents the ASTRAL software (ASTRAL means technical assistance in post-accidental radioprotection) which is aimed to be used as an aid-to-decision tool in the case of an important release of radionuclides in the environment by assessing radionuclide concentration in different environments and food products, determining the potential exposure to irradiation of concerned populations, foreseeing the evolution of the situation, and proposing different scenarios for the management of contaminated areas. The report describes the software general operation, presents the calculation module (main functionalities, concentration index calculation, dose calculation or radiological impact calculation, how countermeasures are taken into account), the data bases (contextual data, data for radio-ecological calculations and for radiological calculations), the software ergonomics (general principles, result selection and display, result printing and input data). Its briefly evokes the development quality assurance, and describes the software implementation architecture

  17. Dexmedetomidine overdosage: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Soumya S Nath

    2013-01-01

    Full Text Available We present a case of dexmedetomidine toxicity in a 3-year-old child. The case report describes the features and outlines the treatment strategy adopted. The child presented with bradypnoea, bradycardia, hypotension, deep hypnosis and miosis. He was successfully managed with oxygen, saline boluses and adrenaline infusion. He became haemodynamically stable with adrenaline infusion. He started responding to painful stimuli in 3 h and became oriented in 7 h. Dexmedetomidine, a selective α2 adrenoceptor agonist, is claimed to have a wide safety margin. This case report highlights the fact that dexmedetomidine administered in a toxic dose may be life-threatening may present with miosis and adrenaline infusion may be a useful supportive treatment.

  18. Neonatal hemophilia: a rare presentation

    Directory of Open Access Journals (Sweden)

    Nuno Ferreira

    2015-12-01

    Full Text Available Hemophilia A is a X-linked hereditary condition that lead to decreased factor VIII activity, occurs mainly in males. Decreased factor VIII activity leads to increased risk of bleeding events. During neonatal period, diagnosis is made after post-partum bleeding complication or unexpected bleeding after medical procedures. Subgaleal hemorrhage during neonatal period is a rare, severe extracranial bleeding with high mortality and usually related to traumatic labor or coagulation disorders. Subgaleal hemorrhage complications result from massive bleeding. We present a neonate with unremarkable family history and uneventful pregnancy with a vaginal delivery with no instrumentation, presenting with severe subgaleal bleeding at 52 hours of life. Aggressive support measures were implemented and bleeding managed. The unexpected bleeding lead to a coagulation study and the diagnosis of severe hemophilia A. There were no known sequelae. This case shows a rare hemophilia presentation reflecting the importance of coagulation studies when faced with unexplained severe bleeding.

  19. Graphical presentation of participants' results

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    The results obtained by 19 participating dosimetry systems are presented in this section. Section 3 of the preceding report, ''Evaluation of the Results of the First IAEA Coordinated Research Program on Intercomparison for Individual Monitoring'', explains the format and conventions used for the graphical presentation. The system number appearing in the upper left hand corner of each page can be used to correlate the dosimeter design information found in Table 2 of the preceding report with the results. However, care should be used in drawing inferences from this correlation, since system performance depends on a number of factors other than detector selection and design characteristics. (orig.)

  20. Technical presentation: Next Generation Oscilloscopes

    CERN Multimedia

    PH Department

    2011-01-01

      Rohde & Schwarz "Next Generation Oscilloscopes" - Introduction and Presentation Agenda: Wednesday 23 March  -  09:30 to 11:30 (open end) Bldg. 13-2-005 Language: English 09.30 Presentation "Next Generation Oscilloscopes" from Rohde & Schwarz RTO / RTM in theory and practice Gerard Walker 10.15 Technical design details from R&D Dr. Markus Freidhof 10.45 Scope and Probe Roadmap (confidential) Guido Schulze 11.00 Open Discussion Feedback, first impression, wishes, needs and requirements from CERN All 11.30 Expert Talks, Hands on All Mr. Dr. Markus Freidhof, Head of R&D Oscilloscopes, Rohde & Schwarz, Germany; Mr. Guido Schulze, ...

  1. DOE Collegiate Wind Competition (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Jones, J.

    2014-02-01

    This presentation for the January Stakeholder Engagement and Outreach webinar outlines the expanded need for workers in the wind industry and provides an overview of the DOE Wind Competition (to be held in May 2014) and the guiding principles of the competition.

  2. Press book presentation progress report

    International Nuclear Information System (INIS)

    2001-07-01

    This document presents four french sites of the ANDRA concerning the radioactive waste disposal. The concerned site are the underground research laboratory of Meuse/Haute-Marne, the Aube Center, the TFA Center and the Manche Center. For each sites, data and information on the geophysics, the capacity, the management or the research programs are analysed. (A.L.B.)

  3. Rose breeding: past, present, prospects

    NARCIS (Netherlands)

    Vries, de D.P.; Dubois, L.A.M.

    1996-01-01

    In this review the PAST, PRESENT and PROSPECT will be considered as three separate periods in the history of the breeding and development of rose cultivars. The recurring theme is the genetic variation. This theme was chosen because there is justified doubt as to sufficient genetic variation

  4. Understanding Algorithms in Different Presentations

    Science.gov (United States)

    Csernoch, Mária; Biró, Piroska; Abari, Kálmán; Máth, János

    2015-01-01

    Within the framework of the Testing Algorithmic and Application Skills project we tested first year students of Informatics at the beginning of their tertiary education. We were focusing on the students' level of understanding in different programming environments. In the present paper we provide the results from the University of Debrecen, the…

  5. Experiments in Multimodal Information Presentation

    NARCIS (Netherlands)

    van Hooijdonk, Charlotte; Bosma, W.E.; Krahmer, Emiel; Maes, Alfons; Theune, Mariet; van den Bosch, Antal; Bouma, Gosse

    In this chapter we describe three experiments investigating multimodal information presentation in the context of a medical QA system. In Experiment 1, we wanted to know how non-experts design (multimodal) answers to medical questions, distinguishing between what questions and how questions. In

  6. Clinical Presentations of Acute Leukemia

    International Nuclear Information System (INIS)

    Shahab, F.; Raziq, F.

    2014-01-01

    Objective: To document the clinical presentation and epidemiology of various types of acute leukemia with their respective referral source at a tertiary level centre in Peshawar. Study Design: An observational study. Place and Duration of Study: Department of Pathology, Hayatabad Medical Complex (HMC), Peshawar, from January 2011 to May 2012. Methodology: A total of 618 bone marrow biopsy reports were reviewed. All biopsy reports labeled as acute leukemia were reviewed for age, gender, address, referring unit, diagnosis on bone marrow examination, presenting complaints, duration of illness and findings of clinical examination. Results: Ninety-two patients were diagnosed as suffering from acute leukemias (15%). ALL was most prevalent (46%), followed by AML (38%) and undifferentiated acute leukemia (16%). Males were affected more compared to females (60% vs. 40%). ALL and AML were predominant in pediatric (64%) and adults (77%) patients respectively. Patients from Afghanistan accounted for 33% of all cases followed by Peshawar (14%). Fever (77%), pallor (33%) and bleeding disorders (23%) were the main presenting complaints. Enlargement of liver, spleen and lymph nodes together was associated with ALL compared with AML (p = 0.004). Conclusion: ALL-L1 and AML-M4 were the most common sub-types. Fever, pallor and bleeding disorders were the main presenting complaints. Enlargement of liver, spleen and lymph nodes was more frequently associated with ALL compared to AML. (author)

  7. Reninoma presenting as cardiac syncope

    Science.gov (United States)

    Tak, Shahid I; Wani, Mohd Lateef; Khan, Khursheed A; Alai, Mohd Sultan; Shera, Altaf Hussain; Ahangar, Abdul G; Khan, Yasir Bashir; Nayeem-ul-Hassan; Irshad, Ifat

    2011-01-01

    Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia. PMID:21677812

  8. Unusual Presentation of Maydl's Hernia

    African Journals Online (AJOL)

    Nikhil NBA, Natarajan K, Mohanty A, et al. An. Unusual Case of Maydl's Hernia. Int J Cur Res Rev. 2013;5(6):22-5. 11. Ganesaratnam M. Maydl's hernia: Report of a Series of Seven Cases and Review of Literature. Brit J Surg. 1985;72:737-8. 12. Weledji EP, Mokake M, Ngowe MN. A Rare. Presentation of Maydl's Hernia.

  9. Secondary syphilis presenting as vertigo

    International Nuclear Information System (INIS)

    Bari, A.U.; Mehmood, T.; Khan, B.; Malik, N.; Malik, K.Z.; Sukhera, A.M.

    2006-01-01

    Syphilis is a chronic, systemic and sexually transmitted infectious disease affecting most of the organs in the body. A young African man presented with vertigo, unsteadiness of gait and a skin rash suggestive of secondary syphilis. Diagnosis was confirmed on serology and was treated with two shots of long-acting penicillin, following which his symptoms settled. (author)

  10. Energy consumption: Past, present, future

    Science.gov (United States)

    1973-01-01

    The energy consumption history of the United States and the changes which could occur in consumption characteristics in the next 50 years are presented. The various sources of energy are analyzed to show the limitations involved in development and utilization as a function of time available. Several scenarios were prepared to show the consumption and supply of energy under varying conditions.

  11. Learning through Dramatic Story Presentation

    Science.gov (United States)

    Tindall, Evie

    2012-01-01

    The use of story with dramatic presentation approaches produces an engaging and powerful instructional choice for today's adult ESL educators. Two engaging and timed-tested approaches are Reader's Theater and Tableau Vivant. Both provide English language learners with content tailored to their abilities in addition to numerable opportunities to…

  12. Police, managerialization and presentational strategies

    NARCIS (Netherlands)

    Terpstra, J.; Trommel, W.A.

    2009-01-01

    Purpose - The managerialization of the police may be seen as an effort to restore the legitimacy of the police. This paper aims to show that the managerialist strategy presently occurring within police forces creates new pitfalls and unintended consequences. Design/methodology/approach - The paper

  13. Viewfoils for environmental capabilities presentation

    International Nuclear Information System (INIS)

    1992-01-01

    This document contains information about the environmental applications of aerial surveys. It discusses the accuracy, dependability, history, advantages, and sensitivity of aerial surveys. Also included, are a brief overview of in-situ gamma spectroscopy and samples of aerial surveys. This document contains entirely of an outline and viewfoils for the presentation

  14. MAMMARY TUBERCULOSIS PRESENTING AS CARCINOMA

    African Journals Online (AJOL)

    She was otherwise well wizh no symptoms referable to other systems. On examination .... cardiac failure. The other ... but chronic oedema of the right arm of moderate degree was present. .... a tuberculous ulcer on the dorsum of the hand, followed ... venous system may also lead to haematogenous dissemination, producing ...

  15. The Present State of Behaviorism

    Science.gov (United States)

    Mowrer, O. Hobart

    1976-01-01

    Assesses the present status of behaviorism by dividing this study into an evaluation of Behaviorism 1, based explicitly on Pavlov's conception of conditioned-response learning, and Behaviorism 11, single-handedly launched and almost completely dominanted by Professor B. F. Skinner. (Author/RK)

  16. Petroleum - its present and future

    Digital Repository Service at National Institute of Oceanography (India)

    SenGupta, R.; Qasim, S.Z.

    World's "published proved" reserve of oil by the end of 1984 was known to be of the order of 95,000 million tonnes. Of this, 57% lies buried in the middle eastern countries. At the present rate of growth in consumption and production of oil...

  17. Reactor enclosure. BRC meeting presentation

    International Nuclear Information System (INIS)

    Fisch, J.W.

    1975-01-01

    The latest status of key components of the Reactor Enclosure System of the Clinch River Breeder Reactor Plant is described. Areas where there have been notable design changes or significant design detail maturity in the six months since the last BRC presentation are highlighted. (auth)

  18. Hypervideos and interactive multimedia presentations

    NARCIS (Netherlands)

    B. Meixner (Britta)

    2017-01-01

    textabstractHypervideos and interactive multimedia presentations allow the creation of fully interactive and enriched video. It is possible to organize video scenes in a nonlinear way. Additional information can be added to the video ranging from short descriptions to images and more videos.

  19. Unusual presentation of gallbladder perforation

    Directory of Open Access Journals (Sweden)

    G. Jayasinghe

    2016-01-01

    Conclusions: Percutaneous abscesses arising from the gallbladder are a rare but potentially serious consequence of acute cholecystitis, and may present in a wide variety of locations. Therefore it is imperative to conduct a full body inspection in the septic patient, even when a source has been identified.

  20. Neutrino astronomy: Present and future

    Indian Academy of Sciences (India)

    Abstract. I briefly review the present and future status of the burgeoning field of neu- ... near future build upon previous results. ... novel radio and acoustic techniques utilized by, for example, experiments such as. GLUE ... Left: Schematic of νµ-induced muon track in detector. Right: .... an eye toward the galactic center).

  1. Clustering semantics for hypermedia presentation

    NARCIS (Netherlands)

    Alberink, M.J.; Rutledge, L.W.; Hardman, H.L.; Veenstra, M.J.A.

    2004-01-01

    Semantic annotations of media repositories make relationships among the stored media and relevant concepts explicit. However, these relationships and the media they join are not directly presentable as hypermedia. Previous work shows how clustering over the annotations in the repositories can

  2. Maternal characteristics and timing of presentation following pre ...

    African Journals Online (AJOL)

    Background: To examine the influence of maternal characteristics on timing of presentation for intervention following pre-labour rupture of membrane (PROM) at term. Materials and Methods: This was a descriptive study of cases of term PROM with singleton births at the University of Benin Teaching Hospital (UBTH) from ...

  3. Summary of presentations and discussions

    International Nuclear Information System (INIS)

    Takeuchi, Mitsuo

    2008-01-01

    In December 2007, the Forum on Stakeholder Confidence discussed its theme entitled 'Link between research, development and demonstration (RD and D) and stakeholder confidence'. It was remarked that regulators need a technical demonstration to aid in evaluating the safety case. Local stakeholders appreciate the opportunity to visualise technological arrangements. In both cases, demonstration adds to confidence in the feasibility of solutions. Some believe there is an important role for analogues in communication with stakeholders, if handled with integrity. To explore and benchmark current practices, it was decided to hold a topical session at the 9. regular meeting of the FSC on 4 June 2008 regarding the use of analogues for confidence building. The session opened with an introductory presentation by the session rapporteur. This incorporated input provided for the purpose by FSC members in cooperation with their country's representative to the NEA RWMC 'Integration Group on the Safety Case'. Three speakers then presented the various uses of analogues by implementers, regulators and scientists to build their own confidence; a fourth speaker dealt with the experience of using natural analogues in public information. The presentations addressed the use of analogues in the field of geological disposal of high-level waste (HLW) and long-lived intermediate level (ILW-LL) radioactive waste. Then the FSC participants split into two working groups for discussion. The outcome of these discussions was reported in plenary on 6 June 2008 and it was agreed to publish proceedings of the session. The present summary, prepared by the session rapporteur with input from the NEA Secretariat, captures the main points heard in the course of the event. It combines data from the formal presentations and remarks made in discussion. The latter represent viewpoints expressed by a group whose primary focus is not natural analogues but rather stakeholder interests. The summary and viewpoints

  4. Pulmonary hyalinizing granuloma presenting with dysphagia: a rare presentation.

    Science.gov (United States)

    Khan, Fazal; Hamid, Arsalan; Fatima, Benish; Hashmi, Shiraz; Fatimi, Saulat

    2017-01-01

    A 25-year-old man presented with a 2-month history of dysphagia and past history of pulmonary and intestinal tuberculosis. A barium swallow showed a point of constriction 42 mm above the gastroesophageal junction. Computed tomography revealed large opacities in bilateral lung fields, encroaching more on the esophagus. The lesion progressively compressed the esophagus as it moved inferiorly. A right posterolateral thoracotomy was performed for sub-anatomical resection of the mass. A biopsy revealed homogenous whirling hyalinized collagen fibers, highly suggestive of pulmonary hyalinizing granuloma, with no evidence of malignancy. Pulmonary hyalinizing granuloma should be considered in the differential diagnosis of longstanding dysphagia.

  5. Folklore in China: Past, Present, and Challenges

    Directory of Open Access Journals (Sweden)

    Juwen Zhang

    2018-04-01

    Full Text Available This article first outlines the long history of folklore collection in China, and then describes the disciplinary development in the 20th century. In Section 3, it presents the current situation in terms of disciplinary infrastructure, development, contribution, and challenge, with a focus on the recent practice of safeguarding Intangible Cultural Heritage. These accounts are largely based on the views of the Chinese folklorists. In the final section, this article discusses the issues of cultural continuity, integration, and self-healing mechanisms in Chinese culture by putting Chinese folkloristics in a historical and world perspective. This paper suggests that, to understand Chinese folklore and culture, one must be aware of the most basic differences between Chinese fundamental beliefs and values and those of the West, and that Chinese folklore and folkloristics present new challenges to the current paradigms put forward in the post-colonial, post-modern, and imperial ideologies.

  6. Neutron sources: Present practice and future potential

    International Nuclear Information System (INIS)

    Cierjacks, S.; Smith, A.B.

    1988-01-01

    The present capability and future potential of accelerator-based monoenergetic and white neutron sources are outlined in the context of fundamental and applied neutron-nuclear research. The neutron energy range extends from thermal to 500 MeV, and the time domain from steady-state to pico-second pulsed sources. Accelerator technology is summarized, including the production of intense light-ion, heavy-ion and electron beams. Target capabilities are discussed with attention to neutron-producing efficiency and power-handling capabilities. The status of underlying neutron-producing reactions is summarized. The present and future use of neutron sources in: fundamental neutron-nuclear research, nuclear data acquisition, materials damage studies, engineering tests, and biomedical applications are discussed. Emphasis is given to current status, near-term advances well within current technology, and to long-range projections. 90 refs., 4 figs

  7. Unusual presentation of twisted ovarian cyst

    Directory of Open Access Journals (Sweden)

    Vineet V Mishra

    2016-01-01

    Full Text Available Ovarian torsion (also termed as adnexal torsion refers to partial or complete rotation of the ovary and a portion of fallopian tube along its supplying vascular pedicle. It occurs commonly in reproductive age group; more on the right side (60% and often presents with acute lower abdominal pain lasting for few hours and up to 24 h, accounting for 2.7% of acute gynecological conditions. It is one of the devastating conditions, hampering blood supply of ovary which may lead to total necrosis of ovarian tissue and complications, if not diagnosed and managed in time. Hence, we present a case on a twisted ovarian cyst in postmenopausal woman with unusual symptomatology leading to delayed diagnosis and loss of an ovary.

  8. Present status of the Penrose inequality

    Energy Technology Data Exchange (ETDEWEB)

    Mars, Marc [Facultad de Ciencias, Universidad de Salamanca, Plaza de la Merced s/n, 37008 Salamanca (Spain)

    2009-10-07

    The Penrose inequality gives a lower bound for the total mass of a spacetime in terms of the area of suitable surfaces that represent black holes. Its validity is supported by the cosmic censorship conjecture, and therefore its proof (or disproof) is an important problem in relation with gravitational collapse. The Penrose inequality is a very challenging problem in mathematical relativity and it has received continuous attention since its formulation by Penrose in the early seventies. Important breakthroughs have been made in the last decade or so, with the complete resolution of the so-called Riemannian Penrose inequality and a very interesting proposal to address the general case by Bray and Khuri. In this review, the most important results on this field will be discussed and the main ideas behind their proofs will be summarized, with the aim of presenting what is the status of our present knowledge in this topic. (topical review)

  9. An unusual presentation of presentation of a branchial cleft cyst.

    Science.gov (United States)

    Vemula, Rahul; Greco, Gregory

    2012-05-01

    Branchial cleft cysts are congenital anomalies that arise from the aberrant embryological development of the branchial apparatus. The location of a branchial cleft cyst is determined by which branchial cleft failed to obliterate during embryological development, with the second branchial cleft cyst being the most commonly recognized lesion. Although the most common location for branchial cleft cysts is between the external auditory canal and the level of the clavicle, the literature does describe unusual locations. We present a case a 15-year-old boy who had an enlarging lesion on his back that had been present since birth. A presumptive radiologic diagnosis of lymphangioma circumscriptum was made. Upon excision of the lesion and pathologic examination, it was determined to be a branchial cleft cyst. The patient had an uneventful postoperative course, and no recurrence was noted after a 2-year follow-up. Our clinical report demonstrates a lesion on the posterior thorax that proved to be a branchial cleft cyst and should always be part of the differential diagnosis for soft tissue masses of the thorax.

  10. Ceramics: past, present, and future.

    Science.gov (United States)

    Lemons, J E

    1996-07-01

    The selection and application of synthetic materials for surgical implants has been directly dependent upon the biocompatibility profiles of specific prosthetic devices. The early rationale for ceramic biomaterials was based upon the chemical and biochemical inertness (minimal bioreactivity) of elemental compounds constituted into structural forms (materials). Subsequently, mildly reactive (bioactive), and partially and fully degradable ceramics were identified for clinical uses. Structural forms have included bulk solids or particulates with and without porosities for tissue ingrowth, and more recently, coatings onto other types of biomaterial substrates. The physical shapes selected were application dependent, with advantages and disadvantages determined by: (1) the basic material and design properties of the device construct; and (2) the patient-based functional considerations. Most of the ceramics (bioceramics) selected in the 1960s and 1970s have continued over the long-term, and the science and technology for thick and thin coatings have evolved significantly over the past decade. Applications of ceramic biomaterials range from bulk (100%) ceramic structures as joint and bone replacements to fully or partially biodegradable substrates for the controlled delivery of pharmaceutical drugs, growth factors, and morphogenetically inductive substances. Because of the relatively unique properties of bioceramics, expanded uses as structural composites with other biomaterials and macromolecular biologically-derived substances are anticipated in the future.

  11. Antimatter. Past, present and future

    International Nuclear Information System (INIS)

    Zichichi, A.

    2001-01-01

    In order to have matter it needs to have fundamental fermions (quarks and leptons), particles (mesons and baryons) and nuclei. For antimatter to exist, the anti fundamental fermions as well as the antiparticles and the antinuclei are needed. The masses associated with these components of matter are the intrinsic (quarks and leptons), the confinement (mesons and baryons) and the binding [either nuclear (nuclei), or electromagnetic (atoms)]. The first two are positive, the two binding ones are negative. These masses have different origins. No one has been able to establish the origin of the intrinsic masses (it could be the Higgs mechanism, but this lacks experimental confirmation so far). The confinement masses are QCD non-perturbative effects. The nuclear binding masses are QCD-induced colour neutral effects; the electromagnetic binding is due to QED and, since QED is the best experimentally checked RQFT, its validity in terms of the CPT symmetry cannot easily be questioned and this is why the electromagnetic binding is not included in this review.If CPT were theoretically well established as it was when discovered, all mass differences, between any matter and its antimatter partner, should be zero

  12. Haunted by a 'Present Absence'

    Directory of Open Access Journals (Sweden)

    Lois Tonkin

    2012-01-01

    Full Text Available Hollway (2007 has highlighted the way a new mother draws intersubjectively on the 'vestigial experience' of her own infantile and child state in relationship with her mother. Developing this I argue that before she has a child a woman anticipates her potential maternal subjectivity through what she 'knows' psychically and socially; both through this 'vestigial experience', through her observation and experience of her mother and other mothers, and the conflicting and contradictory social discourses of mothering in which she is immersed as she grows up. Together these create in her a fantasy maternal subjectivity that has both conscious and unconscious dimensions. This article draws on a psychosocial study of the narratives and drawings of 26 New Zealand women in their 30s and 40s who are 'circumstantially childless' (Cannold 2000; that is women who have always seen themselves as having children but find themselves at the end of their natural fertility not becoming biological mothers for social rather than (at least initially biological reasons. They are engaged in a process of coming to terms with this situation and are in the unusual, but not uncommon, position of being neither 'voluntarily childless' (since they would like to have a child, nor 'involuntarily childless' (since they were/are, at least initially, biologically capable of doing so. It uses a psychosocial reading of the notions of 'ghosts' and 'haunting' to characterize the nature of the relationship between these women and their fantasy child(ren and potential maternal subjectivities.

  13. An unusual presentation of toothpick penetration of colon

    OpenAIRE

    Wani, Imtiaz; Wani, Shamima A; Mir, Shabir; Parra, Khursheed

    2010-01-01

    This case report presents the delayed unusual presentation of plastic toothpick penetrating transverse colon 3 months after ingestion with localized peritonitis. Role of omentum "policeman of abdomen" for salvage is highlighted. Careful observation and long-term lookup for any neglected ingested foreign body are stressed. The delayed presentation can be sometimes proving as a surgical emergency.

  14. An unusual presentation of toothpick penetration of colon

    Directory of Open Access Journals (Sweden)

    Wani Imtiaz

    2010-01-01

    Full Text Available This case report presents the delayed unusual presentation of plastic toothpick penetrating transverse colon 3 months after ingestion with localized peritonitis. Role of omentum "policeman of abdomen" for salvage is highlighted. Careful observation and long-term lookup for any neglected ingested foreign body are stressed. The delayed presentation can be sometimes proving as a surgical emergency.

  15. Presentation of the ASTRAL software

    International Nuclear Information System (INIS)

    2011-01-01

    This report presents the ASTRAL software (ASTRAL means technical assistance in post-accidental radioprotection) which is aimed to be used as an aid-to-decision tool in the case of an important release of radionuclides in the environment by assessing radionuclide concentration in different environments and food products, determining the potential exposure to irradiation of concerned populations, foreseeing the evolution of the situation, and proposing different scenarios for the management of contaminated areas. The report describes the software general operation, presents the calculation module (main functionalities, concentration index calculation, dose calculation or radiological impact calculation, how countermeasures are taken into account), the data bases (contextual data, data for radio-ecological calculations and for radiological calculations), the software ergonomics (general principles, result selection and display, result printing and input data). Its briefly evokes the development quality assurance, and describes the software implementation architecture

  16. Presentation of economic evaluation results.

    Science.gov (United States)

    Chaikledkaew, Usa

    2014-05-01

    The first HTA guidelines for Thailand included a chapter outlining a set of guidelines on how best to report the findings of health economic evaluations, based on a review of best practice and existing guidelines on the presentation of economic evaluation results from around the world. In this second edition of HTA guidelines for Thailand, the recommendations build on the first edition by using a case study to illustrate how the guidelines can be applied in a real research context. The guidelines propose that all reporting include ten key elements: defining the scope of the study, selection of comparator(s), defining the type of economic evaluation, measurement of costs, measurement of clinical effects, handling time in economic evaluation studies, handling uncertainty and sensitivity analysis, presentation of the results, discussion of the results, and disclosure of funding and authors conflict of interest.

  17. RTNS-II: present status

    International Nuclear Information System (INIS)

    Heikkinen, D.W.; Logan, C.M.

    1980-10-01

    The present status of the RTNS-II facility is described and typical operating parameters are given. A brief discussion is given of the methods used in production of the TiT 2 targets as well as their performance and tritium handling at RTNS-II. The various types of non-interactive beam diagnostics presently in use at the neutron sources are outlined. The on-line computer system which provides a time history of an irradiation and records target performance is described. Examples are listed of several representative experimental programs which have been carried out thus far at RTNS-II. These include both active and passive experiments. Finally, several of the major improvements to the facility made since the beginning of the experimental program are given

  18. Presentation of TVO's visitor's centre

    International Nuclear Information System (INIS)

    Aemmaelae, V.M.

    1993-01-01

    There are four nuclear power plant units in Finland, two of which are PWR's owned by Imatran Voima Oy. The two BWR units are located at Olkiluoto and owned by Teollisuuden Voima Oy. This presentation tells about TVO's concept of informing the visitors at Olkiluoto. At the site there are located, in addition to the two nuclear power plant units, the intermediate storage for spent fuel, the repository for low and medium-active waste as well as the training centre. At the Olkiluoto Visitor's Centre all the activities of the company are presented using varied audio-visual aids. The centre has several exhibits and there are also different installations to show how the plant works. (author)

  19. Amebiasis Presenting as Pleuropulmonary Disease

    OpenAIRE

    Kubitschek, Kenneth R.; Peters, Jay; Nickeson, David; Musher, Daniel M.

    1985-01-01

    Seven patients with amebic liver abscess presenting as pleuropulmonary disease were admitted to hospital initially because of pulmonary symptoms and were found to have amebic liver disease. Three categories of pleuropulmonary involvement included reactive inflammation of the pleura or lung, rupture of a hepatic abscess into the pleural space and rupture of a hepatic abscess into the bronchial airways. The preferred medical treatment is with metronidazole, but rupture of hepatic amebic abscess...

  20. Computer training, present and future.

    Science.gov (United States)

    Smith, G. A.

    1972-01-01

    The products of educational firms today lead toward a multimedia approach to the education and training of commercial programmers and systems analysts. Computer-assisted instruction or CAI is a relatively new medium to augment the other media. The government use of computers is discussed together with the importance of computer pretests. Pretests can aid in determining a person's ability to absorb a particular instructional level. The material presented in a number of computer courses is listed.

  1. Sarcoidosis presenting as penile mass

    Directory of Open Access Journals (Sweden)

    Hüseyin Semiz

    2017-01-01

    Full Text Available Sarcoidosis is an inflammatory disease with unknown cause characterized by noncaseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, eye, and musculoskeletal system involvement. Rare involvement of the genital organs (prostate, testis, epididymis has also been reported. However, penile involvement is observed quite rare. In this paper, we report a patient with penile mass who was diagnosed with sarcoidosis on the basis of the laboratory, radiological, and pathological investigations.

  2. Carcinoma caecum - a rare presentation

    International Nuclear Information System (INIS)

    Ali, T.; Mudasser, S.; Mudsser, S.; Sarwar, M.

    2010-01-01

    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)

  3. Water plants past and present

    DEFF Research Database (Denmark)

    Riis, Tenna

    2006-01-01

    How has the condition of the environment developed during the last 100 years? This is an important question because the conditions of the past infl uence those of the present, and knowledge about this development makes it possible to evaluate the causes of changes in species richness, species com...... composition and environmental quality. Here we compare old and contemporary studies of the Danish stream fl ora....

  4. Burning mouth syndrome: Present perspective

    OpenAIRE

    Ramesh Parajuli

    2015-01-01

    Introduction: Burning mouth syndrome is characterized by chronic oral pain or burning sensation affecting the oral mucosa in the absence of obvious visible mucosal lesions. Patient presenting with the burning mouth sensation or pain is frequently encountered in clinical practice which poses a challenge to the treating clinician. Its exact etiology remains unknown which probably has multifactorial origin. It often affects middle or old age women and it may be accompanied by xerostomia and alte...

  5. Present status of CP violation

    International Nuclear Information System (INIS)

    Ng, J.N.

    1989-06-01

    A review of the status of CP violation in kaons is given. Status of our knowledge of quark mixing angles in the standard six quark model is presented. The role Β d o - Βd o transition plays in this study is examined. A comparison of the estimates of CP violation effects from models beyond the standard one is given. Other experiments that have the capability of testing different CP violation models are also discussed. (Author) 35 refs., 6 figs., tab

  6. Nocardial mycetoma: Diverse clinical presentations

    Directory of Open Access Journals (Sweden)

    Sharma Nand

    2008-01-01

    Full Text Available Nocardia spp are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia spp occur as a result of local trauma and contamination of the wound. Clinically, it presents as acute infection (abscesses or cellulitis, mycetoma, or sporotrichoid infection. Differential diagnosis includes eumycetoma, chromomycosis, blastomycosis, coccidioidomycosis, sporotrichosis, tuberculosis, botryomycosis, syphilis, yaws, and neoplasia. Its diagnosis is confirmed by demonstrating the causative organism in exudates (as granules, tissue specimens, or cultures. Early diagnosis will obviate need for drastic surgical measures as early institution of chemotherapy is effective in most patients. However, its diagnosis is often delayed due to diverse clinical presentations and for want of clinical suspicion, particularly in non-endemic areas. This paper presents 4 clinical forms of this not so uncommon disease, emphasizing the importance of high index of clinical suspicion, especially in non-endemic regions; and the significance of repeated examination of exudates for Nocardia granules for an early diagnosis.

  7. Industry Presentation to Regulatory Workshop

    International Nuclear Information System (INIS)

    Treasure, Mark

    2012-01-01

    Mr. Mark Treasure from EDF NGL gave a presentation on industry perspectives on safety culture oversight. Mr. Treasure is the Nuclear Inspection and Oversight Manager within the Safety and Regulation Division. The presentation started with an explanation of the role of the nuclear inspection and oversight group (internal regulator), and their current approach to internal oversight of safety culture. A key element of the current internal regulatory oversight program is Management and Leadership Assessments. These are carried out by a team including management peers from other plants to enhance credibility. Findings can be linked to safety performance, and typically identify issues in areas such as accountability arrangements and strategic focus of the leadership team. Safety indicators have also been introduced to show trends in safety management and safety performance for each EDF UK nuclear power plant. A periodic nuclear safety culture survey is also carried out to identify focus areas and progress. The presentation included discussion on views of the role of the nuclear regulator. Important aspects were identified as: - Supporting the internal regulator by seeking to understand before taking enforcement action, maintaining an open dialogue and recognising that this area is complex and that there is rarely a 'silver bullet' solution. - Communication: being visible and actively discussing safety improvement, and use of language which emphasises nuclear safety rather than legal compliance. - Positive reinforcement to recognise efforts and encourage further improvement

  8. XPL the Extensible Presentation Language

    Directory of Open Access Journals (Sweden)

    A. Santangelo

    2009-01-01

    Full Text Available The last decade has witnessed a growing interest in the development of web interfaces enabling both multiple ways to access contents and, at the same time, fruition by multiple modalities of interaction (point-and-click, contents reading, voice commands, gestures, etc.. In this paper we describe a framework aimed at streamlining the design process of multi-channel, multimodal interfaces enabling full reuse of software components. This framework is called the eXtensible Presentation architecture and Language (XPL, a presentation language based on design pattern paradigm that keeps separated the presentation layer from the underlying programming logic. The language supplies a methodology to expedite multimodal interface development and to reduce the effort to implement interfaces for multiple access devices, by means of using the same code. This paper describes a methodology approach based on Visual Design Pattern (ViDP and Verbal Design Pattern (VeDP, offering examples of multimodal and multichannel interfaces created with the XPL Editor.

  9. Quantum technology past, present, future: quantum energetics (Conference Presentation)

    Science.gov (United States)

    Choi, Sang H.

    2017-04-01

    Since the development of quantum physics in the early part of the 1900s, this field of study has made remarkable contributions to our civilization. Some of these advances include lasers, light-emitting diodes (LED), sensors, spectroscopy, quantum dots, quantum gravity and quantum entanglements. In 1998, the NASA Langley Research Center established a quantum technology committee to monitor the progress in this area and initiated research to determine the potential of quantum technology for future NASA missions. The areas of interest in quantum technology at NASA included fundamental quantum-optics materials associated with quantum dots and quantum wells, device-oriented photonic crystals, smart optics, quantum conductors, quantum information and computing, teleportation theorem, and quantum energetics. A brief review of the work performed, the progress made in advancing these technologies, and the potential NASA applications of quantum technology will be presented.

  10. Variable retinal presentations in nanophthalmos

    International Nuclear Information System (INIS)

    Khan, A.; Zafar, S.N.

    2009-01-01

    Nanophthalmos is an uncommon developmental ocular disorder characterized by a small eye with short axial length, high hyperopia and high lens/eye volume ratio due to arrested development of the globe in all directions. Different types of fundus changes can rarely occur with nanophthalmos. We describe five cases of nanophthalmos, each of them presenting with a different fundus appearance. Our case series highlights variability of pigmentary changes from retinal flecks to bone spicules and bull's eye maculopathy, which are rare in the combinations described here. (author)

  11. Present art of reactivity determination

    International Nuclear Information System (INIS)

    Kaneko, Yoshihiko; Nakano, Masafumi; Matsuura, Shojiro

    1977-01-01

    Experimental techniques for reactivity determination of a reactor have been one of the long standing subjects in reactor physics. Recently, such a requirement was proposed by the reactor designers and operators that the values of reactivity should be measured more accurately. This is because importance is emphasized for the role of reactivity to the performance of reactor safety, economics and operability. Motivated by the requirement, some remarkable progresses are being made for the improvement of the experimental techniques. Then, the present review summarizes the research activities on this subject, identifies several reactor physics problems to be overcome, and makes mention of the future targets. (auth.)

  12. Addison's disease presenting with perimyocarditis.

    Science.gov (United States)

    Baranski Lamback, Elisa; Morandi, Grazia; Rapti, Eleni; Christov, Georgi; Brogan, Paul A; Hindmarsh, Peter

    2018-01-26

    Polyglandular autoimmune syndrome (PGA) and eosinophilic granulomatosis with polyangiitis (EGPA) do not seem to represent a coincidental association. A case of a 15-year-old boy is reported who presented with severe systemic inflammation, perimyocarditis and cardiogenic shock, in whom EGPA was initially suspected and later diagnosed with autoimmune adrenalitis with PGA. The severity of the systemic inflammation and perimyocarditis suggests a more widespread autoimmune-mediated process. Autoimmune adrenal insufficiency should be considered in all cases of pericarditis and perimyocarditis, especially when the severity of clinical manifestations exceeds the expected for the severity of the cardiac findings, as timely identification and prompt treatment may be life-saving.

  13. Metastatic liposarcoma present in mediastinum

    International Nuclear Information System (INIS)

    Vazquez Gonzalez, Jose Manuel; Danta Fundora, Debora; Collado Otero, Juan Carlos; Paredes Lopez, Dagmar I

    2009-01-01

    Authors present the case of a woman aged 59 operated on in three occasions due to the presence of neck nodules. Biopsy from two of them informs that be about a pleomorphous liposarcoma. After 6 years she came to consultation by a picture of high retrosternal pain and slight dyspnea. Thorax tomography shows a solid mass in anterior mediastinum. We made exeresis of a 10 cm diameter soft solid mass. Pathological Anatomy Service reported on relapse of a pleomorphous liposarcoma. In general, the postoperative course was satisfactory. Literature reviewed shows that the surgical treatment is the more used procedure in these cases. (author)

  14. Presentation at Innoventure Annual Competition

    Energy Technology Data Exchange (ETDEWEB)

    None

    2010-03-31

    This report documents the components of the workshop presented at the recent annual competition for the Innoventure program. The goal of the workshop was to focus on the delivery of science, technology, engineering, and math (STEM) concepts in a hands-on experiential learning format to increase interest in national security careers at NNSA, most of which are in the STEM fields. This work is a part of the National Security Preparedness Project (NSPP), being performed under a Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant.

  15. Vitality of optical vortices (Presentation)

    CSIR Research Space (South Africa)

    Roux, FS

    2014-02-01

    Full Text Available stream_source_info Roux3_2014.pdf.txt stream_content_type text/plain stream_size 3018 Content-Encoding UTF-8 stream_name Roux3_2014.pdf.txt Content-Type text/plain; charset=UTF-8 Title Vitality of optical vortices F Stef... Roux Presented at Complex Light and Optical Force VIII SPIE Photonics West 2014 Moscone Center, San Francisco, California USA 5 February 2014 CSIR National Laser Centre, Pretoria, South Africa – p. 1/11 Speckle Amplitude Phase – p. 2/11 Vortex...

  16. Cartography past, present and future

    CERN Document Server

    Rhind, DW

    2013-01-01

    Making maps dates back at least four thousand years and it is widely recognised that many maps are of great historical value and present a skilled method of summarising the real world on a sheet of paper. Less well known is the judgement involved in the selection and simplification of features, the complex transformation of space and the exacting standards which are needed in cartography. This book is primarily a tribute to Professor F.J. Ormeling, former President and Secretary/Treasurer of the ICA and gives a wide ranging review of the current status of cartography, how this status was atta

  17. Sitosterolemia Presenting as Pseudohomozygous Familial Hypercholesterolemia.

    Science.gov (United States)

    Renner, Christian; Connor, William E; Steiner, Robert D

    2016-06-01

    A young girl, age 8.5 years, presented with profound hypercholesterolemia and early xanthomatosis, suggesting homozygous familial (or type II) hypercholesterolemia. The patient's low density lipoprotein (LDL) receptor function and parental lipoprotein profiles were determined to be normal, prompting revision of the initial diagnosis to pseudohomozygous familial hypercholesterolemia. When she subsequently presented with giant platelets, the case was presented to colleagues on an electronic mailing list. It was recommended that plasma and sterol analysis be performed, which led to a diagnosis of sitosterolemia. The presentation of profound hypercholesterolomia in childhood that ultimately is not attributed as due to homozygous or compound heterozygous defects in the LDL receptor gene has been termed pseudohomozygous familial (or type II) hypercholesterolemia (PHT2HC). Patients diagnosed with PHT2HC subsequently confirmed to have sitosterolemia have been previously reported only rarely. The challenge of achieving accurate specific diagnosis and appropriate workup for these conditions in children is discussed in the context of this rare case and review of the historical literature concerning these conditions. © 2016 Marshfield Clinic.

  18. STS-95 Post Flight Presentation

    Science.gov (United States)

    1998-01-01

    The STS-95 flight crew, Cmdr. Curtis L. Brown, Pilot Steven W. Lindsey, Mission Specialists Scott E. Parazynski, Stephen K. Robinson, and Pedro Duque, and Payload Specialists Chiaki Mukai and John H. Glenn present a video mission over-view of their space flight. Images include prelaunch activities such as eating the traditional breakfast, crew suit-up, and the ride out to the launch pad. Also, included are various panoramic views of the shuttle on the pad. The crew can be seen being readied in the "whiteroom" for their mission. After the closing of the hatch and arm retraction, launch activities are shown including countdown, engine ignition, launch, and the separation of the Solid Rocket Boosters. The primary objectives, which include the conducting of a variety of science experiments in the pressurized SPACEHAB module, the deployment and retrieval of the Spartan free-flyer payload, and operations with the HST Orbiting Systems Test (HOST) and the International Extreme Ultraviolet Hitchhiker (IEH) payloads are discussed in both the video and still photo presentation.

  19. OROPHARYNGEAL TUBERCULOSIS: AN UNUSUAL PRESENTATION

    Directory of Open Access Journals (Sweden)

    M H Dadgarnia

    2008-12-01

    Full Text Available "nTuberculosis (TB still represents a major public health problem worldwide. The primary form of disease is most often localized to the lung. In a minority of patients, progressive pulmonary disease spreads to other organ systems through self inoculation via infected sputum, blood and lymphatic system, establishing the secondary form of tuberculosis. We present a patient that was referred to us with complaint of ulcerative mouth lesions from 3 months ago. In physical examination multiple erythematous and irregularly ulcerative lesions affecting soft palate area, uvula and anterior tonsillar pillar was noted bilaterally. Punch biopsy was done from several points that revealed chronic granulomatous inflammation. Ziehl-Nielsen staining of cultured specimen demonstrated acid-fast bacilli. Chest X-ray showed apical pulmonary involvement, suggesting tuberculosis infection. Patient was treated with anti-tuberculosis 4 drugs regimen. In the one year follow-up period after complete treatment; patient didn't have any evidence of disease. Oral and oropharyngeal TB lesions are uncommon, it is estimated that only 0.05-5% of total TB cases may present with oral manifestations, but should be an important consideration in the differential diagnosis of lesions that appear in the oral cavity and oropharynx. The secondary form is more frequent and involves mainly the tongue but involvement of pharynx is quite rare condition. Although tuberculosis of oropharynx is relatively rare, with the increasing incidence of tuberculosis, it must be considered in the differential diagnosis of atypical ulcerative lesions of the mouth and oropharynx.

  20. Early presentation of primary glioblastoma.

    Science.gov (United States)

    Faguer, R; Tanguy, J-Y; Rousseau, A; Clavreul, A; Menei, P

    2014-08-01

    Clinical and neuroimaging findings of glioblastomas (GBM) at an early stage have rarely been described and those tumors are most probably under-diagnosed. Furthermore, their genetic alterations, to our knowledge, have never been previously reported. We report the clinical as well as neuroimaging findings of four early cases of patients with GBM. In our series, early stage GBM occurred at a mean age of 57 years. All patients had seizures as their first symptom. In all early stages, MRI showed a hyperintense signal on T2-weighted sequences and an enhancement on GdE-T1WI sequences. A hyperintense signal on diffusion sequences with a low ADC value was also found. These early observed occurrences of GBM developed rapidly and presented the MRI characteristics of classic GBM within a few weeks. The GBM size was multiplied by 32 in one month. Immunohistochemical analysis indicated the de novo nature of these tumors, i.e. absence of mutant IDH1 R132H protein expression, which is a diagnostic marker of low-grade diffuse glioma and secondary GBM. A better knowledge of early GBM presentation would allow a more suitable management of the patients and may improve their prognosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  1. Teratology - past, present and future.

    Science.gov (United States)

    Ujházy, Eduard; Mach, Mojmír; Navarová, Jana; Brucknerová, Ingrid; Dubovický, Michal

    2012-12-01

    Teratology is the science that studies the causes, mechanisms, and patterns of abnormal development. The authors present an updated overview of the most important milestones and stages of the development of modern teratology. Development of knowledge and society led to the recognition that causes of congenital developmental disorders (CDDs) might be caused by various mechanical effects, foetal diseases, and retarded or arrested development of the embryo and foetus. Based on the analysis of the historical development of hypotheses and theories representing a decisive contribution to this field, we present a survey of the six Wilson's fundamental principles of teratology. The aim of observing these principles is to get insight into developmental relations and to understand mechanisms of action on the level of cell populations (elementary morphogenetic processes), tissues and organs. It is important to realise that any negative intervention into the normal course of these processes, either on genetic or non-genetic basis, inevitably leads to a sequence of subsequent changes resulting in CDDs. Moreover, the classical toxicologic monotonic dose-response paradigm recently has been challenged by the so-called "low dose-hypothesis", particularly in the case of endocrine active substances. These include some pesticides, dioxins, polychlorobiphenyls (PCBs), and bisphenol A. Despite modern approaches of molecular biology and genetics, along with top diagnostic techniques, we are still not able to identify the actual cause in more than 65 to 70% of all congenital defects classified as having an unknown etiology. Today CDDs include any birth defect, either morphological, biochemical, or behavioural.

  2. Cutaneous sporotrichosis: Unusual clinical presentations

    Directory of Open Access Journals (Sweden)

    Mahajan Vikram

    2010-01-01

    Full Text Available Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations. Case 1, a 52-year-old man, developed sporotrichosis over pre-existing facial nodulo-ulcerative basal cell carcinoma of seven-year duration, due to its contamination perhaps from topical herbal pastes and lymphocutaneous sporotrichosis over right hand/forearm from facial lesion/herbal paste. Case 2, a 25-year-old woman, presented with disseminated systemic-cutaneous, osteoarticular and possibly pleural (effusion sporotrichosis. There was no laboratory evidence of tuberculosis and treatment with anti-tuberculosis drugs (ATT did not benefit. Both these cases were diagnosed by histopathology/culture of S. schenckii from tissue specimens. Case 3, a 20-year-old girl, had multiple intensely pruritic, nodular lesions over/around left knee of two-year duration. She was diagnosed clinically as a case of prurigo nodularis and histologically as cutaneous tuberculosis, albeit, other laboratory investigations and treatment with ATT did not support the diagnosis. All the three patients responded well to saturated solution of potassium iodide (SSKI therapy. A high clinical suspicion is important in early diagnosis and treatment to prevent chronicity and morbidity in these patients. SSKI is fairly safe and effective when itraconazole is not affordable/ available.

  3. Bilirubin present in diverse angiosperms.

    Science.gov (United States)

    Pirone, Cary; Johnson, Jodie V; Quirke, J Martin E; Priestap, Horacio A; Lee, David

    2010-01-01

    Bilirubin is an orange-yellow tetrapyrrole produced from the breakdown of heme by mammals and some other vertebrates. Plants, algae and cyanobacteria synthesize molecules similar to bilirubin, including the protein-bound bilins and phytochromobilin which harvest or sense light. Recently, we discovered bilirubin in the arils of Strelitzia nicolai, the White Bird of Paradise Tree, which was the first example of this molecule in a higher plant. Subsequently, we identified bilirubin in both the arils and the flowers of Strelitzia reginae, the Bird of Paradise Flower. In the arils of both species, bilirubin is present as the primary pigment, and thus functions to produce colour. Previously, no tetrapyrroles were known to generate display colour in plants. We were therefore interested in determining whether bilirubin is broadly distributed in the plant kingdom and whether it contributes to colour in other species. In this paper, we use HPLC/UV and HPLC/UV/electrospray ionization-tandem mass spectrometry (HPLC/UV/ESI-MS/MS) to search for bilirubin in 10 species across diverse angiosperm lineages. Bilirubin was present in eight species from the orders Zingiberales, Arecales and Myrtales, but only contributed to colour in species within the Strelitziaceae. The wide distribution of bilirubin in angiosperms indicates the need to re-assess some metabolic details of an important and universal biosynthetic pathway in plants, and further explore its evolutionary history and function. Although colour production was limited to the Strelitziaceae in this study, further sampling may indicate otherwise.

  4. Anaphylactic reactions presenting with hypertension.

    Science.gov (United States)

    Solmazgul, Emrullah; Kutlu, Ali; Dogru, Salim; Ozalper, Veysel; Cetindagli, Ibrahim; Sezer, Ogun; Salmanoglu, Musa; Kilic, Erol; Karabacak, Ercan; Ozturk, Sami

    2016-01-01

    Although a few case reports about hypertensive anaphylaxis (HA) are available in the present literature, there is no study about the prevalence of HA. In this study, we review our cases with anaphylaxis presenting with hypertension and ascertain its prevalence. The documents of the patients who had anaphylactic reactions after the procedures performed for the diagnosis and treatment of allergic diseases in GATA Haydarpasa Clinic of Allergy and Immunology between January 2010 and December 2014 were retrospectively reviewed. Within the study period, 324 patients had undergone 4332 procedures in which 62 of them had developed anaphylaxis. During the procedures, the rate of anaphylaxis was found to be 1.43 %. The rate of HA among the anaphylaxis patients was 12.9 % (8 of 62 patients). During treatments, 2 patients received adrenaline injections without any adverse reaction. HA may be seen at a considerable rate during an anaphylactic reaction. Anaphylaxis and hypertension can be recovered by adrenaline injection when required. According to the best of our knowledge, this study is the first original study about the prevalence of HA in English-language medical literature.

  5. Aboriginal traditional knowledge - panel presentation

    Energy Technology Data Exchange (ETDEWEB)

    Barnaby, J. [JB, Consultant, Paris (France); Duiven, M. [Skeena Fisheries Commission, Kispiox, BC (Canada); Garibaldi, A. [Integral Ecology Group, Ltd., Victoria, BC (Canada); McGregor, D. [Univ. of Toronto, Dept. of Geography and Aboriginal Studies, Toronto, ON (Canada); Straker, J. [Integral Ecology Group, Ltd., Victoria, BC (Canada); Patton, P. [Nuclear Waste Management Organization, Toronto, ON (Canada)

    2011-07-01

    Aboriginal peoples in Canada are playing a more active role in land use and resource management decisions around industrial development in their traditional territories and communities. Both indigenous and non-indigenous people are therefore increasing efforts to collaborate in decision-making and to effectively interweave Aboriginal Traditional Knowledge (ATK) and Western knowledge or science. Challenges exist, in part because non-Aboriginal people often find it difficult to define ATK and to understand the differences from Western perspectives. ATK is best defined as a holistic system that involves not only knowledge but principles of conduct and a strong relationship component. Research has focused on approaches to more easily bridge ATK and Western knowledge, through dialogue/negotiation and shared decision-making that is complementary to both. There are some examples of organizations and communities that have achieved success in this bridging of the two forms of knowledge. The Skeena Fisheries Commission (SFC) in British Columbia manages the fish resource in the Skeena Watershed and generates scientific research through links to ATK. The observations of indigenous people about apparent changes in the resource are subjected to scientific assessment, which has led to changes in how fish are caught, and in how and by whom data is collected. Traditional knowledge has also been incorporated into the reclamation of lands and species in Fort McKay, Alberta, an indigenous community whose traditional way of life has been significantly affected by development of the oil sands. New models have been developed to incorporate ATK into long-term planning for land use. This includes using ATK to develop a 50-to 60-year projection of probable future effects from development and to build strategies for achieving a 'desired future landscape.' To plan for post-mining land reclamation projects, another project makes use of cultural keystone species (CKS), through which

  6. Aboriginal traditional knowledge - panel presentation

    International Nuclear Information System (INIS)

    Barnaby, J.; Duiven, M.; Garibaldi, A.; McGregor, D.; Straker, J.; Patton, P.

    2011-01-01

    Aboriginal peoples in Canada are playing a more active role in land use and resource management decisions around industrial development in their traditional territories and communities. Both indigenous and non-indigenous people are therefore increasing efforts to collaborate in decision-making and to effectively interweave Aboriginal Traditional Knowledge (ATK) and Western knowledge or science. Challenges exist, in part because non-Aboriginal people often find it difficult to define ATK and to understand the differences from Western perspectives. ATK is best defined as a holistic system that involves not only knowledge but principles of conduct and a strong relationship component. Research has focused on approaches to more easily bridge ATK and Western knowledge, through dialogue/negotiation and shared decision-making that is complementary to both. There are some examples of organizations and communities that have achieved success in this bridging of the two forms of knowledge. The Skeena Fisheries Commission (SFC) in British Columbia manages the fish resource in the Skeena Watershed and generates scientific research through links to ATK. The observations of indigenous people about apparent changes in the resource are subjected to scientific assessment, which has led to changes in how fish are caught, and in how and by whom data is collected. Traditional knowledge has also been incorporated into the reclamation of lands and species in Fort McKay, Alberta, an indigenous community whose traditional way of life has been significantly affected by development of the oil sands. New models have been developed to incorporate ATK into long-term planning for land use. This includes using ATK to develop a 50-to 60-year projection of probable future effects from development and to build strategies for achieving a 'desired future landscape.' To plan for post-mining land reclamation projects, another project makes use of cultural keystone species (CKS), through which

  7. Uncommon presentation of pulmonary aspergilloma

    Directory of Open Access Journals (Sweden)

    Baradkar V

    2009-01-01

    Full Text Available Cases of pulmonary aspergilloma without any predisposing factors are rarely reported. Clinical presentation varies from case to case. Here, we report a case of pulmonary aspergilloma in a 60-year-old male patient who was admitted to the Intensive Respiratory Care Unit with spontaneous pneumothorax. The patient had a history of dyspnea on exertion since 9 months and mild haemoptysis since the last 6 months. A computerised tomographic scan of the lungs showed a lesion in the left main bronchus along with obstructive emphysema of the right lung, moderate pneumothorax and mediastinal emphysema. Bronchoscopy was performed and the biopsy samples were processed for histopathological examination and culture on Sabouraud′s dextrose agar, which yielded growth of Aspergillus flavus. Repeat sputum samples also yielded the growth of A. flavus . The patient responded to intravenous liposomaamphotericin B and intercostal drainage.

  8. Site selection: Past and present

    International Nuclear Information System (INIS)

    Tilford, N.R.

    1994-01-01

    Site selection has been going on since the earliest times. The process has evolved through the Industrial Revolution to the present period of exploding population and environmental awareness. Now the work must be done both with increasing sophistication and greater transparency. Modern techniques for site selection have been developed during the last two decades or so, utilizing a teachable body of knowledge and a growing literature. Many firms and individuals have contributed to this growing field. The driving force has been the need for such a process in siting and licensing of critical facilities such as nuclear power plants. A list of crucial, documented steps for identifying social impacts and acceptability are provided. A recent innovation is the self-selection method developed by government. The Superconducting Supercollider serves as an example of this approach. Geological or geologically dependent factors often dominate the process. The role as engineering and environmental geoscientists is to provide responsible leadership, consultation, and communication to the effort

  9. Neurocysticercosis presenting as pseudobulbar palsy

    Directory of Open Access Journals (Sweden)

    Arinaganahalli Subbanna Praveen Kumar

    2014-01-01

    Full Text Available Neurocysticercosis (NCC is the most common helminthic infestation of the central nervous system (CNS and a leading cause of acquired epilepsy worldwide. The common manifestations of NCC are seizures and headache. The NCC as a cause of pseudobulbar palsy is very unusual and not reported yet in the literature. A pseudobulbar palsy can occur in any disorder that causes bilateral corticobulbar disease. The common etiologies of pseudobulbar palsy are vascular, demyelinative, or motor neuron disease. We report a 38-year-old female patient who presented with partial seizures and pseudobulbar palsy. The MRI brain showed multiple small cysts with scolex in both the cerebral hemispheres and a giant intraparenchymal cyst. Our patient responded well to standard treatment of neurocysticercosis and antiepileptics.

  10. Present challenges in hadrontherapy techniques

    Science.gov (United States)

    Amaldi, U.; Braccini, S.

    2011-07-01

    Hadrontherapy is a high-precision technique in cancer radiation therapy, which allows obtaining a superior conformal treatment with respect to photons used in conventional radiation therapy. To reach this ambitious goal without reducing the patient throughput needed in a hospital-based environment, the physical and radiobiological properties of charged hadrons, protons and carbon ions in particular, have to be exploited at best, making use of the most modern technologies issued from research in nuclear and particle physics. In the present days, we are assisting to a continuous technological challenge, leading to the conception and to the development of innovative methods and instruments. In this paper, the most relevant challenges in dose delivery systems, gantries, imaging, quality assurance and particle accelerators are reviewed.

  11. Ebolavirus Evolution: Past and Present.

    Science.gov (United States)

    de La Vega, Marc-Antoine; Stein, Derek; Kobinger, Gary P

    2015-01-01

    The past year has marked the most devastating Ebola outbreak the world has ever witnessed, with over 28,000 cases and over 11,000 deaths. Ebola virus (EBOV) has now been around for almost 50 years. In this review, we discuss past and present outbreaks of EBOV and how those variants evolved over time. We explore and discuss selective pressures that drive the evolution of different Ebola variants, and how they may modify the efficacy of therapeutic treatments and vaccines currently being developed. Finally, given the unprecedented size and spread of the outbreak, as well as the extended period of replication in human hosts, specific attention is given to the 2014-2015 West African outbreak variant (Makona).

  12. Ebolavirus Evolution: Past and Present.

    Directory of Open Access Journals (Sweden)

    Marc-Antoine de La Vega

    Full Text Available The past year has marked the most devastating Ebola outbreak the world has ever witnessed, with over 28,000 cases and over 11,000 deaths. Ebola virus (EBOV has now been around for almost 50 years. In this review, we discuss past and present outbreaks of EBOV and how those variants evolved over time. We explore and discuss selective pressures that drive the evolution of different Ebola variants, and how they may modify the efficacy of therapeutic treatments and vaccines currently being developed. Finally, given the unprecedented size and spread of the outbreak, as well as the extended period of replication in human hosts, specific attention is given to the 2014-2015 West African outbreak variant (Makona.

  13. Tritium practices past and present

    International Nuclear Information System (INIS)

    Gede, V.P.; Gildea, P.D.

    1980-01-01

    History of the production and use of tritium, as well as handling techniques, are reviewed. Handling techniques first used at Lawrence Livermore National Laboratory made use of glass vacuum systems and relatively crude ion chambers for monitoring airborne activity. The first use of inert atmosphere glove boxes demonstrated that uptake through the skin could be a serious personnel exposure problem. Growing environmental concerns in the early 1970's resulted in the implementation by the Atomic Energy Commission of a new criteria to limit atmospheric tritium releases to levels as low as practicable. An important result of the new criteria was the development of containment and recovery systems to capture tritium rather than vent it to the atmosphere. The Sandia National Laboratories, Livermore, Tritium Research Laboratory containment and decontamination systems are presented as a typical example of this technology. The application of computers to control systems is expected to provide the greatest potential for change in future tritium handling practices

  14. Speaker's presentations. Energy supply security

    International Nuclear Information System (INIS)

    Pierret, Ch.

    2000-01-01

    This document is a collection of most of the papers used by the speakers of the European Seminar on Energy Supply Security organised in Paris (at the French Ministry of Economy, Finance and Industry) on 24 November 2000 by the General Direction of Energy and Raw Materials, in co-operation with the European Commission and the French Planning Office. About 250 attendees were present, including a lot of high level Civil Servants from the 15 European State members, and their questions have allowed to create a rich debate. It took place five days before the publication, on 29 November 2000, by the European Commission, of the Green Paper 'Towards a European Strategy for the Security of Energy Supply'. This French initiative, which took place within the framework of the European Presidency of the European Union, during the second half-year 2000. will bring a first impetus to the brainstorming launched by the Commission. (author)

  15. Different presentations of pulmonary criptococosis

    International Nuclear Information System (INIS)

    Londono Palacio, Natalia; Ojeda Paulina; Ortiz, Guillermo; Alwers Rolf C; Munive, Abraham Ali

    1998-01-01

    We presented 4 cases studies of criptococosis, all of them with pulmonary compromise, diagnosed at Hospital Santa Clara in a period of 5 years. It's important to note that none of the patients were HIV positive. In the first case studied the cellular immune compromise has, a multifactorial origin: rheumatoid arthritis and the administration of corticoids. In the second case studied, SLE can explain its origin. In the third case studied, because of the short hospital stay, the investigation with respect to the etiology of the immune-compromise was limited. In the fourth case studied, because of a low CD4 count Elisa immunoassay for HIV was repeated without its confirmation. Spontaneous recuperation was obtained, being free of infection for a period of five years

  16. Atypical presentations of celiac disease

    Directory of Open Access Journals (Sweden)

    Balasa Adriana Luminita

    2016-08-01

    Full Text Available In this study we evaluated the association of celiac disease in 81 children with autoimmune disease and genetic syndromes over a two years periods (January 2014 to July 2016 in Pediatric Clinic in Constanta. Because the extraintestinal symptoms are an atypical presentation of celiac disease we determined in these children the presence of celiac disease antibodies: Anti-tissue Transglutaminase Antibody IgA and IgA total serum level as a screening method followeds in selective cases by Anti-tissue Transglutaminase Antibody IgG, anti-endomysial antibodies, deamidated gliadin antibodies IgA and IgG and intestinal biopsia. In our study 8 patients had been diagnosed with celiac disease with extraintestinal symptoms, of which 4 with type 1 diabetes, 1 patient with ataxia, 2 patients with dermatitis herpetiformis and 1 patient with Down syndrome that associate also autoimmune thyroiditis, alopecia areata, enamel hypoplasia.

  17. Oropharyngeal styloids: An unusual presentation

    Directory of Open Access Journals (Sweden)

    Lathadevi Hassan Thotappa

    2012-01-01

    Full Text Available The close proximity of the styloid process to many of the vital neurovascular structures in the neck makes it clinically significant. The styloid process is said to be elongated if it is longer than 3.0 cm in length. Anatomical variations are very common and clinical symptoms arising from such variations have to be recognized. Elongated styloid processes may cause chronic throat pain along with foreign body sensation, dysphagia, vague facial pain, and otalgia. Surgical excision of an elongated styloid is considered as a satisfactory treatment for such cases. Here, we present a unique case of bilaterally elongated styloids that could be visualized just by depressing the tongue, when they appeared like the tusks of an elephant in the oropharyngeal region.

  18. Splenic abscess: a rare presentation

    Directory of Open Access Journals (Sweden)

    Mohit Bhatia

    2015-01-01

    Full Text Available Splenic abscess is a rare clinical entity with an incidence of 0.2-0.7% in autopsy-based studies. When untreated, splenic abscess is associated with nearly 100% mortality; in treated patients, the mortality rate is 16.6% during the first 90 days. It mostly occurs in patients with neoplasia, immunodeficiency, trauma, diabetes or splenic infarct. The incidence of splenic abscess is thought to be growing because of the increase in the number of immunocompromised patients who are particularly at risk for this disease and also because of the widespread use of diagnostic modalities. However, the optimal treatment for this remains unclear. We present a case of a 42-year-old man diagnosed with multiloculated splenic abscess and was subjected to splenectomy.

  19. Safeguards instrumentation: past, present, future

    International Nuclear Information System (INIS)

    Higinbotham, W.A.

    1982-01-01

    Instruments are essential for accounting, for surveillance and for protection of nuclear materials. The development and application of such instrumentation is reviewed, with special attention to international safeguards applications. Active and passive nondestructive assay techniques are some 25 years of age. The important advances have been in learning how to use them effectively for specific applications, accompanied by major advances in radiation detectors, electronics, and, more recently, in mini-computers. The progress in seals has been disappointingly slow. Surveillance cameras have been widely used for many applications other than safeguards. The revolution in TV technology will have important implications. More sophisticated containment/surveillance equipment is being developed but has yet to be exploited. On the basis of this history, some expectations for instrumentation in the near future are presented

  20. Cavernous hemangioma presenting marked hyperostosis

    International Nuclear Information System (INIS)

    Kobata, Hitoshi; Miyake, Hiroji; Kitamura, Junji; Kajikawa, Hiroshi; Ohta, Tomio

    1988-01-01

    The authors report here a case of hemangioma of the left parietal bone which presented headache and papilledema. This patient is a 37-year-old female who had, prior to admission, complained of increasing headache for one year and blurred vision for three months. She had no history of head injury. Local physical examinations revealed a slight bulging in her left parietal region which was insensitive to palpation and not adherent to the overlying scalp. Neurological examinations revealed bilateral papilledema and an incongruous bitemporal upper quadrant defect in the visual field. All the other neurological and laboratory data were normal. A plain skull roentogenogram showed a 9 x 9 cm osteolytic and characteristic honeycomb lesion in the parietal region. Systemic bone survey revealed a similar lesion in the right tibia which was not histologically examined. A marked accumulation of isotopes was detected on the bone scintigrams at both lesions. Selective external carotid angiograms demonstrated a tumor stain fed by the superficial temporal, occipital, and middle meningial arteries. CT scans of the brain and skull clearly showed a local thickening of and structural changes in the skull bone and also a mass effect on the brain and lateral ventricle. The lesioned bone was removed en bloc and replaced by an artificial bone. It was highly vascular, but not adherent to the overlying dura. The post-operative course was uneventful, and the headache and papilledema disappeared. Hemangioma of the skull presenting marked hyperostosis, as reported above, seems to be rare. In addition, in this case, skeletal angioma without any clinical manifestation was detected. Clinical and radiological pictures of the hemangioma of the skull and other bones were briefly discussed. (author)