Not-so-minor injuries: delayed diagnosis of a large splinter

Introduction: In contrast with victims of major trauma, patients who suffer minor injuries receive little specialist input. In most cases, this causes no difficulty, but there are situations where minor trauma results in persistent disability affecting the quality of life. Case Presentation: A young man sustained a perineal puncture wound resulting from a fall onto a bush. Following an initial delay, he sought medical advice for a continual pain in his right leg, and a discharging perineal wound. A computed tomography (CT) scan and flexible sigmoidoscopy failed to identify the cause, and he was subsequently discharged from hospital. One year after his initial presentation, a magnetic resonance imaging (MRI) scan identified a retained foreign body consistent with a fragment of wood. Conclusions: Penetrating trauma from wooden fragments provides a diagnostic challenge. A stubborn discharge from a wound must always raise the suspicion of retained fragment. Early and appropriate surgical exploration is imperative

Rural population groups

Publication authorized February 28, 1925.Digitized 2007 AES.Includes bibliographical references

Fermi Surface Nesting and the Origin of the Charge Density Wave in NbSe2_2

We use highly accurate density functional calculations to study the band structure and Fermi surfaces of NbSe2. We calculate the real part of the non-interacting susceptibility, Re chi_0(q), which is the relevant quantity for a charge density wave (CDW) instability and the imaginary part, Im chi_0(q), which directly shows Fermi surface (FS) nesting. We show that there are very weak peaks in Re chi_0(q) near the CDW wave vector, but that no such peaks are visible in Im chi_0(q), definitively eliminating FS nesting as a factor in CDW formation. Because the peak in Re chi_0(q) is broad and shallow, it is unlikely to be the direct cause of the CDW instability. We briefly address the possibility that electron-electron interactions (local field effects) produce additional structure in the total (renormalized) susceptibility, and we discuss the role of electron-ion matrix elements.Comment: Replacement of Table II values, minor changes to tex

Phasing diffuse scattering. Application of the SIR2002 algorithm to the non-crystallographic phase problem

A new phasing algorithm has been used to determine the phases of diffuse elastic X-ray scattering from a non-periodic array of gold balls of 50 nm diameter. Two-dimensional real-space images, showing the charge-density distribution of the balls, have been reconstructed at 50 nm resolution from transmission diffraction patterns recorded at 550 eV energy. The reconstructed image fits well with scanning electron microscope (SEM) image of the same sample. The algorithm, which uses only the density modification portion of the SIR2002 program, is compared with the results obtained via the Gerchberg-Saxton-Fienup HIO algorithm. In this way the relationship between density modification in crystallography and the HiO algorithm used in signal and image processing is elucidated.Comment: 7 pages, 12 figure

Cruel to be Kind: Factors Underlying Altruistic Efforts to Worsen Another Person's Mood

When aiming to improve another person’s long-term well-being, people may choose to induce that person to experience a negative emotion in the short term. We labelled this form of agent–target interpersonal emotion regulation altruistic affect worsening and hypothesized that it may happen when three conditions are met: (1) The agents experience empathic concern for the target of the affect-worsening process; (2) the negative emotion to be induced helps the target achieve a goal (anger for confrontation or fear for avoidance); and (3) there is no benefit for the agent. This hypothesis was tested by manipulating perspective taking instructions and the goal to be achieved whilst participants (N = 140) played a computer video game with different goals. Participants following other-oriented perspective taking instructions decided to induce more anger or fear in a supposed fellow participant working to achieve a confrontational or avoidance goal, respectively

Changing Lifeways along the Guadalupe Basin in South Texas: The Results of National Register Testing of a Stratified Multicomponent Prehistoric Site, 41DW277, DeWitt County, Texas

AmaTerra Environmental (formerly Ecological Communications Corporation [EComm]) conducted archeological National Register eligibility testing at Site 41DW277 in December 2009. The site is located in the proposed right-of-way (ROW) for a new bridge along US 183 over the Guadalupe River, DeWitt County, Texas. Site 41DW277 was documented in 2009 by James Abbott and Allen Bettis of the Texas Department of Transportation (TxDOT) and at the time of survey it was thought to be potentially eligible for listing on the National Register of Historic Places (NRHP) or as a State Archeological Landmark (SAL). Due to expected impacts resulting from the proposed bridge construction, testing was recommended to determine NRHP/SAL eligibility. TxDOT hired AmaTerra to complete the work under Texas Antiquities Permit 5460. Testing consisted of excavation of five gradall trenches and 32 test units. AmaTerra found that the site consists of three stratified prehistoric components extending from 1–2 meters in depth and ranging from 2,800 years to 5,200 years BP in age. Three features were documented and artifacts recovered included lithic debris and tools, mussel shell, snail shell, a small amount of bone, and some modern household debris (from the top levels of the units). Burned rock was observed and documented but not collected. An interim report was submitted in January 2010 recommending that the upper components of the site are not eligible for NRHP/SAL listing but that lowest and oldest component is eligible. However, the report also recommended that no further work was needed since the lowest component was not within the area of potential effect (APE) for the bridge replacement. The Texas Historical Commission concurred with this recommendation in February 2010. This report documents the results of the testing and analysis for Site 41DW277. Records and artifacts generated during this project will be curated at the Center for Archaeological Studies at Texas State University

Techno-economic demand projections and scenarios for the Bolivian energy system

Increasing energy access in emerging economies has played an important role to maintain or achieve desirable social and economic development targets. As a consequence, the growing energy requirements need policy instruments to ensure energy supply for future generations. The literature reports many studies with different approaches to model and test policy measures in the energy sector, however few energy-related studies for Bolivia are available. This paper addresses this knowledge gap, representing the first national level energy demand model and projections for Bolivia. The model use demographic, economic, technology and policy trends with a pragmatic model structure that combines bottom-up and top-down modelling. The scenario analysis has a particular focus on alternatives for energy savings, energy mix diversification and air quality. Three scenarios were analysed: Energy Savings, Fuel Substitution and the aggregate effects in a Combined scenario. The reference scenario results show the overall energy consumption grows 134% in 2035 compared to 2012 with an annual average growth of 3.8%. The final energy demand in the energy savings scenario is 8.5% lower than the Reference scenario, 1.5% lower in the fuel substitution scenario and 9.4% lower in the combined Scenario. The aggregate impact of both energy savings and fuel substitution measures leads to potential avoided emissions of 25.84 million Tons of CO2 equivalent in the model horizon 2012-2035

Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: A qualitative study

This article is made available through the Brunel Open Access Publishing Fund - Copyright @ 2011 Barnett et al.Background: Healthcare service innovations are considered to play a pivotal role in improving organisational efficiency and responding effectively to healthcare needs. Nevertheless, healthcare organisations encounter major difficulties in sustaining and diffusing innovations, especially those which concern the organisation and delivery of healthcare services. The purpose of the present study was to explore how healthcare innovators of process-based initiatives perceived and made sense of factors that either facilitated or obstructed the innovation implementation and diffusion. Methods: A qualitative study was designed. Fifteen primary and secondary healthcare organisations in the UK, which had received health service awards for successfully generating and implementing service innovations, were studied. In-depth, semi structured interviews were conducted with the organisational representatives who conceived and led the development process. The data were recorded, transcribed and thematically analysed. Results: Four main themes were identified in the analysis of the data: the role of evidence, the function of inter-organisational partnerships, the influence of human-based resources, and the impact of contextual factors. "Hard" evidence operated as a proof of effectiveness, a means of dissemination and a pre-requisite for the initiation of innovation. Inter-organisational partnerships and people-based resources, such as champions, were considered an integral part of the process of developing, establishing and diffusing the innovations. Finally, contextual influences, both intra-organisational and extra-organisational were seen as critical in either impeding or facilitating innovators' efforts. Conclusions: A range of factors of different combinations and co-occurrence were pointed out by the innovators as they were reflecting on their experiences of implementing, stabilising and diffusing novel service initiatives. Even though the innovations studied were of various contents and originated from diverse organisational contexts, innovators' accounts converged to the significant role of the evidential base of success, the inter-personal and inter-organisational networks, and the inner and outer context. The innovators, operating themselves as important champions and being often willing to lead constructive efforts of implementation to different contexts, can contribute to the promulgation and spread of the novelties significantly.This research was supported financially by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH)

To be or not to be an auctioneer: Some thoughts on the legal nature of online eBay auctions and the protection of consumers

This paper discusses the legal classification of online “eBay” auctions. The discussion has key implications on the scope of consumer protection law as sale by auctions are, for example, excluded from the scope of the Consumer Protection (Distance Selling) Regulations 2000. The paper uncovers that online “eBay” auctions cannot always be considered as traditional auctions and that eBay, as an intermediary, is not to be considered as an auctioneer. This creates difficulties associated with a distributive application of consumer protection laws such as the Consumer Protection (Distance Selling) Regulations 2000. Another set of difficulties is associated with a lenient legal regime applicable to the liability of eBay under the Electronic Commerce (EC Directive) Regulations 2002 . The paper concludes that there is an urgent need to clarify the legal classification of online auctions and to rethink the liability of online auction sites to better protect consumers