Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia: an alternative technique.

Background: One of the challenges faced by the modern-day NHS is workplace shortages, and experienced radiographers for intra-operative neurosurgical imaging is one such scenario. We describe our method for Percutaneous Retrogasserian Glycerol Rhizotomy (PRGR) using frameless neuronavigation which can be used effectively in such scenarios.Method: Stealth neuronavigation is used for needle placement within the foramen ovale and injection of glycerol, under sedation.Results: In our experience of ten procedures, it is accurate, safe and effective. Good results were obtained on all occasions. It can be repeated as often as necessary using the same Stealth® CT scan and reduces exposure for staff and patients, where repeated injections are required.Conclusion: This simple modification of PRGR technique is effective and safe provided the surgeon has previous experience in undertaking this procedure.

Emissions of organic compounds from produced water ponds III: Mass-transfer coefficients, composition-emission correlations, and contributions to regional emissions.

A common method for treating the aqueous phase (produced water) brought to the surface along with oil and natural gas is to discharge it into surface impoundments, also known as produced water ponds. Here we analyze data on the concentration of organic compounds in the water and on the flux of the same compounds into the atmosphere. Flux data extending from about 5 × 10-2 to 10+3 mg m-2 h-1 are consistent with mass-transfer laws given by the WATER9 semi-empirical algorithm, although empirical data display a noise level of about one order of magnitude and predictions by WATER9 are biased high. The data suggest partitioning between hydrocarbons in aqueous solution and in suspension, especially at higher overall concentrations. Salinity of the produced water does not have a detectable effect on hydrocarbon fluxes. Recently impounded waters are stronger emitters of hydrocarbons, while emissions of older waters are dominated by CO2. This aging effect can be explained by assuming, first, poor vertical mixing in the ponds, and second, gradual oxidation of hydrocarbons to CO2. Our measurements account for about 25% of the produced water ponds in the Uinta Basin, Eastern Utah, and when extrapolated to all ponds in the basin, account for about 4% to 14% of all organic compound emissions by the oil and natural gas sector of the basin, depending on the emissions inventory, and about 13% and 58%, respectively, of emissions of aromatics and alcohols.

Emissions of organic compounds from produced water ponds II: Evaluation of flux chamber measurements with inverse-modeling techniques.

In this study, the authors apply two different dispersion models to evaluate flux chamber measurements of emissions of 58 organic compounds, including C2-C11 hydrocarbons and methanol, ethanol, and isopropanol from oil- and gas-produced water ponds in the Uintah Basin. Field measurement campaigns using the flux chamber technique were performed at a limited number of produced water ponds in the basin throughout 2013-2016. Inverse-modeling results showed significantly higher emissions than were measured by the flux chamber. Discrepancies between the two methods vary across hydrocarbon compounds and are largest in alcohols due to their physical chemistries. This finding, in combination with findings in a related study using the WATER9 wastewater emission model, suggests that the flux chamber technique may underestimate organic compound emissions, especially alcohols, due to its limited coverage of the pond area and alteration of environmental conditions, especially wind speed. Comparisons of inverse-model estimations with flux chamber measurements varied significantly with the complexity of pond facilities and geometries. Both model results and flux chamber measurements suggest significant contributions from produced water ponds to total organic compound emission from oil and gas productions in the basin. IMPLICATIONS: This research is a component of an extensive study that showed significant amount of hydrocarbon emissions from produced water ponds in the Uintah Basin, Utah. Such findings have important meanings to air quality management agencies in developing control strategies for air pollution in oil and gas fields, especially for the Uintah Basin in which ozone pollutions frequently occurred in winter seasons.

"In the storminess": multi-disciplinary approaches to scriptural images representing ethical challenges in the pastor-congregant relationship.

In this qualitative study the authors examine the Scriptural images that 10 Lutheran pastors employed in describing the ethical challenges in the pastor-congregant relationship. The analysis of Scriptural images is part of a larger study on pastors' experiences of a mandatory workshop, "Crossing the Boundaries (CTB),"which is required of Evangelical Lutheran Church in Canada (ELCIC) seminarians. The pastors' images were analyzed from the four perspectives of depth psychology, theology, social ethics, and sociology. In commenting on tensions in the pastors' Scriptural images the authors note commonalities among the four theoretical perspectives and discuss implications for practice and future research.

Preventing harm and promoting ethical discourse in the helping professions: conceptual, research, analytical, and action frameworks.

The first in a series of 4 articles, this article provides an overview of the concepts and methods developed by a team of researchers concerned with preventing harm and promoting ethical discourse in the helping professions. In this article we introduce conceptual, research, analytical, and action frameworks employed to promote the centrality of ethical discourse in mental health practice. We employ recursive processes whereby knowledge gained from case studies refines our emerging conceptual model of applied ethics. Our participatory conceptual framework differs markedly from the restrictive model typically used in applied ethics. Our research relies on lived experiences of ethics, while our analytical framework draws attention to the multiple levels and contexts in which ethical dilemmas take place. Finally, our action framework is designed to collaborate with research participants and practitioners in making use of our data and interpretations. We demonstrate how the various frameworks inform each other in an integrative fashion. The article sets the stage for 2 case studies presented in subsequent articles.

The personal is the organizational in the ethics of hospital social workers.

Understanding the social context of clinical ethics is vital for making ethical discourse central in professional practice and for preventing harm. In this paper, we present findings about clinical ethics from in-depth interviews and consultation with 7 members of a hospital social work department. Workers gave different accounts of ethical dilemmas and resources for ethical decision making than did their managers, whereas workers and managers agreed on core-guiding ethical principles and on ideal situations for ethical discourse. We discuss the research team's initial interpretations, the relevance of the extant ethics literature to organizational structures and dynamics, and alternative perspectives on clinical ethics.

Applied ethics in mental health in Cuba: part I--guiding concepts and values.

As part of a project on professionals' lived experience of ethics, this article explores the guiding concepts and values concerning ethics of mental health professionals in Cuba. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans conceptualize applied ethics in terms of its central role in professional practice and its connection to the social context and subjective processes. Findings also show that Cuban professionals are guided not only by a set of professional values but by a set of civic values as well. The former are subdivided into other-oriented values and self-oriented values. The study of ethics in another culture such as Cuba offers a unique point of view from which to critique the social construction of our own conceptions of applied ethics in North America.

Applied ethics in mental health in Cuba: part II--power differentials, dilemmas, resources, and limitations.

This article is the second one in a series dealing with mental health ethics in Cuba. It reports on ethical dilemmas, resources and limitations to their resolution, and recommendations for action. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans experience dilemmas related to (a) the interests of clients, (b) their personal interests, and (c) the interests of the state. These conflicts are related to power differentials among (a) clients and professionals, (b) professionals from different disciplines, and (c) professionals and organizational authorities. Resources to solve ethical dilemmas include government support, ethics committees, and collegial dialogue. Limitations include minimal training in ethics, lack of safe space to discuss professional disagreements, and little tolerance for criticism. Recommendations to address ethical dilemmas include better training, implementation of a code of ethics, and provision of safe space to discuss ethical dilemmas. The findings are discussed in light of the role of power in applied ethics.