CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica

BACKGROUND Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5. METHODS A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine. RESULTS In the CT group, patients needed significantly less oral analgesics (p < 0.001). Overall treatment duration and physician contacts were significantly lower in the CT group (p < 0.001 and 0.002) either. In the CT group, patients lost significant fewer work days due to incapacity (p < 0.001). Surgery had to be performed in 18.2 % of the non-imaging group patients (CT group: 1.9 %; p = 0.008). CONCLUSION This study shows that CT-guided periradicular infiltration in lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept.

The Return of Jewish Woman to Judaism

Anitta Müller-Cohen

Health information exchange: Using metrics to address quality of care and return on investment

Health Information Exchange (HIE) will play a key part in our nation’s effort to improve healthcare. The evidence of HIEs transformational role in healthcare delivery systems is quite limited. The lack of such evidence led us to explore what exists in the healthcare industry that may provide evidence of effectiveness and efficiency of HIEs. The objective of the study was to find out how many fully functional HIEs are using any measurements or metrics to gauge impact of HIE on quality improvement (QI) and on return on investment (ROI).^ A web-based survey was used to determine the number of operational HIEs using metrics for QI and ROI. Our study highlights the fact that only 50 percent of the HIEs who responded use or plan to use metrics. However, 95 percent of the respondents believed HIEs improve quality of care while only 56 percent believed HIE showed positive ROI. Although operational HIEs present numerous opportunities to demonstrate the business model for improving health care quality, evidence to document the impact of HIEs is lacking. ^

(Table 1) Characteristics of South Pole personnel according to forced expiratory flow (FEF25-75) response to altitude

The impact of acute altitude exposure on pulmonary function is variable. A large inter-individual variability in the changes in forced expiratory flows (FEFs) is reported with acute exposure to altitude, which is suggested to represent an interaction between several factors influencing bronchial tone such as changes in gas density, catecholamine stimulation, and mild interstitial edema. This study examined the association between FEF variability, acute mountain sickness (AMS) and various blood markers affecting bronchial tone (endothelin-1, vascular endothelial growth factor (VEGF), catecholamines, angiotensin II) in 102 individuals rapidly transported to the South Pole (2835 m). The mean FEF between 25 and 75% (FEF25-75) and blood markers were recorded at sea level and after the second night at altitude. AMS was assessed using Lake Louise questionnaires. FEF25-75 increased by an average of 12% with changes ranging from -26 to +59% from sea level to altitude. On the second day, AMS incidence was 36% and was higher in individuals with increases in FEF25-75 (41 vs. 22%, P = 0.05). Ascent to altitude induced an increase in endothelin-1 levels, with greater levels observed in individuals with decreased FEF25-75. Epinephrine levels increased with ascent to altitude and the response was six times larger in individuals with decreased FEF25-75. Greater levels of endothelin-1 in individuals with decreased FEF25-75 suggest a response consistent with pulmonary hypertension and/or mild interstitial edema, while epinephrine may be upregulated in these individuals to clear lung fluid through stimulation of beta2-adrenergic receptors.

A return-on-investment framework to identify conservation priorities in Africa

Environmental conservation activities must continue to become more efficient and effective, especially in Africa where development and population growth pressures continue to escalate. Recently, prioritization of conservation resources has focused on explicitly incorporating the economic costs of conservation along with better defining the outcomes of these expenditures. We demonstrate how new global and continental data that spans social, economic, and ecological sectors creates an opportunity to incorporate return-on-investment (ROI) principles into conservation priority setting for Africa. We suggest that combining conservation priorities that factor in biodiversity value, habitat quality, and conservation management investments across terrestrial, freshwater, and coastal marine environments provides a new lens for setting global conservation priorities. Using this approach we identified seven regions capturing interior and coastal resources that also have high ROI values that support further investment. We illustrate how spatially explicit, yet flexible ROI analysis can help to better address uncertainty, risk, and opportunities for conservation, while making values that guide prioritization more transparent. In one case the results of this prioritization process were used to support new conservation investments. Acknowledging a clear research need to improve cost information, we propose that adopting a flexible ROI framework to set conservation priorities in Africa has multiple potential benefits.

Simulated Bromoform emission and concentration using the ocean biogeochemistry model MPIOM/HAMOCC forced by 6-hourly NCEP data

Bromoform (CHBr3) is one important precursor of atmospheric reactive bromine species that are involved in ozone depletion in the troposphere and stratosphere. In the open ocean bromoform production is linked to phytoplankton that contains the enzyme bromoperoxidase. Coastal sources of bromoform are higher than open ocean sources. However, open ocean emissions are important because the transfer of tracers into higher altitude in the air, i.e. into the ozone layer, strongly depends on the location of emissions. For example, emissions in the tropics are more rapidly transported into the upper atmosphere than emissions from higher latitudes. Global spatio-temporal features of bromoform emissions are poorly constrained. Here, a global three-dimensional ocean biogeochemistry model (MPIOM-HAMOCC) is used to simulate bromoform cycling in the ocean and emissions into the atmosphere using recently published data of global atmospheric concentrations (Ziska et al., 2013) as upper boundary conditions. Our simulated surface concentrations of CHBr3 match the observations well. Simulated global annual emissions based on monthly mean model output are lower than previous estimates, including the estimate by Ziska et al. (2013), because the gas exchange reverses when less bromoform is produced in non-blooming seasons. This is the case for higher latitudes, i.e. the polar regions and northern North Atlantic. Further model experiments show that future model studies may need to distinguish different bromoform-producing phytoplankton species and reveal that the transport of CHBr3 from the coast considerably alters open ocean bromoform concentrations, in particular in the northern sub-polar and polar regions.

Simulated Methyl iodide emission and concentration using the ocean biogeochemistry model MPIOM/HAMOCC forced by OMIP data

Production pathways of the prominent volatile organic halogen compound methyl iodide (CH3I) are not fully understood. Based on observations, production of CH3I via photochemical degradation of organic material or via phytoplankton production has been proposed. Additional insights could not be gained from correlations between observed biological and environmental variables or from biogeochemical modeling to identify unambiguously the source of methyl iodide. In this study, we aim to address this question of source mechanisms with a three-dimensional global ocean general circulation model including biogeochemistry (MPIOM-HAMOCC (MPIOM - Max Planck Institute Ocean Model HAMOCC - HAMburg Ocean Carbon Cycle model)) by carrying out a series of sensitivity experiments. The simulated fields are compared with a newly available global data set. Simulated distribution patterns and emissions of CH3I differ largely for the two different production pathways. The evaluation of our model results with observations shows that, on the global scale, observed surface concentrations of CH3I can be best explained by the photochemical production pathway. Our results further emphasize that correlations between CH3I and abiotic or biotic factors do not necessarily provide meaningful insights concerning the source of origin. Overall, we find a net global annual CH3I air-sea flux that ranges between 70 and 260 Gg/yr. On the global scale, the ocean acts as a net source of methyl iodide for the atmosphere, though in some regions in boreal winter, fluxes are of the opposite direction (from the atmosphere to the ocean).

A note on ethnic return migration policy in Kazakhstan : changing priorities and a growing dilemma

This paper offers a brief analysis of the legal aspects of the ethnic return migration policy of Kazakhstan, a post-Soviet Central Asian state that has been active in seeking ties with its diaspora since independence. This paper examines the definition of oralman (repatriates) and the establishment of a quota on the number of Kazakh immigrants who are eligible for government funds to show how the rationale and preferences in repatriation policy have changed over the years. By focusing on changes in migration-related legislation in the late 2000s and early 2010s, the paper notes that two key goals of Kazakhstan’s migration policy are not necessarily consistent with each other: the promotion of an ethnically based nation-building project by encouraging the "return" of co-ethnics living abroad, and building a workforce that is best suited for the development of the state’s economy.

Comparison of natural and forced amplification regimes in plasma-based soft-x-ray lasers seeded by high-order harmonic

The amplification of high-order harmonics (HOH) in a plasma-based amplifier is a multiscale, temporal phenomenon that couples plasma hydrodynamics, atomic processes, and HOH electromagnetic fields. We use a one-dimensional, time-dependent Maxwell-Bloch code to compare the natural amplification regime and another regime where plasma polarization is constantly forced by the HOH. In this regime, a 10-MW (i.e., 100 times higher than current seeded soft x-ray laser power), 1.5-μJ, 140-fs pulse free from the parasitic temporal structures appearing on the natural amplification regime can be obtained.

Forced response of Bladed Disks with Damping Mistuning

The effect of mistuning on the vibration of bladed disks has been extensively studied in the past 30 years. Most of these analysis typically cover the case of small variations of the elastic characteristics (mass and stiffness) of the blades. In this work we study the not so common case of the forced response of a stable rotor with damping mistuning. The Asymptotic Mistuning Model (AMM) is used to analyze this problem. The AMM methodology provides a simplified model that describes the effect of blade to blade damping variation, and gives precise information on the underlying mechanisms involved in the action of damping mistuning.

Transpose return relation method for designing low noise oscillators

In this paper, a new linear method for optimizing compact low noise oscillators for RF/MW applications will be presented. The first part of this paper makes an overview of Leeson's model. It is pointed out, and it is demonstrates that the phase noise is always the same inside the oscillator loop. It is presented a general phase noise optimization method for reference plane oscillators. The new method uses Transpose Return Relations (RRT) as true loop gain functions for obtaining the optimum values of the elements of the oscillator, whatever scheme it has. With this method, oscillator topologies that have been designed and optimized using negative resistance, negative conductance or reflection coefficient methods, until now, can be studied like a loop gain method. Subsequently, the main disadvantage of Leeson's model is overcome, and now it is not only valid for loop gain methods, but it is valid for any oscillator topology. The last section of this paper lists the steps to be performed to use this method for proper phase noise optimization during the linear design process and before the final non-linear optimization. The power of the proposed RRT method is shown with its use for optimizing a common oscillator, which is later simulated using Harmonic Balance (HB) and manufactured. Then, the comparison of the linear, HB and measurements of the phase noise are compared.

A New Collaboration Between Josep Lluís Sert and Joan Miró on Their Return to Spain: From the Republic Pavilion to Joan Miró Studio

Ponencia publicada en las Actas del Congreso Internacional de la EAHN (EUROPEAN ARCHITECTURAL HISTORY NETWORK), celebrado en Bruselas del 31 Mayo -3 Junio 2012.

Arquitecturas desplazadas. Rafael Bergamín y las arquitecturas del exilio español en Venezuela

El siglo XX ha sido el siglo de los desplazamientos. Una ingente cantidad de personas fueron forzadas por motivos políticos, o se vieron obligadas por motivos económicos, a abandonar sus territorios de origen, generando un distanciamiento que en la mayoría de los casos resultaría irrecuperable. Las penurias vividas en Europa, las oportunidades que se abrían en países americanos, o la presión ejercida por los regímenes totalitarios, llevaron a un buen número de profesionales, artistas e intelectuales europeos a territorio americano. El presente trabajo se propone indagar sobre una de esas migraciones que se establecieron en Latinoamérica en la primera mitad del siglo XX: la de los arquitectos españoles que se vieron forzados al exilio. Para ello se busca poner en evidencia no sólo sus aportaciones sino también la influencia que ejerció en su obra la cultura de los países de adopción. Venezuela recibió gran parte del contingente de arquitectos españoles desplazados como consecuencia de la Guerra Civil. Tras México fue el país que mayor número acogió. La llegada de dichos exiliados coincidió con el momento en que la sociedad venezolana, de base agrícola y comercial, pasaría a evidenciar el impacto de la revolución petrolera. Así pues, dicha llegada supuso no sólo la dramática pérdida del mundo previo, implícita en todo exilio, sino el arribo a una sociedad en profundo proceso de cambio. En ambos casos se trataba de “mundos que se desvanecen”. Se propone la asunción de la obra de dichos profesionales como una arquitectura desplazada. Un desplazamiento que se produce en dos sentidos: por un lado, se trata de un desplazamiento físico, por otro, la palabra desplazada habla también de la condición secundaria que adquiere la arquitectura ante el drama vital y de supervivencia que afectó a los exiliados. Así pues, a un desplazamiento físico, verificable, se une un desplazamiento en cuanto al nivel de importancia y de atención asignado a la arquitectura. El trabajo comprende una introducción, cuatro capítulos, y un epílogo, a modo de conclusión. A lo largo de dichos capítulos se conjugan el enfoque individual en la obra de uno de estos arquitectos desterrados, Rafael Bergamín, y la visión “coral” de diversas trayectorias vitales que enfrentaron un destino común. Se elige la figura de Bergamín como eje de desarrollo debido a la presencia significativa que tuvo su obra tanto en España como en Venezuela, y por la caracterización de la misma como obra construida en colaboración. La introducción, “Exilios arquitectónicos”, muestra el sustrato estructural, la fundamentación y la metodología empleada, incluyendo “problematizaciones” sobre el exilio arquitectónico. El primer capítulo, “Memoria de partida”, da cuenta de la formación y actuación, durante la preguerra, de los arquitectos españoles que saldrían al exilio. Se introduce un esquema de base generacional y se revela un panorama para nada unívoco. El segundo capítulo, “Guerra y salida al exilio”, aborda la actuación de dichos arquitectos durante la contienda bélica así como la posterior dispersión general del exilio. El tercer capítulo, “Construir desde lo que se desvanece. Arquitectos del exilio español en Venezuela”, propone diversos presupuestos conceptuales en torno al tema del desplazamiento en la arquitectura, revisando la adscripción disciplinar y profesional de los arquitectos españoles exiliados en Venezuela. El cuarto capítulo, “El regreso”, versa sobre el recorrido final de estos arquitectos. Como marco general, se revisa su itinerario de regreso o, en muchos casos, la imposibilidad de retorno. Por último, se dispone la fuente de los diversos documentos de archivos y repositorios, así como el aparato bibliográfico y referencial, empleados en la investigación. Tres anexos se adjuntan al corpus del trabajo. El primero presenta documentos inéditos, hallados durante el pertinente proceso de investigación; el segundo, dibujos de Bergamín, básicamente de las primeras décadas del siglo XX: caricaturas, anuncios y trabajos de la Escuela; el tercero, un esbozo biográfico de los arquitectos del exilio español. ABSTRACT The 20th Century has been the century of displacements. An enormous number of people were forced to leave their homelands for political or economic reasons, which generated a gap that in most of the cases would be unrecoverable. The hardships that people had to endure in Europe, the opportunities that emerged in American countries, or the pressure exerted by totalitarian regimes drove a good number of European professionals, artists and intellectuals to American territory. This research study is intended to investigate one of those migrations that settled in Latin America during the first half of the 20th century: the one of the Spanish architects that were forced into exile. To achieve this, an attempt was made to expose not only their contributions but also the influence that the culture of the countries which welcomed them exerted in their work. Venezuela received a large portion of Spanish architects who were displaced as a consequence of the Civil War. After Mexico, it was the country that sheltered the greatest number of persons. The arrival of these exiled Spanish architects coincided with the moment in which the Venezuelan society – based on agriculture and commerce – would witness the impact of the revolution of the oil industry. Thus, their arrival supposed not only experiencing the dramatic loss of their previous world – implicit in the notion of the exile – but also settling in a society going through a profound change process. In both cases it was about “two worlds that were vanishing.” The assumption of these architects’ work is regarded as a displaced architecture. A displacement that takes place in two ways: on one hand, there was a physical displacement, and on the other hand, the word displaced also talks about the second place that architecture is given when confronted with the urgent drama of survival that affected the exiled community. Hence, a physical, verifiable displacement is combined with a displacement that has to do with the importance and the attention given to architecture. This research study encompasses an introduction, four chapters, and an epilogue as a conclusion. Throughout the chapters, the individual approach to the work of one of these exiled architects, Rafael Bergamín, runs in parallel to an overall view of various other architects’ career paths that faced a common destiny. The work of the architect Bergamín was chosen as the center of this research study due to the significant presence that his work had in Spain as well as in Venezuela, and because its main characteristic was that it was built in collaboration with other architects. The introduction, “Architectural exiles”, shows the structural contextualization, the explanatory thesis statement and the methodology used, including “problematizations” about the architectural exile. The first chapter, “Memory of departure”, contains the academic background and performance during the pre-war time of the Spanish architects that would go into exile. An outline based on different generations and revealing an unambiguous perspective is introduced. The second chapter, “War and departure into exile”, tackles the performance of the Spanish architects during the war, as well as the following general diaspora into exile. The third chapter, “Building from what vanishes. Architects of the Spanish exile in Venezuela”, proposes various conceptual assumptions concerning the topic of displacement in architecture according to the doctrine and professional affiliations of the Spanish architects exiled in Venezuela. The fourth chapter, “The return”, deals with the end of these architects’ careers. As a general framework, their itineraries to return, or in many cases, the impossibility of returning, are reviewed. Finally, the sources to the various documents of files and repositories, as well as the bibliographical references consulted for the research, are provided. Three annexes have been attached to this research study. The first annex contains unpublished documents found during the research process; the second includes Bergamín’s drawings, basically from the first decades of the 20th century, such as, caricatures, advertisements and assignments done when he was a university student; and the third annex presents a biographical outline of the architects of the Spanish exile.

A bivariate return period based on copulas for hydrologic dam design: accounting for reservoir routing in risk estimation

A multivariate analysis on flood variables is needed to design some hydraulic structures like dams, as the complexity of the routing process in a reservoir requires a representation of the full hydrograph. In this work, a bivariate copula model was used to obtain the bivariate joint distribution of flood peak and volume, in order to know the probability of occurrence of a given inflow hydrograph. However, the risk of dam overtopping is given by the maximum water elevation reached during the routing process, which depends on the hydrograph variables, the reservoir volume and the spillway crest length. Consequently, an additional bivariate return period, the so-called routed return period, was defined in terms of risk of dam overtopping based on this maximum water elevation obtained after routing the inflow hydrographs. The theoretical return periods, which give the probability of occurrence of a hydrograph prior to accounting for the reservoir routing, were compared with the routed return period, as in both cases hydrographs with the same probability will draw a curve in the peak-volume space. The procedure was applied to the case study of the Santillana reservoir in Spain. Different reservoir volumes and spillway lengths were considered to investigate the influence of the dam and reservoir characteristics on the results. The methodology improves the estimation of the Design Flood Hydrograph and can be applied to assess the risk of dam overtopping