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Complex Cases (complex + case)
Selected AbstractsMultidisciplinary approach of complicated crown fractures of both superior central incisors: a case reportDENTAL TRAUMATOLOGY, Issue 4 2008Anca Silvia Vâlceanu Since the development of the adhesive dentistry, many case reports of crown fractures restored using adhesive reattachment techniques were published. Complex cases, in which more than one tooth are involved, with fractures differing from each other, require specific treatment of each fracture, taking different advantages of the different remaining tooth structures. This case report describes a patient with dissimilar crown fractures of both superior central incisors. After the endodontic treatment, the patient was treated using the combination of several techniques: periodontal surgery (crown lengthening with apically repositioned flap and osseous resective surgery), adhesive technique and cast restoration plus esthetic crown. The periodontal procedure re-created the biologic width and proved to be a reliable adjunctive procedure to the adhesive and the prosthetic techniques used. [source] Punctuated Equilibrium and Agenda-Setting: Bringing Parties Back in: Policy Change after the Dutroux Crisis in BelgiumGOVERNANCE, Issue 3 2008STEFAAN WALGRAVE The article analyzes how focusing events affect the public and political agenda and translate into policy change. Empirically, the study focuses on the policy changes initiated by paedophile Marc Dutroux's arrest in 1996 in Belgium. Theoretically, the article tests whether Baumgartner and Jones's (1993) U.S. punctuated equilibrium approach applies to a most different system case, Belgium being a consociational democracy and a partitocracy. Their approach turns out to be useful to explain this "critical case": Policy change happens when "policy images" and "policy venues" shift. Yet, the Dutroux case shows also that political parties, as key actors in the Belgian policy process, should be integrated more explicitly in the punctuated equilibrium theory. Finally, the article argues that the quantitative analysis of longitudinal data sets on several agendas should be supplemented with qualitative case study evidence (e.g., interviews with key decision makers) to unravel the complex case of issue attention and policy change. [source] Another Nakba: Weapons Availability and the Transformation of the Palestinian National Struggle, 1987,2007INTERNATIONAL STUDIES PERSPECTIVES, Issue 2 2010Francesco Strazzari Violent clashes of June 2007 saw Hamas ousting Fatah from the Gaza Strip, thereby making patent the existence of a deep politico-military split within the Palestinian national movement. This article sheds light on the present face of the conflict in the Palestinian territories by adopting a historical-analytical perspective that emphasizes the role played by the availability of small arms and light weapons, as one of the many structural factors that underlie the transformation of the Palestinian struggle. Aware of the essentially contestable and reductionist nature of this endeavor, the authors examine the way in which the weapons acquisition process has changed in the time period from the beginning of the first Intifada in 1987 to the Gaza take-over by Hamas, 20 years later. In doing this, they extend the applicability of existing theories about the correspondence between access to weapons and the changing nature of insurgency, so to better understand a complex case where a national struggle has been spiralling into internecine violence and splintering, in what we may call "another Palestinian Nakba." [source] Statistical dynamical direct methods.ACTA CRYSTALLOGRAPHICA SECTION A, Issue 3 2001The triplet distribution used for kinematical diffraction is extended to the complex case appropriate for dynamical transmission electron diffraction. It is demonstrated that this gives good results if the distributions are handled statistically rather than relying upon single triplet relationships. As a consequence, conventional statistical direct methods will yield a reasonable approximation to the effective dynamical potential for thicknesses when kinematical theory is not appropriate. The recovered effective dynamical potential may be similar to the kinematical potential, but does not have to be and in general will not be. [source] Selective Adsorption of Polychlorinated Dibenzo- p -dioxins and Dibenzofurans by the Zeosils UTD-1, SSZ-24, and ITQ-4CHEMISTRY - A EUROPEAN JOURNAL, Issue 1 2004Ralph Jäger Dr. Abstract Zeosils are microporous solids with a pure silica framework. Due to their hydrophobic properties, zeosils are ideal host materials for the adsorption of hydrophobic guest molecules. We tested zeosils with different pore diameters (UTD-1, SSZ-24 and ITQ-4 as well as CIT-5) for the selective adsorption of the polychlorinated dibenzo- p -dioxins and dibenzofurans. This group of highly toxic substances contains 210 congeners that possess similar chemical properties, but differ in their size and shape. In the experiment, polychlorinated dibenzo- p -dioxins and dibenzofurans were extracted from fly ash of a waste incinerator, adsorbed on amorphous silica, then thermally desorbed and flushed over a sequential arrangement of the zeosils at elevated temperature by a stream of nitrogen. ITQ-4 with the smallest pore diameter was placed first, followed by SSZ-24 and, finally, by UTD-1 with the largest pore diameter. After the experiment, the zeosils were analysed for their contents of the different congeners. The results show that the sorption of the congeners occurs selectively and that it is governed by the size and the shape of the dioxin molecules, which in turn depend on the number of chlorine atoms and the pattern of chlorine substitution (regioisomers). Geometrical reasoning as well as molecular dynamics calculations on the zeosil structures and on the dioxin molecules were helpful in rationalising the results. This work represents an especially complex case of the molecular sieving effect and may lead to a selective on-line monitoring of the concentrations of dioxin molecules in waste gases of industrial combustion processes. The size- and shape-selective sorption of dioxin molecules may also bear some resemblance to the molecular recognition process that occurs in nature at the aryl hydrocarbon receptor. [source] The clinical presentation of mitochondrial diseases in children with progressive intellectual and neurological deterioration: a national, prospective, population-based studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2010CHRISTOPHER M VERITY Aim, Our aim was to study the clinical presentation, mode of diagnosis, and epidemiology of mitochondrial disorders in children from the UK who have progressive intellectual and neurological deterioration (PIND). Method, Since April 1997, we have identified patients aged 16 years or younger with suspected PIND through the monthly notification card sent to all UK consultant paediatricians by the British Paediatric Surveillance Unit. Clinical details obtained from reporting paediatricians are classified by an Expert Group. Results, By July 2008, 2493 cases of PIND had been reported, among which there were 112 children (69 males, 43 females) with mitochondrial diseases presenting between birth and 14 years 7 months (median 12mo), divided into 13 subgroups. In some instances, clinical features were characteristic of mitochondrial disease, but many children presented non-specifically with combinations of developmental delay, hypotonia, failure to thrive, and seizures; 16 children had multisystem disease at presentation. Mortality was high: 40 children had died. Blood and/or cerebrospinal fluid lactate measurements were abnormal in 87 children, and 47 of 78 brain magnetic resonance images showed increased basal ganglia signal. Definite diagnoses were usually made by muscle enzyme or genetic studies. Interpretation, This is a unique population-based study of the mitochondrial disorders that cause childhood neurodegenerative disease. It provides detailed information about the clinical presentation and investigation of these complex cases. [source] A simplified analysis of interface failure under compressive normal stress and monotonic or cyclic shear loadingINTERNATIONAL JOURNAL FOR NUMERICAL AND ANALYTICAL METHODS IN GEOMECHANICS, Issue 4 2005Zenon Mróz Abstract Interface damage and delamination is usually accompanied by frictional slip at contacting interfaces under compressive normal stress. The present work is concerned with an analysis of progressive interface failure using the cohesive crack model with the critical stress softening and frictional traction present at the contact. Both monotonic and cyclic loadings are considered for anti-plane shear of an elastic plate bonded to a rigid substrate by means of cohesive interface. An analytical solution can be obtained by neglecting the effect of minor shear stress component. The analysis of progressive delamination process revealed three solution types, namely: short, medium and long plate solutions. The long plate solution was obtained under an assumption of quasistatic progressive growth of the delamination zone. In view of snap back response, the quasistatic deformation process cannot be executed by either traction or displacement control. The states of frictional slip accompanied by shake down or incremental failure are distinguished in the case of cyclic loading, related to load amplitude and structural dimensions. The analysis provides a reference solution for numerical treatment of more complex cases. Copyright © 2005 John Wiley & Sons, Ltd. [source] Sliding mesh algorithm for CFD analysis of helicopter rotor,fuselage aerodynamicsINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 5 2008R. Steijl Abstract The study of rotor,fuselage interactional aerodynamics is central to the design and performance analysis of helicopters. However, regardless of its significance, rotor,fuselage aerodynamics has so far been addressed by very few authors. This is mainly due to the difficulties associated with both experimental and computational techniques when such complex configurations, rich in flow physics, are considered. In view of the above, the objective of this study is to develop computational tools suitable for rotor,fuselage engineering analysis based on computational fluid dynamics (CFD). To account for the relative motion between the fuselage and the rotor blades, the concept of sliding meshes is introduced. A sliding surface forms a boundary between a CFD mesh around the fuselage and a rotor-fixed CFD mesh which rotates to account for the movement of the rotor. The sliding surface allows communication between meshes. Meshes adjacent to the sliding surface do not necessarily have matching nodes or even the same number of cell faces. This poses a problem of interpolation, which should not introduce numerical artefacts in the solution and should have minimal effects on the overall solution quality. As an additional objective, the employed sliding mesh algorithms should have small CPU overhead. The sliding mesh methods developed for this work are demonstrated for both simple and complex cases with emphasis placed on the presentation of the inner workings of the developed algorithms. Copyright © 2008 John Wiley & Sons, Ltd. [source] Ordering the alternatives of a strategic plan for Valencia (Spain)JOURNAL OF MULTI CRITERIA DECISION ANALYSIS, Issue 3 2001Pablo Aragonés Abstract In this article we present an evaluation of the initiatives involved in a Strategic Plan for Valencia City (Spain) by applying a method to assist Multi-Criteria Decision-Making. The complexity of the case lies in the size of the problem, 47 alternatives and 10 criteria, as well as the need to reach a consensus on the final result. The method followed, which has been named PRES Multi-expert, can be generalized and applied to other complex cases. Thirteen experts have participated in the process, representing different political and social groups of the City, a group of analysts, formed by three lecturers from the Polytechnic University of Valencia, and a consultant, representing the City Hall of Valencia. The PRES algorithm was used to order the alternatives developed in 1992 by Gómez-Senent at this University. In this article we highlight the advantages of applying the Multi-Criteria Decision-Making Aid techniques and the importance of following a procedure to select the criteria, pondering on them and evaluating the alternatives. This procedure ensures that the parties interested in or affected by the decision take part in deciding what measures to adopt. The Multi-expert PRES method facilitates this participation and can be adapted to different types of problems. Copyright © 2001 John Wiley & Sons, Ltd. [source] HP38P MANAGEMENT OF TRAUMATIC PANCREATIC INJURYANZ JOURNAL OF SURGERY, Issue 2007A. M. Warwick Background Trauma to the pancreas is a challenging area both in initial diagnosis and longer-term management. The retroperitoneal location makes clinical diagnosis of injury difficult and delayed diagnosis has morbid complications. Methods A review of patients with a diagnosis of traumatic pancreatic injury was performed, over a period of five years, from 2002 to 2006. We assessed the type of injury that occurred in the pancreas after both blunt and penetrating trauma; the diagnosis and timing of pancreatic injury; the need for operative/radiological intervention; and the complications of these injuries. Specifically patients with complex injuries were evaluated and these cases were critically reviewed. Results We identified 45 of cases of pancreatic trauma, aged 16,85, with a mean ISS of 27.8. Minor injury to the pancreas was found in 29 patients, and 16 patients had severe trauma to the pancreas, either major laceration or transection. Four particularly complex cases were identified, two of which required a Whipple's procedure following gunshot wounds involving the pancreatic head. Two patients with abdominal crush injuries required multiple interventions. Conclusions Patients with pancreatic trauma often have other significant injuries and one should have a high degree of suspicion of pancreatic injury in multiply injured patients. Penetrating injury to the pancreas can result in catastrophic injury requiring radical surgery. Blunt injury should be assessed by magnetic resonance cholangio-pancreatography or at laparotomy. The management of pancreatic trauma is complex and these patients should be managed in a tertiary hospital with involvement by both specialised pancreatic and trauma surgeons. [source] The management of heparin-induced thrombocytopeniaBRITISH JOURNAL OF HAEMATOLOGY, Issue 3 2006David Keeling Abstract The Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology has produced a concise practical guideline to highlight the key issues in the management of heparin-induced thrombocytopenia (HIT) for the practicing physician in the UK. The guideline is evidence-based and levels of evidence are included in the body of the article. All patients who are to receive heparin of any sort should have a platelet count on the day of starting treatment. For patients who have been exposed to heparin in the last 100 d, a baseline platelet count and a platelet count 24 h after starting heparin should be obtained. For all patients receiving unfractionated heparin (UFH), alternate day platelet counts should be performed from days 4 to 14. For surgical and medical patients receiving low-molecular-weight heparin (LMWH) platelet counts should be performed every 2,4 d from days 4 to 14. Obstetric patients receiving treatment doses of LMWH should have platelet counts performed every 2,4 d from days 4 to 14. Obstetric patients receiving prophylactic LMWH are at low risk and do not need routine platelet monitoring. If the platelet count falls by 50% or more, or falls below the laboratory normal range and/or the patient develops new thrombosis or skin allergy between days 4 and 14 of heparin administration HIT should be considered and a clinical assessment made. If the pretest probability of HIT is high, heparin should be stopped and an alternative anticoagulant started at full dosage unless there are significant contraindications while laboratory tests are performed. Platelet activation assays using washed platelets have a higher sensitivity than platelet aggregation assays but are technically demanding and their use should be restricted to laboratories experienced in the technique. Non-expert laboratories should use an antigen-based assay of high sensitivity. Only IgG class antibodies need to be measured. Useful information is gained by reporting the actual optical density, inhibition by high concentrations of heparin, and the cut-off value for a positive test rather than simply reporting the test as positive or negative. In making a diagnosis of HIT the clinician's estimate of the pretest probability of HIT together with the type of assay used and its quantitative result (enzyme-linked immunosorbent assay, ELISA, only) should be used to determine the overall probability of HIT. Clinical decisions should be made following consideration of the risks and benefits of treatment with an alternative anticoagulant. For patients with strongly suspected or confirmed HIT, heparin should be stopped and full-dose anticoagulation with an alternative, such as lepirudin or danaparoid, commenced (in the absence of a significant contraindication). Warfarin should not be used until the platelet count has recovered. When introduced in combination with warfarin, an alternative anticoagulant must be continued until the International Normalised Ratio (INR) is therapeutic for two consecutive days. Platelets should not be given for prophylaxis. Lepirudin, at doses adjusted to achieve an activated partial thromboplastin time (APTT) ratio of 1·5,2·5, reduces the risk of reaching the composite endpoint of limb amputation, death or new thrombosis in patients with HIT and HIT with thrombosis (HITT). The risk of major haemorrhage is directly related to the APTT ratio, lepirudin levels and serum creatinine levels. The patient's renal function needs to be taken into careful consideration before treatment with lepirudin is commenced. Severe anaphylaxis occurs rarely in recipients of lepirudin and is more common in previously exposed patients. Danaparoid in a high-dose regimen is equivalent to lepirudin in the treatment of HIT and HITT. Danaparoid at prophylactic doses is not recommended for the treatment of HIT or HITT. Patients with previous HIT who are antibody negative (usually so after >100 d) who require cardiac surgery should receive intraoperative UFH in preference to other anticoagulants that are less validated for this purpose. Pre- and postoperative anticoagulation should be with an anticoagulant other than UFH or LMWH. Patients with recent or active HIT should have the need for surgery reviewed and delayed until the patient is antibody negative if possible. They should then proceed as above. If deemed appropriate early surgery should be carried out with an alternative anticoagulant. We recommend discussion of these complex cases requiring surgery with an experienced centre. The diagnosis must be clearly recorded in the patient's medical record. [source] Group A streptococcal osteomyelitis: severe presentation and courseACTA PAEDIATRICA, Issue 1 2003D Turner Aim: To evaluate the course of group A streptococcal osteomyelitis associated with severe disease nowadays. Methods: Three consecutive cases of severe group A streptococcal disease with osteomyelitis in children that were documented in Beer Sheva, Israel are described in detail. Results: Two of the three cases were postvaricella. Early in the course of the disease, the presentation resembled that of severe cellulitis. All three patients had severe osteomyelitis and required surgery, and one patient developed chronic osteomyelitis. Sepsis was diagnosed in two cases. Conclusion: Our cases are distinguishable from typical haematogenous staphylococcal osteomyelitis by the severe course and the extensive involvement of bone and soft tissues. The increase in severity of invasive group A streptococcal infections documented throughout the world could account for the difference between our complex cases and the previous reports. [source] Complexity Prediction Instrument to detect ,complex cases' in respiratory wards: instrument developmentJOURNAL OF ADVANCED NURSING, Issue 1 2008Elena Lobo Abstract Title.,Complexity Prediction Instrument to detect ,complex cases' in respiratory wards: instrument development. Aim., This paper is a report of a study to test the hypothesis that the Spanish version of the Complexity Prediction Instrument is a reliable and valid measure of complexity of patients with respiratory disease and to identify the frequency of positive indicators of potential complexity. Background., Respiratory patients are often disabled and severely ill, with co-morbid physical conditions and associated psychosocial problems and need complex nursing care. Method., Trained nurses assessed 299 consecutive adult patients admitted to a respiratory service in Spain from May 2003 until June 2004 with the new, Spanish version of the instrument. Criterion-related validity was tested by studying its ability to predict complexity of care in terms of: severity of illness, scored using the Cumulative Illness Rating Scale; length of hospital stay; ,multiple consultations' during admission; and ,multiple specialists' after discharge. Findings., The hypothesis was supported: patients rating above the standard cut-off point on the Complexity Prediction Instrument scored statistically significantly higher on most of the measures of care complexity studied. Linear regression models showed that the tool was associated with ,length of hospital stay', and predicted both ,multiple consultations' and ,multiple specialists', after controlling for potential confounders. The proportion of ,probable complex cases' was 59·5%. Five positive indicators of potential complexity had a frequency higher than 50%. Conclusion., The Complexity Prediction Instrument is reliable and valid in a new clinical area, respiratory disease. It may be used by nurses for the early prediction of complexity of care. International comparisons may be facilitated with this new Spanish version. [source] | |||||||||||||||||||