Tricky Situations Research Articles

Humongous Head-Neck Surgical Defect: a Reconstructive Challenge

Complex face and neck surgical defects poses reconstructive challenge particularly in tricky situations were prolonged ventilation is contraindicated. The result of an islanded, folded pedicled pectoralis major myocutaneous flap which is a reliable alternative to free flap is shown. A slight modification in conventional technique, where the flap is based solely on its sterno-clavicular fibers preserving the whole of its clavicular head creating a true island flap has been described.

Cardiopulmonary Exercise Test in Myocardial Ischemia Detection

Exercise electrocardiography has low sensitivity for detection of myocardial ischemia. However, when combined with cardiopulmonary exercise testing (CPEX), the sensitivity and specificity of ischemia detection improves significantly. CPEX offers unique advantages over imaging techniques in tricky situations such as balanced ischemia. Early abnormal oxygen uptake would point toward profound coronary stenosis that could be missed in perfusion imaging. CPEX could be an invaluable tool in asymptomatic left bundle branch block pattern, without exposing patients to the risks of computerized tomography or invasive coronary angiography. Normal oxygen uptake curves would rule out significant coronary stenosis as the cause of left bundle branch block pattern. Elseways, abnormal oxygen uptake in patients with normal coronary arteries could indicate microvascular angina. Furthermore, exercise capacity is an excellent predictor of cardiovascular risk in those with and without heart disease. Using two clinical cases we introduce the concept of gas-exchange and hemodynamic changes encountered in ischemic heart disease.

Detecting Causal Relationships in Simulation Models Using Intervention-based Counterfactual Analysis

Central to explanatory simulation models is their capability to not just show that but also why particular things happen. Explanation is closely related with the detection of causal relationships and is, in a simulation context, typically done by means of controlled experiments. However, for complex simulation models, conventional “blackbox” experiments may be too coarse-grained to cope with spurious relationships. We present an intervention-based causal analysis methodology that exploits the manipulability of computational models, and detects and circumvents spurious effects. The core of the methodology is a formal model that maps basic causal assumptions to causal observations and allows for the identification of combinations of assumptions that have a negative impact on observability. First, experiments indicate that the methodology can successfully deal with notoriously tricky situations involving asymmetric and symmetric overdetermination and detect fine-grained causal relationships between events in the simulation. As illustrated in the article, the methodology can be easily integrated into an existing simulation environment.

Target measurements influence on level crossing detection system safety determination

The design of critical safety systems is usually approached through the investigation about the applicability of specific standards that can be applied in that specific field of interest. Even if very often this design strategy can be satisfactory to address the most part of common problems, sometimes a generalized approach may lead to tricky situations where some crucial aspects can be neglected. This risk is high when new technologies or advanced measurement systems are designed. The main reasons may lay in some hidden hazards related to the sensor physics or to the specific context. In this paper the authors discuss how the implementation of a peculiar system for level crossing monitoring (LC) based on a specific radar technology can be jeopardized if a limiting standard approach is followed. Moreover, a sharp analysis of the target to be detected is performed. Safety systems based on single or multi sensor architectures are analyzed discussing the advantages and pitfalls of the different designs in terms of system RAMS parameters. Considerations about measurement uncertainties due to the type and orientation of the specific item to be detected are presented on an empirical basis as well.

Percutaneous biliary intervention: tips and tricks

Percutaneous biliary intervention encompasses diagnostic cholangiography, which is rarely used in isolation now, and therapeutic biliary drainage including percutaneous transhepatic biliary drainage and transhepatic cholecystostomy. With the advantage of being minimally invasive and hence, relatively atraumatic, this technique has made significant foray into management of biliary obstruction (both benign and malignant) and post-surgical biliary complications. This review focuses on the key technical aspects of the procedure along with the commonly anticipated complications that have a significant bearing on the outcome. The authors, thereby, attempt to add their own experience to the existing literature about the various tricky situations that may be encountered during the course of the procedure and tips to circumvent them.Â

Proper orthogonal decomposition preprocessing of infrared images to rapidly assess stress-induced heat source fields

An image processing technique using the proper orthogonal decomposition (POD) of infrared thermal data was developed to improve the speed of assessment of 2D heat source fields accompanying mechanical transformation. This method involved the generation of a reduced orthonormal basis to approximate thermal fields prior to heat source estimation. The robustness of the method was first assessed using a penalising benchmark test. This test involved artificially setting several tricky situations that arise in practice (high diffusivity, low signal-to-noise ratio, complex heat source distribution, etc.). Application of the method to several experimental temperature fields obtained by an infrared focal plane array camera is then presented. The error between the POD approximated solution in terms of heat sources and a reference solution, computed via a local least squares fitting method, was found to be negligible, thus confirming the efficiency and advantages of the POD preprocessing technique – the method enabled us to obtain a reliable estimate of heat sources while drastically reducing the computation cost in terms of CPU time.

Incidental malignancy in cadaver donor: What is the real impact?

Worldwide organ shortage is one of the most common hurdles while treating patients with end-stage liver disease, especially in countries where there is lack of interest in organ donation. Apart from this, cost of this remedy is one reason, which makes this treatment distant dream for many. In such a situation, to lose even a single donor becomes too costly, cost of which is life of some other patients. Extended criteria for liver donation are already in use, though in some situations clinicians feel like trapped between providing best care and managing organ demands. One of such tricky situations is incidentally found malignancy in donor. Recently, we came across such situation during the harvest of liver from a cadaver donor, which made us go through the literature and find the answer. Here, in this review, we share that experience and try to throw light on this enigmatic issue with special focus on incidentally found malignancies in cadaver donor.

Evaluating Consumer Actionns Worker Advice Service, June 2016

This is a report of the Consumer Action Law Centre. Dr Liz Curran was an adviser on the project.The focus of this evaluation sits within a quality framework of continuous development, reflection and improvement of that service.This evaluation report and the quality framework recognises the extent of unmet legal need in Victoria and the critical role non-legal agencies can play in helping meet that need. In addition to providing free legal assistance to individuals, Consumer Action Law Centre (CALC) provides legal secondary consultations (LSC) to Victorian financial counsellors and other community workers through a dedicated telephone legal advice service. Legal Secondary Consultations (LSC) are defined as where a lawyer offers a non-legal professional (such as a doctor, nurse, youth worker, social worker or financial counsellor) legal advice or information on legal processes (such as what happens at court, and how to give evidence or structure reports for a court to provide the required considerations), or on their professional and ethical obligations, or guides the non-legal professional through tricky situations involving their client or their work for clients. Critically, LSCs can build capacity in non-legal professionals likely to come into contact with the most challenging problems, so as to be able to identify or quickly verify that a problem is capable of a legal solution. This orientation towards collaborative, holistic and joined-up service delivery is reflected in CALC’s current strategic plan, which includes actions to explore relationships with other community support agencies and catalyse new approaches to meeting unmet need and ‘hard-to-reach’ communities. Dr Curran was adviser on the project and the report and data collection was undertaken by the Consumer Action Law Centre who have given the author permission to place the report on SSRN, so as to share with others how LSC can enable non-legal professional support, enhance multi-disciplinary practice and reach more clients who are currently excluded from gaining legal help for due to a number of barriers.

A Design Methodology for Medical Processes.

Healthcare processes, especially those belonging to the clinical domain, are acknowledged as complex and characterized by the dynamic nature of the diagnosis, the variability of the decisions made by experts driven by their experiences, the local constraints, the patient's needs, the uncertainty of the patient's response, and the indeterminacy of patient's compliance to treatment. Also, the multiple actors involved in patient's care need clear and transparent communication to ensure care coordination. In this paper, we propose a methodology to model healthcare processes in order to break out complexity and provide transparency. The model is grounded on a set of requirements that make the healthcare domain unique with respect to other knowledge domains. The modeling methodology is based on three main phases: the study of the environmental context, the conceptual modeling, and the logical modeling. The proposed methodology was validated by applying it to the case study of the rehabilitation process of stroke patients in the specific setting of a specialized rehabilitation center. The resulting model was used to define the specifications of a software artifact for the digital administration and collection of assessment tests that was also implemented. Despite being only an example, our case study showed the ability of process modeling to answer the actual needs in healthcare practices. Independently from the medical domain in which the modeling effort is done, the proposed methodology is useful to create high-quality models, and to detect and take into account relevant and tricky situations that can occur during process execution.

Promoting Oral Health in Rural India: The Case of Pepsodent—Case Discussion

Talking about the potential of oral health care market in a country with an outstanding population figure surely makes a whole lot of business sense. An additional dimension of unleashing the wealth in the rural markets further complements the uniqueness of the case. The rural phenomenon in India with an evidently astounding 800+ million residents and their rising levels of disposable income as well as growing affinity towards branded goods comes with its own challenges. Tricky situations in the form of underdeveloped infrastructure, unreliable communication and electricity, or inadequate distribution networks pose serious threat to the ambitious plans of many business giants including the Tata, ITC, Vodafone, Coca-Cola or the likes. Nevertheless, mixed results in most cases keep encouraging corporations to come up with ruralized stepping-up ideas in search of the real gold. With this in the backdrop, the present case focuses on the acceptability of Hindustan Unilever Limited’s Pepsodent toothpaste as a core component of enhancing oral health in rural India after experiencing a stagnated growth of less than a per cent in the year 2012. It discusses Unilever’s plan to earn the numero uno position for its Pepsodent brand by building a strong brand image for itself, not only in competition with the current market leader Pamolive’s Colgate but also by moving beyond the popularity of conventional items of oral cleansing such as neem twigs, salt, ashes, etc. in the rural market.

Challenges in the management of intraocular parasitic infections

Parasitic worms in eye is something which is not very uncommon these days. People who eat undercooked food and have pets at home are at more risk to have parasitic infections. Chemoparalysis has been reported in literature using either viscoelastics or preservative free lidocaine (intracamerally) to paralyze the worms that help in retrieval, but still one can face tricky situations while managing such conditions. Importance lies in the management of such cases as it can be really challenging at times and no report exists in the literature which mentions the importance of topical lidocaine along with viscoelastics or preservative free lidocaine for retrieval of the worm.

Estresse ocupacional em enfermeiros atuantes em setores fechados de um hospital de Pelotas/RS

Aim: To describe the stressors in the activity of nurses working in the hospital closed units. Method: This is a descriptive study with qualitative approach, developed with seven nurses working in the Intensive Care Unit and the Surgical Block. Data were collected in July and August 2011, by semi-structured interview and after signing the free and informed consent, using thematic analysis as a tool for interpretation. Results: We found the following themes: physical structure and material resources, interpersonal, and management as a cause of stress. Final Thoughts: The nurse's role is related to human care, which are permeated by bureaucratic activity and care, which may face tricky situations convivial question ethics, values and beliefs.

The Lost Papers: Managing An Academic Institution (A)

The case illustrates situations that often arise in an organization that have ethical dilemmas for various functionaries in the organization. The perspective of the functionaries is coloured by the role they play in the organization and their perception of their responsibility and accountability. Should pragmatism in such tricky situations over-ride the need for ensuring natural justice to those who may be negatively impacted by the situation? Should ethics and integrity over-ride the risk of loss of reputation an organization may run, at least in the short term, for being ethical? What should the individuals do if they have to deal with authority that may ask them to be unethical? The case provides an interesting context to discuss such imponderable issues.

The Unnaturalists (review)

Reviewed by: The Unnaturalists Kate Quealy-Gainer Trent, Tiffany . The Unnaturalists. Simon, 2012. [320p]. Trade ed. ISBN 978-1-4424-2206-3 $16.99 E-book ed. ISBN 978-1-4424-2208-7 $9.99 Reviewed from galleys R Gr. 7-10. Sixteen-year-old Vespa Nyx's scholarly plans are abruptly put on hold when she discovers that she has magical powers—an offense that, in New London where the Church of Science and Technology reigns supreme, would earn her execution. Meanwhile, Syrus, a young boy living in the wilds surrounding the city, is charged with the task of procuring a witch for the forest's ruling Elemental (a nature spirit) after a band of city guards invades and slaughters a group of Tinkers, an ancient race that protects the magical creatures of the woods. Events bring the two together as Vespa realizes that her father is planning to use her magic to power a science experiment that may be New London's doom and Syrus discovers that his people are meeting fates far worse than death inside the city walls. A steampunk-themed city meets a bevy of fanciful creatures in this intriguing mashup that unabashedly positions technology against nature. The alternation between Vespa's voice and the third-person narration that focuses on Syrus brings the contrast between their [End Page 50] worldviews into sharp relief. Vespa is a charming heroine, at once prickly and vulnerable, competent enough to get out of tricky situations yet still willing to swoon over a handsome rebel. Syrus is slightly less developed, but his compassion for the creatures he is sworn to protect will ring true with animal lovers. Younger fans of The Girl in the Steel Corset (BCCB 9/11) will find plenty to like here. Copyright © 2012 The Board of Trustees of the University of Illinois

Ecology of freshwaters: a view for the twenty-first century

Ecology of freshwaters: a view for the twenty-first century

Design of an Airbag Deployment Algorithm Using a Radar Sensor

An airbag system has been a fundamental safety equipment for saving lives of a driver and passengers. This system has some problems even though it is very efficient for protecting drivers or passengers. After a crash is occurred, airbags must be deployed in a proper time along the crash situation. But it is tricky to deploy at the exact time depending on the situations. These tricky situations happen especially for the airbag deployment algorithm using only the post-crash signals. In general, the airbag deployment algorithm uses airbag control unit(ACU) X-Y sensor and frontal impact sensor(FIS). And it discriminates crash situations along these sensors signals. However, during the crash process, these sensors are broken, rotated or moved. That causes the malfunction of airbag deployment algorithm. In this study, a new airbag deployment algorithm is developed which is enhanced with a radar sensor signal. Using pre-crash information from the radar sensor, the algorithm can judge a crash situation before a real crash is occurred and can revise the post-crash signal.

Finding and transferring policies using stored behaviors

We present several algorithms that aim to advance the state-of-the-art in reinforcement learning and planning algorithms. One key idea is to transfer knowledge across problems by representing it using local features. This idea is used to speed up a dynamic programming based generalized policy iteration. We then present a control approach that uses a library of trajectories to establish a control law or policy. This approach is an alternative to methods for finding policies based on value functions using dynamic programming and also to using plans based on a single desired trajectory. Our method has the advantages of providing reasonable policies much faster than dynamic programming and providing more robust and global policies than following a single desired trajectory. Finally we show how local features can be used to transfer libraries of trajectories between similar problems. Transfer makes it useful to store special purpose behaviors in the library for solving tricky situations in new environments. By adapting the behaviors in the library, we increase the applicability of the behaviors. Our approach can be viewed as a method that allows planning algorithms to make use of special purpose behaviors/actions which are only applicable in certain situations. Results are shown for the “Labyrinth” marble maze and the Little Dog quadruped robot. The marble maze is a difficult task which requires both fast control as well as planning ahead. In the Little Dog terrain, a quadruped robot has to navigate quickly across rough terrain.

Research Summary

What influences a patient to make a complaint and what are the correct procedures for handling these tricky situations when they arise? Suzi Carew-O'Donnell explains.

Shakespeare's Globe Theatre

Shakespeare at the Globe Theatre, London, Summer 2007 Othello May 4-August 19, 2007 As each generation's freshman lecture notes make clear, generic distinction is not only about thematic difference but about varieties of dramatic construction. Genre is unfair, for while comedies allow a more or less even spread of lines across the whole company, and therefore facilitate an ensemble effort (among which a single weak performance can be allowed to fade mercifully into the background), tragedies prioritise an individual--Richard III, Coriolanus, Lear. Occasionally two members of the company carry the productions weight upon their shoulders--Antony and Cleopatra, Juliet and Romeo, Iago and Othello. In the case of these pairings, the dramatic structure can make matters even worse. If the pair is not evenly balanced, the virtues of one performance can serve to magnify the shortcomings of the other. Likewise, a poor performance by one of a pair of protagonists will exaggerate the achievements of the other, while, at the same time, intensifying the deficiencies of the production as a whole. A mediocre Iago and a mediocre Othello may be better for a production than an excellent Iago and a lacklustre Othello. Genre is not fair to its players. Unbalanced pairings of players are not fair to the audience. Bluntly and not without reluctance, have to pronounce Eamonn Walker's performance as Othello to be unfit for the purpose. His rapid delivery, redundant enjambment and his tendency to deliver the speeches as though he were line-running in the privacy of his dressing-room made this a vocally under-powered performance. The rapidity of the reviewer's note-taking often necessitates the appropriation of textual fragments and commentary thereon. When the Duke pondered the eloquence and majesty of Othello's wooing he remarked thoughtfully: I think this tale would win my daughter too against which my notes say, no chance. When Desdemona asked her husband, Why do you speak so faintly?, jotted down quite. Walker's hasty and indistinct verbal delivery made his occupation of the role almost inconspicuous. a character of the supposed charisma of Othello, this was all but fatal to the entire production. (That the program credits Patsy Rodenburg as Voice Coach and Giles Block with Text Work makes the modest amplitude of Walker's performance all the more unfortunate.) To make matters worse, the strength and variety, sensitivity and intelligence of Tim McInnerny's Iago served to point up rather than downplay the shortcomings of his opposite number. McInnerny displayed a deft comic timing throughout and vocally, he moved from rapidly delivered repartee to a sonorous bass for I hate the Moor. McInnerny's multifaceted villain was as mercurial and quick-witted as the role demands, improvising his way around tricky situations and concealing his inner void behind a series of ingenious facades. As he lectured his master on the evils of jealousy or expressed his misgivings about the apparently subtle exit of Cassio, he staggered his words, as though the information was being wrung out of him--a device which made the confiding apparently all the more reluctant and so sincere. He discoursed in fits and starts as though he were struggling to censor himself. Perhaps most disarming of all was McInnerny's matter-of-factness when he addressed the audience directly. Alone onstage he turned to us and explained with utter reasonableness how he would displace Cassio, eliminate Roderigo and make Othello love him For making him egregiously an ass. His treatment of Roderigo, played by Sam Crane as a callow and useless sixth-former from an English public school, was comically superior. Roderigo would enter behind him, shrouded in his cape as though ingeniously undercover. Even without turning towards him, Iago would acknowledge his presence as though his omniscience provided him with 360-degree vision. There was more than a touch of the comic savagery of Toby and Andrew between the pair and McInnerny's Iago would frequently raise his eyes to heaven as though to suggest to the audience, How can this man be so gullible? …

From A to Z

Jan Richards’ alphabetical list of tips for students is a great help in negotiating potentially tricky situations