Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Vibration and buckling analysis of nanotubes (nanofibers) embedded in an elastic medium using Doublet Mechanics

Conference on Emerging Trends in Applied Mathematics and Mechanics (ETAMM) -- MAY 30-JUN 03, 2016 -- Perpignan, FRANCEIn the present study, vibration and buckling of nanotubes (nanofibers) embedded in an elastic medium are studied. A length scale-dependent theory called Doublet Mechanics (DM) is used in the formulation. In this theory, discrete microstructure of solids is considered in the formulation and using a bottom-up approach macro level strains and stresses are obtained from microlevel strains and stresses. Taylor series expansion of the microlevel displacement is used in the definition of the micro strains. The number of terms in the Taylor series describes the microstructure of the considered solids. In this study, nanotube fibers are assumed as an Euler-Bernoulli beam embedded in an elastic medium. Simply supported and clamped boundary conditions are considered at the edges of the beams. Free vibration frequencies and critical buckling loads are obtained and compared with the classical elasticity results. It is shown that scale-dependent DM can be used at the nanolength scale

Clinical dilemma on retropharyngeal cellulitis and croup

We report a case of retropharyngeal cellulitis which exactly mimics the croup symptoms. The case reported was an 19-month-old male. He was brought to the emergency department with a chief complaint of stridor and his mother denied any fever, trauma, upper respiratory or gastrointestinal complaints. He was alert, drooling, and became agitated when approached. He was intermittently stridulous, especially when placed supine, although he was not hoarse at rest. His neck was not hyperextended in the ;amp;#8220;sniffing;amp;#8221; position . He had moderate substernal, intercostal, and supraclavicular retractions an nasal flaring. In addition, mild expiratory wheezing was appreciated upon auscultation. Examination of the neck revealed some anterior and posterior lymphadenopathy. Both lateral neck radiograph and computed axial tomograpy revealed that the present case has retropharyngeal widening and possible abscess. Based on these findings direct larygoscopy and aspiration was performed and diagnosed as cellulitis. Since the symptoms have improved with intravenous metronidazol and ceftriaxone he was discharged from the hospital.Bu olgu, laringotrakeit klinik belirtilerini birebir taklit edip yanılsamalara neden olan retrofaringeal yumuşak doku enfeksiyonlarının ciddiyetini vurgulamak amacıyla sunulmuştur. Olgu acil servise stridor ve hırıltılı solunum yakınmaları ile getirildi. Fizik bakısında alt, üst interkostal retraksiyonları saptanan ve burun kanadı solunumu olması nedeni ile ilk planda krup sendromu olarak düşünülen bir olguydu. Krupa yönelik olarak uygulanan tedavilere yanıtsız ve kliniğin daha da ağırlaşması üzerine çekilen lateral servikal grafi ve boyun tomografisinde retrofaringeal genişleme saptandı. Kulak burun boğaz kliniği operasyon odasında direkt laringoskopi ile drenaj uygulandı. Olgudaki enfeksiyonun retrofaringeal sellülit ile uyumlu olduğu düşünülerek metronidazol ve seftriakson tedavileri başlandı ve şifa ile taburcu edildi

Acute first seizures and seizure-like events in the pediatric emergency unit

Aim: We studied the etiological spectrum of children with acute first seizures and seizure-like events in the pediatric emergency unit of a tertiary care hospital. Material and Methods: Seventy-five children were related to acute first seizures and 32 children were to seizure-like events. Results: Syncope (17%) was the most common cause of seizure-like events. Epilepsy was identified for 28 (37%) children with acute first seizure. Nine children (12%) were considered as first unprovoked afebrile seizure. The remaining seven children with acute first seizure (9.3%) had acute symptomatic seizures based on the extensive metabolic screening and MRG studies. Fifteen children (20%) had seizure reoccurrence in the emergency unit. Conclusion: Status epilepticus occured in 4 patients (5.3%) and those were admitted into the intensive care unit.Amaç: Bu retrospektif çalışmada Çocuk Acil Servisine nöbet ve nöbet benzeri olaylar nedeniyle getirilen çocuklarda etyolojik nedenler araştırıldı. Yöntem ve Gereç: Yetmiş beş çocuk akut nöbet ve 32 çocuk nöbet benzeri olaylar nedeniyle çalışmaya dahil edildiler.Nöbet ve nöbet benzeri olaylar tanımlanarak etyolojik nedenler gözden geçirildi. Bulgular: Nöbet benzeri olaylar arasında senkop %17 en sık karşılan non-epileptik fenomen olarak belirlendi. Epilepsi tanısı 28 çocukta (%37 ) vardı. İlk afebril nöbet 9 çocukta (%12) tanı olarak konuldu. Akut semptomatik nöbet tanısı 7 çocukta (%9.3) metabolik tarama testleri ve kraniyal MRG incelemeleri ardından konuldu. Acil serviste nöbet rekürrensi 15 çocukta (%20) gözlendi. Sonuç: Acil servise ilk nöbet yakınması ile getirilen 4 çocukta (%5.3) status epileptikus izlendi