Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.
"One of the traditional criticism of earthen structures is that they cannot hold in harsh climatic conditions. With this excellent work, Tim Krahn presents in a comprehensive, scientifically sound and not sugar-coated way how rammed earth buildings can hold in cold climates like Canada too. The book is very useful not only for practitioners, but also for scientists and whoever is wondering if rammed earth buildings could be an effective solution to tackle climate change."Alessandro Arrigoni, Postdoctoral Researcher, Dept. of Civil Engineering, University of Toronto
the sound of gravel epub
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Design, Setting, and Participants The Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures (UNIVERSAL) randomized clinical trial is a multicenter, prospective, open-label trial of ultrasonography-guided femoral access vs no ultrasonography for coronary angiography or intervention with planned femoral access. Patients were randomized from June 26, 2018, to April 26, 2022. Patients with ST-elevation myocardial infarction were not eligible.
The inversion of sediment parameters from acoustic propagation measurements relies on an accurate understanding of the physics of sediment acoustic processes. The process is model-based. Acoustic propagation is sensitive to certain acoustic properties including the reflection coefficient at the water-sediment interface, and the sound speed and attenuation profiles within the sediment interior. To be generally useful, the models must be capable of representing the physical processes that connect these acoustic properties to the geophysical properties, over the entire range of possible sediment types, from soft clays, through various compositions of silts and sands, to gravel and hard rock.
Outside the welcome center, I feel along the wall and sit on a bench. The sun has come out. The highway traffic sounds both calamitous and purposeful, as though everyone is escaping an apocalyptic event. I could be sitting here as a wall of fire creeps toward me. Or a horde of zombies.
A car drives by with its window down, and I hear fluttering ribbons of sound: top forty shredded by speed. The autumn trees that line the highway are backlit by the sun, bokeh-bright and pixelated. The shadows are harder to read: murky, indistinct. The feathery tips of tall grasses scrape dryly against my jeans.
Cathy turned to survey the wreckage of her poor little car. She saw wheels silhouetted against the sky, heard the ticking of the cooling motor. Then she picked up new sounds: the roar of a car's engine, followed by the screech of tires and the chatter of gravel. It could be someone stopping to help. On the other hand, it could be the driver of the SUV coming back to finish the job. She thought of hiding. But where? How?
Blood trickled into her eyes again, and even after she wiped it away, it was like looking through crimson gauze. Cathy could make out the man's outline but not his features. He sounded harmless enough. But she supposed even mass murderers could sound harmless.
I dreamed I was running through darkness. My legs were leaden weights and would not propel me toward a dim light shining though the murkiness. A pervading sense of loss enveloped me, and I knew escape was neither imminent nor possible. A loud whirring sound buzzed in my ear and I turned my head from side to side to make it stop.
There were more monks than there had been earlier, more dead monks, bodies splayed across the hard gravel. A few men in armor charged from the dormitory into the meditation hall, and then, for just a moment, the square was still.
The motor took hold with assurance and swept Paul over the hilltop and up to the gate of the Ilium Works. A watchman waved from his pillbox, a buzzer sounded, and the iron, high-spiked gate swung open. He came now to the solid inner door, honked, and looked expectantly at a thin slit in the masonry, behind which another guard sat. The door rumbled upward, and Paul drove up to his office building.
THE SHAH OF BRATPUHR, looking as tiny and elegant as a snuffbox in one end of the vast cavern, handed the Sumklish bottle back to Khashdrahr Miasma. He sneezed, having left the heat of summer above a moment before, and the sound chattered along the walls to die whispering in bat roosts deep in Carlsbad Caverns.
Paul, Shepherd, Baer, and the rest of the contingent from the Albany-Troy-Schenectady-Ilium area walked out onto the dock where earlier arrivals were waiting. All put on dark glasses, which they would wear during the next two weeks to protect their eyes from the unrelenting glare of the summer sun on the river, and on the whitewashed buildings, white gravel paths, white beach, and white cement courts of the Meadows.
While joint noises are commonly thought of as audible sounds, there are also inaudible vibrations that occur within a temporomandibular joint. (10,23-26) Joint Vibration Analysis also records vibrations through accelerometers at intensities and frequencies below the sensitivity of the human ear. (17,23-24,27-30,32-43) These authors have shown that an ipsilateral vibration can also be present, to a measurable degree, on the contralateral (normal) side. Accelerometers can also capture the phase of a vibration bilaterally. This allows for the identification and quantitative analysis of a vibration transferred from the ipsilateral joint to the contralateral joint. (18-21,44-45) 2ff7e9595c
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