Thoraxschmerzen bei Kindern und Jugendlichen - das Herz?

Chest pain in children and adolescents is a frequent observation, although potentially relevant disease is rather rare and then found in situations with acute presentation. In children with an inflammatory/infectious clinical context the differential diagnosis is oesophagitis, pleuropneumonia or pericarditis. Potentially dangerous complications may be found in youth with predisposing conditions for aortic dissection, pneumothorax or pulmonary embolism, or even in rare instances for an acute coronary complication. In these cases aggressive diagnostic work-up is mandatory. In the frequent elective outpatient evaluation of teenagers with long-lasting episodes of chest pain, relevant underlying cardiovascular disease only rarely can be found as the cause. In the elective outpatient evaluation for chest pain, usually patient history and clinical examination may be enough to track the problem, the main role of the physician is to provide reassurance with minimal but appropriate testing.

Child Aggression in a Post-Communist Country: Race and Gender Aspects in a Cross-Cultural Comparison

Gypsies represent approximately 2.5% of the Czech population, but are considerably over-represented among the unemployed, prisoners, schooldropouts, neglected children, etc. Together with racist attitudes on the part of the majority, this causes strong inter-ethnic tension and obviouseconomic, moral and political problems. This research studied the way in which this situation is reflected in peer relations between Gypsy andmajority children in schools. Six samples of children (totalling 2974 children aged 7-15, of whom 15% were Gypsies) were studied through peernomination, teacher assessment and self-reporting. Gypsy/non-Gypsy and gender dichotomies were correlated with measures of aggression,victimisation and acceptance/rejection. The results showed that Gypsy children, both boys and girls, were more likely to nominate their Gypsy peers as aggressors than they nominatemajority children, implying that they tend to direct their rejection toward their own kind. The number of Gypsy children in a class was also animportant factor with Gypsies being more likely to be accepted and less likely to appear aggressive when they were only one or two in a class, thanin a class where there was a greater number of Gypsy pupils. When whole classes were taken as the unit of analysis, Gypsy children were seen asmore likely to behave aggressively in class by their Gypsy and non-Gypsy counterparts as well as by their teachers. At the same time they aremuch less likely to become victims of aggression than are non-Gypsy children, both boys and girls. Mr. Rican also found that the acceptance/rejection patterns of Gypsy children betray their unsatisfactory socialisation. Among their peers, Gypsyor non-Gypsy, they tend to prefer aggressors or children who teachers describe as showing little discipline or effort to succeed at school. Partialcorrelation to assess the influence of seniority on aggressiveness provided a warning that the recent lengthening of compulsory school attendance islikely to bring an increase in aggressiveness. He believes that Gypsy ethnic identity has lost many of its important positive aspects, making itsnegative aspects more prominent and more dangerous. He does however find some possible ways for teachers to reinforce the positive aspects ofGypsy children's identities in order to support their socialisation at schools.

Hypersensitivity reactions to quinolones

Quinolones are one of the most important classes of antimicrobial agents discovered in the recent years and one of the most widely used classes of antibiotics in clinical medicine. Their broad spectrum of activity and pharmacokinetic properties make them ideal agents for treating a variety of infections. Their clinical importance is further demonstrated by their activity against a wide range of diseases of public health importance such as anthrax, tuberculosis, bacterial pneumonia, and sexually transmitted diseases. Like other antibiotics, quinolones can cause various, sometimes dangerous hypersensitivity reactions. The underlying pathomechanisms are only poorly understood. Some are thought to be partly non-immune mediated reactions, others are considered to be IgE- or T cell-mediated reactions. This review gives an insight into the different immunological mechanisms leading to the diverse symptoms of quinolone-induced hypersensitivity reactions, with special emphasis on the role of T cells in such reactions.

How Developers Copy

Copy-paste programming is dangerous as it may lead to hidden dependencies between different parts of the system. Modifying clones is not always straight forward, because we might not know all the places that need modification. This is even more of a problem when several developers need to know about how to change the clones. In this paper, we correlate the code clones with the time of the modification and with the developer that performed the modification to detect patterns of how developers copy from one another. We develop a visualization, named Clone Evolution View, to represent the evolution of the duplicated code. We show the relevance of our approach on several large case studies and we distill our experience in forms of interesting copy patterns.

Aerothermodynamic cycle analysis of a dual-spool, separate-exhaust turbofan engine with an interstage turbine burner

This study focuses on a specific engine, i.e., a dual-spool, separate-flow turbofan engine with an Interstage Turbine Burner (ITB). This conventional turbofan engine has been modified to include a secondary isobaric burner, i.e., ITB, in a transition duct between the high-pressure turbine and the low-pressure turbine. The preliminary design phase for this modified engine starts with the aerothermodynamics cycle analysis is consisting of parametric (i.e., on-design) and performance (i.e., off-design) cycle analyses. In parametric analysis, the modified engine performance parameters are evaluated and compared with baseline engine in terms of design limitation (maximum turbine inlet temperature), flight conditions (such as flight Mach condition, ambient temperature and pressure), and design choices (such as compressor pressure ratio, fan pressure ratio, fan bypass ratio etc.). A turbine cooling model is also included to account for the effect of cooling air on engine performance. The results from the on-design analysis confirmed the advantage of using ITB, i.e., higher specific thrust with small increases in thrust specific fuel consumption, less cooling air, and less NOx production, provided that the main burner exit temperature and ITB exit temperature are properly specified. It is also important to identify the critical ITB temperature, beyond which the ITB is turned off and has no advantage at all. With the encouraging results from parametric cycle analysis, a detailed performance cycle analysis of the identical engine is also conducted for steady-stateengine performance prediction. The results from off-design cycle analysis show that the ITB engine at full throttle setting has enhanced performance over baseline engine. Furthermore, ITB engine operating at partial throttle settings will exhibit higher thrust at lower specific fuel consumption and improved thermal efficiency over the baseline engine. A mission analysis is also presented to predict the fuel consumptions in certain mission phases. Excel macrocode, Visual Basic for Application, and Excel neuron cells are combined to facilitate Excel software to perform these cycle analyses. These user-friendly programs compute and plot the data sequentially without forcing users to open other types of post-processing programs.

A randomised controlled trial of spinal manipulative therapy in acute low back pain

OBJECTIVE: To determine whether treatment with spinal manipulative therapy (SMT) administered in addition to standard care is associated with clinically relevant early reductions in pain and analgesic consumption. METHODS: 104 patients with acute low back pain were randomly assigned to SMT in addition to standard care (n = 52) or standard care alone (n = 52). Standard care consisted of general advice and paracetamol, diclofenac or dihydrocodeine as required. Other analgesic drugs or non-pharmacological treatments were not allowed. Primary outcomes were pain intensity assessed on the 11-point box scale (BS-11) and analgesic use based on diclofenac equivalence doses during days 1-14. An extended follow-up was performed at 6 months. RESULTS: Pain reductions were similar in experimental and control groups, with the lower limit of the 95% CI excluding a relevant benefit of SMT (difference 0.5 on the BS-11, 95% CI -0.2 to 1.2, p = 0.13). Analgesic consumptions were also similar (difference -18 mg diclofenac equivalents, 95% CI -43 mg to 7 mg, p = 0.17), with small initial differences diminishing over time. There were no differences between groups in any of the secondary outcomes and stratified analyses provided no evidence for potential benefits of SMT in specific patient groups. The extended follow-up showed similar patterns. CONCLUSIONS: SMT is unlikely to result in relevant early pain reduction in patients with acute low back pain.

Arc-flash analysis of utility power systems

The electric utility business is an inherently dangerous area to work in with employees exposed to many potential hazards daily. One such hazard is an arc flash. An arc flash is a rapid release of energy, referred to as incident energy, caused by an electric arc. Due to the random nature and occurrence of an arc flash, one can only prepare and minimize the extent of harm to themself, other employees and damage to equipment due to such a violent event. Effective January 1, 2009 the National Electric Safety Code (NESC) requires that an arc-flash assessment be performed by companies whose employees work on or near energized equipment to determine the potential exposure to an electric arc. To comply with the NESC requirement, Minnesota Power’s (MP’s) current short circuit and relay coordination software package, ASPEN OneLinerTM and one of the first software packages to implement an arc-flash module, is used to conduct an arc-flash hazard analysis. At the same time, the package is benchmarked against equations provided in the IEEE Std. 1584-2002 and ultimately used to determine the incident energy levels on the MP transmission system. This report goes into the depth of the history of arc-flash hazards, analysis methods, both software and empirical derived equations, issues of concern with calculation methods and the work conducted at MP. This work also produced two offline software products to conduct and verify an offline arc-flash hazard analysis.

Distal Roux-en-Y gastric bypass for the treatment of morbid obesity

Background: Classical Roux-en-Y gastric bypass (cRYGB) is a combined restrictive and slightly malabsorptive operation. Excess-BMI-loss (EBMIL) in cRYGB is ~60%, but is diminished for super obese patients (BMI > 50 kg/m2). We therefore designed a modified, mainly malabsorptive distal RYGB (dRYGB). Methods: We report mid-term results after 77 consecutive dRYGB in which malabsorption is inversely related to the length of the common channel. The common channel was 100–150 cm long depending on preoperative BMI, the biliopancreatic limb was 100 cm long, which left >>250 cm for the alimentary channel. To avoid the potentially dangerous combination of malabsorption with sustained restriction the pouch size was increased to ~50ml and a 25 mm circular stapler was used for the gastro-jejunostomy. Results: 33 open and later on 44 laparoscopic interventions have been performed. Median preoperative BMI was 50.2 kg/m 2. No severe intraoperative complications have been observed and no anastomotic leakage was noted in the postoperative period. 5 patients needed balloon dilation of an anastomotic stricture. 3 marginal ulcers occurred at the gastrojejunostomy. The 54 patients with a follow-up time of over 12 months (median 24 months) showed an overall median BMI-reduction of 17 to an actual median BMI of 31.6 kg/m2, corresponding to a EBMIL of 74.5%. Obesity-related comorbid conditions were significantly reduced or cured. Intermittent diarrhea or steatorrhea in 12 patients was easily treated by pancreatic enzyme supplementation. Conclusion: dRYGB is technically more demanding than cRYGB, but shows excellent results in terms of weight-loss and therefore also in reduction of comorbidity especially in super-obese patients. Measuring all three limb lengths allows for a calibration of the malabsorption. The quality of food-intake being important to (super-) obese patients in terms of quality of life, a less restrictive pouch seems more adapted to them. Lifelong multidisciplinary follow-up is mandatory.

Are full or empty beer bottles sturdier and does their fracture-threshold suffice to break the human skull?

Beer bottles are often used in physical disputes. If the bottles break, they may give rise to sharp trauma. However, if the bottles remain intact, they may cause blunt injuries. In order to investigate whether full or empty standard half-litre beer bottles are sturdier and if the necessary breaking energy surpasses the minimum fracture-threshold of the human skull, we tested the fracture properties of such beer bottles in a drop-tower. Full bottles broke at 30 J impact energy, empty bottles at 40 J. These breaking energies surpass the minimum fracture-threshold of the human neurocranium. Beer bottles may therefore fracture the human skull and therefore serve as dangerous instruments in a physical dispute.

Flash in the Pan: Cross-Class Cooperation in 1916 Iron Range Strike

In the Iron Range Strike of 1916, working-class wives picketed alongside their husbands in a conflict-ridden and dangerous setting. Mine deputies abused immigrant women on the picket lines and in their homes, with several disquieting reports receiving statewide attention in Minnesota. Many middle-class reformers in the Twin Cities grew sympathetic to the plight of northern mining families and became controversially involved the labor struggle. Some middleclass women worked alongside working-class wives and radical organizers from the Industrial Workers of the World (IWW). At the center of this gendered analysis is the cross-class cooperation between an upper-middle class woman, Lenora Austin Hamlin, a radical reformer, Elizabeth Gurley Flynn, and the story of a working-class housewife, Mikla Masonovich. This study will ask how authentic, prevalent, and unproblematic their stories of cross-class cohesive action actually were. In answering this, it will address and identify those factors that impeded women’s potential for unity. “Flash in the Pan” argues that as a result of both real and perceived differences, these networks of women remained isolated, inhibiting each from gaining sufficient power to work cohesively, and marginalizing their influence. Drawing upon a variety of sources, including media representations in newspapers, and archives of social, labor and women’s organizations, this regional study lends state-level insight into the larger gender-labor historiography.

XIAP discriminates between type I and type II FAS-induced apoptosis

FAS (also called APO-1 and CD95) and its physiological ligand, FASL, regulate apoptosis of unwanted or dangerous cells, functioning as a guardian against autoimmunity and cancer development. Distinct cell types differ in the mechanisms by which the 'death receptor' FAS triggers their apoptosis. In type I cells, such as lymphocytes, activation of 'effector caspases' by FAS-induced activation of caspase-8 suffices for cell killing, whereas in type II cells, including hepatocytes and pancreatic beta-cells, caspase cascade amplification through caspase-8-mediated activation of the pro-apoptotic BCL-2 family member BID (BH3 interacting domain death agonist) is essential. Here we show that loss of XIAP (X-chromosome linked inhibitor of apoptosis protein) function by gene targeting or treatment with a second mitochondria-derived activator of caspases (SMAC, also called DIABLO; direct IAP-binding protein with low pI) mimetic drug in mice rendered hepatocytes and beta-cells independent of BID for FAS-induced apoptosis. These results show that XIAP is the critical discriminator between type I and type II apoptosis signalling and suggest that IAP inhibitors should be used with caution in cancer patients with underlying liver conditions.

A real time simulation model of glucose-insulin metabolism for type 1 diabetes patients

In this paper, a simulation model of glucose-insulin metabolism for Type 1 diabetes patients is presented. The proposed system is based on the combination of Compartmental Models (CMs) and artificial Neural Networks (NNs). This model aims at the development of an accurate system, in order to assist Type 1 diabetes patients to handle their blood glucose profile and recognize dangerous metabolic states. Data from a Type 1 diabetes patient, stored in a database, have been used as input to the hybrid system. The data contain information about measured blood glucose levels, insulin intake, and description of food intake, along with the corresponding time. The data are passed to three separate CMs, which produce estimations about (i) the effect of Short Acting (SA) insulin intake on blood insulin concentration, (ii) the effect of Intermediate Acting (IA) insulin intake on blood insulin concentration, and (iii) the effect of carbohydrate intake on blood glucose absorption from the gut. The outputs of the three CMs are passed to a Recurrent NN (RNN) in order to predict subsequent blood glucose levels. The RNN is trained with the Real Time Recurrent Learning (RTRL) algorithm. The resulted blood glucose predictions are promising for the use of the proposed model for blood glucose level estimation for Type 1 diabetes patients.

Reibung – ein unterschätztes Phänomen in der Verpackungslogistik

„Geiz ist geil!“ ist das Motto eines Handelshauses. Aber diese Philosophie erweist sich immer häufiger als ungeeignet, längerfristigen Erfolg zu sichern. Oftmals wird gerade aus diesem Grund wieder verstärkt auf Qualität geachtet, auf die Qualität von Produkten, auf die Qualität von Herstellungsprozessen, auf die Qualität von Logistikprozessen etc. Dieser Sinneswandel beeinflusst auch alle Verpackungsprozesse, da diese untrennbar mit der Sicherung der Produktqualität und der sicheren Abwicklung aller logistischen Prozesse verbunden ist. Neben der Forderung nach einem wirtschaftlichen Produktschutz als Kernaufgabe der Verpackung müssen jedoch auch zwingende Vorgaben – beispielsweise seitens des Gesetzgebers (z. B. im Lebensmittelbereich, in der Gefahrgutlogistik, im Straßenverkehrsrecht) – beachtet werden. Das führt u. a. dazu, dass alle verpackten Güter so geschützt sein sollten, dass sie den Belastungen im Transportprozess, aber auch den Belastungen aufgrund von Ladungs- und Ladeeinheitensicherungsmaßnahmen standhalten können. Da sich jedoch nicht alle Ladegüter oder Packstücke beliebig für form- oder kraftschlüssige Sicherungsmaßnahmen eignen, sollte bei der Auslegung von Verpackungsmaßnahmen insbesondere der hilfreichen Wirkung von Reibungskräften zur Reduzierung zusätzlicher Sicherungsmaßnahmen Aufmerksamkeit gewidmet werden.

Reibung – ein unterschätztes Phänomen in der Verpackungslogistik

„Geiz ist geil!“ ist das Motto eines Handelshauses. Aber diese Philosophie erweist sich immer häufiger als ungeeignet, längerfristigen Erfolg zu sichern. Oftmals wird gerade aus diesem Grund wieder verstärkt auf Qualität geachtet, auf die Qualität von Produkten, auf die Qualität von Herstellungsprozessen, auf die Qualität von Logistikprozessen etc. Dieser Sinneswandel beeinflusst auch alle Verpackungsprozesse, da diese untrennbar mit der Sicherung der Produktqualität und der sicheren Abwicklung aller logistischen Prozesse verbunden ist. Neben der Forderung nach einem wirtschaftlichen Produktschutz als Kernaufgabe der Verpackung müssen jedoch auch zwingende Vorgaben – beispielsweise seitens des Gesetzgebers (z. B. im Lebensmittelbereich, in der Gefahrgutlogistik, im Straßenverkehrsrecht) – beachtet werden. Das führt u. a. dazu, dass alle verpackten Güter so geschützt sein sollten, dass sie den Belastungen im Transportprozess, aber auch den Belastungen aufgrund von Ladungs- und Ladeeinheitensicherungsmaßnahmen standhalten können. Da sich jedoch nicht alle Ladegüter oder Packstücke beliebig für form- oder kraftschlüssige Sicherungsmaßnahmen eignen, sollte bei der Auslegung von Verpackungsmaßnahmen insbesondere der hilfreichen Wirkung von Reibungskräften zur Reduzierung zusätzlicher Sicherungsmaßnahmen Aufmerksamkeit gewidmet werden.

New Security threats for humanitarian aid workers

Two recent events in Afghanistan and Iraq highlight the current security threats for humanitarian aid workers: Firstly, in July 2004 the humanitarian aid organisation Médecins sans Frontières (MSF) stopped its operations in Afghanistan. This decision followed the targeted killing of five MSF aid workers in Northwestern Afghanistan in June 2004, a brutal act unprecedented in the organisation’s history. Afghanistan has become a dangerous place for aid workers: Since March 2003 more than 30 humanitarian aid workers have been killed. Secondly, in September 2004 the so-called “two Simonas”, staff members of the Italian non-governemental organization (NGO) “Un ponte per” (A Bridge for Bagdad) were abducted in Iraq and, fortunately, released in October 2004. Around 130 foreigners have been seized in Iraq in a wave of abductions that began in April. Most have been released, but around 30 have been killed. Due to the tense security situation in Iraq all the expatriate staff members of Western NGOs have been evacuated in the last months.