144 research outputs found
The International RLN Anatomic Classification System
No full textWith this chapter we offer an anatomy-based classification system of recurrent laryngeal nerve (RLN); a classification that embraces normal anatomy as well as embryological and acquired sources of variation in the trajectory of the right and left RLN in human neck. We endeavor to put forth a classification system that encompasses all of the above sources of variations and is simple and surgically relevant so that it is maximally valuable to the surgeon during thyroidectomy.
This classification system relates to the path/trajectory of the main trunk of the RLN. We appreciate that specific interactions between the nerve and the thyroid gland occur at the tubercle of Zuckerkandl (described in Chap. 9), ligament of Berry (described in Chap. 10) and with the inferior thyroid artery (described in Chap. 7). The surgical approach to the nerve can be conceptualized in a number of different ways and this is detailed in Chap. 13. In this chapter both the basic classification of RLN surgical anatomic path in the neck base as it relates to the thyroid surgery as well as vagal carotid sheath anatomy are described
Valuation of R&D Sequential Exchange Options using Monte Carlo approach
No full textThis article describes a methodology for evaluating R&D investment projects using Monte Carlomethods. R&D projects generally involves multiple phases with or without overlapping. R&D investments are made often in a phased manner, with the commencement of subsequent phase being dependent on the successful completion of the preceding phase, it is known as sequential investment. Moreover, each stage creates an opportunity (option) for subsequent investment. Therefore, R&D projects can be considered as ‘Compound Options' in which investments present uncertainty both in the gross project value and in costs. It is possible to use exchange options to value the R&D investment opportunities. In this paper, we propose to value the European and American Real Compound Exchange options through Monte Carlo simulation. We also provide a set of numerical experiments to provide evidence for the accuracy of the proposed methodology.Pseudo Compound American Exchange option; R&D;Monte Carlo Methods.
Changes in electromyographic amplitudes but not latencies occur with endotracheal tube malpositioning during intraoperative monitoring for thyroid surgery: Implications for guidelines
No full textObjectives/Hypothesis: During intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery, endotracheal
(ET) tube migration can result in a decrease in vocalis electromyographic (EMG) amplitude without a concordant latency
elevation during stimulation of the recurrent laryngeal nerve (RLN).
Study Design: Retrospective review.
Methods: Data were reviewed retrospectively for thyroid and parathyroid surgery patients with IONM of the laryngeal
nerves from January 2015 to December 2015. Recordings of vocalis EMG amplitudes and latencies with RLN stimulation
were obtained with the neuromonitoring ET tube surface electrodes in optimal baseline position, with vertical displacement
away from the vocalis, and with rotational change away from baseline.
Results: ET tube surface electrode EMG recordings were obtained with stimulation of seven left and three right RLNs in
a total of 10 patients. Mean vocalis EMG amplitudes were reduced with vertical displacement 1 and 2 cm both inferior and
superior to baseline and with rotational change (458 and 908 clockwise and counterclockwise, 1808), although amplitude
change with 458 clockwise and 1808 rotation did not meet statistical significance. Mean EMG latency values did not change
significantly from baseline with either rotation or vertical displacement of the ET tube.
Conclusions: An isolated decrease in EMG amplitude without concordant latency elevation should warrant re-evaluation
of ET tube position during thyroid and parathyroid surgery and is in contrast to a combined event, with both EMG amplitude
decrease and concordant latency increase, which is more suggestive of a true neuropraxic injury.
Key Words: Thyroid and parathyroid surgery, intraoperative neural monitoring, electromyography, recurrent laryngeal
nerve, combined event, amplitude change.
Level of Evidence: 4.
Laryngoscope, 00:000–000, 201
STRATEGI PEMERINTAH INDIA DALAM MENGATASI TERORISME J-E-M DIBAWAH PEMERINTAHAN NARENDRA MODI 2014-2022
No full textThe ongoing acts of terrorism by JeM threatened the security and resilience of the Indian state, so the then prime minister of India, Narendra Modi, made a resolution to eliminate and fight all forms of JeM terrorism. This research aims to find out how the Indian government's strategy during the Narendra Modi era in overcoming JeM terrorism. The research method used is descriptive method and data collection is done by library research. The author uses the concept of Counter-Terrorism proposed by Barry R. Posen which consists of efforts to form alliances and cooperation, increase resilience and offensive efforts. India formed alliances and cooperation with several international organizations such as the Shanghai Cooperation Organization, BRICS, Financial Action Task Force (FATF), UN, and also with Pakistan. The improvement of defense capabilities was carried out by the Indian government with efforts to increase the number of NSG personnel and weapons through the purchase of SIG 716 G2 rifles and Rafale fighter jets, as well as increasing the ability of personnel in the field of counter-terrorism through military training such as indra and yudh abhyas exercises. Offensive efforts were made by India through India's Surgical Strike Across the Line of Control 2016 and The Indian Air Force Airstrike on Balakot in 2019 in response to attacks from J-E-M terrorism. All efforts made by India in overcoming J-E-M terrorism are in accordance with the theory of Counter-Terrorism proposed by Barry R. Posen.
Keywords: JeM Terrorism, Counter-Terrorism, Narendra Modi
Psychological treatments in schizophrenia: II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation
No full textBackground. Social skills training and cognitive remediation are psychological techniques with considerable face validity for the treatment of negative symptoms of schizophrenia and their consequences. This paper provides a meta-analytical review of these treatments. It includes an appreciable number of randomized controlled trials, using comparisons against both standard care and other active interventions. However, the assessment of particular outcomes sometimes had to be based on single studies.Method. A detailed search strategy was used to identify randomized controlled trials of social skills training and cognitive remediation, primarily employing electronic databases. Randomized controlled trials (RCTs) that met predefined criteria were then subjected to meta-analysis on a variety of outcome measures.Results. There was no clear evidence for any benefits of social skills training on relapse rate, global adjustment, social functioning, quality of life or treatment compliance. Cognitive remediation had no benefit on attention, verbal memory, visual memory, planning, cognitive flexibility or mental state.Conclusions. Social skills training and cognitive remediation do not appear to confer reliable benefits for patients with schizophrenia and cannot be recommended for clinical practice
The Analysis of Indo- British -US Relations During the Period 2009-2019
No full textIndia is a major power in the Asian continent and hegemonic power in the south Asian region. India is a Strong member of International organizations such as SAARC, Commonwealth organization, the shanghai cooperation and BRICS. Manmohan Sing was the 13th prime minister of India. his second term was from 2019 may 22 to 2014 may 26. He is member of the Indian congress party. The leader of congress party was Sonia Gandhi. Narendra Modi was 14th prime minister of India. His first term was from 2014 may 26 to 2019 may 30. Britain and USA are India most friendly nations. This research seeks to comparatively analyze Indo-British- USA relations during 2nd term of Singh prime minister and the 1st term of Modi prime minister. The author evaluates to research objectives. The researcher will conduct research based on dual research objectives. First, studying of foreign policy of PM Singh & Modi. Second, studying of Indo-British-USA relations during the second term of PM Singh & first term of PM Modi. The author evaluates to broad research questions. First, What are the o foreign policies of PM Singh & Modi? . Second, What are the Indo-British-USA relations during the second term of PM Singh & first term of PM Modi? This research is study based an qualitative data. The researcher used to the secondary data for this research. This study utilized the secondary data from libraries and internet. The researcher used Neo classical realism theory for this research. Studies the country foreign policy and decision making process using Neo classical realism Theory. Recent research on India foreign policy has been minimal. This research is important for those studying Indian political and foreign policy.
DOI: http://doi.org/10.31357/fhss/vjhss.v07i02.1
Turbulence Modeling of Wall Jets using the Algebraic Structure Based Model
No full textReport PRE-2628. The Algebraic Structure Based Model (ASBM) of Langer and Reynolds (2003) provides an innovative approach for modeling the turbulent stresses, while incorporating information on the structure of turbulence and providing closure for Reynolds-averaged Navier-Stokes equations. The normal turbulent stresses, for which the ASBM has shown superior results, are difficult to replicate using the conventional Boussinesq hypothesis that forms the backbone of common eddy-viscosity models. The results for mean velocities and diagonal turbulent stresses, and the computational cost are kept at an acceptable level to allow the model to compete effectively with common eddy-viscosity models. In this work, the ASBM has been applied to two new validation cases; the plain wall jet of Eriksson et al. (1998) and the slot impinging jet of Zhe and Modi (2001). Encouraging results are obtained for the normal turbulent stresses, while the mean velocities and turbulent shear stress are comparable to the v2f eddy-viscosity model of Lien and Durbin (1996). Also drawbacks of the ASBM are pointed out that emerge from the fact that the model is algebraic and hence relies only on local flow properties.Energy TechnologyProcess and EnergyMechanical, Maritime and Materials Engineerin
A Report of Two Cases: Post Flood Autopsy Findings in Urban Patients with An Unusual Presentation of Leptospirosis with Hemorrhagic Pneumonia in Government Medical College, Surat
No full textSouth Gujarat is endemic zone for leptospirosis in paddy workers but recently we have post flood plenty of urban patients who were presented with high grade fever, dyspnea & haemoptysis with rapid deterioration. Clinicians were suspecting an outbreak of Hantavirus or leptospirosis. Both our patients were serologically negative for leptospirosis ante mortem, but alveolar hemorrhage & raised urea was the only finding. Both our patient rapidly deteriorated.
We performed autopsy & took post mortem samples for serologically & HP Examination of tissue. Serological finding showed one patient positive for PCR and second was positive for Leptocheck and IgM ELISA.
On HP examination we observed massive intra-alveolar hemorrhage, interstitial nephritis, vasculitis in spleen and kidney, myocarditis & hemorrhage in various organs like heart, suprarenal gland, and subarachnoid space in both our patient. Levaditi’s stain was also performed but results were not conclusive. IHC for kidney tissue was not possible due to lack of facility. Extensive hemorrhage in lung was the cause of death in both patients. Follow up autopsy studies of 30 patients were showing same histopathological findings
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