Academic literature on the topic 'Almost dual pair'

The diagnoses shown in bold in Figure 18.1 are all surgical emergencies that you must exclude as you clerk the patient. In women, you should consider gynaecological causes, e.g. ectopic pregnancy, ovarian torsion (you can of course narrow these down depending on whether the woman is of childbearing age or not). Also, bear in mind that other abdominal pathology can occasionally present as flank pain (e.g. pancreatitis, diverticulitis, appendicitis). You should ask the standard array of questions about the pain—remember the mnemonic SOCRATES: Site: Where is the pain, and has it always been there? Is it unilateral or bilateral? Kidney stones are almost always unilateral, but the location of the pain may radiate from loin to groin. Often they start with a vague discomfort that is ignored until it becomes a severe pain. Onset: Any trauma or other trigger, or spontaneous? Gradual or sudden? Trauma may lead to musculoskeletal pain or internal bleeding. Character: Is the pain colicky or constant? Is it sharp or dull? Ureteric stones give a colicky (waxing and waning) pain because of periodic spasms of the ureteric smooth muscle walls trying to dislodge the blockage. A constant pain is more consistent with a stone lodged in the kidney, which does not periodically contract (‘vermiculate’) like the ureters, or an inflammatory cause. Musculoskeletal pain is more typically an ache, while nerve impingement causes shooting pains. Radiation: Does the pain radiate to the groin (typical of ureteric pain)? Does it radiate down the leg (typical of lumbar nerve root pain)? Alleviating factors: Does anything make the pain better, e.g. a given posture, eating/drinking, any medications, etc.? Timing: How long has the pain been present? Musculoskeletal back pain can last many weeks, whereas a leaking abdominal aortic aneurysm (AAA) is unlikely to persist for more than a day without resolution, one way or another. Exacerbating factors: Does anything make the pain worse? Patients with peritonitis (e.g. due to a perforated peptic ulcer) are very sensitive to movement. Severity: How severe is the pain (e.g. on a scale of 1–10)? Kidney stones are said to be excruciatingly painful, comparable to childbirth.

The sinister causes can be remembered using the mnemonic VIVID: . . . Vascular: subarachnoid haemorrhage (SAH), haematoma (subdural or extradural), cerebral venous sinus thrombosis, cerebellar infarct Infection: meningitis, encephalitis Vision-threatening: temporal arteritis, acute glaucoma, cavernous sinus thrombosis, pituitary apoplexy, posterior leucoencephalopathy Intracranial pressure (raised): space-occupying lesion (SOL; e.g. tumour, abscess, cyst), cerebral oedema (e.g. trauma, altitude), hydrocephalus, malignant hypertension, idiopathic intracranial hypertension Dissection: carotid dissection . . . The approach to headache is the same as that to pain anywhere in the body: you need to start by characterizing the pain. One useful way of doing this is by following another mnemonic, SOCRATES: . . . Site of pain, and has it moved since it began? Onset of pain—was it sudden or gradual, and did something trigger it? Character of pain—throbbing, dull ache, sharp stabbing? Radiation of pain—has the pain spread? . . . Attenuating factors—does anything make the pain better (e.g. position, medications)? Timing of pain—how long has it gone on for, has it been constant or coming and going? Is it worse at a particular time of the day? Exacerbating factors—does anything make the pain worse (e.g. lying down, standing up, coughing, fatigue)? Severity—on a scale of 0 to 10, where 10 is the worst pain ever (e.g. childbirth). In addition, you should enquire about the presence or absence of the following ‘red flags’: • Decreased level of consciousness. This is a worrying feature of any medical presentation. Combined with headache, SAH needs exclusion. If there is a history of head injury, it could suggest a subdural haematoma (fluctuating consciousness) or extradural haematoma (altered consciousness following a lucid interval). Meningitis and encephalitis can also affect consciousness. • Sudden onset, worst headache ever. Suggests SAH, with blood in the cerebrospinal fluid (CSF) irritating the meninges. It can be informative to ask the patient whether they remember the exact moment when the headache started—a very severe headache of almost instantaneous onset is characteristic of SAH. Patients describe it like, for example, ‘being hit on the back of the head with a bat’.

The Nordic countries—Finland, Denmark, Norway, and Sweden—offer interesting material to investigate gendering processes. In these societies, gender equality policy has long traditions and many propagated goals have been researched: women and men participate in paid work almost to the same extent; women make a significant contribution to family income, because it rests on a dual income model; public, low cost day-care is available to all children over one year of age; women’s level of education is exceeding that of men’s. Yet, the labour market is notoriously segregated both horizontally, meaning that men and women work in different occupations, and vertically meaning that men hold high ranking positions in public and private organisations. The focal phenomenon of this article, entrepreneurship shows even more profound segregation with women and men enterprising in different lines of business and within the same lines of business in different branches (Kovalainen, 1995; Spilling & Berg, 2000). Nordic experience shows that gaining access to men-only spaces does not bring the same prestige, make women equally influential, and powerful as men. Thus, the question remains what are the processes which hinder women entrepreneurs from achieving a significant position? The article offers one possible answer by reporting a study by Pietiläinen (2002) who set out to investigate what kinds of spaces for entrepreneurial action women business owners are offered in the Finnish information and communication technology (ICT) industry.

Even though headaches, sleep disorders, cognitive impairment, burning, numbness, and tingling are potentially debilitating features of fibromyalgia, very few patients first consult a neurologist when they develop what turn out to be fibromyalgia symptoms. It has become apparent that the central, peripheral, and autonomic nervous systems play a more important role in fibromyalgia than was previously thought. This section will focus on these complaints and what causes them. Colleen had a splitting headache. Her temples were throbbing, and she could barely concentrate. When Dr. Smith prescribed Fiorinal, not only did the headache disappear but some discomfort in her upper and lower back that she had never bothered to complain about did also. Over the next few months, Colleen needed Fiorinal almost daily. Whenever she stopped taking it, the headaches returned with a vengeance. Dr. Smith referred her to a neurologist, who diagnosed Colleen as having fibromyalgia with associated “muscular contraction tension headaches.” Colleen was told that the caffeine and barbiturate in Fiorinal helped her headaches in the short term but that continuous use resulted in “rebound” headaches from aspirin, caffeine, and barbiturate withdrawal. The neurologist stopped all her medication and helped Colleen “ride out” the withdrawal. She prescribed amitriptyline (Elavil) at bedtime for headache protection, and Colleen is now much improved. Most fibromyalgia patients complain of recurrent headaches. These headaches usually are one of two types: tension or migraine. Tension headaches are muscular contraction headaches. Patients describe these headaches as a dull “tight band around the head” similar to what they feel in other muscles of the body. A sustained muscle contraction can compress small vessels in the area. Tension headaches and migraines are often associated with low elevations of substance P levels and decreased serotonin levels, stress, and low cellular pH (a more acidic cellular environment). Tension headaches frequently involve the forehead, jaw, and temple areas. Occipital headaches, or pain in the upper part of the back of the neck, can be a type of tension headache and are associated with muscle spasm or stiffness. Osteoarthritis of the cervical spine can also cause occipital headaches.

An actuation mechanism for a dual-arm scara-type robot for automated pick-place operations in semiconductor and flatpanel-display manufacturing applications is described. The mechanism consists of a pivoting platform and two linkages coupled to the platform through a pair of revolute joints. The opposite ends of the linkages are connected to the upper arms of the robot by another pair of revolute joints, forming a pair of three-bar mechanisms coupled through the pivoting platform. When the platform is in its neutral position, both of the arms are retracted. The geometry of the components of th

Heat transfer measurements have been made in the stagnation region of a flat plate with an elliptical leading edge. The radius of curvature at the stagnation point was similar to that of a first stage turbine vane airfoil used in a large commercial high-bypass turbofan engine. The airfoil was mounted downstream of an arc segment of a dual-annular combustor similar to the type used in an advanced turbine engine. Testing was done in air at atmospheric temperature and at pressures up to 376 kPa to simulate the vane leading edge Reynolds number seen in the engine. Spanwise average stagnation regio