The waterfall effect in breast augmentation

The ‘waterfall effect’ is a descriptive term to indicate a sliding ptosis of parenchymal breast tissue over a fixed or encapsulated implant. It occurs more frequently than surgeons anticipate and especially over the longer term after augmentation. Certain breast implants are more prone to contribute to this problem as are implants placed in submuscular pockets that ride high, especially in women with anatomical musculoskeletal variance or asymmetry. This article describes the aetiology of sliding ptosis in more detail, the relevant anatomy and the surgical correction. Understanding the problem enables the surgeon to plan the appropriate procedure and obtain proper informed consent. It is possible that a two stage procedure is necessary should the upper pole of breast require a debulk, either early (3 to 12 months) or later as the breast may slide with ageing of the tissues. The waterfall effect of breast parenchyma over implants is only apparent when the upper torso of the woman is undressed and she is in an erect posture. A significant number of women are happy with this situation and therefore no further action is required. Those that want an improved appearance in these circumstances can try autologous fat transfer to rebulk the surrounding tissues but generally the most likely solution involves a mastopexy with or without implant exchange. The results are highly rewarding but the scars are the legacy. Mastopexy augmentation is a difficult procedure and should only be performed by experienced surgeons. Many surgeons prefer a two stage approach with either an implant based augmentation first to limit scars and see if the patient is happy with the outcome or a first stage mastopexy to decide whether implants or fat graft are actually required as a secondary procedure

An analysis of the systemic risks posed by Fannie Mae and Freddie Mac and an evaluation of the policy options for reducing those risks

Fannie Mae and Freddie Mac are government-sponsored enterprises that are central players in U.S. secondary mortgage markets. Over the past decade, these institutions have amassed enormous mortgage- and non-mortgage-oriented investment portfolios that pose significant interest-rate risks to the companies and a systemic risk to the financial system. This paper describes the nature of these risks and systemic concerns and then evaluates several policy options for reducing the institutions’ investment portfolios. We conclude that limits on portfolio size (assets or liabilities) would be the most desirable approach to mitigating the systemic risk posed by Fannie Mae and Freddie Mac.

Distortion in Heat Treated Tube: A Materials Engineering Approach

Problem: A tube heat treater was making heavily distorted tubes with “hooked” ends on their induction heat treating line. The first and last meter of every tube was more than 1cm out of straightness. Hypothesis: Non-uniform phase transformation can occur from asymmetric heating and cooling, and the observed distortion is due to asymmetric heating and cooling during heat treatment of the tube

Resolving large financial intermediaries: banks versus housing enterprises

This paper examines the policy issues with respect to resolving the possible failure of housing enterprises Fannie Mae or Freddie Mac. The authors compare and contrast these issues with those raised in the context of large bank failures and also identify important differences in the extant supervisory authorities. Based on these discussions, they offer a number of policy suggestions designed to minimize the cost of resolution and protect taxpayers from loss should a large bank or housing enterprise fail.

The Devil's in the Tail: Residential Mortgage Finance and the U.S. Treasury

This paper seeks to contribute to the U.S. housing finance reform conversation by providing a critical assessment of the various types of policy proposals that have been offered. There appears to be a broad consensus to maintain explicit government guarantees for certain narrowly defined borrower populations, such as FHA insurance guarantees for low- and moderate-income and first-time homebuyers. However, the expected role of the federal government in the broader housing finance system is in dispute: ranging from no role; to insuring against only extreme or tail events; to insuring against all losses. However, most proposals agree that any public insurance be priced and available only for loans meeting pre-specified criteria in an effort to limit taxpayer exposure

Satellite data relay and platform locating in oceanography. Report of the In Situ Ocean Science Working Group

The present and future use of satellites to locate offshore platforms and relay data from in situ sensors to shore was examined. A system of the ARGOS type will satisfy the increasing demand for oceanographic information through data relay and platform location. The improved ship navigation provided by the Global Positioning System (GPS) will allow direct observation of currents from underway ships. Ocean systems are described and demand estimates on satellite systems are determined. The capabilities of the ARGOS system is assessed, including anticipated demand in the next decade

Resolving large financial intermediaries: banks versus housing enterprises

This paper examines the policy issues with respect to resolving the possible failure of housing enterprises Fannie Mae or Freddie Mac. The authors compare and contrast these issues with those raised in the context of large bank failures and also identify important differences in the extant supervisory authorities. Based on these discussions, they offer a number of policy suggestions designed to minimize the cost of resolution and protect taxpayers from loss should a large bank or housing enterprise fail

Risk factors for recurrent C lostridium difficile infection in hematopoietic stem cell transplant recipients

Background Recurrent C lostridium difficile infection ( CDI ) represents a significant burden on the healthcare system and is associated with poor outcomes in hematopoietic stem cell transplant ( HSCT ) patients. Data are limited evaluating recurrence rates and risk factors for recurrence in HSCT patients. Methods HSCT patients who developed CDI between January 2010 and December 2012 were divided into 2 groups: non‐recurrent CDI (nr CDI ) and recurrent CDI ( rCDI ). Risk factors for rCDI were compared between groups. Rate of recurrence in HSCT patients was compared to that in other hospitalized patients. Results CDI was diagnosed in 95 of 711 HSCT patients (22 rCDI and 73 nr CDI ). Recurrence rates were similar in HSCT patients compared with other hospitalized patients (23.2% vs. 22.9%, P  > 0.99). Patients in the rCDI group developed the index case of CDI significantly earlier than the nr CDI group (3.5 days vs. 7.0 days after transplant, P  = 0.05). On univariate analysis, patients with rCDI were more likely to have prior history of CDI and neutropenia at the time of the index CDI case. Neutropenia at the time of the index CDI case was the only independent predictor of rCDI (78.8 vs. 34.8%, P  = 0.006) on multivariate analysis. Conclusions The rate of rCDI was similar between HSCT and other hospitalized patients, and the majority of patients developed the index case of CDI within a week of transplantation. Neutropenia at the index CDI case may be associated with increased rates of rCDI .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109272/1/tid12267.pd

Poorest countries experience earlier anthropogenic emergence of daily temperature extremes

Understanding how the emergence of the anthropogenic warming signal from the noise of internal variability translates to changes in extreme event occurrence is of crucial societal importance. By utilising simulations of cumulative carbon dioxide (CO2) emissions and temperature changes from eleven earth system models, we demonstrate that the inherently lower internal variability found at tropical latitudes results in large increases in the frequency of extreme daily temperatures (exceedances of the 99.9th percentile derived from pre-industrial climate simulations) occurring much earlier than for mid-to-high latitude regions. Most of the world's poorest people live at low latitudes, when considering 2010 GDP-PPP per capita; conversely the wealthiest population quintile disproportionately inhabit more variable mid-latitude climates. Consequently, the fraction of the global population in the lowest socio-economic quintile is exposed to substantially more frequent daily temperature extremes after much lower increases in both mean global warming and cumulative CO2 emissions