bluuebunny/crossref_metadata_2025 huggingface dataset:
Soil Sensitivity Studies for Fixed Offshore Platforms
Authors: Akinci N. Onder , Wang Wenming , Kumar Abhimanyu , Proietto Alban , Simoni Steve
Published: April 2017

Soil properties and pile stiffness play a significant role in earthquake and hurricane response of fixed offshore structures. Although behavior of topsides and jackets has been studied extensively, effects of variation in soil properties are typically not taken into account. The objective of this study is to present effects of variation in soil properties on assessment of fixed offshore structures.

Sensitivity studies have been performed for earthquake and hurricane assessments of fixed structures using SACS and USFOS software packages. Response spectrum, time history and pushover analyses were performed considering different soil properties. Performance of several platforms were evaluated and compared.

The sensitivity studies indicated that soil properties and in turn pile stiffness are major parameters affecting the fundamental period and ultimate strength of typical fixed platforms in relatively shallow water. Therefore, it was concluded that dynamic response of fixed platforms is sensitive to the soil properties considered in the analyses. Furthermore, consideration of a range of soil parameters results in variations in locations of damage under different types of extreme events. Considering the uncertainties in soil properties, it is recommended to perform sensitivity studies with varying soil properties to minimize possibility of unconservative or overly conservative designs for fixed structures and their foundations.

Effects of soil properties on different types of extreme event response of fixed offshore structures have not been documented extensively in the literature. This study presents findings and conclusions from assessment studies for a range of offshore platforms. The findings of this study are expected to provide guidance for future assessments and help to better understand and address uncertainties in soil properties.
Development of a Probabilistic Tropical Cyclone Track Uncertainty Cone Using Multi-Model Ensembles
Authors: Ortt Derek , Hebert Chris , Weinzapfel Bob , Eyre Devin
Published: April 2017

Tropical cyclone (TC) forecasts are subject to large amounts of uncertainty. The current operational method of estimating the uncertainty is via historical errors from the past five years of forecasts. Circles are drawn around each of the forecast points such that the actual position of the TC is within the circle 2/3 of the time. The edges of the cone are then connected to create the "cone of uncertainty"

There are drawbacks to the standard "cone of uncertainty". The first is that the cone is misunderstood by many. The second is that the cone remains the same size for all TCs, regardless of the forecast uncertainty or confidence. A forecast with very high confidence will have the same cone size as one with low confidence. The third drawback is that only one possible track can be depicted. Thus, it is possible that a path well away from the area drawn by the cone will be possible.

To overcome the limitation of a historical error- based "cone of uncertainty", we can use model ensembles. Model ensembles are multiple runs of operational forecast models with tweaks made to the initial conditions or the model physics. The ensembles create multiple track forecasts. Probabilistic forecasts can be generated from these forecasts, which can create an objective estimate of the forecast uncertainty based upon the current state of the atmosphere.

Results from the 2016 Atlantic and Pacific hurricane seasons indicate that an ensemble-based probability swath can be used to estimate the forecast uncertainty for TCs. For hurricanes Darby, Lester, Madeline, and Matthew, data indicate that this ensemble-based probability swath is a suitable replacement for the "cone of uncertainty". These four hurricanes remained within the 20 percent swath 71 percent of the time for a 5-day period, which is slightly more than the desired 2/3 of the time depicted by the standard error cone.
Innovation in Reservoir-Driven Shaped Charges Enhances Productivity
Authors: Zuklic Stephen , Satti Rajani , Betancourt David , Harvey William , White Ryan , Sampson Tim , Myers William
Published: April 2017

The performance of shaped charge jet perforators in complex downhole environments remains the status quo for successful cased-hole completions. Traditionally, these perforators have been evaluated using concrete targets under ambient conditions. The designs based on these evaluations were therefore optimized for conditions that don't reflect true downhole environments. Recent testing specifications in sandstone targets (API RP-19B Section 2) have also failed to consider the effects of complex well conditions and rock properties. In addition to the perforator itself, the overall completion design must be considered to properly optimize the perforating event. This is typically done using empirical correlations and first-order modeling software. While beneficial, these methods can misrepresent the complex interactions among the perforator, the reservoir, and the wellbore in the unique set of conditions. Ultimately, this can all lead to the deployment of a perforator optimized with conditions (not tailored to the reservoir) and utilizing generic practices, thereby leading to adverse implications on the overall well completion.

The use of perforation flow laboratories and advances in shaped charge research and engineering have been employed in this study to understand and optimize shaped charge performance at downhole conditions. The perforators that result from a comprehensive test program in conjunction with multi-physics computational modeling are tailored for improved shaped charge performance under reservoir-specific conditions. These bespoke perforators undergo further testing as part of a more comprehensive optimization program to design the overall application on a well-specific basis. A similar scientific approach is also applied for the overall application optimization by integrating laboratory testing, CT imaging, computational flow dynamics, and dynamic event modeling to eventually upscale the results to the field applications.

The results of these processes demonstrate the significant performance improvement in the shaped charge tailored for true reservoir conditions. Field applications examined in this study demonstrate specific uses of optimized perforators, as well as example workflows of how an integrated testing and modeling process can insure the perforators are applied properly. Comparisons demonstrate productivity improvements through these engineered processes.

The new class of reservoir-driven shaped charges is aimed towards increasing production or injection by deeper formation connectivity with the wellbore as well as ensuring perforation contribution efficiency. The productivity gains in these case studies demonstrate the potential improvement in well completions through the use of engineered processes both for initial product design and specific application optimization in perforated completions.
Genesis Spar Continued Service - A Case Study
Authors: Gallagher Daniel J. , Abadin Jose A. , Madden Daniel J.
Published: April 2017

The current economic situation in the Oil and Gas industry has made it imperative to prolong the economic viability of many existing oil fields and facilities. As a result, a Continued Service Assessment (CSA) was performed for the Genesis Spar in the Gulf of Mexico to determine the risks involved with continuing to operate the facility beyond the current planned service life. The understanding of these risks allowed a Continued Service Plan to be developed which addresses each of these risks and demonstrates how the facility will remain fit-for-purpose through a combination of operational decisions, inspection and monitoring, upgrades and repairs (if needed) and an ongoing review of the plan itself.

The CSA covered all aspects of the Genesis Spar hull and marine systems, topside structure, mooring system, and risers. Reviews of the other systems (e.g., production equipment, subsea equipment, controls, etc.) were not included in this assessment.

The result of the CSA was the establishment of a roadmap for continued service including activities required to be performed through the remainder of the original service life as well as those required beyond. This was submitted for approval as an updated In-Service Inspection Plan (ISIP) to the United States Coast Guard (USCG) and as a comprehensive Continued Service Plan (CSP) to both USCG and the Bureau of Safety and Environmental Enforcement (BSEE). Approval has been received from USCG and approval from BSEE is pending the formal response.

This paper presents the challenges faced, the process used to evaluate them, the results of the evaluation and lessons learned through the execution of this project.

Please note that throughout this paper the term "continued service" is used, but this is synonymous with "life extension".
Methodology For Materials Selection Basis of Design, and Equipment Testing Criteria
Authors: Hausler Rudolf H. , Krishnamurthy Ravi , Gomez Joseph , Kusinski Greg
Published: April 2017

This paper will share some of the collaborative efforts completed within DeepStar® Global Deepwater Technology Development Program as part of Phase XII projects in X500 Drilling, Completions & Intervention committee leading to gap identification, industry standards, and guideline deployment.

Selecting safe economical materials for production from the increasingly more important HPHT horizons is a serious challenge because of the required combination of ‘safe and economical’. This challenge is being discussed in the literature as well as the standard writing community at great length. The effort aims at economical materials remaining within safe limits without being overly conservative. It is well known that qualification for sour service has occurred experimentally within a matrix of pH and H2S partial pressure ever since NACE MR0175 was first established some 40 years ago. It has now been recognized within the past 5+ years that it is the H2S concentration in solution which is responsible for the corrosion damage. As the total pressure increases the solubility is no longer proportional to the partial pressure, rather a fugacity correction needs to be applied. As the total pressure still increases further into the realm of 15,000 to 20,000 psi a heretofore not fully appreciated effect occurs in that the high methane pressure reduces the solubility even more than would have been predicted by the fugacity correction alone. Its consequence regarding corrosion, however, is still not well established because testing at these high pressures is, and will be for some time, problematic.

This makes it clear that acquiring representative and relevant environmental data for the MSBOD is only part of the task at hand. The realistic translation of field environment to the test environment is the other part. Hence, appropriate physicochemical models for extreme conditions must become an integral part of the development of the BOD.

In this environment there are two aspects that need to be vigorously pursued. The qualification procedures for the proposed metallurgy need to be clearly delineated and their relevance demonstrated. Test protocols need to be strengthened and results need to be interpreted statistically for relevance. In this context methods for identifying (system) in situ conditions based on external analytical data will also be critically discussed.

A methodology will be proposed whereby the H2S partial pressure on x axis of the familiar pH-pH2S diagram can be displaced by the fugacity based H2S concentration. This will result in a reduction of excess conservatism while maintaining an adequate safety margin. This work was initiated and funded by DeepStar, Global Deepwater Technology Development Program as part of Phase XII projects in the (X500) Drilling, Completions & Intervention Committee.
Assessment, Management and Prevention of Methanol Contamination in Export Crude
Authors: Juarez Joshua , Regel Eric , Anand Tanmay , Bukkaraju Sampath
Published: April 2017

After methanol has been injected into a subsea tree, it flows back with produced fluid, partitioning between the oil, gas and water phases. Under production circumstances where water cut is low, high concentrations of methanol may be left in the oil phase. This leaves export crude contaminated with methanol which may result in penalties incurred due to pipeline export agreements. Several methods have been developed to control or minimize methanol concentration in the oil phase.

The total volumes of methanol injected are compared against expected production flowrate values and a multiphase flow modeling exercise is carried out to track the arrival tendencies of the methanol injected at the tree. A model of the process system is created which considers GOR, water cut, fluid composition and production rates in order to track the partitioning behavior of the methanol. An assessment of the effect of several methanol control methods is conducted in order to select the most appropriate method while considering effect on CAPEX/OPEX, export agreements, and total system modification requirements.

This paper will include a discussion of methanol partitioning behavior and the effect of water cut on export crude contamination levels. This is to provide a basis to identify whether or not methanol contamination may be an issue for a particular production scenario.

This paper will discuss each control method in detail and outline the various benefits and drawbacks to each one. A discussion of the best option for methanol contamination control will investigate several considerations including topsides facilities, whether the owner of the field operates the platform, whether there are other water-producing wells on the platform, and what the methanol export limits are. Each method will have an assessment of the relative impact on CAPEX and OPEX required for implementation.

Methanol injection at the subsea trees is a common solution for hydrate control, valve equalization, and annulus pressure management. Controlling methanol content in export crude will help to alleviate the negative consequences associated with methanol injection during low water cut production scenarios. An effective methanol contamination control method will reduce or even eliminate penalties associated with contaminated crude production.
Well Abandonment and Decommissioning Challenges –Outline of the U.S. Federal Offshore Legal Framework
Authors: Boyd Pollett Buford
Published: April 2017

This Panel will discuss well abandonment challenges, well integrity monitoring and also issues related to regulations, inconsistencies in procedures, costs, and responsibilities. The Panel will also discuss opportunities to provide venues for dialog, collaboration and coordination between industry, regulatory agencies in order to standardize process, increase efficiencies, enhance safety, mitigate against environmental risks, and otherwise provide potential solutions.

This paper outlines the U.S. Federal regulatory background and highlights the U.S. Federal Government's reasoning for the revised Financial Assurance Requirements required for Outer Continental Shelf (OCS) leases, pipeline rights-of-way (ROW), and rights-of-use and easement (RUE).
Bringing Upstream Projects to Final Investment Decision
Authors: Khurana Sandeep , D'Souza Richard , Yanosek Kassia , Christ Florian , Meeks Parker
Published: April 2017

Since the 2014 oil price collapse, the Oil and Gas industry has sought to reduce project development costs to align with a "lower for longer" commodity price scenario. Operators have struggled with limited budgets and cash flow, yet understand that to preserve their portfolio value, they will need to progress developments to Final Investment Decision (FID). In a capital constrained and cost-focused environment, operators and service providers are taking new approaches to project designs, commercial models, partnership opportunities and capital sources in order to jump start project developments.

The panel will address the following:

Project delivery innovations

Novel risk-sharing partnership arrangements

New commercial models, including the role of midstream players providing operational expertise and capital for offshore infrastructure

Joint ventures, strategic partnerships and creative hybrid equity type investments – such as private equity buying into upstream company debt

This manuscript sets the stage for the panel discussion scheduled for 2.00pm to 4.30pm, Tuesday, May 2, 2017 at the conference. The panelists are oil company executives representing small to large independents and integrated oil companies along with service providers as follows:

Tim Duncan, President and CEO, Talos Energy LLC

Susan Cunningham, EVP, Noble Energy

Starlee Sykes, VP, BP

De La Rey Venter (TBC), EVP, Shell

Brian Cothran, North American President, GE Oil and Gas

Sandeep Khurana, Sr. Manager, Granherne- a KBR Company

Kassia Yanosek, Associate Partner, McKinsey and Company
Atti Sociali
Authors: Italiana Società Entomologica
Published: April 2017

non disponibile
The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder
Authors: Schoeman Renata , Liebenberg Rykie
Published: April 2017

Disclaimer: These guidelines do not aim to provide a comprehensive review of all the pertinent literature comprising the evidence base and, as such, should be utilised in conjunction with other guidelines as well as the responsibility of practitioners to maintain a high level of personal knowledge and expertise. Despite the known efficacy of treatment and the substantial costs of untreated attention-deficit/hyperactivity disorder (ADHD), access to healthcare and treatment is not a given for many patients in South Africa (SA). In SA, there is poor identification and treatment of common mental disorders at primary healthcare level and limited access to specialist resources with a service delivery and treatment gap of up to 75%. Medication options are also often limited in emerging markets and in SA psychiatrists, and patients do not have access to the medication armamentarium available in established markets. Furthermore, the majority of South Africans currently utilise the public healthcare sector and may not have access to treatment options referred to in these guidelines. These guidelines should therefore not be seen as a policy document.The process: The South African Society of Psychiatrists’ Special Interest Group (SIG) for adult ADHD was launched on 25 September 2015, with doctors Rykie Liebenberg and Renata Schoeman as convenor and co-convenor, respectively. The overall objective of the ADHD SIG is to improve the basket of care available to patients with ADHD. This is only possible through a combined and concerted effort of individuals with a special interest in and passion for ADHD to improve knowledge about and funding for the care of individuals with the disorder. One of the specific aims of the ADHD SIG was to develop South African guidelines for the diagnosis and treatment of adult ADHD specifically and update guidelines for the treatment of child, adolescent and adult ADHD. Dr Schoeman has recently completed her MBA at the University of Stellenbosch Business School with a thesis entitled ‘A funding model proposal for private health insurance for adult attention-deficit/hyperactivity disorder in the South African context’. This is first South African study exploring the situation with regard to the prevalence and treatment of adult ADHD. Dr Schoeman was tasked by the SIG with the drafting of guidelines. Dr Liebenberg provided valuable input. The guidelines were then circulated to the SIG members, as well as the Chair of the Public Sector SIG, for written feedback and evidence- based suggestions which were then incorporated into the guidelines. The final guidelines were circulated for written approval by the SIG members, followed by formal approval at a SIG meeting held on 14 August 2016, after which it was submitted to the South African Society of Psychiatrists (SASOP) and Psychiatry Management Group (PsychMG) boards for recommendation and ratification.
Computed tomography stroke findings and population demographics at Pelonomi Hospital, Bloemfontein
Authors: Daffue Kevin
Published: April 2017

No abstract available.
Patterns of the cortical watershed continuum of term gestation hypoxic ischaemic injury – The ‘wish-bone sign’
Authors: Chacko Anith , Vedajallam Schadie , Andronikou Savvas , Simpson Ewan , Thai Ngoc J.
Published: April 2017

No abstract available.
Surgical Morphometry of C1 and C2 Vertebrae: A Three-Dimensional Computed Tomography Analysis of 180 Chinese, Indian, and Malay Patients
Authors: Lee Chee Kean , Tan Tiam Siong , Chan Chris Yin Wei , Kwan Mun Keong
Published: April 2017

Study Design

Clinical imaging study.

Purpose

To study the surgical morphometry of C1 and C2 vertebrae in Chinese, Indian, and Malay patients.

Overview of Literature

C1 lateral mass and C2 pedicle screw fixation is gaining popularity. However, there is a lack of C1–C2 morphometric data for the Asian population.

Methods

Computed tomography analysis of 180 subjects (60 subjects each belonging to Chinese, Indian, and Malay populations) using simulation software was performed. Length and angulations of C1 lateral mass (C1LM) and C2 pedicle (C2P) screws were assessed.

Results

The predicted C1LM screw length was between 23.2 and 30.2 mm. The safe zone of trajectories was within 11.0°±7.7° laterally to 29.1°±6.2° medially in the axial plane and 37.0°±10.2° caudally to 20.9°±7.8° cephalically in the sagittal plane. The shortest and longest predicted C2P screw lengths were 22.1±2.8 mm and 28.5±3.2 mm, respectively. The safe trajectories were from 25.1° to 39.3° medially in the axial plane and 32.3° to 45.9° cephalically in the sagittal plane.

Conclusions

C1LM screw length was 23–30 mm with the axial safe zone from 11° laterally to 29° medially and sagittal safe zone at 21° cephalically. C2P screw length was 22–28 mm with axial safe zone from 26° to 40° medially and sagittal safe zone from 32° to 46° cephalically. These data serve as an important reference for Chinese, Indian, and Malay populations during C1–C2 instrumentation.
Passing a Technical Skills Examination in the First Year of Surgical Residency Can Predict Future Performance
Authors: de Montbrun Sandra , Louridas Marisa , Grantcharov Teodor
Published: April 2017

Background

The ability of an assessment to predict performance would be of major benefit to residency programs, allowing for early identification of residents at risk.

Objective

We sought to establish whether passing the Objective Structured Assessment of Technical Skills (OSATS) examination in postgraduate year 1 (PGY-1) predicts future performance.

Methods

Between 2002 and 2012, 133 PGY-1 surgery residents at the University of Toronto (Toronto, Ontario, Canada) completed an 8-station, simulated OSATS examination as a component of training. With recently set passing scores, residents were assigned a pass/fail status using 3 standards setting methods (contrasting groups, borderline group, and borderline regression). Future in-training performance was compared between residents who had passed and those who failed the OSATS, using in-training evaluation reports from resident files. A Mann-Whitney U test compared performance among groups at PGY-2 and PGY-4 levels.

Results

Residents who passed the OSATS examination outperformed those who failed, when compared during PGY-2 across all 3 standard setting methodologies (P < .05). During PGY-4, only the contrasting groups method showed a significant difference (P < .05).

Conclusions

We found that PGY-1 surgical resident pass/fail status on a technical skills examination was associated with future performance on in-training evaluation reports in later years. This provides validity evidence for the current PGY-1 pass/fail score, and suggests that this technical skills examination may be used to predict performance and to identify residents who require remediation.
Resident Experiences With Implementation of the I-PASS Handoff Bundle
Authors: Coffey Maitreya , Thomson Kelly , Li Shelly-Anne , Bismilla Zia , Starmer Amy J. , O'Toole Jennifer K. , Blankenburg Rebecca L. , Rosenbluth Glenn , Cole F. Sessions , Yu Clifton E. , Hepps Jennifer H. , Sectish Theodore C. , Spector Nancy D. , Srivastava Rajendu , Allen April D. , Mahant Sanjay , Landrigan Christopher P.
Published: April 2017

Background

The I-PASS Handoff Study found that introduction of a handoff bundle (handoff and teamwork training for residents, a mnemonic, a handoff tool, a faculty development program, and a sustainability campaign) at 9 pediatrics residency programs was associated with improved communication and patient safety.

Objective

This parallel qualitative study aimed to understand resident experiences with I-PASS and to inform future implementation and sustainability strategies.

Methods

Resident experiences with I-PASS were explored in focus groups (N = 50 residents) at 8 hospitals throughout 2012–2013. A content analysis of transcripts was conducted following the principles of grounded theory.

Results

Residents generally accepted I-PASS as an ideal format for handoffs, and valued learning a structured approach. Across all sites, residents reported full adherence to I-PASS when observed, but selective adherence in usual practice. Residents adhered more closely when patients were complex, teams were unfamiliar, and during evening handoff. Residents reported using elements of the I-PASS mnemonic variably, with Illness Severity and Action Items most consistently used, but Synthesis by Receiver least used, except when observed. Most residents were receptive to the electronic handoff tool, but perceptions about usability varied across sites. Experiences with observation and feedback were mixed. Concern about efficiency commonly influenced attitudes about I-PASS.

Conclusions

Residents generally supported I-PASS implementation, but adherence was influenced by patient type, context, and individual and team factors. Our findings could inform future implementation, particularly around the areas of resident engagement in change, sensitivity to resident level, perceived efficiency, and faculty observation.
Quantification of cortical neurons: a neuroanatomical myth in neuroscience
Authors: Parra J. , Aguirre J. , Mejía F.
Published: April 2017

The objective was to analyze whether there was a definite number of cerebral cortical neurons for humans. Methodology: data was examined for the total number of brain neurons in the literature related to the field of neuroscience. This suggested that the human cerebral cortex has a large number of neurons whose value changes with the life cycle due to several factors that lead to have an indefinite number. Discussion: an analysis based on the literature showed the main factors influencing the total number of cortical neurons such as neurogenesis, apoptosis during life cycle, gender and pathological conditions. The inconsistent assessment of the number of neurons in the human cortex has been discussed by several authors, emphasizing that the values that have been displayed in the literature are presumably uncertain and are based on the views of some authors or the conceptions of others without carrying out replicable scientific studies. The above described has exhibited variable and inconsistent values in different texts about this issue. It has been concluded that the total number of cortical neurons varies due to diverse factors that play a role in determining the number of neurons in the human cerebral cortex.
Anisocoric pupil generated by azygos anterior cerebral artery: a case report
Authors: Wichmann J. , Goulart G. , Xavier L. , Jotz G. , Malysz T. , Borba Junior A. , Campos D.
Published: April 2017

Introduction: In the embryonic period, several developmental anomalies of the cerebral arteries occur. The knowledge of these anatomic variations is important to avoid unnecessary surgery and to undergo surgery or interventional radiology with safety. Objective: In this report, we discuss the hypothesis of the presence of azygos anterior cerebral artery as a possible cause of anisocoric pupil found in a patient with 35 years old. To our knowledge, this variation has not been previously reported. Results: In this study we reported a case of this artery emphasizing some morphological, functional and clinical data about this rare vascular abnormality. Conclusion: The results could be important to offer useful information to anatomists, radiologists, ophthalmologists, neurologists and head and neck surgeons.
Diaphragmatic hernia in an adult cadaver: a case report
Authors: Punja R. , Tewari S. , Malsawmzuali J. , D'Souza A. , Kalthur S.
Published: April 2017

Introduction: The diaphragm is a musculofibrous structure that separates the thoracic cavity from the abdominal cavity. Although it is a continuous sheet, developmental^ it is derived from four different sources: the septum transversum, pleuroperitoneal membranes, lateral and dorsal body wall and the mesentery of oesophagus. Methodology: During routine dissection for undergraduate students in the department of Anatomy, Kasturba Medical College, Manipal a rare variation was encountered in a 65 year old female cadaver. Results: We observed a large defect in the left anterolateral aspect of the diaphragm with associated left pulmonary hypoplasia. The muscular contribution to the diaphragm from the left lateral and dorsal body wall was absent leading to the herniation of abdominal contents into the left thoracic cavity which included the stomach, intestinal loops, left colic flexure and the spleen. Conclusion: Diaphragmatic hernias presenting in adult life are rare and most commonly associated with a history of trauma. Congenital diaphragmatic hernia may remain asymptomatic as in the present case which is extremely rare and could be a chance finding during a routine chest x-ray. Knowledge of this anatomic defect in the diaphragm presenting in adult life would help prevent further complications leading to gastrointestinal or pulmonary distress.
Classification and incidence of medial articular surface in Northeastern-Thai clavicles
Authors: Iamsaard S. , Ailadda K. , Apichakan S. , Panya T.
Published: April 2017

Introduction: The medial articular surface of dried clavicles have been studied to evaluate sex and age in many races. This morphological investigation in Thai population has never been reported. This study aimed to classify the clavicular medial surfaces and to provide their incidences. Materials and Methods: 454 dried clavicles (254 males and 200 females), averaged age (60.69±14.36 years), from KKU Osteological Collection Unit, Department of Anatomy, Faculty of Medicine, Khon Kaen University, were systemically investigated for types and incidence of their medial articular surface. Results: The showed that medial articular surfaces of Northeastern-Thais were classified into 6 types: smooth (type 1 = 7.71%), slight granulation (type 2 = 16.74%), coarse granulation (type 3 = 41.63%), nodule formation (type 4 = 1.54%), undulating (type 5 = 24.89%), and degeneration (type 6 = 7.49%), respectively. Conclusion: These basic data can be used for teaching the medical and paramedical students and also might be applied in forensic sciences especially identifying of Northeastern - Thai clavicle remains.
Pre-hospital notification is associated with improved stroke thrombolysis timing
Authors: Khor MX , Bown A , Barrett A , Counsell CE , MacLeod M-J , Reid JM
Published: April 2017

Intravenous thrombolysis increases disability-free survival after acute ischaemic stroke in a time-dependent fashion. We aimed to determine whether pre-hospital notification, introduction of a CT scanner near to assessment site and introduction of out-of-hours thrombolysis services affect thrombolysis timing.

Methods

Timings related to thrombolysis were collected between May 2012 and June 2014 at a single hospital site; these included time to stroke physician assessment, time to cranial CT imaging and door to needle time. All thrombolysed ischaemic stroke patients admitted via the emergency department were included. Ambulance services were asked to pre-notify the emergency department of any suspected stroke patient during this period.

Results

We studied 182 patients (48% female; mean age 74 years; 59% pre-notified). Pre-hospital notification was associated with a significantly higher rate of CT scanning within 25 minutes (60% vs 24%, odds ratio [OR] 4.7, 95% confidence interval [CI] 2.4–9.0; p<0.001), earlier stroke physician assessment (median 6 vs 32 minutes; p<0.001) and receiving thrombolysis within 60 minutes (89% vs 49%, OR 8.0, 95% CI 3.8–16.9; p<0.001). Being treated outside normal working hours did not alter thrombolysis timing. Logistic regression identified the introduction of a near-site CT scanner (OR 4.6 [95% CI 1.7–12.5]) and pre-hospital notification (OR 4.7, [95% CI 2.3–9.6]) as independent predictors of door to CT time ≤25 minutes, and pre-hospital notification (OR 11.6, [95% CI 4.9-30.3]) and stroke severity (OR 1.15 per point of NIHSS scale, [95% CI 1.08-1.23]) as predictors of door to thrombolysis time ≤60 minutes. The most common perceived timing delays were radiology-related (33%), the need to acutely lower blood pressure (15%) and obtaining consent (12%).

Conclusion

Pre-hospital notification is associated with earlier stroke physician review, CT imaging and delivery of thrombolysis. Referral to an out of hours thrombolysis service was not associated with additional delay.
Qualitative research in healthcare: An introduction to grounded theory using thematic analysis
Authors: Chapman AL , Hadfield M , Chapman CJ
Published: April 2017

In today's NHS, qualitative research is increasingly important as a method of assessing and improving quality of care. Grounded theory has developed as an analytical approach to qualitative data over the last 40 years. It is primarily an inductive process whereby theoretical insights are generated from data, in contrast to deductive research where theoretical hypotheses are tested via data collection. Grounded theory has been one of the main contributors to the acceptance of qualitative methods in a wide range of applied social sciences. The influence of grounded theory as an approach is, in part, based on its provision of an explicit framework for analysis and theory generation. Furthermore the stress upon grounding research in the reality of participants has also given it credence in healthcare research.

As with all analytical approaches, grounded theory has drawbacks and limitations. It is important to have an understanding of these in order to assess the applicability of this approach to healthcare research. In this review we outline the principles of grounded theory, and focus on thematic analysis as the analytical approach used most frequently in grounded theory studies, with the aim of providing clinicians with the skills to critically review studies using this methodology.
Rapid cognitive decline: Not always Creutzfeldt-Jakob disease
Authors: Randall A , Ellis R , Hywel B , Davies RR , Alusi SH , Larner AJ
Published: April 2017

A patient with rapidly progressive cognitive decline over an approximately four month period was suspected to have sporadic Creutzfeldt-Jakob disease. Features thought to support this diagnosis included psychiatric symptoms (anxiety and depression), visual hallucinations and a visual field defect. However, the finding of papilloedema broadened the differential diagnosis. Although standard brain imaging and electroencephalography had shown only non-specific abnormalities, subsequent cerebral angiography disclosed an intracranial dural arteriovenous fistula. Following embolisation, the patient made a good functional recovery. Intracranial dural arteriovenous fistula merits consideration in any patient with subacute cognitive decline, and should be included in the differential diagnosis of sporadic Creutzfeldt-Jakob disease.
Cranial ultrasound for the diagnosis of giant cell arteritis. A retrospective cohort study
Authors: Croft AP , Thompson N , Duddy MJ , Barton C , Khattak F , Mollan SP , Jobanputra P
Published: April 2017

Background

Establishing a diagnosis of giant cell arteritis, or indeed ruling it out, may be difficult. We describe an evaluation of temporal artery colour duplex ultrasound as first line investigation in patients with suspected giant cell arteritis.

Methods

A retrospective cohort study of all patients undergoing colour duplex ultrasound for suspected giant cell arteritis between January 2005 and January 2014 was undertaken at a teaching hospital. A minimum clinical follow-up of three months was required. Patients were classified on the basis of ultrasound reports, using described features such as a halo sign or arterial wall thickening and clinical diagnosis of giant cell arteritis after at least 3 months follow-up, determined by the treating physician. The relationship of colour duplex ultrasound to a final clinical diagnosis of giant cell arteritis was analysed.

Results

A total of 87 patients underwent colour duplex ultrasound: 36 (41%) had clinically confirmed giant cell arteritis at 3-month follow-up. The positive predictive value of colour duplex ultrasound for a clinical diagnosis at 3 months was 97% (95% confidence interval (CI) 93 to 99%) and negative predictive value 88% (95% CI 76 to 95%). Sensitivity was 81% (95% CI 64 to 92%) and specificity 98% (95% CI 90 to 100%).

Conclusions

A high positive and negative predictive value of arteritis on colour duplex ultrasound indicates that temporal artery biopsy may be unnecessary in suspected giant cell arteritis, particularly where clinical suspicion of giant cell arteritis is high or low.
Foot deformities in Renaissance paintings. A mystery of symbolism, artistic licence, illusion and true representation in five renowned Renaissance painters
Authors: Lazzeri D , Castello MF , Grassetti L , Dashti T , Zhang YX , Persichetti P
Published: April 2017

Although Renaissance artists were skilled in representing normal anatomy, a close look at some paintings reveals anatomical variations in the depiction of the feet of human figures. A systematic review has identified 25 paintings by five artists in which the presumptive medico-artistic diagnosis of congenital or acquired foot deformity seems to be varyingly present. The connection between these five painters and what factors have influenced artists’ style in the depiction of such deformities is discussed. The possible iconography and medical–historical meaning of such variations, as well as the possibility of artistic licence and real representation that drove the painters to depict these deformities, is explored and debated.
Enhanced atmospheric oxidizing capacity in simulating air quality with updated emission inventories for power plants especially for haze periods over East China
Authors: Zhang Lei , Zhao Tianliang , Gong Sunling , Kong Shaofei , Tang Lili , Liu Duanyang , Wang Yongwei , Jin Lianji , Shan Yunpeng , Tan Chenghao , Zhang Yingjie , Guo Xiaomei
Published: April 2017

Abstract. Air pollutant emissions play a determinant role in deteriorating air quality. However, an uncertainty in emission inventories is still the key problem for modeling air pollution. In this study, an updated emission inventory of coal-fired power plants (UEIPP) based on online monitoring data in Jiangsu province of East China for the year of 2012 was implemented in the widely used Multi-resolution Emission Inventory for China (MEIC). By employing the Weather Research and Forecasting Model with Chemistry (WRF-Chem), two simulations were executed to assess the atmospheric environmental change by using the original MEIC emission inventory and the MEIC inventory with the UEIPP. A synthetic analysis shows that (1) compared to the power emissions of MEIC, PM2.5, PM10, SO2 and NOx were lower, and CO, black carbon (BC), organic carbon (OC) and NMVOCs were higher in the UEIPP, reflecting a large discrepancy in the power emissions over East China; (2) In accordance with the changes of UEIPP, the modeled concentrations were reduced for SO2 and NO2, and increased for most areas of primary OC, BC and CO, whose concentrations in atmosphere are highly dependent on emission changes. (3) Interestingly, when the UEIPP was used, the atmospheric oxidizing capacity significantly reinforced, reflecting by increased oxidizing agents, e.g. O3 and OH, thus directly strengthened the chemical production from SO2 and NOx to sulfate and nitrate, which offset the reduction of primary PM2.5 emissions especially in the haze days. This study indicated the importance of updating air pollutant emission inventories in simulating the complex atmospheric environment changes with the implications on air quality and environmental changes.
Increase in the Frequency of Tropical Deep Convective Clouds with Global Warming
Authors: Aumann Hartmut H. , Ruzmaikin Alexander , Behrangi Ali
Published: April 2017

Abstract. Deep Convective Clouds (DCC) are extreme rain events associated with large thunderstorms. They form in 0.6 % of the area of the tropical oceans. As the tropical oceans warm in a future climate, the frequency of occurrence of DCC may change. Between 2003 and 2016 the yearly mean temperature of the tropical ocean varied by almost 1 K. We use Atmospheric Infrared Sounder (AIRS) data for this time period to derive the probability of the DCC process as function of the Sea Surface Temperature (SST). The onset of the DCC process shifts about 0.5 K per 1 K of warming of the mean tropical SST. When these results are applied to the temperature distribution predicted by CMIP5 climate models for the end of this century, we find that the frequency of DCC, i.e. the percent of the area of the tropical oceans associated with DCC, which is 0.6 percent in the current climate, increases to 0.9 %, close to a 50 % increase.
Intercalibration between HIRS/2 and HIRS/3 channel 12 based on physical considerations
Authors: Gierens Klaus , Eleftheratos Kostas , Sausen Robert
Published: April 2017

Abstract. HIRS brightness temperatures at channel 12 (T12) can be used to assess the water vapour content of the upper troposphere. The transition from HIRS/2 to HIRS/3 in 1999 involved a shift in the central wavelength of channel 12 from 6.7 μm to 6.5 μm causing a discontinuity in the time series of T12. To understand the impact of this change in the measured brightness temperatures, we have performed radiative transfer calculations for channel 12 of HIRS/2 and HIRS/3 instruments, using a large set of radiosonde profiles of temperature and relative humidity from three different sites. For each radiosonde profile we performed two radiative transfer calculations, one using the HIRS/2 channel response function of NOAA14 and one using the HIRS/3 channel response function of NOAA15, resulting in negative differences of T12 (denoted as ΔT12: = T12/15 − T12/14) ranging between −12 K and −2 K. Inspection of individual profiles for large, medium and small values of ΔT12 pointed to the role of the middle tropospheric humidity. This guided us to investigate the relation between ΔT12 and the channel 11 brightness temperatures which are typically used to detect signals from the middle troposphere. This allowed us to construct a correction for the HIRS/3 T12, a correction that leads to a pseudochannel 12 brightness temperature such as if a HIRS/2 instrument had measured it. By applying this correction we find an excellent agreement between the original HIRS/2 T12 and the HIRS/3 data inferred from the correction method with R = 0.986. Upper tropospheric humidity (UTH) derived from the pseudoHIRS/2 T12 data compared well with that calculated from intersatellite-calibrated data, confirming that the two intercalibrated time series (HIRS/2 and HIRS/3) can be fairly combined to form a continuous HIRS time series for long term UTH analyses.
A new quantitative approach to identify reworking in Eocene to Miocene pollen records from offshore Antarctica using red fluorescence and digital imaging
Authors: Strother Stephanie L. , Salzmann Ulrich , Sangiorgi Francesca , Bijl Peter K. , Pross Jörg , Escutia Carlota , Salabarnada Ariadna , Pound Matthew J. , Voss Jochen , Woodward John
Published: April 2017

Abstract. Antarctic palaeoclimate evolution and vegetation history after the formation of a continent-scale cryosphere at the Eocene–Oligocene boundary, 33.9 million years ago, has remained a matter of controversy. In particular, the reconstruction of terrestrial climate and vegetation has been strongly hampered by uncertainties in unambiguously identifying non-reworked as opposed to reworked sporomorphs that have been transported into Antarctic marine sedimentary records by waxing and waning ice sheets. Whereas reworked sporomorph grains over longer non-successive geological timescales are easily identifiable within younger sporomorph assemblages (e.g. Permian sporomorphs in Pliocene sediments), distinguishing non-reworked from reworked material in palynological assemblages over successive geological time periods (e.g. Eocene sporomorphs in Oligocene sediments) has remained problematic. This study presents a new quantitative approach to identifying non-reworked pollen assemblages in marine sediment cores from circum-Antarctic waters. We measured the fluorescence colour signature, including red, green, and blue fluorescence; brightness; intensity; and saturation values of selected pollen and spore taxa from Eocene, Oligocene, and Miocene sediments from the Wilkes Land margin Site U1356 (East Antarctica) recovered during Integrated Ocean Drilling Program (IODP) Expedition 318. Our study identified statistically significant differences in red-fluorescence values of non-reworked sporomorph taxa against age. We conclude that red fluorescence is a reliable parameter for identifying the presence of non-reworked pollen and spores in Antarctic marine sediment records from the circum-Antarctic realm that are influenced by glaciation and extensive reworking. Our study provides a new tool to accurately reconstruct Cenozoic terrestrial climate change on Antarctica using fossil pollen and spores.
Influence of temperature fluctuations on equilibrium ice sheet
volume
Authors: Mikkelsen Troels Bøgeholm , Grinsted Aslak , Ditlevsen Peter
Published: April 2017

Abstract. Forecasting the future sea level relies on accurate modeling of the response of the Greenland and Antarctic ice sheets to changing temperatures. We show why the steady state of an ice sheet is biased toward larger size if the interannual weather generated fluctuations in temperature are not taken into account in numerical modeling of the ice sheet. We illustrate this in a simple ice sheet model. This bias could, if not taken into account, imply that the risk of collapse in a given climate change scenario is underestimated. We estimate that the effect of temperature variability on the surface mass balance of the Greenland Ice Sheet in recent ensemble forecasting should be adjusted downward by approximately 13 percent of the present day observed value, if assuming a 2 degree warming. Many predicted scenarios of the future climate show an increased variability in temperature over much of the Earth. In light of our findings it is important to gauge the extent to which this increased variability will further influence the mass balance of the ice sheets.