Peripheral facial palsy : Grading, Etiology, and Melkersson-Rosenthal Syndrome

The objective of this study was to assess the utility of two subjective facial grading systems, to evaluate the etiologic role of human herpesviruses in peripheral facial palsy (FP), and to explore characteristics of Melkersson-Rosenthal syndrome (MRS). Intrarater repeatability and interrater agreement were assessed for Sunnybrook (SFGS) and House-Brackmann facial grading systems (H-B FGS). Eight video-recorded FP patients were graded in two sittings by 26 doctors. Repeatability for SFGS was from good to excellent and agreement between doctors from moderate to excellent by intraclass correlation coefficient and coefficient of repeatability. For H-B FGS, repeatability was from fair to good and agreement from poor to fair by agreement percentage and kappa coefficients. Because SFGS was at least as good in repeatability as H-B FGS and showed more reliable results in agreement between doctors, we encourage the use of SFGS over H-B FGS. Etiologic role of human herpesviruses in peripheral FP was studied by searching DNA of herpes simplex virus (HSV) -1 and -2, varicella-zoster virus (VZV), human herpesvirus (HHV) -6A, -6B, and -7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) by PCR/microarray methods in cerebrospinal fluid (CSF) of 33 peripheral FP patients and 36 controls. Three patients and five controls had HHV-6 or -7 DNA in CSF. No DNA of HSV-1 or -2, VZV, EBV, or CMV was found. Detecting HHV-7 and dual HHV-6A and -6B DNA in CSF of FP patients is intriguing, but does not allow etiologic conclusions as such. These DNA findings in association with FP and the other diseases that they accompanied require further exploration. MRS is classically defined as a triad of recurrent labial or oro-facial edema, recurrent peripheral FP, and plicated tongue. All three signs are present in the minority of patients. Edema-dominated forms are more common in the literature, while MRS with FP has received little attention. The etiology and true incidence of MRS are unknown. Characteristics of MRS were evaluated at the Departments of Otorhinolaryngology and Dermatology focusing on patients with FP. There were 35 MRS patients, 20 with FP and they were mailed a questionnaire (17 answered) and were clinically examined (14 patients). At the Department of Otorhinolaryngology, every MRS patient had FP and half had the triad form of MRS. Two patients, whose tissue biopsies were taken during an acute edema episode, revealed nonnecrotizing granulomatous findings typical for MRS, the other without persisting edema and with symptoms for less than a year. A peripheral blood DNA was searched for gene mutations leading to UNC-93B protein deficiency predisposing to HSV-1 infections; no gene mutations were found. Edema in most MRS FP patients did not dominate the clinical picture, and no progression of the disease was observed, contrary to existing knowledge. At the Department of Dermatology, two patients had triad MRS and 15 had monosymptomatic granulomatous cheilitis with frequent or persistent edema and typical MRS tissue histology. The clinical picture of MRS varied according to the department where the patient was treated. More studies from otorhinolaryngology departments and on patients with FP would clarify the actual incidence and clinical picture of the syndrome.

Truckies and health promotion: A “hard-to-reach” group without a “proper” workplace.

This literature review was undertaken to inform a settings based health promotion research project, conducted by a public health research team at the Queensland University of Technology (QUT). The aim of this project is to identify how transport workplaces can support their truck drivers to access healthy food options and increase physical activity. Truck drivers in Australia are at increased risk of numerous chronic diseases, in part due to the restrictions placed upon them by the environment in which they work. Barriers to good health through adequate nutrition and physical activity are the result of a complex interaction between government regulations, corporate policies, the built environment and individual factors. Few interventions target this population in a meaningful and sustainable way, though evidence exists for interventions which can be translated into truck drivers working environment.

Clinical teaching: Maintaining an educational role for doctors in the new health care environment

Context and objectives: Good clinical teaching is central to medical education but there is concern about maintaining this in contemporary, pressured health care environments. This paper aims to demonstrate that good clinical practice is at the heart of good clinical teaching. Methods: Seven roles are used as a framework for analysing good clinical teaching. The roles are medical expert, communicator, collaborator, manager, advocate, scholar and professional. Results: The analysis of clinical teaching and clinical practice demonstrates that they are closely linked. As experts, clinical teachers are involved in research, information retrieval and sharing of knowledge or teaching. Good communication with trainees, patients and colleagues defines teaching excellence. Clinicians can 'teach' collaboration by acting as role models and by encouraging learners to understand the responsibilities of other health professionals. As managers, clinicians can apply their skills to the effective management of learning resources. Similarly skills as advocates at the individual, community and population level can be passed on in educational encounters. The clinicians' responsibilities as scholars are most readily applied to teaching activities. Clinicians have clear roles in taking scholarly approaches to their practice and demonstrating them to others. Conclusion: Good clinical teaching is concerned with providing role models for good practice, making good practice visible and explaining it to trainees. This is the very basis of clinicians as professionals, the seventh role, and should be the foundation for the further development of clinicians as excellent clinical teachers.

Solubilities of Hexadecanoic and Octadecanoic Acids in Supercritical CO2 With and Without Cosolvents

The solubilities of hexadecanoic acid (palmitic acid) and octadecanoic acid (stearic acid) in supercritical carbon dioxide without cosolvents and with two cosolvents, namely, ethanol and 3-methyl-1-butanol, were determined at (308 and 318) K at pressures varying from (12.8 to 22.6) MPa. The solubility data, in both the absence and presence of cosolvents, were correlated by a model proposed by Mendez-Santiago and Teja.

Futility and the law: Knowledge, practice and attitudes of doctors in end of life care

Despite the potential harm to patients (and others) and the financial cost of providing futile treatment at the end of life, this practice occurs. This article reports on empirical research undertaken in Queensland that explores doctors’ perceptions about the law that governs futile treatment at the end of life, and the role it plays in medical practice. The findings reveal that doctors have poor knowledge of their legal obligations and powers when making decisions about withholding or withdrawing futile treatment at the end of life; their attitudes towards the law were largely negative; and the law affected their clinical practice and had or would cause them to provide futile treatment.

What does “futility” mean? An empirical study of doctors’ perceptions

Objective(s) To describe how doctors define and use the terms “futility” and “futile treatment” in end-of-life care. Design, Setting, Participants A qualitative study using semi-structured interviews with 96 doctors across a range of specialties who treat adults at the end of life. Doctors were recruited from three large Australian teaching hospitals and were interviewed from May to July 2013. Results Doctors’ conceptions of futility focused on the quality and chance of patient benefit. Aspects of benefit included physiological effect, weighing benefits and burdens, and quantity and quality of life. Quality and length of life were linked, but many doctors discussed instances when benefit was determined by quality of life alone. Most doctors described the assessment of chance of success in achieving patient benefit as a subjective exercise. Despite a broad conceptual consensus about what futility means, doctors noted variability in how the concept was applied in clinical decision-making. Over half the doctors also identified treatment that is futile but nevertheless justified, such as short-term treatment as part of supporting the family of a dying person. Conclusions There is an overwhelming preference for a qualitative approach to assessing futility, which brings with it variation in clinical decision-making. “Patient benefit” is at the heart of doctors’ definitions of futility. Determining patient benefit requires discussions with patients and families about their values and goals as well as the burdens and benefits of further treatment.

Slow rotation of a sphere in a non-Newtonian fluid with or without suction or injection

The flow generated by the rotation of a sphere in an infinitely extending fluid has recently been studied by Goldshtik. The corresponding problem for non-Newtonian Reiner-Rivlin fluids has been studied by Datta. Bhatnagar and Rajeswari have studied the secondary flow between two concentric spheres rotating about an axis in the non-Newtonian fluids. This last investigation was further generalised by Rajeswari to include the effects of small radial suction or injection. In Part A of the present investigation, we have studied the secondary flow generated by the slow rotation of a single sphere in non-Newtonian fluid obeying the Rivlin-Ericksen constitutive equation. In Part B, the effects of small suction or injection have been studied which is applied in an arbitrary direction at the surface of the sphere. In the absence of suction or injection, the secondary flow for small values of the visco-elastic parameter is similar to that of Newtonian fluids with inclusion of inertia terms in the Oseen approximation. If this parameter exceeds Kc = 18R/219, whereR is the Reynolds number, the breaking of the flow field takes place into two domains, in one of which the stream lines form closed loops. For still higher values of this parameter, the complete reversal of the sense of the flow takes place. When suction or injection is included, the breaking of the flow persists under certain condition investigated in this paper. When this condition is broken, the breaking of the flow is obliterated.

Lippu, uhri, kansakunta : Ryhmäkokemukset ja -rajat Suomessa 1917 1945

This dissertation deals with the notions of sacrifice and violence in connection with the Fin¬nish flag struggles between 1917 and 1945. The study begins with the basic idea that sacrificial thinking is a key element in nationalism and the social cohesion of large groups. The method used in the study combines anthropological notions of totemism with psychoanalytical object relation theory. The aim is to explore the social and psychological elements of the Finnish national flag and the workers flags during the times of crisis and nation building. The phenomena and concepts addressed include self-sacrifice, scapegoating, remembrance of war, inclusion, and exclusion. The research is located at the intersection of nationalism studies and the cultural history of war. The analysis is based primarily on the press debates, public speeches and archival sources of the civic organizations that promoted the Finnish flag. The study is empirically divided into three sections: 1) the years of the Revolution and the Civil War (1917 1918), 2) the interwar period (1919 1938), and 3) the Second World War (1939 1945). The research demonstrates that the modern national flags and workers flags in Finland maintain certain characteristics of primitive totems. When referred to as a totem the flag means an emotionally charged symbol, a reservoir of the collective ideals of a large group. Thus the flag issue offers a path to explore the perceptions and memory of sacrifice and violence in the making of the First Republic . Any given large group, for example a nation, must conceptually pursue a consensus on its past sacrifices. Without productive interpretation sacrifice represents only meaningless violence. By looking at the passions associated with the flag the study also illuminates various group identities, boundaries and crossings of borders within the Finnish society at the same time. The study shows further that the divisive violence of the Civil War was first overcome in the late 1930s when the social democrats adopted a new perception of the Red victims of 1918 they were seen as part of the birth pains of the nation, and not only the martyrs of class struggle. At the same time the radical Right became marginalized. The study also illuminates how this development made the Spirit of the Winter War possible, a genuine albeit brief experience of horizontal brother and sisterhood, and how this spirit was reflected in the popular adoption of the Finnish flag. The experience was not based only on the external and unifying threat posed by the Soviet Union: it was grounded in a sense of unifying sacrifice which reflected a novel way of understanding the nation and its past sacrifices. Paradoxically, the newly forged consensus over the necessity and the rewards of the common sacrifices of the Winter War (1939 1940) made new sacrifices possible during the Continuation War (1941 1944). In spite of political discord and war weariness, the concept of a unified nation under the national flag survived even the absurdity of the stationary war phase. It can be said that the conflict between the idea of a national community and parliamentary party politics dissolved as a result of the collective experience of the Second World War.

Oscillations of a three-component assembly with or without magnetic field

The plasma is taken to be composed of singly ionized molecules, free electrons and neutral molecules, each of the component being described by the hydromagnetic equations, modified to take into account the displacement current, existence of free charge in the medium, and the modified current equation without involving the scalar conductivity. The basic equations are linearized and only small amplitude waves are considered. In the absence of any external magnetic field, the transverse and longitudinal modes of oscillation separate out. In the transverse part a coupled plasma oscillation occurs which could be propagated only above a certain critical frequency and in the longitudinal part one extraordinary mode of propagation occurs having a forbidden range of frequencies. When there is an external applied magnetic field, ordinary and extraordinary waves are propagated along the direction of the magnetic field, whereas only ordinary waves are propagated transverse to the magnetic field. The critical frequencies above which these waves are propagated are evaluated and, the possible explanation of this medium like behaviour could be the implicit assumption of conductivity being not a scalar.

The Merger Storm Recognizes No Borders: An Analysis of Media Rhetoric on a Business Manoeuvre

Despite the central role of the media in contemporary society, studies examining the rhetorical practices of journalists are rare in organization and management research. We know little of the textual micro strategies and techniques through which journalists convey specific messages to their readers. Partially to fill the gap, this paper outlines a methodological framework that combines three perspectives of text analysis and interpretation: critical discourse analysis, systemic functional grammar and rhetorical structure theory. Using this framework, we engage in a close reading of a single media text (a press article) on a recent case of industrial restructuring in the financial services. In our empirical analysis, we focus on key arguments put forward by the journalists’ rhetorical constructions. We maintain that these arguments—which are not frame-breaking but rather tend to confirm existing presuppositions held by the audience—are an essential part of the legitimization and naturalization of specific management ideas and ideologies.

Generalised vortex motion of compressible fluid with and without magnetic field and suction

The laminar boundary layer over a stationary infinite disk induced by a rotating compressible fluid is considered. The free stream velocity has been taken as tangential and varies as a power of radius, i.e. v∞ ˜ r−n. The effect of the axial magnetic field and suction is also included in the analysis. An implicit finite difference scheme is employed to the governing similarity equations for numerical computations. Solutions are studied for various values of disk to fluid temperature ratio and for values of n between 1 and −1. In the absence of the magnetic field and suction, velocity profiles exhibit oscillations. It has been observed that for a hot disk in the presence of a magnetic field the boundary layer solutions decay algebraically instead of decaying exponentially. In the absence of the magnetic field and suction, the solution of the similarity equations exists only for a certain range of n.

Size effect in self consolidating concrete beams with and without notches

The aim of this study is to obtain the fracture characteristics of low and medium compressive strength self consolidating concrete (SCC) for notched and un-notched plain concrete beams by using work of fracture G(F) and size effect model G(f) methods and comparing them with those of normal concrete and high performance concrete. The results show that; (i) with an increase in compressive strength, G(F) increases and G(f) decreases; (ii) with an increase in depth of beam, the decrease in nominal stress of notched beam is more when compared with that of a notchless beam.

Integrating strong and weak discontinuities without integration subcells and example applications in an XFEM/GFEM framework

Partition of unity methods, such as the extended finite element method, allows discontinuities to be simulated independently of the mesh (Int. J. Numer. Meth. Engng. 1999; 45:601-620). This eliminates the need for the mesh to be aligned with the discontinuity or cumbersome re-meshing, as the discontinuity evolves. However, to compute the stiffness matrix of the elements intersected by the discontinuity, a subdivision of the elements into quadrature subcells aligned with the discontinuity is commonly adopted. In this paper, we use a simple integration technique, proposed for polygonal domains (Int. J. Nuttier Meth. Engng 2009; 80(1):103-134. DOI: 10.1002/nme.2589) to suppress the need for element subdivision. Numerical results presented for a few benchmark problems in the context of linear elastic fracture mechanics and a multi-material problem show that the proposed method yields accurate results. Owing to its simplicity, the proposed integration technique can be easily integrated in any existing code. Copyright (C) 2010 John Wiley & Sons, Ltd.

Chronopotentiometry with power-law perturbation functions at an expanding plane electrode with and without a preceding blank period for systems with a coupled first-order homogeneous chemical reaction

The systems formalism is used to obtain the interfacial concentration transients for power-law current input at an expanding plane electrode. The explicit results for the concentration transients obtained here pertain to arbitrary homogeneous reaction schemes coupled to the oxidant and reductant of a single charge-transfer step and the power-law form without and with a preceding blank period (for two types of power-law current profile, say, (i) I(t) = I0(t−t0)q for t greater-or-equal, slanted t0, I(t) = 0 for t < t0; and (ii) I(t) = I0tq for t greater-or-equal, slanted t0, I(t) = 0 for t < t0). Finally the potential transients are obtained using Padé approximants. The results of Galvez et al. (for E, CE, EC, aC) (J. Electroanal. Chem., 132 (1982) 15; 146 (1983) 221, 233, 243), Molina et al. (for E) (J. Electroanal. Chem., 227 (1987) 1 and Kies (for E) (J. Electroanal. Chem., 45 (1973) 71) are obtained as special cases.