987 resultados para intermittent


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The present dissertation focuses on the dual number in Ancient Greek in a diachronical lapse stretching from the Mycenaean age to the Attic Drama and Comedy of the 5th century BC. In the first chapter morphological issues are addressed, chiefly in a comparative perspective. The Indo European evidence on the dual is hence gathered in order to sketch patterns of grammaticalisation and paradigmatisation of specific grams, growing increasingly functional within the Greek domain. In the second chapter syntactical problems are tackled. After a survey of scholarly literature on the Greek dual, we engage in a functional and typological approach, in order to disentangle some biased assessments on the dual, namely its alleged lack of regularity and intermittent agreement. Some recent frameworks in General Linguistics provide useful grounds for casting new light on the subject. Internal Reconstruction, for instance, supports the facultativity of the dual in each and every stage of its development; Typology and the Animacy Hierarcy add precious cross linguistical insight on the behaviour of the dual toward agreement. Glaring differences also arise as to the adoption — or avoidance — of the dual by different authors. Idiolectal varieties prove in fact conditioned by stylistical and register necessity. By means of a comparison among Epics, Tragedy and Comedy it is possible to enhance differences in the evaluation of the dual, which led sometimes to forms of ‘censure’ — thus triggering the onset of competing strategies to express duality. The last two chapters delve into the tantalising variety of the Homeric evidence, first of all in an account of the notorious issue of the Embassy of Iliad IX, and last in a commentary of all significant Homeric duals — mostly represented by archaisms, formulae, and ad hoc coinages.

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Wireless Sensor Networks (WSNs) offer a new solution for distributed monitoring, processing and communication. First of all, the stringent energy constraints to which sensing nodes are typically subjected. WSNs are often battery powered and placed where it is not possible to recharge or replace batteries. Energy can be harvested from the external environment but it is a limited resource that must be used efficiently. Energy efficiency is a key requirement for a credible WSNs design. From the power source's perspective, aggressive energy management techniques remain the most effective way to prolong the lifetime of a WSN. A new adaptive algorithm will be presented, which minimizes the consumption of wireless sensor nodes in sleep mode, when the power source has to be regulated using DC-DC converters. Another important aspect addressed is the time synchronisation in WSNs. WSNs are used for real-world applications where physical time plays an important role. An innovative low-overhead synchronisation approach will be presented, based on a Temperature Compensation Algorithm (TCA). The last aspect addressed is related to self-powered WSNs with Energy Harvesting (EH) solutions. Wireless sensor nodes with EH require some form of energy storage, which enables systems to continue operating during periods of insufficient environmental energy. However, the size of the energy storage strongly restricts the use of WSNs with EH in real-world applications. A new approach will be presented, which enables computation to be sustained during intermittent power supply. The discussed approaches will be used for real-world WSN applications. The first presented scenario is related to the experience gathered during an European Project (3ENCULT Project), regarding the design and implementation of an innovative network for monitoring heritage buildings. The second scenario is related to the experience with Telecom Italia, regarding the design of smart energy meters for monitoring the usage of household's appliances.

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Il cancro colorettale (CRC) rimane la prima causa di morte nei paesi occidentali.Dal 15% al 25% dei pazienti affetti da CRC presenta metastasi epatiche sincrone (CRLM) al momento della diagnosi.La resezione epatica radicale rimane l’unica terapia potenzialmente curativa in presenza di CRLM con una sopravvivenza a 5 anni compresa tra il 17% ed il 35% ed a 10 anni tra il 16% e il 23% rispettivamente. La tempistica ottimale per la resezione chirurgica in caso di presentazione sincrona di CRC è controversa.Questo studio intende dimostrare che le resezioni epatiche ecoguidate radicali ma conservative simultanee ad una resezione colorettale rappresentano una tecnica sicura ed efficace nei pazienti con CRC avanzato. 48 pazienti sono stati sottoposti ad una resezione simultanea colorettale ed epatica. L’età media +SD (range) era di 64,2+9,7 (38-84).Un solo paziente è deceduto entro 30 giorni. La mortalità post operatoria è stata complessivamente del 2,1%. Nove pazienti (18,8%) hanno sviluppato una o più complicanza ,4 (8,3%) di grado III-IV sec. Clavien-Dindo e 5 (10,4%) di grado I-II. La durata complessiva dell’intervento chirurgico simultaneo è stata di 486,6+144,0 (153-804) minuti.Questo studio conferma che le resezioni colorettali ed epatiche simultanee possono essere eseguite senza un significativo aumento della morbilità e mortalità perioperatorie, anche in pazienti sottoposti ad una resezione anteriore ultrabassa ed in quelli in cui sia indicato il clampaggio intermittente dell’ilo epatico. L’IOUS è efficace nel ridurre l’estensione della resezione epatica in pazienti sia con CRLM anche multiple e bilobari .Poichè le complicanze maggiori sono frequenti dopo resezioni epatiche maggiori simultanee, riducendo l’estensione della resezione del parenchima epatico si può avere un impatto favorevole sul decorso post operatorio.Le resezioni epatiche ecoguidate radicali ma conservative simultanee ad una resezione colorettale sono una tecnica sicura ed efficace in pazienti con carcinoma colorettale avanzato e andrebbero considerate l’opzione primaria in casi selezionati

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A field study of thermal circulation over very gentle slope is described for a specific day characterised by weak synoptic conditions. The emphasis was on morning and evening transitions, but measurements cover the entire day; therefore a brief analysis is performed to represent the general thermal circulation pattern. Both transition periods are characterised by complex dynamic behaviours. During evening transition, the upslope flow has got through a stagnation condition characterised by wind velocity U<0:5 m=s. Only when the stagnating air has become negative buoyant, the flow is allowed to pour downslope like a slab. Some features of front formation has been found during the transition development, such as delay time of downslope flow start up along the slope, and the presence of positive turbulent kinetic energy at the onset of the motion. Eventually the observed evening transition has followed a mixed mechanisms, with features from different models. Therefore the Rayleigh number seems not to be a good criterion by which parametrise evening transition itself. Morning transition is characterised by destruction of nocturnal temperature inversion and the onset of upslope flow. Inversion destruction can be described in terms of CBL growth at surface and inversion decent from the top of the layer. KH has found to be a good indicator of inversion breakup, if used as parameter to study the inversion breakup in terms of temperature reversal. After the inversion breakup, buoyancy and mechanical productions supply the flow with the necessary energy to start the upslope wind. More quantitative analysis are provided by the study of stability parameters and turbulent kinetic energy budgets. Gradient Richardson number has been used in this terms, finding that a mixed SBL-CBL behaviour dominates the most of the observed layers. Tke budget has shown high turbulent behaviour during morning transition while the evening transition has developed entirely in laminar condition, apart from short intermittent turbulent events.

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BACKGROUND: Peripheral artery disease (PAD) is common and imposes a high risk of major systemic and limb ischemic events. The REduction of Atherothrombosis for Continued Health (REACH) Registry is an international prospective registry of patients at risk of atherothrombosis caused by established arterial disease or the presence of 3 atherothrombotic risk factors. METHODS AND RESULTS: We compared the 2-year rates of vascular-related hospitalizations and associated costs in US patients with established PAD across patient subgroups. Symptomatic PAD at enrollment was identified on the basis of current intermittent claudication with an ankle-brachial index (ABI) <0.90 or a history of lower-limb revascularization or amputation. Asymptomatic PAD was diagnosed on the basis of an enrollment ABI <0.90 in the absence of symptoms. Overall, 25 763 of the total 68 236-patient REACH cohort were enrolled from US sites; 2396 (9.3%) had symptomatic and 213 (0.8%) had asymptomatic PAD at baseline. One- and cumulative 2-year follow-up data were available for 2137 (82%) and 1677 (64%) of US REACH patients with either symptomatic or asymptomatic PAD, respectively. At 2 years, mean cumulative hospitalization costs, per patient, were $7445, $7000, $10 430, and $11 693 for patients with asymptomatic PAD, a history of claudication, lower-limb amputation, and revascularization, respectively (P=0.007). A history of peripheral intervention (lower-limb revascularization or amputation) was associated with higher rates of subsequent procedures at both 1 and 2 years. CONCLUSIONS: The economic burden of PAD is high. Recurring hospitalizations and repeat revascularization procedures suggest that neither patients, physicians, nor healthcare systems should assume that a first admission for a lower-extremity PAD procedure serves as a permanent resolution of this costly and debilitating condition.

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Arterial pressure-based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CI(L)) and the FloTrac-Vigileo monitor (CI(V)). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CI(TD)). CI(V)-CI(TD) bias ranged from -1.38 (95% confidence interval = -2.02 to -0.75 L/minute/m(2), P = 0.02) to -2.51 L/minute/m(2) (95% confidence interval = -3.36 to -1.65 L/minute/m(2), P < 0.001), and CI(L)-CI(TD) bias ranged from -0.65 (95% confidence interval = -1.29 to -0.01 L/minute/m(2), P = 0.047) to -1.48 L/minute/m(2) (95% confidence interval = -2.37 to -0.60 L/minute/m(2), P < 0.01). For both APCOs, bias to CI(TD) was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CI(TD) was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CI(TD). In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation.

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Peripheral artery disease is a progressive disease. Primary ischemic leg symptoms are muscle fatigue, discomfort or pain during ambulation, known as intermittent claudication. The most severe manifestation of peripheral artery disease is critical limb ischemia (CLI). The long-term safety of gene therapy in peripheral artery disease remains unclear. This four center peripheral artery disease registry was designed to evaluate the long-term safety of the intramuscular non-viral fibroblast growth factor-1 (NV1FGF), a plasmid-based angiogenic gene for local expression of fibroblast growth factor-1 versus placebo in patients with peripheral artery disease who had been included in five different phase I and II trials. Here we report a 3-year follow-up in patients suffering from CLI or intermittent claudication. There were 93 evaluable patients, 72 of them in Fontaine stage IV (47 NV1FGF versus 25 placebo) and 21 patients in Fontaine stage IIb peripheral artery disease (15 NV1FGF versus 6 placebo). Safety parameters included rates of non-fatal myocardial infarction (MI), stroke, death, cancer, retinopathy and renal dysfunction. At 3 years, in 93 patients included this registry, there was no increase in retinopathy or renal dysfunction associated with delivery of this angiogenic factor. There was also no difference in the number of strokes, MI or deaths, respectively, for NV1FGF versus placebo. In the CLI group, new cancer occurred in two patients in the NV1FGF group. Conclusions that can be drawn from this relatively small patient group are limited because of the number of patients followed and can only be restricted to safety. Yet, data presented may be valuable concerning rates in cancer, retinopathy, MI or strokes following angiogenesis gene therapy in the absence of any long-term data in angiogenesis gene therapy. It may take several years until data from larger patient populations will become available.

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PURPOSE: To evaluate arterial lesion characteristics and their impact on angiographic and clinical outcomes after endovascular below-the-knee (BTK) revascularization. MATERIALS AND METHODS: Between April 2008 and June 2009, 33 patients (mean age 74.9 years) with 34 limbs and 50 arterial segments (mean lesion length 59.3 mm) undergoing endovascular BTK revascularization agreed to undergo prospective clinical and intraarterial angiographic 6-month follow-up evaluation. Clinical indication for BTK revascularization was critical limb ischemia (CLI) in 18 patients and delayed wound healing without hemodynamic evidence of CLI and intermittent claudication (IC) in 15 patients. RESULTS: Binary restenosis was observed in 40% of treated segments at 6 months. Primary sustained clinical improvement was 82.4% and 55.9% at 3 months and 6 months. Lesion length was independently associated with binary restenosis (hazard ratio [HR] 1.013, 95% confidence interval [CI] 1.000-1.016, P = .05) and lower rates of primary sustained clinical improvement (HR 1.024, 95% CI 1.006-1.042, P = .008). CONCLUSIONS: Endovascular BTK revascularization yields clinical and angiographic benefits both for patients with IC and for patients with CLI. Although arterial lesion length adversely affects angiographic and clinical outcomes after endovascular revascularization, limb salvage rates were substantially higher compared with the comparatively low patency rates after BTK angioplasty.

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The clinical validity of at-risk criteria of psychosis had been questioned based on epidemiological studies that have reported much higher prevalence and annual incidence rates of psychotic-like experiences (PLEs as assessed by either self rating questionnaires or layperson interviews) in the general population than of the clinical phenotype of psychotic disorders (van Os et al., 2009). Thus, it is unclear whether “current at-risk criteria reflect behaviors so common among adolescents and young adults that a valid distinction between ill and non-ill persons is difficult” (Carpenter, 2009). We therefore assessed the 3-month prevalence of at-risk criteria by means of telephone interviews in a randomly drawn general population sample from the at-risk age segment (age 16–35 years) in the Canton Bern, Switzerland. Eighty-five of 102 subjects had valid phone numbers, 21 of these subjects refused (although 6 of them signaled willingness to participate at a later time), 4 could not be contacted. Sixty subjects (71% of the enrollment fraction) participated. Two participants met exclusion criteria (one for being psychotic, one for lack of language skills). Twenty-two at-risk symptoms were assessed for their prevalence and severity within the 3 months prior to the interview by trained clinical raters using (i) the Structured Interview for Prodromal Syndromes (SIPS; Miller et al., 2002) for the evaluation of 5 attenuated psychotic and 3 brief limited intermittent psychotic symptoms (APS, BLIPS) as well as state-trait criteria of the ultra-high-risk (UHR) criteria and (ii) the Schizophrenia Proneness Instrument, Adult version (SPI-A; Schultze-Lutter et al., 2007) for the evaluation of the 14 basic symptoms included in COPER and COGDIS (Schultze-Lutter et al., 2008). Further, psychiatric axis I diagnoses were assessed by means of the Mini-International Neuropsychiatric Interview, M.I.N.I. (Sheehan et al., 1998), and psychosocial functioning by the Scale of Occupational and Functional Assessment (SOFAS; APA, 1994). All interviewees felt ‘rather’ or ‘very’ comfortable with the interview. Of the 58 included subjects, only 1 (2%) fulfilled APS criteria by reporting the attenuated, non-delusional idea of his mind being literally read by others at a frequency of 2–3 times a week that had newly occurred 6 weeks ago. BLIPS, COPER, COGDIS or state-trait UHR criteria were not reported. Yet, twelve subjects (21%) described sub-threshold at-risk symptoms: 7 (12%) reported APS relevant symptoms but did not meet time/frequency criteria of APS, and 9 (16%) reported COPER and/or COGDIS relevant basic symptoms but at an insufficient frequency or as a trait lacking increase in severity; 4 of these 12 subjects reported both sub-threshold APS and sub-threshold basic symptoms. Table 1 displays type and frequency of the sub-threshold at-risk symptoms.

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The early detection and treatment of persons at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. The two current favored at-risk approaches, i.e., the «ultra high risk» and the «basic symptom» criteria, were developed mainly using adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For «ultra-high risk» criteria, there is indication of some attenuated psychotic symptoms being potentially nonspecific in adolescents, and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only a preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adaption to the special needs of children and adolescents is needed. If a «Prodromal Risk Syndrome for Psychosis» or «Attenuated Psychotic Symptoms Syndrome» are included in the upcoming DSM-5, it should be highlighted that its suitability for children and adolescents is only insufficiently known.

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Electric power grids throughout the world suffer from serious inefficiencies associated with under-utilization due to demand patterns, engineering design and load following approaches in use today. These grids consume much of the world’s energy and represent a large carbon footprint. From material utilization perspectives significant hardware is manufactured and installed for this infrastructure often to be used at less than 20-40% of its operational capacity for most of its lifetime. These inefficiencies lead engineers to require additional grid support and conventional generation capacity additions when renewable technologies (such as solar and wind) and electric vehicles are to be added to the utility demand/supply mix. Using actual data from the PJM [PJM 2009] the work shows that consumer load management, real time price signals, sensors and intelligent demand/supply control offer a compelling path forward to increase the efficient utilization and carbon footprint reduction of the world’s grids. Underutilization factors from many distribution companies indicate that distribution feeders are often operated at only 70-80% of their peak capacity for a few hours per year, and on average are loaded to less than 30-40% of their capability. By creating strong societal connections between consumers and energy providers technology can radically change this situation. Intelligent deployment of smart sensors, smart electric vehicles, consumer-based load management technology very high saturations of intermittent renewable energy supplies can be effectively controlled and dispatched to increase the levels of utilization of existing utility distribution, substation, transmission, and generation equipment. The strengthening of these technology, society and consumer relationships requires rapid dissemination of knowledge (real time prices, costs & benefit sharing, demand response requirements) in order to incentivize behaviors that can increase the effective use of technological equipment that represents one of the largest capital assets modern society has created.

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Solar energy is the most abundant persistent energy resource. It is also an intermittent one available for only a fraction of each day while the demand for electric power never ceases. To produce a significant amount of power at the utility scale, electricity generated from solar energy must be dispatchable and able to be supplied in response to variations in demand. This requires energy storage that serves to decouple the intermittent solar resource from the load and enables around-the-clock power production from solar energy. Practically, solar energy storage technologies must be efficient as any energy loss results in an increase in the amount of required collection hardware, the largest cost in a solar electric power system. Storing solar energy as heat has been shown to be an efficient, scalable, and relatively low-cost approach to providing dispatchable solar electricity. Concentrating solar power systems that include thermal energy storage (TES) use mirrors to focus sunlight onto a heat exchanger where it is converted to thermal energy that is carried away by a heat transfer fluid and used to drive a conventional thermal power cycle (e.g., steam power plant), or stored for later use. Several approaches to TES have been developed and can generally be categorized as either thermophysical (wherein energy is stored in a hot fluid or solid medium or by causing a phase change that can later be reversed to release heat) or thermochemical (in which energy is stored in chemical bonds requiring two or more reversible chemical reactions).

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Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in high-risk permanent atrial fibrillation.

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Abdominal pain is a very common complaint in a primary care consultation. The causes of abdominal pain are extremely diverse and range from conditions that require urgent surgical remedy to those without serious underlying pathology where the problem either settles spontaneously, or becomes chronic without any abnormalities on laboratory or clinical workup. While tests are helpful in confirming diagnoses, clinical judgement based on a careful history and physical examination remains extremely important in choosing from the extremely wide differential diagnoses and in the management of the condition. In this article, we will deal with chronically recurrent intermittent abdominal pain. Our aim is especially to provide guidance on the possibility that abdominal pain is a symptom of chronic inflammatory bowel disease (IBD) or an identifiable functional condition and when the diagnosis of irritable bowel syndrome should be made.

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A 2-year-old, female goat from Connecticut was submitted for necropsy with a 5-day history of pyrexia and intermittent neurologic signs, including nystagmus, seizures, and circling. Postmortem examination revealed suppurative meningitis. Histologic examination of the brain revealed that the meninges were diffusely infiltrated by moderate numbers of lymphocytes, macrophages, and fibrin, with scattered foci of dense neutrophilic infiltrate. Culture of pus and brainstem yielded typical mycoplasma colonies. DNA sequencing of the 16S ribosomal RNA gene revealed 99% sequence homology with Mycoplasma mycoides subspecies capri and Mycoplasma mycoides subspecies mycoides Large Colony biotype, which are genetically indistinguishable and likely to be combined as a single subspecies labeled M. mycoides subsp. capri. The present case is unusual in that not only are mycoplasma an uncommon cause of meningitis in animals, but additionally, in that all other reported cases of mycoplasma meningitis in goats, systemic lesions were also present. In the present case, meningitis was the only lesion, thus illustrating the need to consider mycoplasma as a differential diagnosis for meningitis in goats.