Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among young children and adults. This primary injury initiates an inflammatory response that may lead to a secondary brain injury. Nursing care in the critical care setting supports prevention or reduction of secondary injury through control of intracranial pressure (ICP), mean arterial pressure (MAP), and the subsequent cerebral perfusion pressure (CPP). While secondary injury may be preventable, some nursing interventions may contribute to increased ICP and decreased CPP. Patients with increased ICP or decreased CPP are at risk for poor clinical outcomes. This literature review examined the effort of routine nursing care interventions on outcomes of TBI patients in the critical care setting. Eleven research articles studying head of bed elevation, head and neck positioning, turning, and spacing of patient care activities were the focus of the analysis. Results typically showed positive outcomes by elevating the head of the bed to thirty degrees. CPP was also maintained at thirty degrees, but showed varied results. ICP and CPP are best controlled with the head and neck in a neutral position. Turning patients is a routine nursing intervention that contributes to increased ICP in some positions in some patients. Most studies suggest ICP is lowest in the supine position and highest in the left lateral position, but differences in findings were noted. Providing basic nursing care interventions in close succession also may contribute to increases in ICP in some patients. Results from this review provide evidence to support the importance of assessing and planning care for each TBI patient individually. It is hoped that findings from this review will provide guidance for bedside nurses to improve clinical practice and drive future research to support best practices for care of patients who suffer TBI.

This work deal with different variants of the turning milling heads for CNC machines.The report depicts actual design solution of the turning milling head formilling machine, including technical report and economical conclusions.

There is a high incidence of head injury in children, yet few studies have systematically studied cognitive outcome. This study was designed as a survey to (a) establish the nature of intellectual and neuropsychological deficits that occur after head injuries of differing severity in children aged 6 to 14 years, (b) establish the nature of recovery curves in the first year after injury, and (c) determine which medical and psychosocial factors are associated with poor cognitive outcome and which functions show persisting impairment. From 1134 children admitted with head injury to Red Cross and Groote Schuur Hospitals during a 2-year period, a consecutive sample of all those who had post-traumatic amnesia (PTA) over 1 hour, a compound depressed or basal skull fracture, a seizure, or any evidence of neurological involvement, was collected (n=388). Further requirements that they should be between 6 and 14 years, English or Afrikaans speaking, and have no history of significant cerebral pathology or mental retardation, reduced the sample to 123 children. Severity groups were formed according to the length of PTA: 56 moderates (PTA less than 1 day), 40 severes (PTA 1 to 7 days), and 28 very severes (PTA more than 7 days). They were matched for age, sex, socioeconomic status and ethnic group with 46 controls who had traumatic injury not involving the head. Detailed accident, medical and psychosocial data were collected. The children were assessed on a battery of tests covering intelligence, language, motor speed, visuographic and memory functions, as soon as they were out of PTA (Tl), 3 months later (T2), and at 1-year post-injury (T3). The 4 groups are compared at each interval on Tukey' s studentized range test and the extent of recovery within and between the groups is compared by repeated measures analysis of variance.

Introduction: Frailty represents a complex geriatric syndrome associated with elevated rates of postoperative complications as shown for several malignant entities, including head and neck cancer. A specific screening instrument to assess frailty in head and neck patients does not exist. Both the FRAIL Scale and the G8 questionnaire are well-established and easy to use as screening tools. The present study’s aim was to assess the potential of frailty screening to predict postoperative complications in head and neck patients prior to surgery. Patients and methods: We recorded demographic data, pre-existing medical conditions and clinical characteristics in a prospective cohort of 104 head and neck cancer patients undergoing major head and neck surgery and assessed frailty prospectively on the day of admission utilizing the G8 questionnaire and the FRAIL Scale. We analyzed the link between occurrence of postoperative complications up to the twenty-first postoperative day and age, frailty and other covariates using χ 2 tests and receiver operating characteristic (ROC) curves. Results: There was no significant correlation between patients’ pre-existing medical conditions and postoperative complications. Whereas chronological age alone did not predict the occurrence of postoperative complications, frailty posed the highest risk for complications. Frailty according to either the G8 questionnaire or the FRAIL Scale predicted occurrence of complications with an area under the curve (AUC) of 0.64 (p = 0.018) and 0.62 (p = 0.039) and severe complications with an AUC of 0.72 (p = 0.014) and 0.69 (p=0.031), respectively. Neither frailty score correlated with age or with each other. Conclusion: Prospective screening using the FRAIL Scale or the G8 questionnaire reliably detected frailty in our sample group. Frailty is linked to increased risk of postoperative complications. The correct prediction of severe postoperative complications as shown identifies vulnerable cases and triggers awareness of potential complications. Anticipating risk allows for a more comprehensive view of the patient and triggers decision making towards risk adjustment, and therefore a selective view of alternative treatment modalities.

North Carolina implemented a statewide mandatory oceanfront 30-year setback on June 1, 1979. This research evaluated the effectiveness of the setback policy in the town of Nags Head in protecting private property from ocean hazards, preventing the encroachment of structures on public beaches, and minimizing public costs of inappropriately-sited development. To date, no process has been established for evaluating the effectiveness of the setback program. This research is proposed as one way to evaluate the success of oceanfront setbacks on a local basis. The town of Nags Head, located on Bodie Island, was selected for analysis because it represents one of the most developed areas of the Outer Banks, and has witnessed significant growth over the past twenty years. Due to Bodie Island’s northeast orientation, Nags Head has experienced severe erosion in many areas, stemming in part from northeasters and other coastal storms. The research involved collecting data on structures built since June 1, 1979 within the study area. Oceanfront setbacks from the vegetation line at the time of construction were obtained from survey measurements, and field measurements taken in January and February 1994 determined the present location of the structure relative to the vegetation line. Site-specific erosion rates were then determined and compared to the long-term rate used by the Division of Coastal Management in the delineating oceanfront setback per lot. Predictions of the time until each structure would be located within the zone of imminent collapse, as defined by FEMA, were made based on both long-term erosion rates and actual rates occurring over each structure’s lifetime. These predictions were then compared to the years remaining until each structure was 25 years old (30-year setback less the 5-year zone of imminent collapse), and determinations of setback success or failure were made on a per lot basis. Results of the analysis yielded low setback success rates within the study area, raising doubts about the ability of long-term erosion rate setbacks to sufficiently protect oceanfront property in areas frequented by severe coastal storms. The research supports the continuation of the oceanfront setback program, but discusses policy shortcomings, suggests possible policy alternatives, and recommends topics for further research regarding oceanfront setbacks. / Master of Science

Master of Music / Department of Music, Theatre, and Dance / Reginald L. Pittman / The songs presented in this report are works I performed in my Master’s Recital on March 30, 2014. This report will take an in-depth analysis at the selected composers’ life and styles of writing and the works they created. The scores studied in this report include: “Thus saith the Lord: But who may abide” from George Frideric Handel’s Messiah, “Soave sia il vento” from Wolfgang Amadeus Mozart’s Cosí fan Tutte, “Liebesbotschaft,” “Ihr Bild,” and “Das Fischermädchen” from Franz Schubert’s Schwanengesang, Vincenzo Bellini’s “Vaga luna che inargenti,” Giuseppe Verdi’s “Il Poveretto,” Gaetano Donizetti’s “Che vuoi di più,” Reynaldo Hahn’s “Á Chloris,” “Si mes vers avaient des ailes,” and “L’Heure Exquise” from Chanson grises, and “Ships of Arcady,” “Beloved,” “A Blackbird Singing,” and “Nocturne” from Michael Head’s Over the Rim of the Moon.

Objective Adolescence is recognised as a risk period for offending and head injury (HI), with higher rates of HI found in the young offender (YO) population compared to the general population. Drug and alcohol use has also been associated with increased risk of offending. This study aims to explore the relationships between HI, Post-concussion symptoms (PCS), reactive and proactive aggression, and offending behaviour in YOs, whilst considering the effects of drug and alcohol use on these relationships. Participants A sample of ninety eight males was recruited from a Young Offender Institute: the age range was 16-18 years of age with an average age of 17. Design A between subjects cross sectional design was employed. Participants were recruited using an opportunistic sampling strategy. Main Measures Self-rated/report measures of: HI, Post-Concussion Symptoms (Adapted Rivermead Post-Concussion Symptom Questionnaire), Aggression (Reactive-Proactive Scale), criminal histories, and drug and alcohol history. Results HI was reported by 73.5% of the overall sample, with 61.1% reporting a “knock out”. Frequency and severity of HI was associated with significantly higher PCS scores. Examination of covariate- drug and alcohol use did not affect these relationships. PCS were a significant predictor of reactive aggression, total number of convictions and number of previous violent convictions. However, dosage of HI (severity and frequency) was not a significant predictor of reactive aggression or criminal profiles. Conclusions There appears to be a dose-response effect of severity and frequency of HI on PCS, with PCS predicting reactive aggression. Such symptoms may compromise functions and lead to increased aggression. This highlights the need for better screening and interventions for HI and on-going symptoms in YOs.

BACKGROUND:The aim of the study is to assess the effectiveness of intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT) for the prevention of retropharyngeal nodal recurrences in locally advanced head and neck cancer.METHODS:A retrospective review of 76 patients with head and neck cancer undergoing concurrent chemoradiation or postoperative radiotherapy with IMRT or IGRT who were at risk for retropharyngeal nodal recurrences because of anatomic site (hypopharynx, nasopharynx, oropharynx) and/or the presence of nodal metastases was undertaken.The prevalence of retropharyngeal nodal recurrences was assessed on follow-up positron emission tomography (PET)-CT scans.RESULTS:At a median follow-up of 22months (4-53months), no patient developed retropharyngeal nodal recurrences.CONCLUSION:Prophylactic irradiation of retropharyngeal lymph nodes with IMRT or IGRT provides effective regional control for individuals at risk for recurrence in these nodes.

Bei dieser Arbeit handelt es sich um eine retrospektive Studie bezüglich Inzidenz und Therapie von Mundhöhlen- und Oropharynxkarzinomen, welche in dem Zeitraum von 1993 bis 2009 in der HNO-Klinik der Universität Leipzig als „High Volume Center“ behandelt wurden, mit besonderem Augenmerk auf die Stadien III-IV nach UICC/AJCC. In unserer Studie konnten wir eine Zunahme der an der Universität in Leipzig registrierten Patienten mit Mundhöhlen- und Oropharynxkarzinomen über die Jahre 1993 bis 2009 verzeichnen. Männer waren mehr als fünfmal so häufig betroffen wie Frauen. Diese Verteilung hielt sich über den Beobachtungszeitraum konstant. Bei den weiblichen Patientinnen wurden im Durchschnitt niedrigere Tumorstadien bei Erstdiagnose festgestellt. Frauen hatten insgesamt eine höhere 5-Jahresüberlebensrate. Die Stadienverteilung nach UICC/AJCC bei Erstdiagnose eines Mundhöhlen- und Oropharynxkarzinoms blieb über die Jahre hinweg annähernd gleich. Es wurden meist hohe Stadien festgestellt (62,7% Stadium IV). Das mittlere Erkrankungsalter von Mundhöhlen- und Oropharynxkarzinomen sank über den Beobachtungszeitraum. Das Alter bei Rezidivmanifestation blieb allerdings über die Jahre gleich und lag unter dem durchschnittlichen Alter bei Erstdiagnosestellung. In diesem Zeitraum wird in der Literatur eine zunehmende Infektionsrate mit HPV beschrieben, welche gemäß der Literaturdaten mit einem jüngeren Erkrankungsalter einhergeht. Über die Jahre fanden wir in dem von uns untersuchten Patientenkollektiv der Universitätsklinik Leipzig eine stetige Verbesserung der mittleren Überlebensraten. In zeitlicher Assoziation zu dieser Entwicklung fand eine Änderung der Therapiemodalitäten insbesondere mit Einführung der systemischen Chemotherapie ab ca. 2004 in Richtung einer zunehmenden multimodalen Therapie statt. Es konnte ein Vorteil im Gesamtüberleben nach einer kombiniert-operativen Therapie mit adjuvanter Radiochemotherapie gegenüber allen anderen Therapieformen gezeigt werden. Insbesondere im Stadium IV nach UICC/AJCC zeigte sich ebenfalls ein Vorteil der kombinierten Radiochemotherapie gegenüber einer alleinigen Radiotherapie.

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