Arterial-portal fistula treated with hepatic arterial embolization and portal venous aneurysm stent-graft exclusion complicated by type 2 endoleak.

Intrahepatic arterioportal fistulas may be complicated by portal hypertension. An associated portal venous aneurysm (PVA) may impinge upon adjacent structures or rupture. We present a 65-year-old man with an intrahepatic Intrahepatic arterioportal fistula and 6.4 × 5.8 cm right portal vein aneurysm extending within 0.4 cm of the hepatic margin, associated with pain concerning for impending rupture. The PVA was refractory to transarterial embolization due to recruitment of arterial collaterals. Therefore, it was additionally excluded from the portal vein with a 12 mm × 9.5 cm venous stent graft. Although endovascular therapy thrombosed the aneurysm and improved symptoms, it was complicated by a type 2 endoleak into the PVA

Numerical simulation of scour development due to submerged horizontal jet

River engineeringNumerical modelling in river engineerin

Implementation of a new Layer-Subroutine for fractional sediment transport in SISYPHE

Water Qualit

High Reynolds number tests of a Douglas DLBA 032 airfoil in the Langley 0.3-meter transonic cryogenic tunnel

A wind-tunnel investigation of a Douglas advanced-technology airfoil was conducted in the Langley 0.3-Meter Transonic Cryogenic Tunnel (0.3-m TCT). The temperature was varied from 227 K (409 R) to 100 K (180 R) at pressures ranging from about 159 kPa (1.57 atm) to about 514 kPa (5.07 atm). Mach number was varied from 0.50 to 0.78. These variables provided a Reynolds number range (based on airfoil chord) from 6.0 to 30.0 x 10 to the 6th power. This investigation was specifically designed to: (1) test a Douglas airfoil from moderately low to flight-equivalent Reynolds numbers, and (2) evaluate sidewall-boundary-layer effects on transonic airfoil performance characteristics by a systematic variation of Mach number, Reynolds number, and sidewall-boundary-layer removal. Data are included which demonstrate the effects of fixing transition, Mach number, Reynolds number, and sidewall-boundary-layer removal on the aerodynamic characteristics of the airfoil. Also included are remarks on model design and model structural integrity

Collecting Histories of Education and Employment Activities from Young Adults with Serious Mental Health Conditions

Young adulthood is a critical time for establishing the foundation of an adult working life. As adolescents mature and explore career interests, they also begin to focus in on particular career pathways. However, lower levels of employment and educational attainment, as well as the demands of parenting, prevent and delay Youth and Young adults (Y&YAs) with serious mental health conditions (SMHCs) from participating in settings where career development and exploration activities typically occur. Of Y&YA parents who do work, the majority will work part-time, at low-level service jobs, and at low salaries (Osgood, et al., 2005). Y&YA parents with SMHCs are particularly vulnerable as they are more likely than their normative peers to experience unemployment, poverty, and dependence on government assistance (Luciano, et al., 2013). Through a one-time, semi-structured interview, this study seeks to describe the education and employment activities of Y&YAs between the ages of 25-30 with SMHCs, explore barriers and facilitators to these activities, and understand how parenting affects these experiences. Preliminary findings will be presented as they relate to themes of career exploration/development, the barriers and facilitators to education and employment activities this population encounters, including the impact that parenthood can have on these activities in young adulthood. We will also describe the education and employment activities and trajectories that were obtained as part of these interviews

A case of massive splenomegaly due to chronic myeloproliferative neoplasm

A 34-year-old female, HIV non-reactive, presented to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, complaining of 7 months abdominal pain. She endorsed shortness of breath and early satiety for the same duration, but denied fever, chills, night sweats, and weight loss. The remainder of her review of systems was negative. She had no significant past medical history. There were no identifiable risk factors for myeloproliferative disorders, including family history, known genetic syndromes, chemical exposure, or history of ionizing radiation. On physical exam, she was noted to have a visible spleen (figure 1) which crossed into the right upper quadrant as well as the pelvis, and was non-tender to palpation. There was no cervical or axillary lymphadenopathy. The remainder of her exam was unremarkable

Numerical Modelling of Sediment Transport at Weirs

Hydrodynamic

Sanguineous Pericardial Effusion and Cardiac Tamponade in the Setting of Graves’ Disease: Report of a Case and Review of Previously Reported Cases

Introduction. Pericardial effusion in the setting of hyperthyroidism is rare. We present a patient with Graves’ disease who developed a sanguineous pericardial effusion and cardiac tamponade. Case Description. A 76-year-old man presenting with fatigue was diagnosed with Graves’ disease and treated with methimazole. Two months later, he was hospitalized for uncontrolled atrial fibrillation. Electrocardiography showed diffuse low voltage and atrial fibrillation with rapid ventricular rate. Chest radiograph revealed an enlarged cardiac silhouette and left-sided pleural effusion. Thyroid stimulating hormone was undetectable, and free thyroxine was elevated. Diltiazem and heparin were started, and methimazole was increased. Transthoracic echocardiography revealed a large pericardial effusion with cardiac tamponade physiology. Pericardiocentesis obtained 1,050 mL of sanguineous fluid. The patient progressed to thyroid storm, treated with propylthiouracil, potassium iodine, hydrocortisone, and cholestyramine. Cultures and cytology of the pericardial fluid were negative. Thyroid hormone markers progressively normalized, and he improved clinically and was discharged. Discussion. We found 10 previously reported cases of pericardial effusions in the setting of hyperthyroidism. Heparin use may have contributed to the sanguineous nature of our patient’s pericardial effusion, but other reported cases occurred without anticoagulation. Sanguineous and nonsanguineous pericardial effusions and cardiac tamponade may be due to hyperthyroidism

Risk Assessment Overview

Risk assessment is used in many industries to identify and manage risks. Initially developed for use on aeronautical and nuclear systems, risk assessment has been applied to transportation, chemical, computer, financial, and security systems among others. It is used to gain an understanding of the weaknesses or vulnerabilities in a system so modification can be made to increase operability, efficiency, and safety and to reduce failure and down-time. Risk assessment results are primary inputs to risk-informed decision making; where risk information including uncertainty is used along with other pertinent information to assist management in the decision-making process. Therefore, to be useful, a risk assessment must be directed at specific objectives. As the world embraces the globalization of trade and manufacturing, understanding the associated risk become important to decision making. Applying risk assessment techniques to a global system of development, manufacturing, and transportation can provide insight into how the system can fail, the likelihood of system failure and the consequences of system failure. The risk assessment can identify those elements that contribute most to risk and identify measures to prevent and mitigate failures, disruptions, and damaging outcomes. In addition, risk associated with public and environment impact can be identified. The risk insights gained can be applied to making decisions concerning suitable development and manufacturing locations, supply chains, and transportation strategies. While risk assessment has been mostly applied to mechanical and electrical systems, the concepts and techniques can be applied across other systems and activities. This paper provides a basic overview of the development of a risk assessment