The Approach to and Management of Altered Mental Status in the Emergency Department

Acute encephalopathy, otherwise known as altered mental status (AMS), is a common complaint in adult patients presenting to the emergency department. It is an umbrella term for any acute change to cognition or behavior and can correlate with many underlying etiologies. Due to the life threatening nature of many such etiologies, it is imperative that the approach to the diagnosis and resolution of AMS in the emergency setting be as prompt, yet thorough as possible. The purpose of this article is to provide an evidence based, up to date approach to the evaluation of the patient with AMS with special emphasis on common etiologies and red flag presentations specific to the emergency department. Related publications on altered mental status focus on other settings or specific age groups. There is also little research that is up to date regarding clinical recommendations. Therefore, this article intends to close such gaps in knowledge within current literature

Probleme des permischen Tierstils

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Stipa Monoplane with Venturi Fuselage

This report presents a detailed examination of the factors that went into the design of the Stipa monoplane. The model tested in the wind tunnel was made dissymmetrical externally, in order to produce a lift even at an angle of attack of 0 degrees with respect to the longitudinal axis of the tube

Bleeding Pseudocyst of the Pancreatic Head. The role of Omentoplasty and Local Hemostasis

Treatment of bleeding psedoaneurysms and pseudocysts of the pancreas is controversial. Surgical treatment with pancreatic resection or trancystic arterial ligation is not always satisfactory since postoperative mortality rate is high, especially for lesions located in the pancreatic head and rebleeding is not unusual. Two patients with bleeding pseudoaneurysms (one post traumatic, one spontaneous) and one with a hemorrhagic pseudocyst of the pancreatic head were treated surgically with arterial suture and omentoplasty. Bleeding was controlled in all, without any postoperative mortality or morbidity. No rebleeding occurred with a follow up of 33, 26 and 12 months. Trancystic ligation of bleeding vessels with omentoplasty may be a useful approach, which should be compared to arterial embolization in the future

Phase Properties of Different HfO2 Polymorphs: A DFT-Based Study

none4Background: Hafnium Dioxide (HfO2) represents a hopeful material for gate dielectric thin films in the field of semiconductor integrated circuits. For HfO2, several crystal structures are possible, with different properties which can be difficult to describe in detail from an experimental point of view. In this study, a detailed computational approach has been shown to present a complete analysis of four HfO2 polymorphs, outlining the intrinsic properties of each phase on the basis of atomistic displacements. Methods: Density functional theory (DFT) based methods have been used to accurately describe the chemical physical properties of the polymorphs. Corrective Hubbard (U) semi-empirical terms have been added to exchange correlation energy in order to better reproduce the excited-state properties of HfO2 polymorphs. Results: the monoclinic phase resulted in the lowest cohesive energy, while the orthorhombic showed peculiar properties due to its intrinsic ferroelectric behavior. DFT + U methods showed the different responses of the four polymorphs to an applied field, and the orthorhombic phase was the least likely to undergo point defects as oxygen vacancies. Conclusions: The obtained results give a deeper insight into the differences in excited states phenomena in relation to each specific HfO2 polymorph.openEmiliano Laudadio, Pierluigi Stipa, Luca Pierantoni, Davide MencarelliLaudadio, Emiliano; Stipa, Pierluigi; Pierantoni, Luca; Mencarelli, David

Reactions between 1-Methyl-2-phenyl-3-nitrosoindole, Activated with Benzoyl Chloride, with Indole and Indolizine Derivatives as Nucleophiles: a Case of 1,3-Migration.

2-Phenyl-3-nitrosoindole activated with PhCOCl reacts with indoles and indolizines (NuH) affording products of 1,2-addiction which undergo 1,3-nucleophilic migration in acid media

An enhanced sea-ice thermodynamic model applied to the Baltic sea

A refined Semtner 0-layer sea-ice model (ESIM1) is presented and applied to the Baltic landfast sea-ice. The physical model is capable of simulating seasonal changes of snow and ice thickness. Particular attention is paid to reproducing the snow-ice and the super-imposed-ice formation which play important roles in the total mass balance of the Baltic sea-ice. The model prognostic variables include all kinds of ice and snow layers that may be present during a Baltic landfast ice season and, in general, in every coastal area of an ice-covered ocean. The assessment of the model capabilities was done for 1979–1993 for four different stations in the Baltic Sea. A sensitivity test stresses the relevant role of some of the physical parameters, such as the oceanic heat flux, while a scenario analysis highlights the robustness of the model to perturbed physical forcing. Our results show that one of the key variables in modelling sea-ice thermodynamics is the snow layer and its metamorphism, and including the meteoric ice dynamics into a sea ice model is relevant to properly simulate any ice season, also in view of climate change scenario