Metastatic renal cell carcinoma presenting as an aural polyp

Renal cell carcinoma may metastasize to the head and neck region at different stages of its evolution. We present a case of an undiagnosed renal cell carcinoma presenting as an ear polyp, and discuss the difficulties of the diagnosis and the management of these tumours.     

EVALUATING SOFTWARE OUTSOURCING OPTIONS Do Your Software Operations Add Value ?

If you don't know the current productivity rates, usage volumes, and other quantitative baseline data for your software operations, then software might not be a key component of the company's core business. The evaluation criteria in this article can help the IS executive determine the outsourcing options for software operations.     

The rationale for cementless total hip replacement

Current cementing techniques of distal plugging, pulsatile water cleaning of the canal, and retrograde filling with PMMA in a low-viscous state prepared using porosity reduction techniques and then pressurized have been shown to give excellent results at 10 or more years after operation. However, physical and aging characteristics of PMMA do not guarantee that those results will hold up in the 20- to 30-year time frame. Fifteen-year experience with bony ingrowth systems indicate the development of a durable interface without PMMA, although the interface does appear more vulnerable to attack by the biologic reaction to HMWPE debris. Bone remodeling appears more favorable around proximally fixed bone ingrowth prostheses than around distally fixed prostheses. Softening of the physical characteristics of the stem tip may reduce the incidence of thigh pain. Patients with high activity potential and a life expectancy of greater than 25 years should be strongly considered for a proximally fixed bone ingrowth or ongrowth prosthesis.     

Thermomechanical behaviour of composites

This paper derives the governing equations for the thermomechanical behaviour of composites. When the basic equations for the thermoelastic behaviour of solids were first derived in the nineteenth century several approximations were made. The effect of these assumptions are discussed and illustrated by the results of a simple laboratory test. The implications of this work on the analysis of impact damaged laminates are then discussed.     

A distributed adverse drug reaction detection system using intelligent agents with a fuzzy recognition‐primed decision model

Discovering unknown adverse drug reactions (ADRs) in postmarketing surveillance as early as possible is highly desirable. Nevertheless, current postmarketing surveillance methods largely rely on spontaneous reports that suffer from serious underreporting, latency, and inconsistent reporting. Thus these methods are not ideal for rapidly identifying rare ADRs. The multiagent systems paradigm is an emerging and effective approach to tackling distributed problems, especially when data sources and knowledge are geographically located in different places and coordination and collaboration are necessary for decision making. In this article, we propose an active, multiagent framework for early detection of ADRs by utilizing electronic patient data distributed across many different sources and locations. In this framework, intelligent agents assist a team of experts based on the well‐known human decision‐making model called Recognition‐Primed Decision (RPD). We generalize the RPD model to a fuzzy RPD model and utilize fuzzy logic technology to not only represent, interpret, and compute imprecise and subjective cues that are commonly encountered in the ADR problem but also to retrieve prior experiences by evaluating the extent of matching between the current situation and a past experience. We describe our preliminary multiagent system design and illustrate its potential benefits for assisting expert teams in early detection of previously unknown ADRs. © 2007 Wiley Periodicals, Inc. Int J Int Syst 22: 827–845, 2007.     

Ab<Emphasis Type="Italic"> initio</Emphasis> investigation of boron diffusion paths in germanium

Boron is observed to diffuse very slowly in germanium, as opposed to its behaviour in silicon where it exhibits Transient Enhanced Diffusion effects in implanted samples. As a result of this slow diffusion, boron is a very stable dopant, allowing devices to be created with very well-defined doping regions. To understand this superior performance, calculations were performed on a variety of boron diffusion paths, within vacancy and interstitial mediated methods. It was found that the vacancy mediated diffusion which is associated with the fast diffusion of many other species in germanium exhibits a total barrier of 5.8 eV. Interstitial-mediated diffusion had a total barrier for migration of 3.4 eV in the neutral and singly negative charge states, 3.2 eV for the positive charge state, but a formation barrier of 4.1 eV. Thus the barrier for interstitial-mediated diffusion is dominated by the formation energy of the self-interstitial.     

Emission of trace toxic metals during pulverized fuel combustion of Czech coals

A study of the trace elements emission (As, Se, Cd, Co, Cr, Cu, Zn, Hg, Tl, Pb, Ni, Sn, Sb, V, Mn and Fe) from pulverized coal combustion has been made at six heating and power stations situated in the Czech Republic. The amount of chlorine in coal has considerable influence on volatilization of some elements such as Zn, Cu, Pb, Hg and Tl, which is explained by the formation of thermodynamically stable compounds of these elements with chlorine. Generally, the affinities for Cl follows the order Tl > Cu > Zn > Pb > Co > Mn > Sn > Hg. The experimental data indicates enrichment of some of the trace toxic elements in the emissions (Cu, Zn, As, Se, Cd, Sn, Sb, Hg and Pb) and good agreement was obtained by thermodynamic equilibrium calculations with a few exceptions. In the case of Fe, Mn, Co, Cr and Sn calculated values are overestimated in the bottom ash and there are zero predicted amounts of these elements in the fly ash. In comparison, the results from experiments show up to 80% of these elements retained in fly ash. This implies that there exist additional steps leading to the enrichment by Fe, Mn, Co, Cr and Sn of small particles. Such mechanisms could include the ejection during devolatilization of small inorganic particles from the coal of bottom ash particles, or disintegration of the char containing these metals to small particles of fly ash. On the other hand, there are slightly overestimated or similar values of relative enrichment factors for As, V, Cu, Cd, Sb, Tl and Pb in the fly ashes and zero predicted values for bottom ashes. Our experimental results show about 5% or less of these elements are retained in bottom ashes, so they probably remain in the bottom ash inside unburned parts of coal. Copyright © 2003 John Wiley & Sons, Ltd.     

Using internal fibre geometry to improve the performance of pin-loaded holes in composite materials

The anisotropic nature of fibre reinforced composites leads to large stress concentrations around pin-loaded holes through standard weave cloths. Proper understanding of how this anisotropic nature affects the load distribution around holes can be utilised to reduce these concentrations if sufficient thought is given to the internal fibre geometry near to the hole. Such local reinforcements need not be highly complex and can be readily produced without excessive effort, producing significant improvements in performance.     

The effects of observational feedback on treatment integrity in school-based behavioral consultation.

Evaluated the effects of performance feedback on levels of treatment integrity in school-based behavioral consultation. Three teachers employed in a residential treatment community were responsible for treatment implementation. Treatment integrity was defined as the percentage of 2-min intervals during which contingent teacher reinforcement for student on-task behavior was directly observed. Teacher and child behavior were monitored across baseline, traditional consultation, and consultation with performance feedback conditions in a multiple baseline design. Following a Problem Identification Interview and Problem Analysis Interview (J. R. Bergan, 1977), mean levels of treatment integrity for the 3 teachers ranged from 9% to 37%. The addition of a performance feedback package increased treatment integrity for all 3 teachers to levels ranging from 60% to 83%. The findings contribute to a growing literature supporting the need for direct assessment of treatment integrity in school-based consultation research and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)