Lack Of Flow Research Articles

Chemical characteristics of antarctic lakes of the Thala Hills

The article presents the results of measurements of the principal ions content, electrical conductivity and pH for 13 lakes and small (temporary) water ponds in the east part of the Thala Hills, Enderby Land, East Antarctica. Water sampling was carried out by participants of the seasonal Belarusian Antarctic expeditions in the period from 2011 to 2018. The purpose of the study is the evaluation of the hydrochemical composition of lakes and temporary ponds of the Thala Hills (on an example of the Vecherny Oasis), identification of natural and anthropogenic factors which determine the variability of the hydrochemical parameters for assessment of vulnerability of lakes and temporary ponds to anthropogenic impacts and climate change. It is shown that the waters of the lakes of this region are low mineralized with the sum of ions within the range of 10.6–87.5 mg/l (the average is 34.5 mg/l), electrical conductivity — 19.3–130.0 μS/cm (61.3 μS/cm). The water is characterized as slightly acidic and neutral. The waters of small (temporary) ponds are characterized by greater variability of hydrochemical parameters in comparison with lakes: the sum of ions is in the range of 6.7–915.0 mg/l (the average is 158.0 mg/l), the electrical conductivity is 4.6–1663.0 μS/cm (the average is 267.0 μS/cm). Coefficients of variation for most compounds in the waters of temporary ponds exceed 100 %. In most cases the predominance of sodium and chloride ions was established, which indicates the influence of marine aerosols on chemical composition of water lakes and temporary ponds. Elevated concentrations of mineral elements in the water of temporary ponds are caused by the lack of flow and, and as a consequence of thies, the accumulation of salts as a result of evaporation.

POSSIBILIDADES E LIMITAÇÕES DA TERAPIA NUTRICIONAL ENTERAL NA COMPREENSÃO DE CUIDADORES E PROFISSIONAIS DE UMA REDE PÚBLICA DE SAÚDE EM REGIÃO DE FRONTEIRA

Objetivo: Analisar possibilidades, limites e desafios da terapia de nutrição enteral domiciliar na rede pública de saúde e o perfil nutricional de pacientes pós-alta hospitalar de Foz do Iguaçu, PA. Métodos: Estudo de delineamento transversal e quanti-qualitativo. Participaram do estudo 12 indivíduos usuários de nutrição enteral domiciliar (com e sem acompanhamento nutricional); 12 cuidadores e oito profissionais de saúde. Na coleta de dados, utilizaram-se anamnese nutricional (usuários) e entrevistas (profissionais e cuidadores). As entrevistas foram gravadas, transcritas e analisadas na perspectiva teórica de Bardin; para o perfil nutricional, utilizaram-se fita inelástica e adipômetro, comparando-se os resultados às recomendações. Resultados e discussão: Houve predomínio do gênero feminino e de adultos para cuidadores e profissionais, enquanto entre os indivíduos em nutrição enteral, de idosos e mulheres. Sete destes estavam sob dieta manipulada; a frequência de complicações foi maior no grupo sem acompanhamento nutricional, assim como de óbitos e perfil antropométrico menos satisfatório. Os cuidadores mostraram-se desorientados e inseguros em relação à condução da nutrição enteral no domicílio, sobretudo no grupo desassistido por nutricionista. Profissionais e cuidadores apontaram a importância de acompanhamento profissional após a alta hospitalar e de oferta de dietas; fragilidades na rede pela ausência de fluxo, orientações padronizadas e encaminhamentos; com indicação de protocolo em rede para a condução da terapia de nutrição enteral domiciliar. Conclusões: Estes resultados mostram a notoriedade de formação dos cuidadores, equipe multiprofissional e intervenção gestora no cuidado domiciliar.DOI: 10.12957/demetra.2019.36926

GW29-e0150 Thoracic Endovascular Aortic Repair for Acute Type A Intramural Hematoma

Intramural hematoma (IMH) is defined as a special subgroup of aortic dissection without identifiable intimal tear and lack of flow in the false lumen of the aorta. It is typically recognized by preoperative imaging techniques by crescentic or, in some cases, circumferential thickening of the aortic

Acolhimento: percepção de enfermeiros em uma unidade de urgência e emergência

Objetivos: identificar a percepção dos enfermeiros sobre o acolhimento e analisar sua articulação com os fundamentos da Política Nacional de Humanização (PNH). Método: pesquisa qualitativa, com 14 enfermeiros que atuam no Pronto-Socorro Adulto do Hospital das Clínicas da Universidade Federal do Triângulo Mineiro. Os dados foram coletados em dezembro de 2015, por meio de entrevista semiestruturada e analisados conforme análise de conteúdo. Resultados: emergiram as categorias: o acolhimento como atendimento inicial, em que o acolhimento é descrito como ação na entrada do usuário no serviço; acolhimento com vistas à humanização, demonstrando entendimento e aplicação de acordo com a PNH; dificuldades para desenvolver o acolhimento devido à sobrecarga de trabalho, a falta de fluxo e de infraestrutura. Conclusões: os enfermeiros demonstraram compreender o significado de acolhimento. Porém, existem pontos frágeis na aplicabilidade, merecendo atenção dos gerentes de saúde para efetivar que os princípios da PNH sejam garantidos.

Case 253: Thrombosed Umbilical Venous Varix in an Infant

History A 3-month-old previously healthy girl presented to an outside institution with a 4-day history of low-grade fever, irritability, and a tender "knot" in the upper abdomen. Ultrasonography (US) was performed at an outside hospital. US images were not available for review; however, they showed a mass in the left hepatic lobe, per the outside report, and the patient was referred to our institution for further evaluation. Her parents reported a normal full-term pregnancy, with regular prenatal care and normal prenatal US findings. The baby was born after an uncomplicated gestation. She was delivered at term via an uncomplicated cesarean section due to a maternal history of cesarean section. The perinatal course was uncomplicated, and there was no history of umbilical catheterization, per the parents. On arrival at our institution, the patient had a temperature of 38.2°C. All other vital signs were normal. Palpation revealed a tender and firm mass in the periumbilical region; otherwise, physical examination findings were normal. Results of laboratory work-up were normal, except for elevated white blood cell count (26 600/mm3 [26.6 × 109/L]; normal, 6000-17 500/mm3 [6-17.5 × 109/L]). The patient underwent US followed by intravenous contrast material-enhanced (10 mL ioversol, Optiray 320; Medtronic, Santa Rosa, Calif) computed tomography (CT) on the same day.

TCTAP A-046 Thoracic Endovascular Aortic Repair for Acute Type A Intramural Hematoma

Intramural hematoma (IMH) is defined as a special subgroup of aortic dissection without an identifiable intimal tear and lack of flow in the false lumen of the aorta. It is typically recognized by preoperative imaging techniques by crescentic or, in some cases, circumferential thickening of the

Testicular torsion – an important consideration in neonatal scrotal swelling

Scrotal swelling in a neonate is rarely caused by testicular torsion, but it is an important differential diagnosis as acute treatment can prevent loss of fertility. The clinical findings differ, depending on whether the torsion has occurred in utero (prenatal) or after birth (postnatal). Postnatal testicular torsion presents with pain, redness, and swelling of the affected testis and requires acute surgical intervention to restore the blood flow and prevent ischemic necrosis. Contrary, prenatal testicular torsion will present with a hard, discolored untender mass that has already atrophied. It is important to quickly distinguish between prenatal versus postnatal cases to enable timely surgery of postnatal torsion, whereas the treatment of prenatal torsion is less urgent. A thorough clinical examination and ultrasonography with Doppler to detect blood flow or the lack of flow are the cornerstones in establishing an early diagnosis.

Understanding gaps in research networks: using “spatial reasoning” as a window into the importance of networked educational research

This paper finds its origins in a multidisciplinary research group’s efforts to assemble a review of research in order to better appreciate how “spatial reasoning” is understood and investigated across academic disciplines. We first collaborated to create a historical map of the development of spatial reasoning across key disciplines over the last century. The map informed the structure of our citation search and oriented an examination of connection across disciplines. Next, we undertook a network analysis that was based on highly cited articles in a broad range of domains. Several connection gaps—that is, apparent blockages, one-way flows, and other limitations on communications among disciplines—were identified in our network analysis, and it was apparent that these connection gaps may be frustrating efforts to understand the conceptual complexity and the educational significance of spatial reasoning. While these gaps occur between the academic disciplines that we evaluated, we selected a few examples for closer analysis. To illustrate how this lack of flow can limit development of the field of mathematics education, we selected cases where it is evident that researchers in mathematics education are not incorporating the important work of mathematicians, psychologists, and neuroscientists—and vice versa. Ultimately, we argue, a more pronounced emphasis on transdisciplinary (versus multidisciplinary or interdisciplinary) research might be timely, and perhaps even necessary, in the evolution of educational research.

Ischemic Stroke After Wasp Sting

BackgroundDespite the common occurrence of hymenopteran stings worldwide, primary neurologic manifestations including stroke are rare. We report a case of a healthy male who developed a right middle cerebral artery (MCA) territory ischemic stroke after getting stung by a wasp. Case ReportA 44-year-old man with hypertension presented to the hospital with sudden-onset left hemiparesis, left facial weakness, and dysarthria after being stung by a wasp. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) scans of the brain revealed a right MCA territory infarct and a lack of flow in the distal right internal carotid artery and MCA. He was treated with intravenous tissue plasminogen activator. A computed tomography angiography scan of the brain performed 24 hours later revealed multiple regions of vasoconstriction in the territory of the bilateral MCA. Evaluations for causes of stroke, including echocardiography and telemetry, were not revealing. Immunologic testing showed significantly elevated levels of serum wasp immunoglobulin E. Therapy with aspirin and atorvastatin was started. At discharge, the patient had a mild left facial droop but normal strength in his left arm and leg. Why Should an Emergency Physician Be Aware of This?Emergency physicians encounter large numbers of hymenopteran sting cases each year. These patients typically present with local reactions, such as itching, pain, and erythema. Systemic manifestations, such as anaphylaxis causing severe hypotension and bronchospasm, are less common but deadly. Neurologic complications, such as ischemic stroke, are extremely rare. This manuscript highlights the pathophysiology and management of stroke after a hymenopteran sting. There are no guidelines for the management of stroke after a hymenopteran sting, and therefore we intend to provide some guidance to physicians for treating stroke after a hymenopteran sting.

Relative Hypodense Vertebral Artery Sign on Computerized Tomography in Atherosclerotic Near Occlusion

A 52-year-old white male presented with an acute onset of slurred speech along with hypoesthesia in the entire left arm. The acute computed tomography (CT) showed relative hypodensity in the intracranial segment of left vertebral artery (VA) that was not present in historical images, pointing to the possible lack of flow. The site of occlusion was confirmed by magnetic resonance imaging (MRI) that showed susceptibility effect in the affected artery. By means of historical native CT comparison the site of VA thrombosis was correctly predicted. Local atherosclerotic thrombosis of the VA could be relatively hypodense on native CT and still have positive susceptibility weighted imaging (SWI) sign.

Noninvasive measurement of cerebrospinal fluid flow using an ultrasonic transit time flow sensor: a preliminary study.

OBJECT Mechanical failure-which is the primary cause of CSF shunt malfunction-is not readily diagnosed, and the specific reasons for mechanical failure are not easily discerned. Prior attempts to measure CSF flow noninvasively have lacked the ability to either quantitatively or qualitatively obtain data. To address these needs, this preliminary study evaluates an ultrasonic transit time flow sensor in pediatric and adult patients with external ventricular drains (EVDs). One goal was to confirm the stated accuracy of the sensor in a clinical setting. A second goal was to observe the sensor's capability to record real-time continuous CSF flow. The final goal was to observe recordings during instances of flow blockage or lack of flow in order to determine the sensor's ability to identify these changes. METHODS A total of 5 pediatric and 11 adult patients who had received EVDs for the treatment of hydrocephalus were studied in a hospital setting. The primary EVD was connected to a secondary study EVD that contained a fluid-filled pressure transducer and an in-line transit time flow sensor. Comparisons were made between the weight of the drainage bag and the flow measured via the sensor in order to confirm its accuracy. Data from the pressure transducer and the flow sensor were recorded continuously at 100 Hz for a period of 24 hours by a data acquisition system, while the hourly CSF flow into the drip chamber was recorded manually. Changes in the patient's neurological status and their time points were noted. RESULTS The flow sensor demonstrated a proven accuracy of ± 15% or ± 2 ml/hr. The flow sensor allowed real-time continuous flow waveform data recordings. Dynamic analysis of CSF flow waveforms allowed the calculation of the pressure-volume index. Lastly, the sensor was able to diagnose a blocked catheter and distinguish between the blockage and lack of flow. CONCLUSIONS The Transonic flow sensor accurately measures CSF output within ± 15% or ± 2 ml/hr, diagnoses the blockage or lack of flow, and records real-time continuous flow data in patients with EVDs. Calculations of a wide variety of diagnostic parameters can be made from the waveform recordings, including resistance and compliance of the ventricular catheters and the compliance of the brain. The sensor's clinical applications may be of particular importance to the noninvasive diagnosis of shunt malfunctions with the development of an implantable device.

Book Review: Clinics in Plastic Surgery: Necklift

Malcolm D. Paul, ed. Clinics in Plastic Surgery: Necklift. New York: Elsevier, 2013. ISBN-10: 0323227376 It is often hard to be critical of a book written in good faith and with every good intention by surgeons invited from different parts of the world, by a single editor himself with a strong reputation as an international speaker. I have to say, though, that this book, Clinics in Plastic Surgery: Necklift , edited by Malcolm D. Paul, is not one to get too excited about. It is not actually exclusively about lifting the neck: it is about methods to nonsurgically tighten the superficial skin and to surgically rejuvenate the aging neck but mostly at a level above the hyoid only. At first glance, the book is disappointingly small in size but not small enough to put in a pocket. It is rather unattractively color mismatched and could be easily lost behind a cupboard or under a short table leg. It is a thin book, deficient in pages, sometimes with blank sheets, yet it is supposed to contain substance and exciting tips and tricks from all of its 16 invited authors (presumably with major contributions from some junior doctor coauthors). It is not set out in chapters per se, and this adds to the somewhat difficult-to-follow and confused lack of flow to the book. It is really a collection of anecdotes and personal preferences. Some authors clearly understand what we, as readers, want to know. Others, unfortunately, say very little of interest and stick to some pre-thought-out questions presented by the editor. I will expand upon these later. On balance, I think this book may be useful to some young plastic surgeons engaging in the concept of facial aesthetic surgery and perhaps as guidance to those wanting ideas to improve their current outcomes. There are apparently some good operative videos that accompany certain chapters. I would be surprised …

Ultrasound findings of subacute thyroiditis: a single institution retrospective review

High resolution ultrasonography features have also been described as having a useful supporting role in the diagnosis of subacute granulomatous thyroiditis (ST), and images are generally characterized by heterogeneous hypoechoic areas of the affected tissue with lack of flow on color Doppler US. To determine the sonographic features of subacute granulomatous thyroiditis. We reviewed the medical records of patients referred at the Endocrine and Metabolic Unit of our Institution between January 2010 and December 2011. A total of 7520 patients were evaluated in our department between January 2010 and December 2011. Among them, 22 (0.3%) patients had a diagnosis of ST (19 women and 3 men, 45.4 ± 9.7 year; range, 33-62 years). Ultrasound examination showed bilateral ST in 64% of patients. Thyroid volume was 13.2 ± 7.7 mL, without difference if ST was unilateral (13.2 ± 7.1 mL) or bilateral (13.9 ± 8.3 mL). On grayscale US, heterogeneous diffusely or focally marked hypoechoic areas, like "lava flow", were found in all the lesions. Our data confirm the high sensitivity of US in the diagnosis of ST: diffuse hypoechoic and confluent areas with the characteristic features like "lava flow".

Retroperitoneal hematoma: An unexpected complication during intervention on an occluded superficial femoral artery via a retrograde popliteal artery approach

Peripheral arterial disease involvement of the superficial femoral artery (SFA) is common. Different endovascular techniques are used successfully for revascularization of this artery. A retrograde approach to chronic total occlusion (CTO) of the SFA through the ipsilateral popliteal artery has been used occasionally if an antegrade approach is not feasible or has failed. Some of the known complications encountered during this approach are arteriovenous fistula formation at the access site, occlusion of the popliteal artery if closure devices are used, and bleeding. There are no reports of perforation or bleeding of the SFA or the external iliac artery (EIA) during a popliteal approach, probably due to lack of flow in the occluded segment of the SFA. We report a case in which a retroperitoneal hematoma occurred due to retrograde blood flow through the established true channel in the proximal SFA and subsequently to the dissection plane with a wire tip perforation in the EIA, which was treated by stopping retrograde filling with prolonged balloon inflation in the distal SFA before the CTO.

Ultrasound imaging of the “on call” acute scrotum

Causes of the acute scrotum1. Vascular– Spermatic cord torsion– Torsion of the appendix testis2. Trauma– Testicular rupture/fracture– Haematoma/haematocele– Penetrating injury3. Infective/Inflammatory– Epididymitis/epididymo-orchitis– Testicular abscess– Fournier’s gangrene4. Miscellaneous– Acute idiopathic scrotal oedema– Inguinoscrotal hernia– Testicular tumours– Henoch–Schonlein purpuraTorsion of the spermatic cord– Is a surgical emergency—irreversible ischaemia occurs after 6 h– Represents 17% of all acute scrotal presentations, the incidence is 1 in 4000 males– Intravaginal torsion is associated with the bell-clapper deformity. Presentation is most commonly between the ages of 12–18 years– Extravaginal torsion is rare and occurs in utero or the perinatal period, the testis is usually unsalvageable– Greyscale ultrasound may be normal in immediate post-torsion period. Following this, sonographic changes frequently mimic acute epididymo-orchitis.– Lack of flow or diminished flow on colour/power Doppler ...

Philadelphia's Lost Waterfront

Philadelphia's Lost Waterfront

The association between popliteal vein compression and deep venous thrombosis: results of a pilot study

A pilot study to clarify the association between popliteal vein compression (PVC) and deep venous thrombosis (DVT). It is assumed that PVC and the associated change in blood flow increases the likelihood of DVT. We have selected patients who were referred to a vascular laboratory for a DVT duplex and scanned for both DVT and PVC. Duplex criteria for the diagnosis of a DVT were lack of flow and inability to compress the vein. The study was performed over 12 weeks. Of the 54 eligible patients, 16 had a DVT. Five of 18 patients with PVC had a distal DVT (27.7%), while five of 36 patients without PVC had distal DVT (16.7%). The difference was statistically significant (relative risk 2.9, P < 0.05). There appears to be an association between the presence of PVC and an increased likelihood of developing a DVT. If confirmed in larger studies, this will have strong implications for patient positioning in theatres, as there is a high incidence of PVC in supine anaesthetized patients.

Novel Use of Endoscopic Ultrasound to Successfully Treat Parastomal Varices with N-butyl-2-cyanoacrylate: Presidential Poster

Purpose: Describe a novel role for endoscopic ultrasound (EUS) in the treatment of parastomal varices with N-butyl-2-cyanoacrylate (NBCA). Case Report: A 74 year old female with a hx of ulcerative colitis s/p colectomy with end ileostomy, morbid obesity, COPD (O2 dependent), and Laennec's cirrhosis was transferred to our institution for transfusion dependent ostomy bleeding. The patient had over a dozen admissions to her local hospital and required 34 units of PRBC over the last year. CT demonstrated parastomal varices with cirrhotic liver morphology. Two previous attempts at transjugular intrahepatic portosystemic shunt (TIPS) were unsuccessful due to adverse anatomy. Options were discussed with the patient. A trial of beta-blockers was thought suboptimal given her COPD. A retrial of TIPS at our institution was offered but the patient refused. Consequently, we decided to employ EUS to localize the parastomal varices and then use NBCA to obliterate them. The patient was prepped with Mg citrate overnight. First, an adult gastroscope was advanced 20 cm into the stoma. No blood was seen and the mucosa was normal with no large vessels. Subsequently, a radial echoendoscope was used to visualize two prominent parastomal varices below the mucosal surface of the ileostomy by US. Flow was confirmed with Doppler. A linear echoendoscope was then inserted. Using a 22-G FNA needle, a mixture of 0.5 ml NBCA and 1.5 ml lipoidal was injected into the varices with good immediate effect. Lack of flow was confirmed after injection by Doppler. Ex-vivo, needle and scope channel were immediately flushed with Lipoidol. A total of 5.5 ml of glue was used. The patient tolerated the procedure well, was discharged home after 3 days, and has had no further episodes of bleeding. Discussion: Parastomal varices are a known complication of stoma creation in patients with portal HTN. Established treatments for parastomal varices include TIPS and surgery. We describe a case of parastomal varices in a patient who could not undergo either of these treatment modalities. Additionally, her significant comorbidities were a relative contraindication to even medical therapy with beta-blockers. Consequently, we employed EUS-guided NBCA glue to treat her parastomal varices. Though a few cases of parastomal varices treated with glue exist in the literature, all of the previous situations have employed a direct percutaneous approach. Consequently, this is the first reported case where EUS is successfully used for visualization and obliteration of varices in this patient population. Although further evaluation is warranted, EUS appears to be a safe and important adjunct modality in the treatment of stomal varices by NBCA glue injection.

Technical and organisational aspects in enterprise resource planning systems implementation: lessons from a Spanish public hospital

Public resources should always be managed efficiently, more so in times of crisis. Due to the specific characteristics of the healthcare sector, there is a need for special attention, especially in regards to hospitals. Administrators need useful tools to be able to efficiently manage available resources, such as enterprise resource planning (ERP) systems. Therefore, an analysis of the effects of their implementation and use in hospitals is valuable. This study has two purposes. One is to analyse the role ERP systems play in aiding the integration of hospital data, with focus on user satisfaction as well as possible resistance to change. The other purpose is to analyse the effects of implanting and using ERP systems in the hospital environment and identifying how certain variables influence the process, especially the existence of different organisational cultures. Results indicate that clinical information has become notably more integrated, despite the lack of flow in the economic–financial area. The heterogeneous nature of the different groups, clinical (Medical, Nursing) and non-clinical (Economic–Financial, Accounting), had a negative influence on the implementation process, and limited the integration of information as well as the system's performance.

Hemorrhagic Cerebral Venous Infarction in a Patient with Atrial Fibrillation:

Venous sinus thrombosis is an uncommon cause of stroke. Magnetic resonance imaging and magnetic resonance venography are sensitive and specific non-invasive tools for the diagnosis. This is a report of patient who presented with atrial fibrillation and heart failure. The course of the disease was complicated by left-sided transverse sinus thrombosis leading to hemorrhagic stroke. There was normal looking transverse sinus upon contrast injection with gadolinium despite the lack of flow on magnetic resonance venography. It is postulate that this apparently normal transverse sinus appearance on post gadolinium T1-weighted imaging was a result of thrombus enhancement in the acute stage of the venous occlusion. This finding could mislead the diagnosis if it was read in isolation without the confirmation of the occlusion in magnetic resonance venography.